The anatomical basis and rational for the transoral approach during the surgical excision of the sublingual salivary gland for the management of plunging ranula.

PURPOSE: The aim of this study was to illustrate and confirm that the complete intraoral excision of the sublingual gland alone, is anatomically the most rational approach, for the management of plunging ranula. MATERIAL AND METHODS: We retrospectively reviewed clinical charts of diagnosed HIV-infected patients presenting with plunging ranula. The intraoral approach was used for the complete excision of the sublingual gland with evacuation of the pseudocystic content only. Neither extra oral approach, nor ranula dissection / drainage was performed. The surgical procedure was performed using local anesthesia. Pre- and postoperative MRI-scan investigations were recorded. Histological reports were documented to confirm the diagnosis of oral mucocele. Patients were clinically monitored. RESULTS: We identified 90 adults presenting with oral mucocele, type ranula. Seventy (77%) of them were diagnosed with HIV infection. Plunging ranula was recorded in 35 (50%) patients from the latter group. The study enrolled 11 operated patients whose files contained useable data, including an acceptable follow-up period. The postoperative follow-up period ranged from three to 15 months. The clinical and postoperative MRI-scans of operated patients demonstrated satisfactory results. There were neither postoperative complications nor recurrence of ranula reported. CONCLUSION: The location of the sublingual gland in the floor of the mouth coupled with the physio-pathogenesis of the plunging ranula, makes the transoral complete excision of the offending gland, with the intraoral evacuation of the pseudocyst, anatomically the most rational approach for plunging ranula management. There is no need for cervical approach, ranula dissection and/or postoperative placement of drainage.

Identification of predictive variables for the recurrence of oral mucocele.

BACKGROUND: Oral mucocele is the most common minor salivary gland lesion with good prognosis after surgical removal. However, its recurrence is not rare, sometimes bothersome. This study aimed to identify the possible predictive variables affecting the recurrence rate of oral mucocele. MATERIAL AND METHODS: The histoclinical data of 164 patients diagnosed with oral mucocele were retrospectively obtained by reviewing dental records. The predictive variables for its recurrence were identified by analyzing its recurrence rate according to clinical variables. RESULTS: The recurrence rate showed the significant differences according to location and age. Oral mucocele recurred with significantly higher frequency on the ventral mucosa of tongue (50.0%) than on the labial/buccal mucosa (8.8%). Its recurrence was significantly more common in the younger patients (aged < 30 years, 16.0%) than in the older patients (aged > 30 years, 4.4%). However, there was no significant difference in recurrence rates between surgical procedures using scalpels and those using lasers. CONCLUSIONS: Patients with oral mucocele should be more carefully informed of its possible recurrence, especially when it is found on the ventral surface of the tongue or in a younger population.

Superficial Mucocele of the Ventral Tongue: Presentation of a Rare Case and Literature Review.

The superficial mucocele is a rare variant of the common mucocele and noted microscopically by subepithelial pools of mucin. To increase the understanding of oral superficial mucoceles, a database was created from the demographics of case reports and case series from a PubMed search. At least 200 patients with superficial mucoceles have been described in the English-language literature, 82 of whom had biopsy-proven lesions; additional clinical information was available for 39 of these 82 patients. Compiled data suggest superficial mucoceles offered phenotypic distinctions from the common mucocele because they were more apt to occur in middle-aged women, often on the soft palate and buccal mucosa. Affected patients frequently had multiple lesions that were smaller than 3 mm and nearly 50% of patients developed recurrence. This report also describes the first histopathologically confirmed case of a superficial mucocele arising on the ventral tongue in a 22-year-old man. It is speculated that the glossal lesion might have developed from long-term impingement from exposed metal barbs from an orthodontic splint. Persistent lesions or atypical presentations underscore the need for histopathologic examination.

Biopsy of different oral soft tissues lesions by KTP and diode laser: histological evaluation.

INTRODUCTION: Oral biopsy aims to obtain clear and safe diagnosis; it can be performed by scalpel or laser. The controversy in this latter application is the thermal alteration due to tissue heating. The aim of this study is the histological evaluation of margins of "in vivo" biopsies collected by diode and KTP lasers. MATERIAL AND METHODS: 17 oral benign lesions biopsies were made by diode 808 nm (SOL, DenMatItalia, Italy) and KTP 532 nm (SmartLite, DEKA, Italy). Samples were observed at OM LEICA DM 2000; margin alterations were evaluated through Leica Application Suite 3.4. RESULTS: Epithelial and connective damages were assessed for each pathology with an average of 0.245 mm and a standard deviation of ± 0.162 mm in mucoceles, 0.382 mm ± 0.149 mm in fibromas, 0.336 mm ± 0.106 mm in hyperkeratosis, 0.473 mm ± 0.105 mm in squamous hyperplasia, 0.182 mm in giant cell granuloma, and 0.149 mm in melanotic macula. DISCUSSION: The histologic aspect of lesions influenced the response to laser, whereas the greater inflammation and cellularity were linked with the higher thermal signs. Many artifacts were also associated to histologic procedures. CONCLUSION: Both tested lasers permitted sure histologic diagnosis. However, it is suggested to enlarge biopsies of about 0.5 mm, to avoid thermal alterations, especially in inflammatory lesions like oral lichen planus.

