Dermatologic Manifestations of Mucocele (Mucous Cyst) Treatment & Management

Updated: Mar 27, 2019
  • Author: Christopher R Shea, MD; Chief Editor: William D James, MD  more...
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Treatment

Medical Care

Patients with asymptomatic, superficial mucoceles (mucous cysts) may require reassurance only. Partial or total electrodesiccation and intralesional injections of triamcinolone acetonide have been reported as treatments for mucoceles. Topical clobetasol propionate 0.05% has been reported as an effective intervention for multiple, recurrent mucoceles. [20]

Intralesional sclerotherapy using polidocanol or sodium tetradecyl sulfate has also been used successfully. [21, 22] Intralesional injection of absolute ethanol has also been reported as an alternative therapy for mucocele of the glands of Blandin-Nuhn. [23]

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Surgical Care

For definitive management, if indicated, the minor salivary gland may be excised, just as in cases with persistent irritation.

The treatment of choice for a deep mucocele and the classic form is surgical excision, which should include the immediate adjacent glandular tissue. In one study, the risk of recurrence following surgical resection in children varied significantly by location and age, with a 50% recurrence rate in cases located on the ventral mucosa of tongue, compared with 8.8% recurrence in lesions of the labial/buccal mucosa. Recurrence was much more common in the patients younger than 30 years than in older patients. [24]

Cryosurgery with liquid nitrogen spray or cryoprobe is an alternative therapeutic modality. [25, 26] After day 4 to week 1, a necrotic surface is observed in the treated area. The latter separates from the surrounding mucosa in 1-2 weeks, exposing a new epithelialized surface. The advantages of the procedure include a simple application, minor discomfort during the procedure, and a low incidence of complications (eg, secondary infection, hemorrhage); however, recurrence is possible.

Another therapeutic strategy is argon laser treatment, typically administrated at a constant pulse duration of 0.3 seconds, using a laser beam diameter of 1.5-2 mm and a power setting of 2-3 W. Lesions presenting as firm nodules are treated with a continuous exposure and a power setting of 2.5-3.5 W. The necrotic area posttreatment is well defined by day 8-12, with complete wound healing in approximately 2 weeks. The only reported complications are swelling and mild discomfort for up to 10 days. [27] The advantages of argon laser over cryosurgery consist of less discomfort in the postoperative period, less edema and irritation, and a reduced healing time. A disadvantage of this therapeutic alternative is the requirement of specialized equipment.

The use of carbon dioxide laser appears to be a superior treatment modality for mucocele, with minimal recurrence. [28] It has the advantages of allowing precise surgical technique, lack of bleeding for a clear operative field, minimal wound contraction and scarring, and a short operative time. [29, 30, 31] As such, it has been proposed to be particularly useful in the treatment of those who are intolerant of long procedures, including children. A disadvantage is the requirement of expensive, specialized equipment, and necessary protection for both the patient and physician performing the laser vaporization. [30]

Erbium laser treatment has also been described in a pediatric patient, with excellent results. [32]

Diode laser vaporization (940 nm in contact mode) was used successfully in one reported patient with an extravasation-type mucocele of the lower lip. [33]

Microwave ablation has been used with good results in a small number of patients. [34]

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Consultations

Possible consultations may include the following:

  • Dermatologist

  • Dermatologic surgeon

  • Oral medicine specialist

  • Oral surgeon

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Complications

Secondary infection and local bleeding are rare complications. Traumatic neuroma may occur as a sequela following laser or cryosurgery. [35]

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