What Are Mucous Cysts?

A mucous cyst, also known as a mucocoele, is a fluid-filled swelling that

occurs on the lip or the mouth.
The cyst develops when mucus from the mouths salivary glands
becomes plugged. Most cysts are on the lower lip but can occur
anywhere inside the oral cavity. Most cysts are temporary and painless.
However, cysts can become permanent if they are not treated.
What Causes Mucous Cysts?
Mucous cysts are most commonly caused by trauma to the oral cavity,
such as:

lip biting (most common cause)

piercings
accidental rupture of salivary gland
adjacent teeth causing chronic damage
cheek biting
Poor dental hygiene and a habit of lip or cheek biting due to stress can
also put you at higher risk for developing mucous cysts.
What Are the Symptoms of Mucous Cysts?
The symptoms of a mucous cyst vary by how deep the cyst lies within
the skin and how often lip cysts occur. Most cysts are not painful, but
they can be bothersome. Frequent cysts can become painful over time.
Symptoms of superficial (close to the surface of the skin) cysts:

raised swelling
bluish color
soft to the touch
lesions less than 1 cm in diameter
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Symptoms of cysts deeper within the skin include:

more nodule (appears more like a rounded bump)

whitish color
tender to the touch

How Are Mucous Cysts Diagnosed?

Doctors rely on clinical symptoms for diagnosis. Your doctor may also
ask about a history of trauma associated with lip biting to make an
accurate diagnosis.
In certain cases, a biopsy of the cyst may be required to make a
positive diagnosis. During this a small tissue sample will be removed.
The tissue will be microscopically examined. By looking at the cells,
doctors can decide if the cyst is cancerous or not.
Doctors may require a biopsy in cases where:

the mucous cyst is larger than 2cm

the cysts appearance suggests adenoma (cancer) or lipoma
there is no history of trauma
How Are Mucous Cysts Treated?
Treatment is based upon the severity of the mucous cyst. Sometimes
cysts may not require treatment and will heal on their own over time.
Superficial cysts often resolve spontaneously. To prevent infection or
tissue damage, do not try to open or remove cysts at home. Frequent or
recurring cysts may require further medical treatment.
Treatments used in mucous cysts that are not very severe include:

laser therapy: a small, directed beam of light is used to remove the

cyst

cryotherapy: the cyst is removed by freezing

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intralesional corticosteroid injection: a small needle injects a

steroid into the cyst to reduce inflammation and accelerate healing
To prevent recurrenceor to treat especially severe cystsyour doctor
may recommend surgical removal of the cyst or even the complete
salivary gland.
Mucous cysts can take anywhere from a week to two years after
treatment to heal, depending on the type and severity of the cyst. Even
after healing, the only way to ensure a cyst will not come back is to
have it surgically removed. Avoid habits like lip or cheek biting to help
prevent future cysts.
Symptoms
Mucoceles often show up on the inside of your lower lips, your gums,
the roof of your mouth, or under your tongue. Those on the floor of the
mouth are called ranulas. These are rare, but because they are larger,
they can cause more problems with speech, chewing, and swallowing.
Mucoceles may have these characteristics:
Moveable and painless
Soft, round, dome-shaped
Pearly or semi-clear surface or bluish in color
2 to 10 millimeters in diameter
Treatment
Mucoceles often go away without treatment. But sometimes they
enlarge. Don't try to open them or treat them yourself. See your doctor,
your child's pediatrician, or your dentist for expert advice.
These are the two types of treatment a doctor or dentist most commonly
uses:
Removing the gland. The dentist or doctor may use a scalpel or laser to
remove the salivary gland. Local anesthesia numbs the pain.
Helping a new duct to form. Called marsupialization, this technique
helps a new duct form and helps saliva leave the salivary gland.
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The dentist or doctor:

Disinfects the area
Puts a stitch through the mucocele and ties a knot
Gently presses out saliva
Removes the stitch after about a week
Other types of treatment that may bring down swelling or prevent the
need for surgery include steroid injections and medications applied to
the surface of the mucocele.
Overview
An oral mucocele is a harmless, fluid-containing (cyst-like) swelling of
the lip or mouth lining (mucosa) due to mucus from the small salivary
glands of the mouth leaking into the soft tissue, usually from injury
(trauma) or blockage of the gland. A similar lesion, the mucus-retention
cyst, occurs from blockage and backup of saliva in the gland.
Who's At Risk
Mucoceles occur most commonly in children or young adults. There
may be a history of trauma or lip biting. The similar-appearing mucusretention cysts occur more often in older adults and without any history
of preceding trauma. Tartar-control toothpaste might be the cause in
some mucoceles.
Signs and Symptoms
Mucoceles usually occur on the lower lip and inner part of the cheek, as
these are frequent areas of mouth trauma, but they can occur anywhere
inside the mouth. A mucocele is usually a single bump with a slight
bluish or normal skin color, varying in size from 1/2 to 1 inch, and it is
soft and painless. A mucocele may appear suddenly, while a mucusretention cyst may slowly enlarge.
Self-Care Guidelines
Many mucoceles will go away on their own in 36 weeks. Mucusretention cysts often last longer. Avoid the habit of chewing or sucking
on the lips or cheek when these lesions are present.
When to Seek Medical Care
See your doctor if the bump persists for over 2 months or if it is growing,
bleeding, interfering with talking or chewing, or painful.
Treatments Your Physician May Prescribe
If the doctor is not sure of the diagnosis, a biopsy may be done. Minor
surgery may be suggested to remove the lesion.
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What is Oral Mucocele?