Giant dacryocystocele and congenital alacrimia in lacrimo-auriculo-dento-digital syndrome.

The lacrimo-auriculo-dento-digital syndrome, also known as Levy-Hollister syndrome, is a rare multiple congenital dysplasia characterized by malformation of the lacrimal apparatus and by aural, dental, and digital anomalies. Since the first report in 1973, different clinical findings such as urogenital malformations and facial dysmorphism have been described in the affected patients, showing that the phenotypic spectrum of the syndrome is broad. The authors report for the first time an association among giant dacryocystocele, alacrima, and agenesis of the lacrimal puncta in a patient with lacrimo-auriculo-dento-digital syndrome.

Calcifying cystic odontogenic tumor radiographically mimicking a sinus mucocele.

The calcifying cystic odontogenic tumor or Gorlin cyst is an uncommon lesion with a variable clinical behavior and considerable histopathologic diversity. The authors report a case of calcifying cystic odontogenic tumor that was being treated as a maxillary sinus mucocele. The possibility of mimicking numerous odontogenic and nonodontogenic lesions makes the calcifying cystic odontogenic tumor difficult for a clinical diagnosis. The present case demonstrates that a specific knowledge in oral pathology is required to differentiate odontogenic lesions.

The role of MRI and CT in diagnosis and treatment planning of cherubism: a 13-year follow-up case report.

AIM: Cherubism is characterised by mesenchymal alterations during the development of the jaws secondary to perivascular fibrosis. According to the ALARA (As Low As Reasonably Achievable) principle, it is important to avoid conditions where the amount of radiation used is more than that needed for the procedure, because there is no benefit from unnecessary radiation. However, the use of MRI has been poorly studied in cherubism. MATERIALS AND METHODS: The patient underwent head and neck MRI and 3D CT for imaging assessment. RESULTS: MRI is necessary to evaluate the extension of dysplastic tissue and the cystic part of the lesions. Bone window CT only allows evaluation of strong densitometric alterations of cherubism lesions. Moreover, on radiographic film it is not always possible to distinguish fibrous tissue from mucous pseudocystic tissue. By contrast, these differences are readily evident on MRI. CONCLUSION: MRI, in addition to other traditional radiographs and CT, could be useful in helping the clinician in the diagnosis and treatment of cherubism.

Pharyngeal mucoceles in dogs: 14 cases.

This report describes the clinical features of a series of dogs with pharyngeal salivary mucoceles. A retrospective study of 14 dogs with pharyngeal mucocele was performed. Medical records from 1983 to 2003 were reviewed for information regarding signalment, clinical signs, diagnosis, surgical procedures, and short-term and long-term outcome. Miniature and toy poodles were common breeds in the study population, and 79% of the dogs were male. The most common presenting sign was dyspnea (50%). Diagnosis was by fine-needle aspirate, which revealed a mucoid substance in 93% of dogs. Histopathology of the excised salivary glands revealed lymphoplasmacytic inflammation in all dogs that had histopathology performed. Forty-three percent of the dogs had a cervical mucocele on the same side as the pharyngeal mucocele. Surgical therapy was performed in 13 dogs, which consisted of excision of the mandibular and sublingual salivary glands, excision of the mucocele, or marsupulization of the mucocele. Only two dogs had recurrence of the pharyngeal mucocele. In this study, pharyngeal mucoceles occurred in predominantly small dogs that frequently presented with respiratory signs. Surgical treatment was successful in most dogs.

Live Intraoral Dirofilaria repens of Lower Lip Mimicking Mucocele-First Reported Case from Croatia.

Dirofilariasis is an endemic infestation in tropical and subtropical countries caused by about 40 different species. It rarely occurs in the oral cavity and is mostly presented as mucosal and submucosal nodules. Differential diagnoses include lipoma, mucocele, and pleomorphic adenoma. We report a rare case of oral dirofilariasis mimicking mucocele in a 41-year-old male patient from Croatia without an epidemiological history of travelling outside the country. He came in because of non-painful lower lip swelling that had lasted for two months. The parasite was surgically removed from the lesion. This is the first reported case of oral dirofilariasis in Croatia. It is important to point out this rare diagnosis in order to make dentists aware of the possibility of the presence of such an infestation in common lesions of the oral mucosa.

