Efficacy of polidocanol

sclerotherapy in mucocele of
the minor salivary gland

GUIDED BY: PRESENTED BY:

DR GAGAN KHARE DR NASIM
(PROFRESSOR ) PG I YEAR
ORAL & MAXILLOFACIAL SURGERY ORAL & MAXILLOFACIAL SURGERY
INTRODUCTION

• Mucocele is the most common nonneoplastic retention cyst in the minor

salivary glands, usually occurring at the inner surface of the lower lip or at
the inferior surface of the lingual apex.
• Mucocele has a bluish to translucent color, is soft and dome-shaped, varies
from 0.3 cm to 2.2 cm and is located at the submucosa.
• Mucocele of the minor salivary gland often occurs in children and
adolescents .
• It is caused by multiple factors, such as biting the tongue or lip, which
injures the minor salivary gland duct and leads to mucus leakage into the
tissue space.
• It may also be caused by injury or inflammation that causes duct
obstruction, which leads to mucus retention; mucus accumulation will
swell the gland or acinus, and translucent blisters will be formed.
Various treatments for mucocele
• Surgical excision
• Iodine tincture
• Pingyangmycin
• OK-432 therapy
• Anhydrous alcohol injection
• Laser therapy
• Cryotherapy
• Microwave therapy
• Micro-marsupialization
 Surgical excision Iodine tincture Pingyangmycin

• Intraoperative • Promotes • Multiple adverse

bleeding fibrosis of flat reactions such as
• Swelling after epithelial cells • fever
surgery but has a poor • pulmonary fibrosis
• Scarring curative effect.
• anaphylactic shock
• Damage to • Leakage and
• necrosis
adjacent ducts overdose may
cause tissue
• Recurrence
necrosis.
 OK-432 therapy,
Absolute ethanol Cryotherapy ,
Laser treatment
injection (AEI) Microwave therapy

• Painful •Repeated treatments • Repeated

• Poor compliance •High cost treatments
especially in young • Targeting accuracy is
patients. low.
• Peripheral tissue
liquefaction
• necrosis

 Because the available therapies have various disadvantages that

limit their clinical application, a novel alternative treatment should
be developed
POLIDOCANOL
• Polidocanol is a sclerosant that can induce endothelial lysis and cause
vessel destruction that sequentially triggers intravascular thrombosis.
• Polidocanol sclerotherapy has been widely used in treating venous
malformations, digital mucous cysts, placenta accrete and lymphatic
malformations.
• However, no publication has reported its application in mucocele of
the minor salivary gland.
• In this study, they conducted a clinical trial to explore and evaluate
the efficacy and safety of intralesional polidocanol sclerotherapy in
the treatment of mucous gland cysts.
METHODS
• Participants were enrolled from June 2016 to June 2017 at Liaocheng
People’s Hospital.
• Inclusion criteria were patients diagnosed with
- mucocele of the minor salivary gland.
• Exclusion criteria were patients who
(1) showed allergy to polidocanol or constituents
(2) had severe systemic diseases,
(3) had loss of mobility
(4) had severe arterial occlusion
(5) had thromboembolic disease
(6) had a high risk of thrombosis
(7) had recurrence-caused mucocele fibrosis
(8) had mucocele at the rupture stage.
• Patients’ basic information such as gender, age, mucocele sites and
sizes was collected and recorded for statistical analysis.
• In total, 112 patients were enrolled in study and were treated with
intralesional sclerotherapy with polidocanol.
• All polidocanol sclerotherapy procedures were performed in a sterile
treatment room without anesthesia.
• After one treatment, the participants were followed for over 6
months.
Intralesional polidocanol sclerotherapy

• The treatment area was disinfected with 0.5% chlorhexidine solution.