Oral mucocele or also known as the mucus cyst of the oral mucosa is a
swelling in the oral cavity particularly in the lower lip of the oral cavity.
The condition is linked to the obstruction and rupture of the salivary
gland and the accumulation of mucin within the connective tissue of the
oral mucosa. Mucocele is rated as 17th most common oral lesion
affecting children and young adults with peak prevalence occurring in
individuals aged 10 to 20 years. It is a common condition of the oral
cavity that equally affects men and women without racial predilection.
The oral mucocele is characterized by a lump forming inside the lower
lip which is rather firm and can be discomforting.
The salivary glands are exocrine glands that have a duct and produces
saliva. It is also a gland that secretes an enzyme necessary for the
breakdown of starch into maltose. The saliva that is produced by the
salivary gland is an essential factor in digestion. There are different
types of glands in the oral cavity that function in producing saliva and
are located in the different areas of the oral cavity.
Parotid glands are the largest of the salivary gland that envelopes the
mandibular ramus. The serous saliva is secreted through the oral cavity
via the Stensens duct. The gland can be located close to the
mandibular ramus just in front of the mastoid process of the temporal
bone.
Submandibular glands are located below the lower jaws and
produced both the serous saliva and the mucus. The saliva is secreted
to the oral cavity passing through the Whartons ducts. The majority of
the saliva in the oral cavity is coming from the submandibular gland
although it is much smaller than the parotid gland.
Sublingual glands are situated beneath the tongue in front of the
submandibular glands. This gland secretes mainly mucus that is
secreted to the oral cavity through numerous excretory ducts as this
gland has no striated ducts.
Minor salivary glands are distributed in the submucosa throughout the
oral cavity. There are approximately 800 to 1000 minor salivary glands.
Symptoms
Oral mucocele is generally painless and asymptomatic. The onset of
the swelling is rapid with the lump fluctuating in size. It usually occurs
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as a single lump or bump on the inside of the lower lip with a color that
may be light bluish or translucent. The size of the lump also varies and
ranging from a half inch to an inch and is often soft and firm.
The mucocele often develop on the surface of the lower lip but it can
also develop on the inner side of the cheeks, floor of the mouth or in the
front of the ventral tongue. The superficial lesion usually has a bluish
tinge while deeper lesion has a normal skin color.
The lump in mucocele is dome shaped and superficial mucocele are
transparent and fluid filled that may appear as single or multiple.
Mucocele on the anterior ventral surface of the tongue on the other
have a reddish color resulting from constant or repeated trauma against
the lower teeth.
The mucocele that develop on the floor of the mouth is relatively large
in size with blue to translucent hue resembling the belly of the frog. The
large size of the oral mucocele or know as oral ranula can displace the
tongue. The consistency of the lump is like mucus and do not blanch
when pressed with a finger or tongue depressor.
The mucocele is generally painless except when accidentally bitten can
the pain be perceived. It can get in the way of mastication and can also
affect the speech or manner of speaking. The mucocele on the hand
can be annoying and may rupture and release a reddish fluid. The
onset can linger for a few weeks although there are instances where
mucocele linger for a year.
Causes
The incidence of oral mucocele is basically due to an obstruction in the
duct of the salivary gland. The obstruction is the result of a break or a
discontinuation in the duct caused by trauma. The obstruction in the
salivary duct results to an interference in the release of saliva to the oral
cavity. The increase in the size of the salivary gland is the result of the
accumulation of the saliva that was not released into the oral cavity due
to the obstruction.
There are actually two phenomena that explain the etiology of the oral
mucocele which are:
Mucus extravasation phenomenon explains oral mucocele arising
from the rupture in the salivary gland that resulted from trauma and
thereby resulting in swelling of the connective tissue that composed of
machine that accumulated.
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Mucus retention cyst explains the onset of oral mucocele as a result

of obstruction or rupture of the salivary gland.
The trauma in the salivary gland may be the result of the following:

Mechanical injury during the process of mastication where the

tissue of the lower lip gets caught between the teeth in the maxillary
anterior and in the mandibular anterior.

Habitual biting of the lip may accidentally bite the salivary gland
resulting in trauma subsequently the onset of oral mucocele.

Crush type injury can also result to oral mucocele

Chronic irritation of the oral cavity such as from cigarette smoking

and extreme heat can injure the salivary gland.

Surgical procedures in the oral cavity may also cause trauma to

the salivary gland.

