Oral mucocele of unusual size on the buccal mucosa: clinical presentation and surgical approach. The Open Dent J 2012, 6, 67-8.

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口腔病理科 On-Line KMU Student Bulletin

原文題目(出處)： Oral mucocele of unusual size on the buccal mucosa: clinical presentation and surgical approach. The Open Dent J 2012, 6, 67-8.

原文作者姓名： Juliana Seo, Ingrid Bruno, Gabriela Artico, Aluana dal Vechio, Dante A. Migliari

通訊作者學校： Department of Oral Medicine and Oral Pathology, School of Dentistry, University of São Paulo, São Paulo, Brazil

報告者姓名(組別)： Intern D 組陳世杰

報告日期： 2012/12/11

內文：

I. Abstract:

Oral mucoceles are small-size, benign minor salivary gland pathologies. The most frequent localizations of these lesions are the lower lip mucosa.

However, in some cases, they grow to an unusual size and hinder the preliminary diagnosis of mucocele.

The purpose of this article is to report a case of a large oral mucocele with a diameter of 3.5 cm on the buccal mucosa of a 43-years-old male patient.

The surgical procedure was carried out for a complete removal of the lesion.

II. INTRODUCTION

Oral mucoceles：

1. Common lesions of the oral mucosa, most frequently on the lower labial mucosa 2. Arising from the rupture of a minor salivary gland duct with subsequent

extravasations of mucus into surrounding soft tissue.

3. SDoft, painless, translucent bluish swelling occurring 4. Small-sized lesions, with a mean diameter of less than 1cm

This article reports a case of a large OM resembling a begin neoplasm, located on the buccal mucosa.

III. CASE REPORT

Patient: 43 y/o, male, rather large, painless swelling on the left buccal mucosa for 1 year

Systemic disease

Hypertension controlled with antihypertensive drugs Extraoral examination:

cervical lymph nodes were not palpable

Intraoral examination: bluish nodule, of approximately 3.5 cm in diameter, covered by a normal mucosa.

On palpation, the lesion was soft and painless OH: satisfactory

Missing: tooth 34, 35

No history of trauma to the affected area Differential diagnosis

The overall clinical appearance of the lesion suggested a benign lesion 1. Large mucocele,

2. pleomorphic adenoma → excluded because of the softness and spongy texture and the cyst-like nature

3. lipoma → excluded from the diagnosis based on the lesion’s bluish color Treatment surgical excision

local anesthesia, a 1-cm-wide fusiform incision, gentle dissection to avoid any tissue rupture

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Microscopic examination

Central area of amor phous mucous-like material surrounded by a granulation tissue containing foamy macrophages.

Adjacent minor salivary glands, dilated ducts and fragments of mucosa covered by stratified squamous epithelium

Histopathological analysis

confirmed the diagnosis of mucocele 12-month follow-up

there was total healing without recurrence

IV. DISCUSSION

1. Oral mucoceles is asymptomatic in most cases, but when appearing as multiple and recurrent lesions they may cause severe pain.

2. The lower lip is the most common site, although they can be found in any region where there are salivary glands, but rarely in the palate, retromolar space and the buccal mucosa

3. Usually around 1 cm

The present case was uncommon in light of the lesion’s diameter (3.5cm) and its location on the buccal mucosa.

4. Treatment include cryotherapy, carbon dioxide and erbium lasers, intralesional corticosteroid, gamma-linolenic acid; however the gold standard treatment is surgical excision

P.S. γ-次亞麻油酸 (Gamma Linolenic Acid，GLA)屬於 Omega-6(ω-6)不飽和脂肪酸，必需藉由飲食中攝取或由亞麻油酸(LA)經酵素轉化而成。它可以在體內主要功能是合成前列腺素E1（ Prostaglandin E1，

PGE1）。

前列腺素在身體中扮演很多重要角色，如：減少發炎反應、幫助降低血壓、減少血小板不正常的凝集、協助調節荷爾蒙平衡，以舒解經前症候群與更年期障礙，是調節人體生理機能的重要活性物質。 5. Classic characteristics of OMs: a) History of trauma. B) Rapid appearance of a

blush swelling C) lower lip mucosa

6. In this case: No trauma history. Speculating that absence of premolar.

7. In order to minimize relapse, remove the lesion completely and provide dental prosthesis fabrication

8. P’t refused to accept dental prosthesis fabrication.

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題號題目

1 Which of the following is not the classic characteristic of oral mucoceles?

(A) Most occur over lower lip (B) With pain and tenderness

(C) Benign lesion

(D) History of trauma

答案(B) 出處：Neville, Oral and Maxillofacial Pathology, 3rd Ed P.391

題號題目

2 What’s the most common and gold standard treatment of oral mucoceles?

(A) Topical medication

(B) Excision

(C) Decompression

(D) Cryotherapy

答案( B ) 出處：Neville, Oral and Maxillofacial Pathology, 3rd Ed.P392