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Micro‑marsupialization of mucocele in a pediatric patient: A case report

Article in International Journal of Applied Dental Sciences · April 2022

DOI: 10.22271/oral.2022.v8.i2c.1500

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 International Journal of Applied Dental Sciences 2022; 8(2): 143-145

ISSN Print: 2394-7489

ISSN Online: 2394-7497
IJADS 2022; 8(2): 143-145 Micro‑marsupialization of mucocele in a pediatric
© 2022 IJADS
www.oraljournal.com
patient: A case report
Received: 07-12-2021
Accepted: 10-01-2022
Dr. Bhatt Bhagyashree, Dr. Rao Dinesh, Dr. Panwar Sunil and Gupta
Dr. Bhatt Bhagyashree Surabhi
Postgraduate Student,
Department of Paediatric
DOI: https://doi.org/10.22271/oral.2022.v8.i2c.1500
Dentistry Pacific Dental College
& Hospital, Udaipur, Rajasthan,
India Abstract
Most common lesions seen in children are mucoceles. However, treating these lesions in small children is
Dr. Rao Dinesh a complicated task as they do not cooperate during surgical procedures. Various techniques have been
Professor and Head, described for the treatment of mucocele; but most of these procedures are invasive. Also, procedures
Department of Paediatric from wide excision with scalpel to laser are associated with few complications. Micro‑marsupialization is
Dentistry, Pacific Dental College a minimally invasive technique for the management of mucocele, especially in the pediatric age group.
& Hospital, Udaipur, Rajasthan, Since, it is easy to accomplish with minimum armamentarium and can be performed under topical
India anesthesia with low incidence of complications. The current case report describes the successful
management of mucocele by micro‑marsupialization in a pediatric patent.
Dr. Panwar Sunil
Professor, Department of
Paediatric Dentistry, Pacific
Keywords: Mucocele, micro-marsupialization, minimally invasive technique
Dental College & Hospital
Udaipur, Udaipur, Rajasthan, Introduction
India Mucocele is a common oral mucosal lesion that occurs more frequently in children and
adolescents, which originates from the minor salivary glands [1]. These lesion resulting from
Gupta Surabhi
Senior Lecturer,
either trauma or change in the drainage system of the salivary glands resulting in mucous
Department of Paediatric accumulation. These lesions are benign, generally painless, depending on the location, can
Dentistry, Pacific Dental College cause discomfort and create trouble, especially in pediatric population. Lesions are most
& Hospital, Udaipur, Rajasthan, commonly affected with equal gender predilection and with a clinical history of a painless
India swelling. However, lesions are often recurrent in nature that may present for months or even
years before the patient seek treatment. According to the microscopic features, oral mucoceles
can be classified as “mucus retention”, which occurs due to ductal obstruction with subsequent
retention of saliva within the ducts, whereas “extravasation” occurs due to trauma to the
salivary duct and pooling of mucus into the connective tissue [2].
The definitive treatment consists of surgical removal of the lesion along with the affected
minor salivary glands. However, different techniques have been used to manage oral
mucoceles; such as marsupialization, micro-marsupialization, incision and drainage,
sclerotherapy with OK-432 (Picibanil, an immunotherapy agent), laser excision, cryosurgery,
electro surgery or even with no treatment [3-5]. Micro-marsupialization is a minimally invasive
procedure given by Morton and Bartley for management of ranula [6]. It has been recognized as
a simple and low cost treatment option, which does not require infiltration of local anesthesia
and is well-tolerated by pediatric patients. Micro-marsupialization [2, 6], involves the placement
of a single suture which is passed internally through the lesion along with its widest diameter.
This procedure is especially recommended for adults, who have systemic conditions,
individuals with contraindications for surgical procedures, and young children in which
Corresponding Author:
behaviour modification is required [7, 8].
Dr. Bhatt Bhagyashree Thus, this paper presents a report of oral mucocele in a 7 year-old child that was successfully
Postgraduate Student, managed using a micro-marsupialization procedure.
Department of Paediatric
Dentistry Pacific Dental College Case report
& Hospital, Udaipur, Rajasthan,
India
A 7-year-old girl presented at our pediatric dental facility with a chief complaint of painless
swelling on the inner aspect of right lower lip region for 3 weeks.
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International Journal of Applied Dental Sciences http://www.oraljournal.com

