Lip

Mucous Retention Cyst

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Mucous Retention Cyst, Mucocele, Ranula

  • Epidemiology
  1. Most common in children and young adults
  • Definitions
  1. Mucocele (Mucous Retention Cyst, typically of the lip)
    1. Traumatic rupture of small Salivary Glands with spillage of mucin (typically within the lower lip)
  2. Ranula (Mucocele of the mouth floor)
    1. Mucocele of the oropharyngeal floor
    2. Most often due to submaxillary or Sublingual Gland duct obstruction
    3. Plunging Ranula extends beyond the mylohyoid Muscle
  • Causes
  1. Local Trauma (e.g. biting lip)
  • Pathophysiology
  1. Results from Traumatic rupture of Salivary Glands
  2. Results in mucin spillage into lower lip
  • Signs
  1. Benign lesion 1-2 cm diameter
  2. Round, regular, translucent or bluish Nodule
  3. Distribution
    1. Typically occurs on inside of lower lip
    2. May occur in any oral surface with Salivary Glands
  4. Consistency
    1. Early lesions are fluctuant
    2. Later lesions are firm and fibrotic
  • Differential Diagnosis
  1. Lip Neoplasm
  2. Lip Aneurysm
  3. Dermoid Cyst
  • Management
  1. Small Mucoceles resolve spontaneously without treatment
  2. Local treatment techniques
    1. Indicated in lesions that are typical for Mucocele
    2. Anesthesia with Local Lidocaine with Epinephrine at the base of the lesion
    3. Technique 1
      1. Shave the lesion with scalpel, removing the top 50-75% but leaving the base
      2. Obtain Hemostasis
    4. Technique 2
      1. Place 4-0 or 5-0 Nylon Suture through the Mucocele, creating 2 holes in its surface
      2. Tie the Suture and remove in 5-7 days
    5. Other techniques
      1. Cryotherapy
      2. Electrocautery
  3. Surgical excision
    1. Indicated for suspicious lesions (refer to otolaryngology, oral facial surgery or dermatology)
    2. Also excise minor Salivary Glands at Mucocele base
    3. Send for pathology to rule-out neoplasia
  • References
  1. Warrington (2020) Crit Dec Emerg Med 34(1): 13
  2. Randall (2022) Am Fam Physician 105(4): 369-76 [PubMed]