J Oral Maxillofac Surg

65:855-858, 2007

Treatment of Mucocele of the Lower Lip

With Carbon Dioxide Laser
I-Yueh Huang, DDS, MS,* Chun-Ming Chen, DDS, MS,†
Yu-Hsun Kao, DDS, MS,‡ and
Philip Worthington, MD, BSc, FDSRCS§

Purpose: The aim of this report was to evaluate the outcome and complications of the treatment of
numerous patients with mucoceles of lower lip by means of CO2 laser vaporization.
Materials and Methods: This study included 82 patients with biopsy-confirmed mucocele of the
lower lip who were treated with CO2 laser vaporization from January 1999 to December 2003; the data
on recurrence and complications were collected.
Results: There was a recurrence in 2 cases. Complications were rare, except for mild discomfort. One
patient felt temporary numbness at the operative site. There was no bleeding and minimal scar formation.
Conclusion: CO2 laser vaporization to treat the mucocele of the lower lip is effective and has few
complications. Because the operative time is shorter than with the excisional method, it is especially
good for children and for less cooperative patients with this lesion.
© 2007 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 65:855-858, 2007

The mucocele, a mucus accumulation phenomenon
of the salivary gland, is a common lesion of the oral
cavity. There are 2 types: 1) mucous extravasation
cyst, generally regarded as being of traumatic origin,
such as lip biting and 2) the mucous retention cyst,
resulting from obstruction of the duct of a minor or
accessory gland.1,2 The clinical feature is a well-doc-
umented phenomenon involving the lip, cheek,
tongue, palate, and floor of mouth; 44% to 79% of
mucoceles occur on the lower lip. There is no gender
predilection, and it can arise at any age.1
*Lecturer, Instructor, Department of Oral and Maxillofacial Sur-
gery, Chon Ho-Memorial Hospital, Kaohsiung Medical University,
Kaohsiung, Taiwan; Visiting Scholar of Department of Oral and
Maxillofacial Surgery, University of Washington, Seattle, WA.
†Assistant Professor, Department of Oral and Maxillofacial Sur-
gery, Chon Ho-Memorial Hospital, Kaohsiung Medical University,
Kaohsiung, Taiwan.
‡Resident, Department of Oral and Maxillofacial Surgery, Chon
Ho-Memorial Hospital, Kaohsiung Medical University, Kaohsiung,
Taiwan.
§Professor Emeritus and Former Chairman, Department of Oral
and Maxillofacial Surgery, University of Washington, Seattle, WA.
Address correspondence and reprint requests to Dr Worthington:
Department of Oral and Maxillofacial Surgery, University of Washing-
ton, Box 357134, Seattle, WA 98195; e-mail: worthington03@
comcast.net
© 2007 American Association of Oral and Maxillofacial Surgeons
0278-2391/07/6505-0005$32.00/0
doi:10.1016/j.joms.2006.11.013
On clinical presentation, the mucocele appears as
an asymptomatic nodule with a pink or bluish color,
and the size may vary (Fig 1). The lesion often arises
within a few days after minor trauma, reaches a cer-
tain size, and may persist unchanged for months un-
less treated. If the content of the cyst is drained, it
usually consists of a thick, mucinous material. Some
lesions regress and enlarge from time to time and may
disappear after traumatic injury, which results in
drainage.1
Conventional treatment of the mucocele is excision
with the associated overlying mucosa and glandular
tissue down to the muscle layer. After excision, there
may be occasional recurrence because surgery may
damage the surrounding minor salivary glands, but
this possibility is less likely if the adjacent glandular
acini are removed. If the mucocele is merely incised,
the contents will drain, but the lesion will reform as
soon as the incision heals.
Cryosurgery is an alternative nonsurgical method; a
gas expansion cryosurgical system or cotton swab
with liquid nitrogen can produce effective results.3,4
Carbon dioxide (CO2) laser energy has a very high
water absorption coefficient, is independent of tissue
color, and is well absorbed by all soft tissue that are
high in water content, with minimal effects on adja-
cent nontarget tissue. The CO2 laser generates a lot of
heat, which readily carbonizes tissue. Because this
carbonized or charred layer is a biological dressing, it
should not be removed. These properties make the
CO2 laser ideal for surgical use on oral soft tissue.5,6