• The needle of a sterile empty 21 G syringe was pierced near the mucocele
until it reached the cyst cavity, and cystic fluid was extracted.
• After the mucocele shrunk, the periphery of the lesion was compressed to
prevent blood backflow.
• The needle was held in position, and the syringe was switched to one with
3% polidocanol according to previous research.
• Polidocanol was slowly injected into the cavity until the cystic wall turned
white.
• The needle was then withdrawn and the injection area was compressed
with a cotton ball for 3 min in case of polidocanol exudation.
Efficacy evaluation criteria
• The therapeutic efficacy evaluation criteria were as follows:
• Cured: the mucocele vanished without showing obvious mucosa
abnormality, and no scarring or recurrence was observed during follow-up.
• Remarkably improved: the mucocele disappeared or significantly shrunk,
mucosa color turned normal or lighter, and no recurrence or scar formation
was observed during follow-up.
• Generally improved: the mucocele shrank or turned into an indurated,
immobile painless nodule with white mucosa, and no recurrence was
observed during follow-up.
• Invalid: No obvious changes with the mucocele, or repeated mucocele
swelling and relapse.
• Mucocele of the inferior surface of the apex of the tongue: Image A was
taken before polidocanol sclerotherapy;
• Images B, C, and D were taken at 1 month, 3 months, and 6 months post-
treatment with one injection of polidocanol, respectively
• Mucocele of the lower lip: Image A was taken before
polidocanol sclerotherapy;
• Images B, C, and D were taken at 1 month, 3 months, and
RESULTS

• In total, 64 males and 48 females were involved in this research.

• Patients’ ages ranged from 3 to 65 years old with a median age of 17.5
years old.
• Data showed that the incidences of mucocele in children (age<15 y) and
adolescents (age 15 y-20 y) were higher than other age groups (age >20 y).
• A Chi-square test was applied, and no significant differences regarding the
therapeutic effects were observed between different genders (P=0.490).
• Mucocele occurred mostly on the lower lip, followed by the inferior
surface of the lingual, and occasionally at the buccal and palatum.
• They observed that polidocanol sclerotherapy for mucocele on the lower
lip was more effective compared to the inferior surface of the lingual apex.
• The sizes of the mucocele ranged from 0.3 to 2.2 cm (median size 1.2 cm),
and those located at the palatum were usually smaller (0.3 cm-0.5 cm).
• No statistically significant difference in the therapeutic effect was found
among sizes.
• After one treatment, 102 patients were cured, 8 were remarkably
improved, and 2 were generally improved, resulting in a 91.07% overall
cure rate of intralesional sclerotherapy with polidocanol in treating
mucocele of the minor salivary gland.
• All patients were satisfied with the curative effect, and no patient required
further treatment.
DISCUSSION

• Mucocele of the minor salivary gland is a common lesion that results from the
accumulation of mucous secretion resulting from mechanical injury, gland duct
obstruction or other alterations.
• Mucocele of the minor salivary gland usually occurs in young people. It was
reported that the peak age is between 10-20 years old.
• Since children usually have poor compliance with surgery and have a narrow
operation field, painless treatment strategies with a high compliance and cure
rate are more preferred for young patients with mucocele.
• In this study, they conducted polidocanol sclerotherapy for mucocele of the
minor salivary gland.
• They found that the treatment was more effective for mucoceles located at the
lower lip than those at the inferior surface of the lingual apex.
• The anterior lingual salivary glands are a mix of mucous and serous glands that
are embedded within the musculature of the anterior tongue ventrum;
therefore, it was difficult to accurately target these mucocele.
• This may explain the relatively unsatisfactory treatment effects for mucoceles in
this area.
• Polidocanol was originally developed as a detergent.
• It is an anionic surfactant that is cytotoxic for endothelial cells and can lyse
erythrocytes, leukocytes and platelets.
• It can activate intracellular signaling pathways that regulate intracellular
calcium release and nitric oxide production, further inducing cellular injury
or death.
• Polidocanol-induced cell death may also result from activation of
apoptosis pathways or direct chemical toxicity on the cell membrane .
• In addition, the ionic characteristic of polidocanol may interfere with
plasma proteins and membrane protein synthesis.
• Polidocanol also has an anti-angiogenesis effect; therefore, it was used for
treating vascular malformations .
• The satisfied therapeutic effect of polidocanol on mucocele of the minor
salivary gland in research may be associated with its cytotoxicity and anti-
angiogenesis characteristics.
LIMITATIONS
• They showed a significant difference in therapeutic effects among
different mucocele locations.
• However, they were not able to exclude the influence of small size
and the uneven distribution of samples.
• In order to further verify the clinical value of polidocanol
sclerotherapy for mucocele of the minor salivary gland, they will
conduct a randomized controlled trial in the future.
CONCLUSION