Concordance between clinical and histopathologic diagnoses of oral mucosal lesions.

PURPOSE: To study the epidemiology of oral soft tissue lesions in New Zealand from 2002 to 2006 and to determine the concordance between the clinical diagnosis and the definitive histopathologic diagnosis achieved by general dental practitioners and by specialists. MATERIALS AND METHODS: The details from biopsy referrals and the corresponding histopathologic reports of oral soft tissue lesions were recorded into a statistical software package, and the concordance between the clinical diagnosis and histopathologic diagnosis was determined for all the lesions. RESULTS: Most biopsies were benign lesions, and both clinician groups achieved a high diagnostic concordance for these lesions. However, when considering all lesion types, the overall concordance for both groups was a moderate 50.6%, with little difference between specialists and general dental practitioners, although specialists were more accurate in diagnosing a malignant or premalignant lesion. CONCLUSIONS: The clinical and histopathologic concordance achieved by oral health practitioners in New Zealand appears to be moderate.

Oral mucoceles; extravasation cysts and retention cysts. A study of 298 cases.

Oral mucoceles can be divided in two different forms, extravasation and retention cysts. The aim of this study was to identify the frequency of each form, sex- and age distribution, location, recurrences, referent and the differences between the two forms. A total of three-hundred-five cases were retrieved from the Department of Oral Pathology at the Institution of Odontology, The Sahlgrenska Academy at Göteborg University between 1993 and 2003. Seven referrals were disregarded because there was insufficient information, leaving 298 cases for this study. In relation to other studies, our study investigated a larger number of cases. Extravasation cysts were the most common type (258 cases). There was a slight predominance among women (55%) and the most frequent location was the lower lip (71%). 84% occurred between the ages of 0 and 40 years with peak incidence in the second decade (34%). 62% of the referrals came from specialists, 28% from general practitioners, and 10% from the Department of Oral Medicine. Retention cysts were not found as frequently as extravasation cysts (40 cases) and the occurrence in women was also a bit higher (58%). We found a more even distribution regarding age and location. The most common locations were floor of the mouth (25%), cheek (20%), and lower lip (18%). They occurred more often between the ages of 11 and 30 (31%), and between 50 and 80 (50%). 75% of the referrals came from specialists, 15% from general practitioners,and 10% from the Department of Oral Medicine. Recurrences were unusual for both cyst types. 17 cases of extravasation cysts were reported as recurrences and one case of retention cyst.

[Osteoblastoma of the middle nasal concha: a rare tumor of the facial massif that should be taken into consideration]. / Ostéoblastome du cornet moyen: tumeur rare du massif facial à ne pas méconnaitre.

Osteoblastoma is a rare benign bone tumor, accounting for 1% of all bone tumors. It mainly occurs in the long bones, more rarely in the jaws. Osteoblastoma of the jaws mainly involves the mandible while nasosinusal involvement is very rare. The diameter of the tumor can grow to 10 cm. On X-ray, the tumor may appear as a well or poorly defined clear lesion, usually scattered with mineral patches. Recurrence rate is very low after surgical resection as well as the risk of malignant transformation. We report the case of a 13-year old female patient presenting with nasal obstruction evolving over the last 3 months associated with episodes of epistaxis and left blurred vision. Clinical examination showed voluminous nasal concha with polyploid mucosa filling all the left nasal fossa with left axial exophthalmos. CT scan of the facial massif showed left frontoethmoidal expansive process measuring 50*47*36 mm, spontaneously hypodense, heterogeneous, non enhanced after injection of the Contrast materials, responsible for destruction of the ethmoidal labyrinth, swelling of the bony walls with mass effect on the ipsilateral orbit. The suspected diagnosis was frontoethmoidal mucocele. Hence, the decision to perform endonasal surgery. Whitish thick liquid was collected by the cranial portion of the middle nasal concha sugesting infected mucocele. Resection of the middle nasal concha was performed. The histological examination showed osteoblastoma of the middle nasal concha . Outcome was marked by regression of the exophthalmos with no recurrence during 1-year follow up period.

Soft Tissue Disorders of the Mouth.

Soft tissue disorders of the mouth encompass a wide expanse of pathophysiology. This article focuses on the identification, etiology, management, and complications of common infectious processes (candidiasis, dental caries, and herpes labialis), inflammatory lesions (sialolithiasis, oral lichen planus, and aphthous ulcer), and benign entities (bony tori and mucocele).

Adult nasolacrimal sac mucocele.

Adult nasolacrimal sac mucocele is an uncommon mass arising in the medial canthal region of the orbit. Twenty-one cases with lacrimal sac mucocele were reviewed retrospectively. We gathered information about the clinical characteristics, natural history, mechanism for mucocele formation and optimal management of this disorder. The results show that the medial canthal mass was confirmed to be dacryo-cystocele-associated with distal nasolacrimal duct obstruction and proximal obstruction at the junction of the common canaliculus and sac. The interventional procedure of polyurethane stent placement is a practicable and simplified treatment for lacrimal sac mucocele.

