Kaohsiung Journal of Medical Sciences (2011) 27, 276e279

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ORIGINAL ARTICLE

Mucoceles of the oral cavity in pediatric patients

Chung Wei Wu a, Yu-Hsun Kao a, Chao-Ming Chen a, Han Jen Hsu a,
Chun-Ming Chen a,b, I-Yueh Huang a,b,*

a
Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital,
Kaohsiung Medical University, Kaohsiung, Taiwan
b
Department of Oral and Maxillofacial Surgery, School of Dentistry, College of Dental Medicine,
Kaohsiung Medical University, Kaohsiung, Taiwan

Received 29 June 2010; accepted 21 September 2010

Available online 17 April 2011

KEYWORDS Abstract Mucoceles are quite common in the oral cavity, but reports on pediatric patients
Children; are very rare. The aims of this study were to present our data and experience in the treatment
Mucoceles; of mucoceles of the oral cavity in pediatric patients, to compare them with those of other
Oral cavity; countries, and to remind the pediatric physician to devote much attention to lesions of the oral
Pediatric cavity in children. This retrospective study is based on the record of the patients who received
surgical treatment for mucoceles of the oral cavity with pathologic confirmation at the Depart-
ment of Dentistry, Kaohsiung Medical University Hospital, Taiwan, between 2000 and 2004.
Patients younger than 18 years were included in this study. The analyzed data included age,
gender, site, size, histopathologic findings, surgical methods, and complications. There were
a total of 289 patients with mucoceles confirmed by histopathologic examination. As many
as 64 patients were younger than 18 years. Of the 64, 34 were girls and 30 were boys; 89.1%
of the lesions were in the lower lip; and 48.4% of the lesions were less than 5 mm in diameter.
Histopathologic findings showed that all mucoceles were of the extravasation type. As many as
30 patients were treated by carbon dioxide laser vaporization, and two cases recurred (6.67%);
34 patients were treated by surgical excision, and the recurrence rate (5.88%) was not statis-
tically different for the treatment methods. The laser vaporization has the advantage of less
bleeding, no sutures, and saving time, especially suitable for children with oral mucocele.
Copyright ª 2011, Elsevier Taiwan LLC. All rights reserved.

* Corresponding author. Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical
University, No. 100, Tz-you 1st Road, Kaohsiung 807, Taiwan.
E-mail address: iyuhu@cc.kmu.edu.tw (IY Huang).

1607-551X/$36 Copyright ª 2011, Elsevier Taiwan LLC. All rights reserved.

doi:10.1016/j.kjms.2010.09.006

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Mucoceles in children
Introduction
Mucocele is a common lesion of the oral cavity and may be
classified as the mucous extravasation cyst and the mucous
retention cyst [1]. Clinical features are well documented
(Fig. 1). On clinical presentation, mucocele appears as an
asymptomatic nodule, in pink or bluish color, and the size
may vary, usually involving the lip, cheek, tongue, palate,
and floor of mouth; there is no sex predilection, and it can
occur at any age, but some studies have reported the
second decade with the highest incidence [2e4]. Conven-
tional treatment of mucocele is excision by electrosurgery
or scalpel, which included the associated overlying mucosa
and glandular tissue down to the muscle layer. Vaporization
by carbon dioxide (CO2) laser [5] and cryosurgery [6] were
also done. Mucoceles are not uncommon in children. There
are many articles regarding mucoceles of the oral cavity in
the dental literature, but reviews of mucoceles of the oral
cavity in pediatric patients are rare. Some articles discus-
sing mucoceles in children were published in pediatric or
dermatology journals, to remind the physician that oral
health is an integral part of a child’s overall health [3,4],
but few of them discussed the treatment for mucoceles.
This is the first article on oral mucoceles in pediatric
patients in Taiwan. We consider dental experience to be
unique and valuable to medicine, and hope our presenta-
tion contributes to it.
Patients and methods
This retrospective study selected patients from the clinical
database according to the ICD9-527.6 mucocele, including
ranula of the oral cavity; 411 patients were identified from
the Department of Dentistry, Kaohsiung Medical University
Hospital, Taiwan, from January 2000 to December 2004. In
total, there were 289 patients with histopathologic reports
of mucocele of the oral cavity. Patients younger than 18
years were selected for this study, excluding those with
improper record of personal data, tumor size, and position.
Figure 1. The mucocele appears as an asymptomatic
nodule, with pink or bluish color, and the size may vary, usually
involving the lip.
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277
A specimen was obtained from the central portion of the
lesion using a scalpel or tissue scissors under local anes-
thesia by mental nerve block using 2% xylocaine with
epinephrine 1:100,000, before treatment with CO2 laser
vaporization. The patient was examined the following day,
1 week and 1 month after surgery, and was told to return
for further examination if healing was not complete or if
there was any recurrence. Patients were divided into three
groups: 0e6 years, 7e12 years, and 13e18 years of age. We
noted gender and site (including upper lip, lower lip, buccal
mucosa, tongue, mouth floor, vestibulae, and others). Size
was classified into three groups: smaller than 5 mm,
between 6 mm and 10 mm, and larger than 10 mm; surgical
methods used were excision by electrosurgery or scalpel
and CO2 laser vaporization; and complications included
recurrence, pain, and others. The data were analyzed by
Chi-square test.
Results
There were 411 patients who were reviewed for clinical
impression of mucocele in the oral cavity during the 5-year
period, of which 289 patients came with histopathologic
reports; 70 (24.9%) patients younger than 18 years were
selected for chart reviewing after excluding those with
improper record of personal data, tumor size, and location.
Finally, 64 cases younger than 18 years were included in this
study. Of the 64 patients, 30 were boys and 34 were girls
[male (M):female (F) Z 1:1.13]. In the age group of 0e6
years, there were 9 cases (14.1%); in the age group of 7e12
years, there were 22 cases (34.4%); and in 13e18 years
group, there were 33 cases (51.5%). The mean age was
12.3  4.8 years (M: 13.4  4.1; F: 11.4  5.3); 48.4% of the
lesions were less than 5 mm in size (31 of 64). There were
28 cases with lesions of sizes between 6 mm and 10 mm
(43.8%), and in five cases, they were greater than 10 mm
(7.8%). There were 57 lesions (89.1%) located in the lower
lip, the most common location of the lesion; two cases
occurred in the buccal mucosa, two cases in the mouth
floor, and three cases on the tongue. Pathologic examina-
tion showed all mucoceles to be of extravasation type. Of
the cases, 30 were treated using CO2 laser and 34 by exci-
sion. There were totally four recurrent cases (6.25%),
including two from the CO2 laser group (6.67%) and two
from the excision group (5.88%) (Table 1) Wound dehis-
cence was noted in one case of the excision group and
prolonged duration of wound healing was noted in two
patients of the CO2 laser group. According to Chi-square
test analyses, recurrence rate is not statistically different
for the treatment methods.
Discussion
Mucoceles are common oral lesions in children; about
11.6e21.8% of all pediatric oral biopsies showed mucoceles
[7e10]. In 1998, Dr Chen et al. [11] of our department
reported that 28.6% of all biopsies from pediatric patients
showed mucoceles, which is higher than that reported by
most studies. Many articles discuss mucoceles in dental
journals, but few of them focus on children. The first study
on mucoceles in pediatric patients was published in
278 C.W. Wu et al.