Congenital mucocele in newborn babies is believed to be the result

of birth trauma affecting the oral cavity.
Treatment
Oral mucocele usually resolve on its own without treatment in a matter
of 3 to 6 weeks from initial onset. Other mucocele on the other may
linger longer and may also increase their size while others may recur
after it has resolved.
Superficial oral mucocele can be treated with application of Clobetasol
0.05% or may also be treated with a gamma-linolenic acid. The
drawback however with these treatments is the tendency of the
mucocele to recur after is has resolved from the treatment.
Oral mucocele from mucus extravasation phenomenon is
recommended for surgical removal of the mucocele together with the
adjacent salivary glands. A simple and small incision on the inside of the
lower lip where the mucocele occurred can be done to remove the oral
mucocele. Recovery from surgical removal of the oral mucocele
generally takes about two weeks with recommended limited range of
motion of the lips for about 3 to 5 days following the operation. A soft
diet is also required for a period of 3 to 5 days after the surgical removal
procedure.
Background
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Collectively, the mucocele, the oral ranula, and the cervical, or plunging,
ranula are clinical terms for a pseudocyst that is associated with mucus
extravasation into the surrounding soft tissues. These lesions occur as
the result of trauma or obstruction to the salivary gland excretory duct
and spillage of mucin into the surrounding soft tissues.
Mucoceles, which are of minor salivary gland origin, are also referred to
as mucus retention phenomenon and mucus escape reaction. The
superficial mucocele, a special variant, has features that resemble a
mucocutaneous disease. At times, the mucus retention cyst, also
referred to as the sialocyst or the salivary duct cyst, is included in this
group of lesions but appears to represent a separate entity on the basis
of its clinical and histopathologic features. Although the mucus retention
cyst is discussed in this article, its features are differentiated from the
features of the pseudocysts. The lesions of the sinus, such as sinus
mucoceles, antral pseudocysts, and retention cysts, are not included in
this discussion.
Ranulas are mucoceles that occur in the floor of the mouth and usually
involve the major salivary glands. Specifically, the ranula originates in
the body of the sublingual gland, in the ducts of Rivini of the sublingual
gland, and, infrequently from the minor salivary glands at this location.
These lesions are divided into 2 types: oral ranulas and cervical or
plunging ranulas. Oral ranulas are secondary to mucus extravasation
that pools superior to the mylohyoid muscle, whereas cervical ranulas
are associated with mucus extravasation along the fascial planes of the
neck. Rarely, the mucocele arises within the submandibular gland and
presents as a plunging ranula.
Pathophysiology
The development of mucoceles and ranulas depend on the disruption of
the flow of saliva from the secretory apparatus of the salivary glands.
The lesions are most often associated with mucus extravasation into
the adjacent soft tissues caused by a traumatic ductal insult; the insults
include a crush-type injury and severance of the excretory duct of the
minor salivary gland. The disruption of the excretory duct results in
extravasation of mucus from the gland into the surrounding soft tissue.
The rupture of an acinar structure caused by hypertension from the
ductal obstruction is another possible mechanism for the development
of such lesions. Furthermore, trauma that results in damage to the
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glandular parenchymal cells in the salivary gland lobules is another

potential mechanism.[1]
Regarding superficial mucoceles, trauma does not always appear to
play an important role in the pathogenesis. In many cases, mucosal
inflammation that involves the minor gland duct results in blockage,
dilatation, and rupture of the duct with subepithelial spillage of fluid.
Changes in minor salivary gland function and composition of the saliva
may contribute to their development. In some cases, an immunological
reaction may be the cause.
Studies have revealed increased levels of matrix metalloproteins, tumor
necrosis factor-alpha, type IV collagenase, and plasminogen activators
in mucoceles compared with that of whole saliva. [2] These factors are
further hypothesized to enhance the accumulation of proteolytic
enzymes that are responsible for the invasive character of extravasated
mucus.[3]
Besides ductal disruption, partial or total excretory duct obstruction is
involved in the pathogenesis of ranulas in some instances. The duct
may become occluded by a sialolith, congenital malformation, stenosis,
periductal fibrosis, periductal scarring due to prior trauma, excretory
duct agenesis, or even a tumor. Although most oral ranulas originate
from the secretions of the sublingual gland, they may develop from the
secretions of the submandibular gland duct or the minor salivary glands
on the floor of the mouth. The mucus extravasation of the sublingual
gland almost exclusively causes cervical ranulas. The mucus escapes
through openings or dehiscence in the underlying mylohyoid muscle.
Occasionally, ectopic sublingual glands may be responsible for the
problem. When mucus secretions escape into the neck through the
mylohyoid muscle, they extend into the fascial tissue planes and cause
a diffuse swelling of the lateral or submental region of the neck. The
continuous secretions from the sublingual gland allow for relatively rapid
accumulation of mucus in the neck and a constantly expanding cervical
mass. Unlike the submandibular gland, the sublingual gland is defined
as a spontaneous secretor, capable of producing secretions without
neural stimulation. Inflammatory reaction to these secretions results in
the formation of granulation tissue and subsequent fibrosis that may
result is the entrapment of the fluid and the sealing of the leak.
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The mucus retention cyst may also develop because of ductal

obstruction; however, many of these lesions actually represent a distinct
cystic entity of unknown cause. When ductal occlusion is involved, it is
usually caused by a sialolith or an inspissated secretion that results in
ductal dilatation and focal containment of the mucoid material.

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