Mucocele and Ranula Follow-up

  • Author: Catherine M Flaitz, DDS, MS; Chief Editor: William D James, MD   more...
 
Updated: Feb 6, 2012
 

Further Inpatient Care

  • Routine postsurgical care is required for patients who undergo the surgical procedure under general anesthesia.
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Further Outpatient Care

  • Typical wound care after surgical management is required.
  • Patients who receive marsupialization with gauze packing should be informed that the dressing is spontaneously expelled in 7-14 days.
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Complications

  • A low risk of bleeding and low-to-moderate peripheral nerve damage exists after excision of a mucocele.
  • No complications are associated with superficial mucoceles, unless the lesions are surgically excised.
  • Complications are more common with surgical intervention in oral and cervical ranulas than other treatments.
    • Possible surgical complications include the following: injury to the Wharton duct, leading to stenosis, obstructive sialadenitis, and leakage of saliva; injury to the lingual nerve with temporary or permanent paresthesia; and injury to the marginal mandibular branch of the facial nerve with paresthesia. Postoperative hematoma, infection, or dehiscence of the wound may occur.
    • In addition, incomplete removal of the oral ranula increases the risk for developing a cervical ranula, while a cervical ranula may extend into the mediastinum. Approximately 45% of plunging ranulas occur after attempts to remove oral ranulas, which can result in a compromised airway. Cervical ranulas can extend into the mediastinum and provoke a sterile mediastinitis that may be life threatening.
  • The complications of a mucus retention cyst are the same as those for a mucus retention phenomenon and an oral ranula, depending on the location.
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Prognosis

  • If adequate and complete surgical excision is accomplished, the patient should expect no recurrence of mucoceles. If the adjacent minor salivary glands are not removed or are transected, the risk for recurrence increases. In the case of the anterior lingual mucocele, the offending glands of Blandin and Nuhn are deep within the musculature of the tongue and require knowledge of tongue anatomy and adequate resection to prevent recurrences. In recent pediatric studies, the recurrence rates range from approximately 6-8% following surgery.[25, 38] In a small clinical study involving children, the recurrence rates for surgical excision verus carbon dioxide laser vaporization were very similar, 5.88% and 6.67%, respectively.[38]
  • Superficial mucoceles are likely to recur periodically, and new lesions may develop over time.
  • Inadequate surgical therapy for oral ranulas may result in the creation of cervical ranulas. As noted previously, almost one half of cervical ranulas are those occurring after surgical attempts to eliminate oral ranulas. When these lesions are managed by marsupialization alone, the recurrence rate is high. Lesions usually develop 6-8 weeks after surgery, but recurrences may be found as late as 12 months.
  • With adequate surgical excision, mucus retention cysts are not likely to recur.
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Patient Education

  • Educate the patient regarding early recognition of a mucocele, an oral ranula, or a cervical ranula recurrence.
  • If oral habits are contributing to the formation of mucoceles, it is important to eliminate the contributing factor, such as aggressive lip biting or sucking.
  • Educate the patient to recognize signs and symptoms of wound infection after surgical intervention and to seek the care of a dentist or physician if necessary.
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Contributor Information and Disclosures
Author

Catherine M Flaitz, DDS, MS  Professor of Oral and Maxillofacial Pathology and Pediatric Dentistry, Department of Diagnostic Sciences, University of Texas Health Sciences Center at Houston, Dental Branch

Catherine M Flaitz, DDS, MS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Academy of Oral Medicine, American Academy of Pediatric Dentistry, American Dental Association, International Association for Dental Research, and International Association of Oral Pathologists

Disclosure: Trimira, LLC Clinical contract for study Co-investigator on clinical grant; Trimira, LLC Honoraria Speaking and teaching; GC America Clinical contract for study Co-investigator on clinical grant

Coauthor(s)

M John Hicks, DDS, MS, PhD, MD  Professor, Department of Pathology, Baylor College of Medicine; Medical Director of Ultrastructural Pathology, Medical Director of Cytogenetics and Molecular Cytogenetics, Department of Pathology, Texas Children's Hospital

M John Hicks, DDS, MS, PhD, MD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Society for Clinical Pathology, College of American Pathologists, International Academy of Pathology, and International Association of Oral Pathologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Timothy McCalmont, MD  Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Apsara Consulting fee Independent contractor

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS  Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

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Classic example of a mucocele in a child. The fluctuant, translucent-blue nodule on the lower labial mucosa has been present for 6 weeks. Trauma from sucking on the lower lip was suspected to be the cause.
Fluctuant submucosal nodule of the lower lip consistent with a mucocele.
Surgical excision of the mucocele in Media File 2.
Mucocele on the midline ventral surface of the tongue involving the glands of Blandin and Nuhn.
Example of 2 superficial mucoceles of the soft palate in a 50-year-old woman. The red lesion represents a recently ruptured mucocele, and the translucent papular lesion represents an intact mucocele.
Unilateral oral ranula in a young adult manifesting as a purple swelling.
Ranula on the floor of the mouth with focal ulceration.
Example of a cervical ranula with no oral involvement in an adult. The swelling developed after a car accident in which the individual had trauma to the face and neck.
Low-power photomicrograph of a mucocele with attenuation of the mucosal surface and pooling of mucus (hematoxylin-eosin, original magnification X40).
High-power photomicrograph of a mucocele with pooling of mucus and numerous foamy histiocytes (hematoxylin-eosin, original magnification X400).
Intermediate-power photomicrograph of an affected minor salivary gland lobule with atrophy of the acinar structures, ductal ectasia, and fibrosis (hematoxylin-eosin, original magnification X100).
 
 
 
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