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WORLD JOURNAL OF ORTHODONTICS

194
LOWER-LIP MUCOCELE IN A PATIENT
UNDERGOING ORTHODONTIC TREATMENT
Irineu Gregnanin Pedron, DDS,
MS
1
Endrigo Sperto Rodrigues
dos Santos, DDS
1
Andria Perrella, DDS, MS
1
Maria Aparecida Borsatti, PhD
1
Carlos Alberto Adde, PhD
1
World J Orthod 2008;9:194195
T
he term mucocele refers to salivary
extravasations, which vary in size
from a few millimeters to centimeters,
involving minor salivary glands in the
oral cavity. Its incidence is greater on
the lower lip, and it can also occur on
the jugal mucosa, palate, or tongue ven-
trum; its prevalence does not show pref-
erence toward age, ethnicity, or gender.
The diagnosis may be based on clinical
characteristics, history, evolution, or
anatomic-pathological examination.
1,2
A 25-year-old African-American male
sought treatment for swelling on his lower
lip. Clinically, there was an increase in
labial volume of fluctuating consistency.
There was a sessile, slightly erythema-
tous ulceration in the central region of its
smooth surface that was asymptomatic
and had episodic variation in size (Fig 1).
The patient reported that, 1 month prior,
he had experienced an acute trauma in
which his lower lip had pressed against
the fixed orthodontic appliance while
playing sports. Based on these clinical
characteristics and the patients history,
an initial clinical diagnosis of mucocele
was made.
Many techniques have been proposed
for the treatment of mucoceles, but in the
present case, surgical excision, which is
most common,
1,2
was selected. Other
techniques have been proposed for the
treatment of mucoceles, including micro-
marsupialization; marsupialization and
insertion of alginate followed by enucle-
ation; cryosurgery; treatment with sys-
temi c use of gamma- l i nol eni c aci d
(a prostaglandin precursor that yielded
satisfactory results with low recurrence
rates); and laser surgery.
3,4
Baurmash
1
emphasized that regardless of the tech-
nique being used, follow-up sessions are
critical due to the high rate of recurrence
of mucoceles; Baurmash also suggested
a diet that stimulates salivary flow in the
postoperative period.
Under local infiltrative anesthesia at
a distance, the mucosa was excised.
Using curved Metzenbaum scissors, the
dissection was performed to separate
the lesion and its associated minor sali-
vary gland from the adjacent tissue. The
lesion ruptured, and salivary extravasa-
tion occurred. The mucosa was subse-
quently sutured. The anatomic fragment
was fixed using 10% formaldehyde and
was sent to the Surgical Pathology Labo-
ratory of the College of Dentistry of the
University of So Paulo to confirm the
1
Department of Stomatology, Faculty
of Dentistry, University of So Paulo,
So Paulo, SP, Brazil.
CORRESPONDENCE
Dr Irineu Gregnanin Pedron
Rua Flores do Piau, 347
So Paulo, SP, Brazil
CEP: 08210-200
E-mail: igpedron@usp.br
Short Clinical Communication
Pedron 8/7/08 12:07 PM Page 194
COPYRIGHT 2007 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS
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195
VOLUME 9, NUMBER 3, 2008 Pedron et al
mucocele diagnosis. After 3 days, the
patient reported slight discomfort and
bleeding due to loss of suture fixation
that was probably caused by friction with
the fixed orthodontic appliance. The
region was anesthetized and resutured.
The patient was instructed to place a pro-
tective wax over the brackets and ortho-
dontic wire that came in contact with the
surgical wound. Remaining sutures were
removed at the 10-day postoperative
appointment. At the follow-up session 30
days af ter surger y, a poor heal i ng
process was observed, due to attrition of
the labial mucosa with the fixed ortho-
dontic appliance (Fig 2). At the time of
this writing, the patient has been under
observation for 24 months and shows no
signs of recurrence.
Mechanical trauma is the main etio-
logical factor of excretory duct rupture of
the salivary gland in question, which can
lead to the extravasation of saliva into
the surrounding connective tissue.
1,2
In the present case, it is important to
point out the need to temporarily remove
the fixed orthodontic appliance or pro-
tect the surgical wound after surgery by
placing wax on the brackets and wire.
Di f f i cul ti es i n the heal i ng process
occurred because of contact and friction
between the surgical wound and fixed
orthodontic appliances.
REFERENCES
1. Baurmash HD. Mucoceles and ranulas. J Oral
Maxillofac Surg 2003; 61:369378.
2. Rose EC, Rose C. Mucocele on the lower lipA
case report. J Orofac Orthop 2004; 65:433435.
3. Jinbu Y, Tsukinoki K, Kusama M, Watanabe Y.
Recurrent multiple superficial mucocele on the
palate: Histopathology and laser vaporization.
Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2003; 95:193197.
4. Huang IY, Chen CM, Kao YH, Worthington P.
Treatment of mucocele of the lower lip with car-
bon dioxide laser. J Oral Maxillofac Surg 2007;
65:855888.
Fig 1a A mucocele on the lower lip resulting from mechanical
trauma.
Fig 2 Thirty days postoperative. Observe the slightly defi-
cient tissue healing resulting from contact with the fixed
orthodontic appliance.
Pedron 8/7/08 12:07 PM Page 195
COPYRIGHT 2007 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS
ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER