口腔病理科 On-Line KMU Student Bulletin
- 1 -
原文題目(出處)： Mucocele of the glands of Blandin–Nuhn—clinical, pathological, and therapeutical aspects. Oral Maxillofac Surg 2011; 15:11-13.
原文作者姓名： Patricia Adachi, Ana Maria Pires Soubhia, Fernando K.
Horikawa, Elio Hitoshi Shinohara
通訊作者學校： Oral Pathology Department, Araçatuba Dental
School-UNESP, Rua José Bonifácio, Araçatuba, SP, Brazil 報告者姓名(組別)： 劉青穎 Intern F組
報告日期： 101/02/10
內文：
Purpose ：This study aims to review anatomical, clinical, and pathological concepts as well as to discuss the most adequate therapeutic approach to the mucoceles of the glands of Blandin–Nuhn
Discussion：The glands of Blandin–Nuhn are localized in the ventral part of the tongue, next to the apex in the lingual median plane. Development of a mucocele in this site is rarely seen; besides, as the glands of Blandin–Nuhn are not encapsulated and are directly overlapped to the muscle tissues, their manipulation tends to be different from the other oral mucoceles
Conclusion：As Blandin–Nuhn mucoceles are uncommon and their clinical appearance could be similar to other lesions, it is important that health professionals know their clinical and histopathological features to avoid having them misdiagnosed
Introduction：
1. Mucocele
common lesion of the oral mucosa
rupture of a salivary duct and extravazation of the mucin into the surrounding soft tissues
nodular and/or vesicobullous lesions
fast growing at the beginning and which can afterwards vary in size.
bluish color with a translucent aspect and a flabby consistency
often found in young people
frequently associated with areas that are subject to traumas
Site
lower lip(higher incidence)
any region of small salivary glands (tongue, buccal mucosa, superior lip, and palate)
2. Mucoceles of the glands of Blandin–Nuhn
Uncommon
Harrison – 9/400 cases
Jinbu et al. - 9.9%
Moraes et al. – 48/312 (15.4%)
Tongue as the 2nd most frequent site of occurrence.
Anatomic and clinical characteristics
The Blandin–Nuhn glands
A compact group of small mixed mucous and serous salivary glands
Situated on both sides of the midline of ventral tongue surface
Plica fimbriate Lingual frenum
口腔病理科 On-Line KMU Student Bulletin
- 2 -
Embedded in the muscles of the ventral aspect, and re-covered by a thin layer of mucosa
5-7 ducts open in the oral cavity medial to the plica fimbriate on the undersurface of the tongue, laterally to the lingual frenum
Each gland about 8 mm in width and 12 to 25 mm in depth
Sugerman et al
mucoceles of the Blandin–Nuhn glands are clinically similar to 1. vascular lesions
2. pyogenic granulomas 3. polyp
4. squamous papiloma, depending on the vascularization degree and the atrophy of the acinus
According to author , they have found 2 types of Blandin- Nuhn mucoceles A. Characterized by a submucosal lesion covered with integral mucosa, at
2 to 4 cm in size and of a long-term development with no symptoms B. More protuberant, frequently presents a pedunculated base, and is
characterized by painful sensibility and local traumas history
Mucoceles in these glands:
Higher in youth and females
Traumatic injury to a duct or ducts with partition of this structure is the most likely etiologic factor leading to the development of these lesions
Most probably by the frequent oscillation of the tongue
Histopathological characteristics
2 types of benign salivary glands lesions involving either extravasation or retention of mucus.
1. The extravasation type of mucocele:
Consists in a circumscribed cavity in the conjunctive tissue and in the submucosa, causing an elevation of the mucosa with thinning of the surface epithelium, as if it had been stretched
The walls: fibrous conjunctive tissue
Presence of granulation tissue, which contains leukocytes and phagocytes.
There is no epithelium lining the cavity, sometimes the line of fibroblasts limiting the cavity can be confused with flattened epithelium cells
2. The retention-type lesion
True cyst
Cavity lined by squamous epithelium varying from cubical to columnar or atrophic
Alteration of acinus & ducts , with interstitial inflammation or sialadenitis, dilatation of the intralobular and interlobular ducts with mucus accumulation
口腔病理科 On-Line KMU Student Bulletin
- 3 -
Decomposition of the cells of the individual acinus - mucus formation in the area
Mucocele consist in mucus extravazation phenomenon with no epithelium lining the mucin collection
extravazation-type lesion is more common in young patients
most patients diagnosed for mucocele of the glands of Blandin–Nuhn in the literature were under 40 years old.
Composition of the secretory products of these glands
Not precisely known
Seromucous acini in their anterior portion
Mucous acini capped by seromucous demilunes in their posterior portion
Treatment
When mucoceles are present in the buccal cavity, they can be easily traumatized
Source of irritation and annoyance to the patient
Therefore, they should be surgically removed
Usually, the surgical excision includes the servicing mucous glands with evacuation of its contents
Larger lesions
marsupialization
cryosurgery
laser ablation
micro-marsupialization.
Alternatives to surgery
steroid injections
a method where the cystic cavity is filled with rubber impression material presurgically, improving the visual access for surgical excision
Baurmash- the technique for managing moderate to large Blandin–Nuhn mucoceles
To completely unroof the lesion along its entire periphery to visualize and remove all of the glands present
Healing without complication or recurrence should follow
Small mucoceles are completely excised and primarily closed
healing is rapid and uneventful
Author:
Mucoceles affecting the glands of Blandin and Nuhn should be removed up to the muscle plan, including the small glands found in the surgical field, to avoid recurrence
When only marsupialization is performed, the lesion can re-occur as soon as
口腔病理科 On-Line KMU Student Bulletin
- 4 -
the draining site is repaired Conclusion:
Blandin–Nuhn mucoceles are uncommon
Clinical appearance could be similar to other lesions as vascular lesions, pyogenic granulomas, polyp, and squamous papiloma
excision followed by anatomic-pathological examination be performed, to avoid having them misdiagnosed
1 Which of the following statement about mucocele is wrong?
(A) Mucocele results from rupture of a salivary gland duct and spillage of mucin into the surrounding soft tissue.
(B) Lower lip is the most common site for the mucocele.
(C) Mucoceles are most common in older people, because they are more likely to experience trauma that induces mucin spillage.
(D) Superficial mucoceles have been reported to occur in association with lichenoid disorder, such as lichen planus, lichenoid drug eruptions, and chronic graft-versus-host disease(GVHD).
答案(C ) 出處：Oral and Maxillofacial Pathology third edtion pg 454-455 Mucoceles are most common in children and young adults.
2 Which of the following statement about the treatment and prognosis of mucocele & ranula is correct?
(A) Some mucoceles are short-lived lesions that rupture and heal by themselves.
(B) Treatment of mucocele is local surgical excision without the removal of adjacent minor salivary glands that may be feeding into the lesion.
(C) Marsupialization is often successful for larger ranulas developing from the body of sublingual glands.
(D) If sublingual glands is removed, meticulous dissection of the lining of the ranula is still necessary.
答案(A ) 出處：Oral and Maxillofacial Pathology third edtion pg 456-457
(B) To minimize the risk of recurrence, the surgeon should remove any adjacent minor salivary glands that may be feeding into the lesion when the area is excised.
(C) Marsupialization is often unsuccessful for larger ranulas developing from the body of sublingual gland, and most author emphasize that removal of the offending gland is the most important.
(D) If the gland is removed, then meticulous dissection of the lining of the lesion may not be necessary for the lesion to resolve, even for plunging ranula.
