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Case Report

Micromarsupialization combined with intralesional

corticosteroids to treat mucocele: A case report
Rajeshwari Javali, Basavaraj Bhagwati, Sharanamma Bhagwati1
Departments of Oral Medicine and Radiology and 1Periodontics, S.B. Patil Dental College and Hospital, Bidar,
Karnataka, India

Abstract

Oral mucoceles are the most common benign lesions of the minor salivary gland in the oral mucosa. Various treatment
options include marsupialization, surgical excision, dissection, laser ablation, cryosurgery, electrocautery, and intralesional
steroid injections. However, most of them are invasive. The objective of this case report is to emphasize a less invasive
combination treatment procedure as an alternative for the invasive treatment of mucoceles. This therapy was performed
by using intralesional corticosteroid injection along with micromarsupialization to treat the mucocele on the lower labial
mucosa. Three intralesional dexamethasone (4 mg) injections followed by standard silk sutures with 1‑week interval over
a 3‑week duration demonstrated complete resolution of the mucocele. A 3‑month and 6‑month follow‑up revealed no
signs of recurrence. This combination therapy can be a noninvasive option to treat mucoceles as this treatment modality
is well‑tolerated by patients owing to its simple execution without any reported complications.
Key words: Intralesional, micromarsupialization, mucocele, steroids

Introduction Delbem[2] and Luiz,[3] respectively. We present a case

treated by a combination of these two techniques.

M
ucocele is a common lesion of the oral mucosa.
There are extravasation and retention type of
mucoceles. Extravasation mucocele results
Case Report
from broken salivary gland ducts and the consequent
A 22‑year‑old female patient reported to the Department
spillage into the surrounding soft tissues. Retention
of Oral Medicine and Radiology with a chief complaint
mucocele appears due to a decrease or an absence
of a painless swelling on the left lower labial mucosa
of glandular secretion produced by blockage of the
since 3 weeks [Figure 1]. There was a mild change in
salivary gland ducts.[1] In many cases, local surgical
the shape of the lower lip, for which the patient was
excision is necessary. Several other conservative
techniques have been used in the treatment of
mucoceles. Micromarsupialization and intralesional This is an open access article distributed under the terms of the
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How to cite this article: Javali R, Bhagwati B, Bhagwati S.

DOI: Micromarsupialization combined with intralesional corticosteroids
10.4103/0972-1363.189974
to treat mucocele: A case report. J Indian Acad Oral Med Radiol
2016;28:44-7.

Address for correspondence: Dr. Rajeshwari Javali, Assistant Professor, Department of Oral Medicine and Radiology,
S.B. Patil Dental College and Hospital, Naubad, Bidar - 585 401, Karnataka, India. E‑mail: paradise_903@yahoo.com
Received: 16‑01‑2016  Accepted: 13‑08‑2016  Published: 08-09-2016