• There are various treatments for mucocele of the minor salivary gland.
• Compared to other treatments, polidocanol sclerotherapy showed
advantages such as no need for anesthesia, simpler operation, less
invasiveness, fewer adverse reactions and a higher cure rate.
• It also does not affect the appearance of patients or the function of the
lesion region.
• More importantly, polidocanol sclerotherapy is more compliant for most
patients, especially for children, who compose a large proportion of
mucocele patients.
• Therefore, it is a promising treatment option for mucocele of the minor
salivary gland in clinical applications.
CROSS REFERENCES
 Treatment of 63 Subjects With Digital Mucous Cysts With
Percutaneous Sclerotherapy Using Polidocanol
Gavin A. Esson and Stephen A. Holme, MD

• Dermatol Surg 2016;42:59–62·DOI: 10.1097/DSS.0000000000000601

• BACKGROUND:
• Digital mucous cysts (digital myxoid cysts or DMCs) are
benign cystic swellings typically affecting the digital distal
interphalangeal joint or the proximal nail fold. Many
treatment modalities exist; however, permanent scarring,
wound infection, and recurrence are common. Polidocanol
sclerotherapy has been reported as a potential treatment.
• OBJECTIVE:
• To assess the efficacy and safety of percutaneous
polidocanol sclerotherapy in the treatment of DMC.
• MATERIALS AND METHODS:
• The authors performed polidocanol sclerotherapy in 63
patients (23 men and 40 women). For each patient, the
• RESULTS:
• Of the 63 subjects treated, 43 (68.3%) experienced complete
resolution of the cyst by 6 weeks, and 49 (77.8%) experienced
complete resolution by 12 weeks. Side effects were minor and had
resolved in all patients by 12-week review.
• CONCLUSION:
• Percutaneous polidocanol sclerotherapy is a simple, safe, and
effective approach to treating DMC, and is suitable for office-based
practice
Treatment of Low-flow Vascular Malformations by
Ultrasound-guided Sclerotherapy with Polidocanol
Foam: 24 Cases and Literature Review
• S. Blaise, M. Charavin-Cocuzza, H. Riom, M. Brix, C. Seinturier,
J.M. Diamand , G. Gachet, P.H. Carpentier
2010 European Society for Vascular Surgery. Published by Elsevier
doi:10.1016/j.ejvs.2010.10.009
• Objectives:
• Treatment by sclerotherapy has been suggested as a first-
line treatment
• of low-flow vascular malformations.
• This study reports our experience in treating low flow
vascular malformations by ultrasound-guided sclerosis
with polidocanol foam at the Vascular Medicine
Department in Grenoble, France.
• Design:
• Retrospective single-centre consecutive series.
• Materials and methods:
• Between January 2006 and December 2009, we analysed
the complete records of patients with symptomatic low-
flow vascular malformations of venous, lymphatic or
complex type treated by ultrasound-guided sclerosis.
• Results:
• A total of 24 patients between 7 and 78 years were treated (19 venous
malformations, three KTSs and two venous-lymphatic malformations).
• The concentrations of polidocanol used ranged from 0.25% to 3%. The
average number of sessions was 2.3.
• After a median follow-up at 5 months after the last session, 23 out of 24
patients reported a decrease in pain; in nine cases (37.5%), over 50%
reduction in size was observed, and in 14 cases (58.3%), a reduction of less
than 50% of the original size was obtained.
• Two minor side effects were reported.
REFERENCES
• Jian-Lin Liu et al. The efficacy of polidocanol sclerotherapy in mucocele of the
minor salivary gland. doi: 10.1111/jop.12764
• S. Blaise et al. Treatment of Low-flow Vascular Malformations by
Ultrasound-guided Sclerotherapy with Polidocanol
Foam: 24 Cases and Literature Review. 2010 European Society for Vascular
Surgery. doi:10.1016/j.ejvs.2010.10.009
• Gavin A. Esson and Stephen A. Holme, MD. Treatment of 63 Subjects With Digital
Mucous Cysts With Percutaneous Sclerotherapy Using Polidocanol. Dermatol Surg
2016;42:59–62·DOI: 10.1097/DSS.0000000000000601
• Parsi K. Interaction of detergent sclerosants with cell membranes. Phlebology.
2015;30(5):306-315.
• Hamel-Desnos C, Ouvry P, Benigni JP, et al. Comparison of 1% and 3% polidocanol
foam in ultrasound guided sclerotherapy of the great saphenous vein: a
randomised, double-blind trial with 2 year-follow-up. "The 3/1 Study". European
journal of vascular and endovascular surgery : the official journal of the European
Society for Vascular Surgery. 2007;34(6):723-729