Table 1 Comparison of two treatment groups

Variables CO2 laser (n Z 30) Excision (n Z 34) p
n (%) n (%)
Gender
Male 12 (40) 18 (52.94) 0.3005
Female 18 (60) 16 (47.06)
Age (yr)
0e6 6 (20) 3 (8.82) 0.2973
7e12 8 (26.67) 14 (41.18)
13e18 16 (53.33) 17 (50)
Size (cm)
<0.5 14 (46.67) 17 (50) 0.8864
0.6e1.0 14 (46.67) 14 (41.18)
>1.0 2 (6.67) 3 (8.82)
Complication 1 (3.33) 2 (5.88) 0.6302 Figure 2. To expose the base of the lesion, it was everted,
Recurrence 2 (6.67) 2 (5.88) 0.8971 and the adjacent minor salivary glands were removed
completely. Suture is not necessary; the wound is left open and
dressed with steroid ointment.
Pediatric Dermatology in 2008. In all, 36 cases were
was set at 5 W in a continuous cutting mode. The central ray
analyzed [3]. We present our data and experience to work
was applied from the center to the periphery gradually until
in concert with the article from Brazil [3], and this article
all fluid disappeared, and the diameter of the wound was
might be the first one from an Asian country in English
about 6e8 mm even with the larger lesions (greater than
literature. In our study, 24.9% of the patients were pedi-
10 mm), which was enough to remove the whole lesion and
atric patients (70 of 289), unlike studies from other coun-
the adjacent glands by everting the base of the lesion and
tries; 50e70% of the mucocele patients were younger than
the offending glands until the muscle layer was reached.
20 years [2,4], and 34.6% were younger than 15 years, as
Once the lesion and the adjacent glands were completely
reported by Dr. Nico et al. [3]. The mean age was 11.8  5.0
vaporized, the surgical bed and walls were treated with the
years (M: 13.0  4.5 years; F: 10.9  5.2 years), similar to
defocused laser beam to achieve complete hemostasis and
10.57 years as reported by Dr Jones and Franklin [9]. Age at
shrinkage of the wound. The wound was left open without
presentation is greater in boys, but the bias might be
sutures and dressed with a steroid ointment (Fig. 2). Careful
because of the differing definition of “pediatric” patients;
dissection of the affected minor salivary gland is not
some articles selected patients younger than 20 years;
necessary with this technique as the surrounding minor
some were limited to 15 years of age; and we selected
salivary glands are easily removed with the laser beam. We
patients younger than 18 years as study samples. In the
treated 30 patients with CO2 laser, and 34 were treated by
total number, the male to female ratio was 1.3:1 (141 were
excision. Four cases recurred; each treatment group had two
males and 105 were females); but in pediatric groups, our
cases. The results show no statistical difference between the
study showed the boys to girls ratio to be 1:1.13; girls were
two treatment groups, but 66.7% (6 of 9) of the patients
more predominant than boys as reported in most articles,
younger than 6 years received CO2 laser vaporization and had
1:1.1 in United Kingdom [12] and 1:2.6 in Brazil [3].
no recurrence except for some mild complications, such as
The most common site of mucoceles was the lower lip;
delayed wound healing and pain. Vaporization with CO2 laser
our study showed 89.1% in children and 76.02% in adults. In
means that it is not necessary to suture the wound; there is
Japan, 77.9% of mucoceles occurred in the lower lip [13],
less bleeding, and this saves time and seems especially
and in Brazil, 83.3% occurred in the lower lip [3]. Only 3.1%
suitable for children.
of our cases were mucoceles of the glands of Blan-
The experience of the Department of Dentistry in
dineNuhn, which is lower than that in other articles that
Taiwan might contribute different features of mucoceles of
reported 8.3e9.9% [3,13], and our previous report showed
the oral cavity in pediatric patients. Excision by CO2 laser
only 11.1% (2 of 18) of mucoceles of the glands of Blan-
for mucocele is especially suitable for children.
dineNuhn found in patients younger than 20 years, which
did not support the view that they were more prevalent in
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