44 © 2016 Journal of Indian Academy of Oral Medicine & Radiology | Published by Wolters Kluwer - Medknow
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Javali R et al.: Micromarsupialization and intralesional corticosteroids in mucocele
esthetically concerned and visited our Department
for its treatment. Past medical and family history
was noncontributory. Patient was under orthodontic
treatment since 4 months and provided a positive
history of lip biting. Upon examination, the lesion
appeared as a well‑circumscribed, dome‑shaped bluish
swelling, measuring approximately 2 cm × 1.5 cm in
size, smooth surfaced, nontender, and fluctuant with
no other abnormality. A diagnosis of mucocele was
made. Although a bluish lesion developing after trauma
is suggestive of mucocele, a differential diagnosis
of vascular malformation, such as lymphangioma,
soft tissue neoplasm, such as schwannoma, salivary
gland tumors, and cysticercosis was considered. The
patient was administered a combination therapy of
micromarsupialization and intralesional injection
of dexamethasone. The technique was performed
as follows: The area was disinfected with 0.1%
iodine; a topical anesthetic was applied to cover the
entire lesion for approximately 3 minutes, 1 ml of
dexamethasone (4 mg/2 ml) was injected into the
base of the lesion with an insulin needle [Figure 2].
After injection, micromarsupialization was performed
to drain the mucus and reduce the size of lesion.
This technique consisted of passing a thick silk
suture through the internal part of the lesion along
its widest diameter followed by making a surgical
knot [Figures 3 and 4]. After 1 week, the size of the lesion
was reduced [Figure 5], and the same procedure was
repeated. On the third visit, the size of the lesion further
decreased and the patient received the last injection
and suture. This process (intralesional injection of
dexamethasone combined with micromarsupialization)
was repeated 3 times at 1‑week intervals. Complete
resolution was observed after 3 weeks [Figure 6]. After
3 and 6 months of follow‑up, there was no history or
sign of recurrence or local discomfort.
Figure 1: Mucocele on the lower labial mucosa
Journal of Indian Academy of Oral Medicine & Radiology | Jan‑Mar 2016 | Vol 28 | Issue 1
Discussion
Mucocele is a common lesion and affects the general
population. When located on the floor of the mouth,
these lesions are called ranulas because the inflammation
resembles the belly of a frog.[4] Yamasoba et al.[5] highlight
two crucial etiological factors in mucoceles, namely,
traumatism and obstruction of salivary gland ducts.
A study by Bagán et al.[6] showed that 5% were retention
mucoceles whereas the other 95% were extravasation.
They proposed that extravasation mucoceles undergo
three evolutionary phases. In the first phase, mucous
spills diffusely from the excretory duct into conjunctive
tissues where some leucocytes and histiocytes are found.
Granulomas appear during the resorption phase where
histocytes, macrophages, and giant multinucleated cells
are associated with a foreign body reaction. In the final
phase, connective cells form a pseudocapsule without
epithelium around the mucosa. Retention mucoceles
are formed by dilation of the duct secondary to its
obstruction or are caused by a sialolith or dense mucosa.
The majority of retention cysts develop in the ducts of
the major salivary glands.[5]
The incidence of mucoceles is generally high, 2.5 lesions
per 1000 patients, frequently in the second decade of
life,[7,8] and rarely among children under 1 year of age.
According to several studies, there is no difference
between genders[5,6,7] and no difference in the clinical
presentation of retention and extravasation mucocele.
Mucocele presents as bluish, soft, and transparent
cystic swelling. The blue color is caused by vascular
congestion, cyanosis of the tissue above, and the
accumulation of fluid below. Coloration can also vary
depending on the size of the lesion, proximity to the
surface, and upper tissue elasticity.[7,9] Lesion duration
is not constant, varying from a few days to 3 years. [5]
Figure 2: Intralesional administration of dexamethasone
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Javali R et al.: Micromarsupialization and intralesional corticosteroids in mucocele

Figure 3: Micromarsupialization using suture Figure 4: Surgical knot with suture

Figure 5: Regression in the size of the lesion after the first week of
follow-up
The lower lip is the most frequent site for a mucocele
because it is the most probable place for a trauma.
The main accepted treatment for mucocele is surgical
management. However, Yamasoba et al. showed a 2.8%
recurrence in lesions which were removed surgically.[5]
Other treatment options are laser ablation, cryosurgery,
electrocautery, intralesional steroid injections, OK‑432,
gamma‑linolenic acid, and micromarsupialization.
We treated a mucocele by a combination therapy. The
proposed mechanism was: Injection of a high‑potency
corticosteroid to promote the shrinkage of dilated
salivary ducts or pools similar to a sclerosing agent.[3]
The introduction of a suture which, according to the
literature, causes epithelialization around the suture,
establishing new excretory ducts between the surface
and the underlying salivary gland tissue and leading
to the disappearance of the lesion. [10] An important
factor observed during the execution of the technique is
that only topical anesthesia over the lesion needs to be
applied that considerably favors cooperative behavior of
Figure 6: Complete resolution of the mucocele after the third week
the patient. The mucus content of the lesion is the reason
why we only need to anesthetize the mucosa that covers
the lesion. The immediate extravasation of mucus after
the passage of the suture and consequent reduction of the
lesion in volume is a fundamental clinical characteristic
for the diagnosis of mucus retention phenomena. If the
extravasation does not occur, biopsy and histopathologic
analysis are recommended.
Conclusion
The combination of micromarsupialization and
intralesional injection of corticosteroid is an alternative
to be considered because it is a simple procedure with
a good prognosis.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.

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Javali R et al.: Micromarsupialization and intralesional corticosteroids in mucocele

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