eMedicine Specialties > Dermatology > Benign Neoplasms

Mucous Cyst

Author: Christopher R Shea, MD, Professor and Chief, Section of Dermatology, Department of Medicine, University of Chicago
Coauthor(s): Markus D Boos, PhD, Medical Scientist Training Program, Pritzker School of Medicine, University of Chicago
Contributor Information and Disclosures

Updated: Oct 30, 2009

Introduction

Background

A mucous cyst is a benign, common, mucus-containing cystic lesion of the minor salivary glands in the oral cavity. Some authors prefer the term mucocele since most of these lesions are not true cysts in the absence of an epithelial lining. The lesions can be located directly under the mucosa (superficial mucous cyst), in the upper submucosa (classic mucous cyst), or in the lower corium (deep mucous cyst). Two types of mucous cysts occur based on the histologic features of the cyst wall: a mucous extravasation cyst formed by mucous pools surrounded by granulation tissue (92%), and a mucous retention cyst with an epithelial lining (8%).1

Pathophysiology

The mechanism of mucous cyst formation is unclear; however, a traumatic etiology rather than an obstructive phenomenon is considered more likely. Chaudhry et al showed that the escape of mucus into the surrounding tissue after severing the excretory salivary ducts led to mucous cyst formation.2 The frequent location of the mucous cyst in the lateral aspect of the lower lip also supports the role of trauma as an etiologic factor. Although obstruction may play a role in the etiology of the mucous cyst, Chaudhry et al demonstrated that ligation and cutting of the salivary glands' ducts in rodents did not result in mucous cyst formation.2 Lymphatic vessels may also contribute to the early stages of mucous cyst development. Specifically, the growing mucous cyst may induce a pressure gradient that causes lymphatics to swell with interstitial fluid, eventually rupturing and delivering this fluid back to the mucous cyst.3

Frequency

United States

The prevalence of oral mucous cyst is 2.5 lesions per 1000 population.4

Mortality/Morbidity

Mucous cyst, a benign condition, is self-limited in most cases.

Race

Mucous cysts are most frequent in whites.

Sex

The incidence of mucous cyst is about equal in males and females.5

Age

Although patients of all ages can be affected, more than half of mucous cyst cases occur in those younger than 30 years. Mucous retention cysts are more frequent in older persons; conversely, the majority of mucous cysts in younger patients represent the extravasation type.6 Mucous cysts of the glands of Blandin-Nuhn (present on the ventral surface of the tongue) appear to be more prominent in young patients.6

Clinical

History

The clinical presentation varies by the type and the location of the lesion.

  • People with superficial mucous cysts may complain of single or multiple blisters that often spontaneously burst, leaving shallow ulcers.
    • These lesions completely heal in a period of a few days.
    • Sometimes, lesions recur in the same site.
  • The classic presentation of mucous cysts is a shiny, dome-shaped papule that waxes and wanes over several months.
  • A mucous cyst located in the deep soft tissue has a slow growth phase, resulting in a firm, deep mass.
  • Rare cases have been described in the neck arising from ectopic salivary glands; these lesions are associated with cheilitis glandularis apostematosa.
  • The appearance of superficial mucous cysts as a consequence of chronic graft versus host disease has been reported in patients receiving allogeneic bone marrow transplants. They typically are asymptomatic and therefore may not be identified.7

Physical

The clinical presentation of mucous cysts depends on the depth of the lesion.

  • Superficial mucous cyst
    • The mucus accumulates immediately below the mucosa, resulting in small translucent vesicles (0.1-0.4 cm in diameter) in the soft palate, retromolar region, and buccal mucosa.
    • In time, these blisters may burst spontaneously or by trauma, leaving shallow ulcers or erosions.
  • Classic mucous cyst
    • This form presents as a collection of mucus in the upper submucosa producing a well-defined, mobile, painless, dome-shaped swelling.
    • These lesions often exhibit a smooth, blue surface.
    • The size varies from a few millimeters to several centimeters in diameter; 75% of the lesions are less than 1 cm in diameter.
    • Eventually, the surface turns irregular and whitish due to multiple cycles of rupture and healing caused by trauma or puncture.
    • The most frequent locations are the lower lip, floor of the mouth, cheek, palate, retromolar fossa, and dorsum of the tongue; the upper lip is usually spared.
    • Larger lesions commonly affect the floor of the mouth; these are called ranulas because of the similarity to the throat pouch of frogs. A ranula can extend beyond the oral cavity, as far as the upper mediastinum or skull base.
    • When the mucus accumulates in the deep soft tissues, the presentation is of an enlarging, painless mass assuming the pink coloration of the mucosa.

Causes

A traumatic etiology is favored for mucous cysts. Animal models and the location of these lesions in areas of high traumatic exposure support this theory.8,9,10,11

More on Mucous Cyst

Overview: Mucous Cyst
Differential Diagnoses & Workup: Mucous Cyst
Treatment & Medication: Mucous Cyst
Follow-up: Mucous Cyst
Multimedia: Mucous Cyst
References
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References

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Further Reading

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Keywords

mucous cyst, MC, mucocele, mucus extravasation phenomenon, mucus escape reaction, mucus retention cysts, mucous extravasation phenomenon, mucous escape reaction, mucous retention cysts

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Contributor Information and Disclosures

Author

Christopher R Shea, MD, Professor and Chief, Section of Dermatology, Department of Medicine, University of Chicago
Christopher R Shea, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society of Dermatopathology, Arthur Purdy Stout Society, Association of Professors of Dermatology, Chicago Dermatological Society, Dermatology Foundation, Illinois Dermatological Society, International Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Markus D Boos, PhD, Medical Scientist Training Program, Pritzker School of Medicine, University of Chicago
Disclosure: Nothing to disclose.

Medical Editor

David P Fivenson, MD, Associate Director, St Joseph Mercy Hospital Dermatology Program, Ann Arbor, Michigan
David P Fivenson, MD is a member of the following medical societies: American Academy of Dermatology, Medical Dermatology Society, Michigan Dermatological Society, Michigan State Medical Society, Photomedicine Society, Society for Investigative Dermatology, and Wound Healing Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Warren R Heymann, MD, Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey
Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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