Diagnostic Considerations

Mucoceles may mimic the following:

Benign or malignant salivary gland neoplasms
Hemangioma
Lymphangioma
Myxoid tumor ^[21]
Venous varix or venous lake
Lipoma
Soft irritation fibroma
Oral lymphoepithelial cyst
Gingival cyst in adults
Soft tissue abscess
Cysticercosis (parasitic infection)
Anterior lingual mucoceles (Blandin-Nuhn mucoceles) may resemble the following:
Pyogenic granuloma
Fibroepithelial polyp

Superficial mucoceles may be confused with the following:

Cicatricial pemphigoid
Bullous lichen planus
Recurrent herpes simplex infection
Minor aphthous ulcers (once lesions have ruptured) ^[16]

Oral ranula may resemble the following:

Benign or malignant salivary gland neoplasm
Dermoid cyst
Soft tissue space abscess
Hemangioma
Lymphangioma
Lipoma
Plexiform neurofibroma
Pleomorphic adenoma ^{[22, 23]}
Mucoepidermoid carcinoma ^[24]
Heterotopic gastrointestinal cyst

Cervical ranula may appear similar to the following:

Thyroglossal duct cyst
Branchial cleft cyst
Cystic hygroma ^{[25, 26]}
Submandibular sialadenitis
Intramuscular hemangioma
Cystic or neoplastic thyroid disease
Infectious cervical lymphadenopathy (Epstein-Barr virus, cat scratch disease, tuberculosis)
Hematoma
Lipoma
Laryngocele
Dermoid cyst

A mucus retention cyst has a similar differential diagnosis as a mucocele and a ranula, depending on its location.

At least one report of a squamous cell carcinoma arising in a cervical ranula exists.^[27]This finding emphasizes the need for excluding a neoplastic cause for the development of these reactive lesions.

Differential Diagnoses

Workup

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Media Gallery

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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Author

Catherine M Flaitz, DDS, MS Chair, Division of Diagnostic Sciences, Professor of Oral and Maxillofacial Pathology, Department of Diagnostic Sciences and Surgical Dentistry, University of Colorado School of Dental Medicine, Anschutz Medical Campus

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, American Dental Education Association, International Association for Dental Research

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Academy of Pediatric Dentistry Board of Trustees; Commissioner of Dental Accreditation; Director, American Board of Oral and Maxillofacial Pathology, American , Executive Council of American Academy of Oral and Maxillofacial Pathology <br/>Serve(d) as a speaker or a member of a speakers bureau for: American Academy of Pediatric Dentistry Speakers Bureau<br/>Travel Grant from GC America; American Academy of Pediatric Dentistry for Continuing Education Presenter for: Multiple speaking engagements for state and national dental meetings.

Coauthor(s)

M John Hicks, DDS, MD, PhD, MS Professor with Tenure, Department of Pathology and Immunology, Baylor College of Medicine; Medical Director of Ultrastructural Pathology, Department of Pathology, Texas Children's Hospital; Professor of Pediatrics, Baylor College of Medicine; Adjunct Professor, Department of Pediatric Dentistry, School of Dentistry, University of Texs Health Science Center at Houston

M John Hicks, DDS, MD, PhD, MS 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, International Association of Oral Pathologists

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio

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

Disclosure: Nothing to disclose.

Chief Editor

Jeff Burgess, DDS, MSD (Retired) Clinical Assistant Professor, Department of Oral Medicine, University of Washington School of Dental Medicine; (Retired) Attending in Pain Center, University of Washington Medical Center; (Retired) Private Practice in Hawaii and Washington; Director, Oral Care Research Associates

Disclosure: Nothing to disclose.

Additional Contributors

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, United States and Canadian Academy of Pathology

Disclosure: Received consulting fee from Apsara for independent contractor.

Mucocele and Ranula Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

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