Giant ossifying fibroma complicated by mucocele of sphenoid sinus--case report.

Ossifying fibroma is a benign tumour that rarely involves the skull. It is most commonly seen in the facial bones with a particular predilection for the mandible. It shares many pathological features with fibrous dysplasia. Ossifying fibroma is an expansive lesion and shows larger non-ossified areas of fibrous tissues. When the tumour is located deeply, encasing the optic-carotid complex, surgical removal becomes difficult because of its ossifying nature. Following surgical resection, the recurrence rate is very low. In the present study, a rare case of giant ossifying fibroma of sphenoid bone which had an intracranial extension with a coexistent mucocele is reported.

[A case of maxillary sinus mucocele with orbital involvement]. / Orbital yayilimli maksiller sinüs mukoseli: Olgu sunumu.

Maxillary sinus mucoceles account for less than 10% of all paranasal sinus mucoceles. They are reported mostly as long-term sequelae of Caldwell-Luc operations. Orbital involvement is an extremely rare condition that might result in orbital complications. A 43-year-old woman presented to the ophthalmology department with progressive ophthalmologic complaints. She was referred to our department for suspicion of a mass in the left maxillary sinus. The patient had undergone a left Caldwell-Luc sinus procedure two years before followed by two maxillary sinus lavages. Findings of computed tomography and magnetic resonance imaging of the paranasal sinuses were suggestive of a maxillary mucocele. Endoscopic sinus surgery and Caldwell-Luc procedure were performed to remove the mucocele that filled the maxillary sinus. Because the eyeball prolapsed through the defect in the inferior orbital wall to the maxillary antrum, a Silastic sheath was placed between the orbital base and the eyeball. No postoperative complication was observed.

Oral Nodular Lesions in Patients with Sjögren's Syndrome: Unusual Oral Implications of a Systemic Disorder.

Sjögren's syndrome (SS) is a systemic chronic autoimmune disorder affecting the lacrimal and salivary glands. SS may manifest as primary SS (pSS) or secondary SS (sSS), the latter occurring in the context of another autoimmune disorder. In both cases, the dry eyes and mouth affect the patient's quality of life. Late complications may include blindness, dental tissue destruction, oral candidiasis and lymphoma. This paper reports two cases of SS, each of them presenting unusual oral nodular lesion diagnosed as relapsed MALT lymphoma and mucocele. The importance of the diagnosis, treatment and management of the oral lesions by a dentist during the care of SS patients is emphasized, as the oral manifestations of SS may compromise the patient's quality of life.

[Indication for endoscopic procedures in maxiloethmoydal mucoceles]. / Indicación del tratamiento endoscópico de los mucoceles maxiloetmoidales.

The Functional Endoscopic Sinus Surgery has posibilitated a change in the diagnosis, treatment and postsurgical management of many nasosinusal diseases. Mucoceles of the paranasal sinuses are an ideal indication for performing these surgical procedures when good accesibility conditions are present. Under these circumstances, external approach, with the subsequent impairments and morbility, could be avoided. An endoscopically treated extensive maxilloethmoydal mucocele is presented and key points to endoscopic treatment indication are provided.

Mucocele of the hard palate in children.

OBJECTIVE: Mucus retention cyst of the hard palate may result from obstruction of the ducts of the minor salivary glands, and it was defined as a mucocele. Although, the disease is not common in the hard palate, it was previously reported by many authors in the soft palate. The aim of our study was to present pediatric patients who were diagnosed to have mucocele of the hard palate, and to evaluate the outcome of the surgical excision of this lesion. METHODS: This is a case series study included 8 pediatric patients who presented with cystic lesions on the hard palate which were removed surgically, and were diagnosed as mucoceles. Preoperative data, surgical procedures, and postoperative outcome were presented. Follow up of patients was performed for at least one year. RESULTS: The swelling was detected as a single isolated lesion, on the side of the hard palate, covered with healthy mucosa, not tender, oval or round in shape, and measuring 0.4 to 1.7cm in its greatest dimension. Computed tomography showed a well defined cavity which was not invading the bone, and not disrupting the muscles of the palate. Histopathological examination confirmed that the lesion was a cavity that is lined with an epithelial layer with pseudoepitheliomatous hyperplasia. No patients developed intraoperative or postoperative complications, and no recurrence was detected in any patient. CONCLUSIONS: Oral mucoceles can develop on the hard palate of the children, the lesions are mucus retention cysts. Complete surgical removal of the lesions with their cystic wall is a good treatment options, it carries no risk of recurrence.