From the Guidelines
Parotid mucoceles should be initially managed with conservative measures, including warm compresses, oral antibiotics, and aspiration of the fluid collection, with surgical intervention considered if conservative management fails. The goal of treatment is to prevent infection, reduce saliva production, and prevent reaccumulation of the mucocele. Conservative measures may include warm compresses, oral antibiotics such as amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days if infection is suspected, and aspiration of the fluid collection using a 18-20 gauge needle 1. This aspiration may need to be repeated multiple times. For persistent cases, anticholinergic medications like glycopyrrolate 1-2 mg twice daily can reduce saliva production. Pressure dressings may also help prevent reaccumulation.
Key Considerations
- Parotid mucoceles develop when trauma or inflammation damages the gland's ductal system, allowing saliva to leak into surrounding tissues rather than flowing normally into the mouth.
- Without proper treatment, these collections can become infected or form permanent cystic structures, so prompt evaluation by an otolaryngologist is recommended, especially for cases that don't respond to initial management.
- Imaging may help determine whether the mass is arising from within or outside the parotid gland, the characteristics of the mass, and whether additional masses are present, but histologic diagnosis is usually needed to exclude malignancy 1.
Treatment Options
- Conservative management: warm compresses, oral antibiotics, aspiration of the fluid collection
- Anticholinergic medications: glycopyrrolate 1-2 mg twice daily to reduce saliva production
- Pressure dressings: to prevent reaccumulation
- Surgical intervention: parotid duct ligation or partial parotidectomy if conservative management fails It is essential to note that the management of parotid mucoceles should prioritize minimizing morbidity and preserving quality of life, while also addressing the underlying cause of the condition. In cases where surgical intervention is necessary, the goal is to achieve complete excision of the mucocele while preserving facial nerve function, as recommended by the American Society of Clinical Oncology (ASCO) guideline for the management of salivary gland malignancy 1.
From the Research
Definition and Characteristics of Mucocele
- Mucoceles are benign, mucus-filled extravasation pseudocysts that commonly arise on the lower lip of children and young adults 2, 3.
- They can appear anywhere in the oral mucosa, such as the lip, cheeks, and the floor of the mouth, but mainly appear in the lip 3.
- Mucoceles may have a soft consistency, bluish, and transparent cystic swelling, history of bursting and collapsing due to which resolves themselves then refilling which may be repeated 3.
Treatment Options for Mucocele
- Surgical excision is commonly performed to remove these lesions, but other treatments include marsupialization, micromarsupialization laser ablation, cryotherapy, intralesional steroid injection, and sclerosing agents 2.
- The treatment of choice is surgical removal of the mucocele 3.
- Diode laser can be used for the excision of mucocele, with advantages including minimal discomfort, bleeding, recurrence, and better compliance among patients 4.
Parotid Mucocele
- Traumatic sialoceles commonly arise from injury to the parotid duct, and treatment options are discussed in the context of acute parotid duct injury and delayed presentations after injury 2.
- Surgical excision of the parotid salivary gland is a technically challenging but effective treatment option for traumatic mucoceles in dogs 5.
- There is no specific information available on the treatment of parotid mucocele in humans, but the general treatment options for mucoceles can be applied 2, 3, 4.
Antibiotic Treatment in Parotid Gland Surgery
- The value of routine prophylactic antibiotic treatment in parotid gland surgery remains undetermined, but it is recommended for patients undergoing extensive parotid gland surgery with neck dissection 6.
- Perioperative antibiotic treatment has no role in routine parotid gland surgery, but it may be beneficial in certain cases with high risk of wound infection 6.