Treatment of Mucous Cysts Over the Lips in Children
Surgical excision is the most effective treatment for mucous cysts over the lips in children, with complete removal of the cyst and its wall providing the highest cure rate and lowest recurrence. 1
Diagnosis and Initial Assessment
- Mucous cysts (mucoceles) of the lips present as single, isolated lesions covered with healthy mucosa, typically oval or round in shape, and measuring between 0.4 to 1.7 cm in diameter 2
- These lesions result from obstruction of the ducts of minor salivary glands or from breaks in the epithelium of the gland secreting saliva into extra-glandular space 3
- Imaging studies like computed tomography may be used to confirm that the lesion is a well-defined cavity not invading bone or disrupting surrounding muscles 2
Treatment Options
First-Line Treatment: Surgical Excision
- Complete surgical removal of the cyst with its cystic wall is the treatment of choice, showing the highest cure rate (95%) compared to other treatment modalities 1, 4
- For lip mucoceles, surgical excision should include:
- Complete removal of the cyst
- Removal of surrounding minor salivary glands to prevent recurrence 4
- The procedure can be performed under local anesthesia for cooperative children or general anesthesia for younger patients 4
Surgical Approach Options
- Traditional external approach: Effective but may leave a visible scar 3
- Intraoral approach: Recommended for cysts located in the lip to avoid visible scarring on the face 5
- An intraoral incision is made and blunt dissection performed through the orbicularis oris muscle until the cyst wall is exposed
- The cyst is then carefully dissected from surrounding tissue and completely removed 5
Second-Line Treatments
If surgery is contraindicated or refused, alternative options include:
Third-Line Treatments
- Corticosteroid injection: Shows approximately 61% cure rate 1
- Expression of cyst content: Shows only 39% cure rate and has high recurrence 1
Post-Treatment Care
- Lubricate lips with lip balm or lip cream (avoid prolonged use of petroleum jelly as it can promote mucosal cell dehydration and increase risk of secondary infection) 6
- Maintain good oral hygiene with soft toothbrush and mild fluoride-containing toothpaste 6
- Avoid irritants that may delay healing:
- Spicy foods
- Hot foods and drinks
- Citrus fruits 6
Follow-Up and Monitoring
- Regular follow-up for at least one year is recommended to monitor for recurrence 2
- Parents should be instructed to inspect the child's oral mucosa regularly 6
- Any sign of recurrence should prompt reassessment and consideration of repeat surgical intervention 4
Special Considerations
- The lips deserve special consideration due to their critical role in cosmesis and function 6
- Lip mucoceles have a tendency to ulcerate, potentially resulting in pain and bleeding in the short term and increased scarring and disfigurement in the long term 6
- For small lesions in cosmetically favorable areas, early surgical resection may be considered 6
- For lesions located exclusively on the vermilion, they can be removed with a transverse mucosal incision 6
- Bulkier lesions that cause lengthening of the lip or cross the vermilion-cutaneous border are best addressed with a wedge excision 6