Sabtu, 10 Desember 2011

Notes on Mucocele and Mucous Retention cyst-Etiology,Clinical Features,Differential Diagnosis and Treatment

Salivary glands react to injury or obstruction by under going atrophic degeneration and necrosis with replacement of the parenchyma by inflammatory cells and ultimately fibrous scar formation

It is a tissue swelling composed of pooled mucus that escapes into the connective tissue from several excretory ducts

When salivary duct is severed the acinar cells will continue to secrete saliva into the severed duct.
At the site of the cut/severance the secretory product escape into the connective tissue forming a pool of mucus that distends the surrounding tissue.

Minor glands of the lip are most prone to severance as a result of injury or biting the mucosa.
Intra oral minor salivary can also be effected as result of some irritation as well.

Clinical features
Mostly encountered in children and young adults.
Two third of the mucoceles occur in the 3rd decade of life.
Both males and females are effected equally.
Site: mucosal surface of the lower lip
              buccal mucosa
              floor the mouth
              ventral of the tongue and palate

Clinical appearance of the mococele depends on its location within the submucosa
More superficial zones of mucous extravasations presents a fluctuant mass with bluish translucent appearance.
Patient usually feels the mucocele and the fluctuation in its size
Pain is quite rare .
Initially the mucocels are well circumscribed but with repeated truma they become nodular ,more diffuse and firm on palpation.
The mucoceles have finely vascularized and distended, appearance often referred to as frogs belly that’s why they are also called Ranulas
When part of this ranula is deep seated in to the sumental or submandibular space then the term used is the” Plunging Ranula”

Differential diagnosis
  • Mucoepidermoid carcinoma
  • Cavernous hemangeoma (when there is hemorrhage)
  • Blisters seen in some bullous and desqumative disease.

Underlying pool of mucin distends the sarface epithelium.
The mucin is walled of by the rim of granulation tissue or in long standing cases by condensed collagen.
An epithelial lining is lacking
The mucinous material  basophilic or acidophillic and contains  neutrophils and large oval foam cells the histocytes .
The base of the mucocele will reveal feeder duct.
Long standing mucoceles will show acinar degeneration with fibrosis and minimal inflammation .

Minor salivary gland mucocele will not resolve on its own it must be surgically excised.
To minimize the chances of recurrence the feeder gland should also be removed.
Post surgical parasthesia might occur when the branches of the mental nerve are severed

Surgical Removal of Mucocele-Video

Mucus retention cyst
It is a swelling caused by an obstruction of a salivary gland excretory duct resulting in an epithelial lining cavity containing mucus. Mucus retention cyst is sometimes also referred as Sialocyst
The mucus retention cyst is lined by epithelium and rarely occur in the major salivary gland, when they do occur they are multiple i.e. poly cystic disease of the parotid gland
Clinical features:
Encountered in adults from 3rd -5th decade.
The lesion is painless and fluctuant and at times bluish in appearance.
Site: parotid cysts are located in the    superficial lobe as fluctuant well defined mass.
    -with in the oral cavity the floor of the mouth is the most common place.
    -this is followed by the lip and the buccal mucosa
The epithelium of the cyst is stratified cuboidal or columnar duct like epithelium.
The cytoplasm in the of these cells is either clear or eosinophlic and my show some features mucous differentiation
70% of these cyst are unilocular rest of the 30% have multilocular pattern.
Simple excision is the treatment of choice with caution of rupturing the cystic sacs.
Recurrence is rare.
However damage to the adjacent gland may result in a mucocele formation.

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