855
856
FIGURE 1. The mucocele of the right lower lip (size: 7 to 8 mm).
Huang et al. Treatment of Mucocele With Carbon Dioxide Laser.
J Oral Maxillofac Surg 2007.
The CO2 laser has been in surgical use for many
years but is not commonly used in the treatment of
mucocele.7,8
The advantage inherent in this system is that it
affords excellent treatment of this condition while at
the same time minimizes complications and recur-
rences. Previous reports on this topic were limited to
case reports or series with very few cases only.7,9 The
purpose of this study is to evaluate the recurrence
rate and complications of treatment with CO2 laser by
reviewing numerous cases limited to the lower lip
mucocele.
Materials and Methods
The clinical records of patients presenting in our
department with a mucocele of the lower lip were
reviewed. Between 1999 and 2003, 257 patients were
identified in that 5-year period. There were 222 pa-
tients who agreed to have some form of surgery,
either electrocautery, CO2 laser vaporization, or sharp
surgical excision. The assignment of patients to treat-
ment groups was random; 82 patients were treated by
the CO2 laser. This initial report deals only with those
patients treated by laser; it is hoped that this retro-
spective review will be followed with a further study
to compare the results with those cases treated by
other modalities.
In each case, an incisional biopsy was performed
immediately before the patient proceeded to laser
treatment. In all 82 patients, the histological diagnosis
coincided with the clinical diagnosis. The size of the
swelling and its duration, together with any compli-
cations of the treatment (including recurrences),
were recorded.
Of the 82 patients, 45 were male and 37 were
female. Age ranged from 1 year to 58 years (mean,
TREATMENT OF MUCOCELE WITH CARBON DIOXIDE LASER
20.8 years). In the under-12 years age group, there
were 18 patients, and the size of lesions ranged from
3 to 20 mm in diameter; 61 were less than 10 mm
diameter. The duration of the lesions ranged from 1
week to 2 years. In 66 patients, the mucocele had
been present for more than 3 months.
Surgical Technique and
Postoperative Care
Local anesthesia was achieved by mental nerve block
using 2% Xylocaine (Ashapharmaceuticals, Wayne, PA)
with epinephrine 1:100,000. All patients had incisional
biopsy before treatment with CO2 laser vaporization.
The specimen was obtained from the central portion
of the lesion with a scalpel or tissue scissors (Fig 2).
The Sharplan hand-held CO2 laser (Advanced Medical
Worldwide, Woodinville, WA) was used in all cases,
usually at a power setting of 5 to 8 watts in a contin-
uous cutting mode. Vaporization was done from the
central area of the lesion and mucous fluid was seen
extravasating from the site (Fig 3). The central ray was
applied from the center to the periphery gradually
until all fluid disappeared, and the diameter of the
wound was about 6 to 8 mm; even with the larger
lesions (⬎10 mm), that was enough to remove the
whole lesion and adjacent glands by everting the base
of the lesion and offending glands until the muscle
layer was reached (Fig 4). Once the lesion and the
adjacent glands were completely vaporized, the sur-
gical bed and walls were then treated with the defo-
cused laser beam to achieve complete hemostasis and
shrinkage of the wound (Fig 5). The wound was left
open without sutures and dressed with steroid oint-
ment (Fig 6). The patient was examined the following
day and at 1 week after surgery and was told that if
FIGURE 2. Incisional biopsy was performed before vaporization,
and the specimen was sent for pathologic examination.
Huang et al. Treatment of Mucocele With Carbon Dioxide Laser.
J Oral Maxillofac Surg 2007.
HUANG ET AL
FIGURE 3. Vaporization with CO2 laser.
Huang et al. Treatment of Mucocele With Carbon Dioxide Laser.
J Oral Maxillofac Surg 2007.
healing was not complete by 3 weeks, he or she
should return for further examination and to return if
there was any recurrence.
Results
At the 1-day and 1-week postoperative examina-
