What is the appropriate management for a patient presenting with a mucocele?

Management of Mucocele

Surgical excision is the definitive treatment of choice for oral mucoceles, with the lowest recurrence rate compared to alternative approaches. 1, 2, 3

Anatomic Location Determines Management Strategy

Oral Mucoceles (Lip, Buccal Mucosa, Palate)

• Surgical excision with removal of the affected minor salivary gland is the gold standard, providing the most effective treatment with minimal recurrence 1, 3
• The lower lip is the most common location for extravasation mucoceles, typically affecting children and young adults 1
• Alternative treatments exist but have higher recurrence rates: marsupialization, micromarsupialization, laser ablation, cryotherapy, intralesional steroid injection, and sclerosing agents 2
• Asymptomatic superficial mucoceles or multiple lesions may be observed without intervention, as they can spontaneously resolve 4
• Symptomatic lesions causing discomfort warrant surgical excision or CO2 laser treatment 4

Ranulas (Sublingual Gland Mucoceles)

• Treatment must address the sublingual gland itself, not just the mucocele, to prevent recurrence 2
• Ranulas are classified as superficial or plunging types, which influences the surgical approach 2

Paranasal Sinus Mucoceles

• Endoscopic marsupialization is the preferred approach, providing safe and effective drainage with low recurrence rates 5, 6
• Frontal and frontoethmoidal sinuses are most commonly affected (40% frontal, with frontoethmoidal combinations also frequent) 6
• Clinical presentation typically includes frontal headache and ophthalmic symptoms (diplopia, proptosis, orbital swelling, epiphora, ptosis) due to mass effect on adjacent orbital structures 6
• Common etiologies include prior functional endoscopic sinus surgery (FESS), trauma, neoplasms, and chronic inflammation 6
• In patients with EGPA (eosinophilic granulomatosis with polyangiitis), endoscopic surgery can be performed for mucoceles, though this population often requires multiple procedures (48% underwent endoscopic sinus surgery in one series) 5

Key Clinical Pitfalls

• Do not confuse superficial mucoceles with vesiculobullous lesions such as pemphigoid, bullous lichen planus, or herpes virus infection—histopathologic confirmation may be necessary 4
• Oral mucoceles characteristically have a history of bursting and refilling cycles, with soft consistency and bluish, transparent appearance 1
• Incomplete excision of the causative salivary gland leads to recurrence—ensure complete removal of the affected gland during surgical excision 1, 3
• For paranasal sinus mucoceles, imaging with CT or MRI is essential before intervention to define extent and plan surgical approach 6