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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 5  |  Issue : 3  |  Page : 127-129

Combination therapy in a large lower lip mucocele: A non-invasive recommended technique


1 Department of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Oral Medicine, Azad University Dental School, Tehran, Iran

Date of Web Publication15-Jul-2014

Correspondence Address:
Maryam Baharvand
Department of Oral Medicine, Dental School of Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Tabnak St, Chamran highway, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2155-8213.136769

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  Abstract 

Introduction: Salivary mucocele is a common benign lesion of the oral cavity, usually presented as a single bluish lesion caused by trauma to the minor salivary gland ducts. We aimed to describe a new combination therapy (micromarsupialization plus intralesional corticosteroid injection) to treat a large mucocele on the lower lip. Case Report: We administered three intralesional dexamethasone (8 mg/2 ml) shots along with standard silk sutures in one-week intervals on a large labial mucocele (primary size: 3.5 cm Χ 1.5 cm) of a 26-year-old man over a three-week duration. Complete healing was obtained three weeks after treatment. A six-month follow-up revealed no signs of recurrence or complications. Discussion: Combination of intralesional dexamethasone and micromarsupialization leads to complete healing of a large lower lip mucocele, and can be considered as an alternative therapeutic method to conventional surgery.

Keywords: Dexamethasone, mucocele, micromarsupialization


How to cite this article:
Mortazavi H, Baharvand M, Alirezaei S, Noor-Mohammadi R. Combination therapy in a large lower lip mucocele: A non-invasive recommended technique. Dent Hypotheses 2014;5:127-9

How to cite this URL:
Mortazavi H, Baharvand M, Alirezaei S, Noor-Mohammadi R. Combination therapy in a large lower lip mucocele: A non-invasive recommended technique. Dent Hypotheses [serial online] 2014 [cited 2019 Sep 22];5:127-9. Available from: http://www.dentalhypotheses.com/text.asp?2014/5/3/127/136769


  Introduction Top


Mucocele includes mucus extravasation phenomenon and mucus retention cyst. [1] Extravasation mucocele results from a broken salivary gland duct and retention mucocele results from dilation of the duct secondary to obstruction or a local trauma. [2] Retention mucocele is more common than extravasation mucocele (95% vs. 5%). [3] Some mucoceles get ruptured and healed by themselves, but in many cases local surgical excision is necessary. There are some other conservative techniques that can be useful in the treatment of mucoceles. [4],[5],[6],[7] This article aimed to describe micromarsupialization plus intralesional steroid injection to treat a large lower lip mucocele. To the best of our knowledge, this is the first report of such a combination therapy to treat labial mucocele, whereas micromarsupialization and intralesional steroid injection have been used separately by Delbem [4] and Luiz, [6] respectively.


  Case Report Top


A 26-year-old man was referred to the Department of Oral & Maxillofacial Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran with the chief complaint of a swelling on his lower lip [Figure 1]. All treatment protocol was descirbed for subject and Informed consent was written by patient. The patient was aware of the swelling for three months with episodic fluctuations in its size. Intraoral examination revealed pinkish-blue coloration, soft, asymptomatic nodule measuring 3.5 cm × 1.5 cm on the right side of the labial mucosa. The patient had a positive history of lip biting especially during work. No history of systemic disease was obtained. According to provisional diagnosis of mucocele, the patient was submitted to combination therapy of micromarsupialization and intralesional injection of dexamethasone phosphate (DEXADIC® , Caspian Tamin Pharm. Co, Rasht, Iran) [Figure 2]. In this patient, 1 ml of dexamethasone 8mg/2ml was injected into the base of the lesion under local anesthesia. After injection, micromarsupialization was carried out to drain the mucus and reduce the size of lesion. This technique consisted of passing a thick silk thread through the lesion and then making a surgical knot. On the second visit (after seven days), the size of lesion was reduced to 3 cm × 1.5 cm. A new suture was made and the patient was given the second shot. On the third visit, the size of lesion decreased to 1.5 cm × 1 cm, and the patient received the last injection and suture. This process (intralesional injection of dexamethasone combined with micromarsupialization) was repeated three times at one-week intervals. Complete healing was observed after three weeks [Figure 3]. After six months of followup, there was no history or sign of recurrence or local discomfort.
Figure 1: Large labial mucocele before treatment

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Figure 2: Micromarsupialization using silk suture on the lesion after injection of dexamethasone

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Figure 3: Complete healing of the mucocele after three weeks of combination therapy

