Finding an unexplained swelling in the mouth, or any other region for that matter, can be quite scary. The first thing that comes to mind is the dreaded "C" word. Thankfully, there are other much more harmless causes for such swellings when compared to cancer. A mucocele is one of them and it is quite often seen in children.
What is a mucocele?
A mucocele is a harmless lump or bump that may be found in your child’s mouth. It can be found in slightly older children or young adults as well, but children around the age of five are most commonly affected. It is basically a cyst-like accumulation of mucus which may be present on the inside of the lower lip, or on the roof of the mouth, or on the gums, or on the floor of the mouth below your child’s tongue. When they are present on the floor of the mouth, they are referred to as a ranula and are larger in size. Ranulas are quite big and may cause problems in speech or chewing.
A mucocele may be confused with a mucus-retention cyst which presents due to back up of saliva due to blockage of the salivary gland.
Causes of mucocele formation in children
There are multiple salivary glands in the mouth which produce saliva. This saliva reaches the mouth via the salivary ducts. A mucocele is formed when any of the salivary ducts get blocked or damaged. This damage to the duct can happen due to your child having a habit of repeatedly sucking in the lower lip or cheek or due to any injury or trauma to the area.
Symptoms associated with a mucocele in children
- Mucoceles are usually painless and movable.
- They may be bluish, pinkish, or shiny translucent in color.
- Mucoceles may range in size from two to ten millimeter.
- They are soft, spongy and shaped like a dome.
Differential diagnosis of a mucocele
While diagnosing a mucocele, the doctor will definitely rule out a mucous retention cyst, fibroma, lipoma, hemangioma, venous disorders, sialolith, phlebolith as well as benign and malignant salivary gland tumors.
Treatment of mucoceles in children
An injection of steroids into the mucocele may be recommended to try and reduce the inflammation around the salivary ducts and open up the path for a normal mucous flow. This method can be quite effective in the beginning but does see a high rate of relapse as the inflammation returns. The fast and minimally invasive nature of the treatment means it is worth trying at the beginning of the treatment.
A complete surgical excision of the mucocele and the affected gland is the most permanent treatment option. This can be carried out using a scalpel and traditional techniques or using electrosurgery or a laser.
The use of scalpel requires local anesthesia, as well as great skill and technique to prevent any damage to neighboring structures. Electrosurgery generates a lot of heat and may cause additional damage although it allows the surgeon to work with a clean, bloodless field. Another major disadvantage of this method is the difficulty in controlling the depth of the tissues affected by the electrosurgical unit.
Cryosurgery was also used a little while back but the popularity of this method has decreased as lasers have become more affordable and widely available.
Marsupialisation is a process of forming a new duct which will help the saliva exit the salivary gland. The dentist or the doctor will drain the mucocele with a minor incision, ensure that all the mucus and saliva is removed from the mucocele completely and then put a stitch through it. The stitch is removed after about a week and the chances of success of this procedure are dependent on complete disinfection of the healing area.
Around one percent of people will develop a mucocele, which means it is pretty common by relative standards. There does not seem to be a gender predilection for this condition and the lower lip is the most commonly affected area. The symptoms are mild, if any, and the treatment is straightforward. The only concern is the high chance of recurrence. Surgical excision of the mucocele and the associated gland structures provides the best chance for permanent treatment of the same.