Oral Mucocele: LASER Excision Using Diode LASER-940NM

INTRODUCTION

Mucoceles are the “mucus filled cavities” present in various cavities such as oral cavity, paranasal sinuses and lacrimal sac.¹ Mechanical obstruction of salivary glands results in salivary obstructive diseases; mucus extravasation and mucus retention being the most common types of diseases of which mechanical obstruction is the main cause.² Extravasation cyst occurs due to rupture of the salivary gland ductal system as a result of mechanical trauma causing spillage of mucin into the adjacent soft tissues.^3,4 Mucus retention cysts occur markedly by the obstruction of salivary ductal walls that results in dilatation of the salivary ducts without spillage of any mucin.^5,6

CASE REPORT

A 6 years old female patient presented a swelling in the labial mucosa of left lower region. Swelling had been persisting for few months and also interfered in mastication (Figure 1).

Clinical examination revealed a soft, painless swelling which was filled with fluid. The lesion measured approximately 1 × 1 cm in size. Clinical examination and history of the lesion presented by the patient concluded the lesion to be Mucocele.

There are many approaches for treatment of mucoceles which were explained to the patient’s guardian and an informed written consent form was acquired from her father for the excision of the lesion with the most recent treatment modality available, LASER.

Marginal infiltration with 1:80,000 Xylocaine was done and removal was carried out using soft tissue 940 nm Diode LASER, diameter of the tip was 400µm with power setting of 1.5W under continuous mode (Figure 2). Comprehensive excision of the mucocele was done using undermining strokes (Figure 3,4). The specimen was exposed to histopathological analysis (Figure 6,7). Patient was prescribed analgesics.

DISCUSSION

Mucoceles are among the most common oral lesions. Mucoceles are more prevalent in children and young adults with an equal or no predilection for any gender.⁷ Mucoceles are dome-shaped elevated swellings that accumulate mucin and is the characteristic feature of mucocele. These lesions appear bluish in colour with transparent hue of variable sizes ranging from 1-2 mm to multi centimeters in dimension.^3,8 The most common location of occurrence for mucocele is lower lip with lesser frequency of occurrence on buccal mucosa and least on the floor of mouth.⁹

Nico et al in 2008 analyzed 36 mucoceles and they found that location of 83% of mucoceles was the lower lip. Clinical features of mucocele include external swelling that interferes with speech and mastication with mild to moderate discomfort.⁷

Histopathologic analysis of the sampled tissue shows well-defined, cyst-like spaces sorrounded by granulation tissue. Mucinophages are also well appreciated in the distorted wall of granulation tissue.¹⁰

Mucoceles have a predisposition to recur. Hence, to prevent recurrence, healthy marginal tissue around the lesion should also be removed along with the leasion en mass. We have different treatment modalities available for the removal of mucocele such as scalpel incision, marsupialization, micromarsupialization, surgical excision, corticosteroid intralesional injections, laser ablation, cryosurgery and electrocautery method.⁸

In the present case, excision was accomplished using 940 nm soft tissue diode laser which renders excellent hemostasis intraoperatively with nominal requirement for anaesthesia. Also, the fact that healing is rapid with laser was the main concern of use of laser.^11,12,13

Laser leads to faster coagulation of blood, as suturing is not required after excision with laser because laser denatures the proteins which act as natural dressing for the wound.

CONCLUSION

The presented case report gives adequate acquaintance for the use of diode laser as a treatment approach for mucocele removal. It increases patient acceptance and fastens healing with least intraoperative and postoperative complications.

REFERENCES