The medical history was non-contributory; however, the silk suture material from one side of the lesion to the other
patient gave a positive history of lip biting since for year. and surgical knot was tied, leaving space between the knot
General examination did not reveal any abnormality. On and the lesion (Figure 2). The patient was advised to apply
intraoral examination, swelling was present on 2-3mm below 0.5% chlorhexidine gel for 7 days post-operatively to prevent
vermillion border of right lower lip region with a bluish any secondary infection. The patient was recalled after 7 days
translucent hue, which was approximately 1×1 cm in diameter for the suture removal. In the event of loss of the suture, the
with round to oval shape. (Figure 1) The swelling was non- patient was instructed to visit the operating pediatric dentist
tender, soft to the touch and non-compressible. No secondary immediately.
alterations such as ulceration, fistula formation, infection or In the present case, the sutures were maintained for 7 days, by
discharge were observed. Based upon the signs and which mucocele was compressed, epithelization was seen and
symptoms, a clinical diagnosis of oral mucocele of the lower complete healing had occurred. The patient was told to return
lip was made. The area was disinfected with a 0.1% povidone if there were any signs of recurrence. The patient was
iodine solution and a topical anesthetic gel was applied over followed up every 3 months. No recurrence has been reported
the entire surface of the lesion for approximately 3 minutes. in the six-month post-surgery (Figure 3).
Single interrupted suture was placed bypassing number 3.0

Fig 1: Mucocele on the lower right lip

The diagnosis of oral mucocele is mainly made according to

its clinical features and appearance. Its location, history of
trauma, history of lip biting habit, rapid appearance,
variations in size, bluish-colour and consistency is some of
the important factors that should be considered before making
any positive diagnosis. On palpation, the lesion is often
fluctuating [11]. Different treatment approaches have been
proposed in literature such as surgical excision of the lesion
with or without associated salivary gland, marsupialization,
electrosurgery, cryosurgery, laser excision, high-potency
topical corticosteroids, gamma-linolenic acid, OK-432, nickel
gluconate-mercurius heel-potentized swine organ preparations
Fig 2: Suture passed from one side of the lesion to the other and micro-marsupialization [9].
In 1995, Morton and Bartley6 recommended the placement of
a silk suture in the dome of the ranula. Later, in 2000, Delbem
et al., [2] used the micro-marsupialization technique which
comprised of draining the accumulated saliva by passing and
maintaining a single 4.0 silk suture through the internal part
of the lesion along its widest diameter for 7 days. This will
help to create a new epithelialized tract along the path of the
suture. The technique is minimally invasive, quick and can be
done under topical anesthesia. The procedure hardly takes 3
minutes, causes no tissue damage or inflammation, and is
particularly suitable for young children who cannot tolerate
long or invasive procedures and patients whose cooperation is
difficult to achive [2]. The use of micro-marsupialization
Fig 3: Post-operative photograph shows good healing after 6 months technique for mucoceles has been limited. However, we
preferred this technique in the present case as per patient’s
Discussion age, physical and emotional status and fear of infiltrative
Mucoceles are common oral pathological condition in with anesthesia. Piazzetta et al., [12] observed that children would
the prevalence of 2.5 lesions/1000 populations [9]. Typically it find it challenging to keep the suture in place for a long period
is not considered a clinical problem, however sometimes it of time and would be also more likely to cause discomfort and
becomes alarming to the parents when seen in children [10]. secondary infections due to inadequate oral hygiene practice.
The lesions are rarely seen in infants and neonates and can However, in the present case the sutures were maintained for
appear at any site of oral mucosa, where salivary glands are 7 days with uneventful healing.
present [9].

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International Journal of Applied Dental Sciences http://www.oraljournal.com

In the present case no post-operative discomfort was

experienced by the paediatric patient, and no recurrence was
observed even after 12 months of surgery. The minimal need
of post-operative care make this technique a good treatment
option for the management of mucoceles, particularly in
pediatric patients. The only disadvantage may be that micro-
marsupialization does not allow a biopsy to be conducted, and
the diagnosis remains totally clinical [12]. Moreover, it should
be carefully used in palatal or buccal lesions, as minor
salivary gland tumors are often located in those areas and can
be wrongly diagnosed as mucoceles.

Conclusion
Micro-marsupialization might be a treatment option for
children as well as in adolescents with mucoceles. This
method is simple to execute, minimally invasive, requires no
local anesthesia, and has a less postoperative complications
rate, and is well tolerated by patients.

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