tions, there were no complaints of pain or bleeding.
One patient had a local paresthesia at the operative
site, but this resolved in 2 weeks’ time. All wounds
healed uneventfully. No patients returned with de-
layed healing at 3 weeks postoperatively. Of the 82
patients, 2 developed a recurrent mucocele; one was
a male patient at the 3-month follow-up examination.
This recurrence was revaporized and did not recur
thereafter. The other recurrence was, at the patient’s
FIGURE 4. To expose the base of the lesion, it was everted, and the
adjacent minor salivary glands were removed completely.
Huang et al. Treatment of Mucocele With Carbon Dioxide Laser.
J Oral Maxillofac Surg 2007.
857
FIGURE 5. After vaporization, the defocus regimen is used for
hemostasis.
Huang et al. Treatment of Mucocele With Carbon Dioxide Laser.
J Oral Maxillofac Surg 2007.
request, retreated using electrosurgery and did not
recur again.
Discussion
The lower lip mucocele can be treated by sharp
excision with a scalpel, by electrosurgery, by cryosur-
gery, and by CO2 laser vaporization. Regardless of the
method chosen, it is important that the procedure
extend to the muscle layer.
This initial test of the effectiveness of the laser
vaporization method shows that it has some advan-
tages. It is a precise cutting tool that causes minimal
damage to adjacent tissue, especially the muscle layer.
Coagulation of small vessels is excellent, and postop-
erative bleeding is thus decreased. Sterilization of the
FIGURE 6. Topical application of steroid ointment to cover the
opened wound without suture.
Huang et al. Treatment of Mucocele With Carbon Dioxide Laser.
J Oral Maxillofac Surg 2007.
858
operation site is virtually instantaneous, and the acute
inflammatory reaction is delayed and minimal.
Trauma to the tissue is diminished, and there is little
scar formation.
Although the CO2 laser has been used for years, the
report of its use in the treatment of mucoceles ap-
pears to have been limited to single case reports or
small numbers.7,10
In order to evaluate the effectiveness and compli-
cation rate of the CO2 laser, this initial study was
performed on 82 patients in all of whom the clinical
diagnosis was confirmed by histopathology. The op-
erating time needed is brief (3 to 5 minutes), there is
little tissue damage and reaction, and it seems partic-
ularly suitable for children and other patients who
cannot tolerate long procedures.
In the 82 patients treated, there were only 2 recur-
rent mucoceles, and these were successfully re-
treated (1 by laser, 1 at the patient’s request by elec-
trosurgery).
This study showed few complications; there was
one local and temporary paresthesia, which resolved
within 2 weeks. It would seem that there is no reason
to expect more nerve injury than with sharp exci-
sional surgery.
We had no cases of neuroma formation.11 There
were no complaints of pain at the 1-week postopera-
tive examination, and there were no instances of
continuing pain, bleeding, or infection.
The disadvantages of the CO2 laser vaporization
method are that the equipment is expensive, and
adequate protection must be provided for the patient
and operator. Such equipment will, however, be avail-
able in many institutions, and this is just a further
application of its use.
Key points in performing this procedure are:
Removal of the adjacent glandular acini around the
lesion.
TREATMENT OF MUCOCELE WITH CARBON DIOXIDE LASER
Destruction of the lesion must extend to the muscle
layer.
An area of vaporization of 6 to 8 mm is usually suffi-
cient even for larger lesions. This allows preserva-
tion of more tissue.
Although the time taken for local anesthesia to be-
come effective is common to all methods of treat-
ment, the actual operating time with the laser is
short (3 to 5 minutes).
This initial report indicates that CO2 laser vaporiza-
tion of the lower lip mucocele is an effective treat-
ment method that is well-suited to young patients and
to those intolerant of long procedures.
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