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  Discussion Top


In our study we reported a large lower lip mucocele in a 26-year-old male. According to Chi, Baurmash and Bagán Sebastián, there is no sex predilection in presence of mucocele. [1],[2],[3] In accordance with our case, Baurmash and Chi demonstrated that mucocele most frequently occurred in the first three decades of life and are rare among children younger than one year of age. [1],[2] In almost all previous studies, mucocele was most frequently located in the lower lip. For example, lower lip mucocele was reported in 82% of cases by Chi. [1] The duration of the lesion in our case was about three months. Yamasoba showed that the lesion duration may vary from a few days to three years. [8] This wide range of duration may be related to the finding that approximately half (48%) of their patients were not aware of their lesions, which were diagnosed by a specialist on a routine examination. [3] Mucoceles are presented in various sizes but they are rarely larger than 1.5 cm in diameter. [2] However, in the present study,we reported a lower lip mucocele larger than 1.5 cm (3.5 cm) in diameter.The main accepted treatment for mucocele is surgical extirpation of the surrounding mucosa and glandular tissue down to the muscle layer. However, Yamasoba showed a 2.8% recurrence in the lesions which were removed surgically. [8] Except for conventional surgical treatments, there are some conservative methods such as cryosurgery, intralesional injection of steroids, intralesional injection of OK-432, CO 2 laser, and micromarsupialization. [4],[5],[6],[7],[9],[10] Prasad showed that all patients treated with cryosurgery were cured without any complication and recurrence. [9] In a study by Yeh, 36 lesions were removed using cryosurgery and only 5.6% reappeared. [5] Injection of a high-potency topical corticosteroid has been also used in the treatment of painful and recurrent oral mucocele by Luiz. It seems that corticosteroids promote the shrinkage of dilated salivary ducts or pools like a sclerosing agent. [6] Treatment of salivary mucocele of the lower lip by OK-432 was described by Ohta, who injected OK-432 solution into the lesion with a 27-gauge needle; the lesions disappeared in 16 of 20 cases. As a side effect, local discomfort at the injection site was observed in 10% of patients. [10] Yagüe-García compared the results after oral mucocele resection with CO 2 laser versus scalpel and showed that among the cases treated by conventional surgery, the recurrence rate was 8.8%. Moreover, 13.2% of patients suffered from postoperative complications, whereas there were no relapses or complications in cases submitted to CO 2 laser treatment. [7] Delbem described treatment of mucocele in 14 children by micromarsupialization technique with 85% success rate. The main aim of this method is to drain the mucus and reduce the size of the lesion. This technique has the advantage of being simple and relatively painless, with minimum trauma. [4] In our case, we combined intralesional steroid injection with micromarsupialization and obtained a perfect result. In conclusion, our experience confirms that combination of intralesional steroid injection with micromarsupialization can be regarded as a substitute for surgery in the treatment of salivary mucocele.

 
  References Top

1.Chi AC, Lambert PR 3 rd , Richardson MS, Neville BW. Oral mucoceles: Aclinicopathologic review of 1,824 casesincluding unusual variants. J Oral Maxillofac Surg 2011;69:1086-93.  Back to cited text no. 1
    
2.Baurmash HD. Mucoceles and ranulas. J Oral Maxillofac Surg 2003;61:369-78.  Back to cited text no. 2
[PUBMED]    
3.Bagán Sebastián JV, Silvestre Donat FJ, Peñarrocha Diago M, MiliánMasanet MA.Clinico-pathological study of oral mucoceles. Av Odontoestomatol 1990;6:389-91, 394-5.  Back to cited text no. 3
    
4.Delbem AC, Cunha RF, Vieira AE, Ribeiro LL. Treatment of mucus retention phenomena in children by the micro-marsupialization technique: Case reports. Pediatr Dent 2000;22:155-8.  Back to cited text no. 4
    
5.Yeh CJ. Simple cryosurgical treatment for oral lesions. Int J Oral Maxillofac Surg 2000;29:212-6.  Back to cited text no. 5
[PUBMED]    
6.Luiz AC, Hiraki KR, Lemos CA Jr, Hirota SK, Migliari DA. Treatment of painful and recurrent oral mucoceles with a high-potency topical corticosteroid: A case report. J Oral Maxillofac Surg 2008;66:1737-9.  Back to cited text no. 6
    
7.Yagüe-García J, España-Tost AJ, Berini-Aytés L, Gay-Escoda C. Treatment of oral mucocele-scalpel versus CO2 laser. Med Oral Patol Oral Cir Bucal 2009;14:e469-74.  Back to cited text no. 7
    
8.Yamasoba T, Tayama N, Syoji M, Fukuta M.Clinicostatistical study of lower lip mucoceles. Head Neck 1990;12:316-20.  Back to cited text no. 8
    
9.Prasad M, Kale TP, Halli R, Kotrashetti SM, Baliga SD. Liquid nitrogen cryotherapy in the management of oral lesions: A retrospective clinical study. J Maxillofac Oral Surg 2009;8:40-2.  Back to cited text no. 9
    
10.OhtaN, Fukase S, Suzuki Y, Aoyagi M. Treatment of salivary mucocele of the lower lip by OK-432. AurisNasus Larynx 2011;38:240-3.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


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