An oral mucosal cyst (also called a mucocele or mucocele) is a small capsule filled with fluid. According to dentists, such cysts are generally harmless and painless, but they can cause discomfort because they feel like a foreign object.
Mucoceles usually occur on the inner surface of the lips, but can also appear on the tongue, palate, buccal mucosa, and floor of the mouth. These cysts also form around tongue or lip piercings. A cyst on the bottom of the mouth is called a ranula, and on the gum - an epulis. Mucous cysts are bluish in color and filled with clear fluid. The dentist usually recognizes them at first sight.
Cyst removal
Sometimes, especially if the drained cyst recurs, surgical removal of the mucocele may be required. Complications from such interventions are extremely rare and include risks standard for surgical operations, such as infection and adverse reactions to local anesthesia. Be sure to consult with your dentist and surgeon to make sure you understand the risks.
If the cyst does not burst on its own, then if left untreated, a permanent lump may form in its place. Such bumps are harmless, but in general, if any tumors appear in the oral cavity, you should consult a dentist. It is important that he carefully examine the suspicious area of the oral cavity and, if necessary, conduct the necessary research, because your dental health is an integral part of the health of the whole body.
Pleomorphic adenoma (mixed tumor). This benign tumor is the most common, occurring in 72% of all epithelial tumors of the salivary glands. In terms of frequency of lesions, the parotid salivary gland is in first place, the mucosalivary glands of the palate are in second place, then, respectively, the submandibular, sublingual and minor salivary glands, glands of the lip, cheek, and tongue.Pleomorphic adenoma grows painlessly, slowly, over several years and can reach large sizes. When the adenoma is localized in the parotid salivary gland, paresis of the facial muscles is not observed. Upon examination, a tumor is detected in the area of the salivary gland, mobile, often with a bumpy surface. Its consistency is densely elastic, sometimes with areas of softening due to the mucus-like component. The skin above it does not change, it folds freely. The salivary function of the affected gland is usually not affected. Pleomorphic adenoma has a capsule, but may not be completely encapsulated, in which case the tumor cells penetrate into the adjacent glandular tissue. This explains tumor recurrences after extracapsular removal. Sometimes tumor growth accelerates significantly (within 1 month), and pain may appear. Such symptoms are characteristic of tumor malignancy; in such cases it is interpreted as carcinoma in pleomorphic adenoma.
The diagnosis of a tumor is clarified by cytological examination of the punctate, which is obtained in the needle in the form of a crumbly whitish mass.
Macroscopically, pleomorphic adenoma is a tumor in a thin translucent capsule, on a section in the form of a pasty mass of white-gray color with areas of mucus and compaction.
Microscopically, the tumor, in addition to pronounced epithelial tissue, contains mesenchyme-like areas consisting of myxoid or cartilage-like structures, the presence of which is explained by the accumulation of mucoid or hyaline substance between the myoepithelial cells.
Treatment is surgical. If the tumor is localized in the submandibular and sublingual salivary glands, the tumor is removed along with the gland. Tumors located on the palate, cheek, lips, tongue are excised within unaffected tissues. The peculiarity of the operation on the parotid salivary gland is associated with the branching of the facial nerve in the thickness of the gland. The nature and extent of surgical intervention depend on the size and location of the tumor. In all cases, it is necessary to excise the tumor with adjacent glandular tissue. Some authors suggest extracapsular tumor removal. When the tumor is localized in the lower pole of the gland, resection of this section is used. If the tumor occupies the anterior section and lies in the gland above the branches of the facial nerve, subtotal resection of the gland is performed in the plane of the branches of the facial nerve. Parotidectomy with preservation of the branches of the facial nerve is performed when most of the gland is affected and the tumor recurs, as well as when there is a tumor of the pharyngeal part of the gland. Access to the gland is carried out by two well-known methods - Kovtunovich and Redon. In the first case, the operation begins with exposure of the peripheral part of the facial nerve (middle branch), in the second - the central trunk.
The operation is parotidectomy with preservation of the branches of the facial nerve. A skin incision is made in front of the auricle 2-3 mm, starting from the scalp of the temple, bordering the earlobe and continuing in the retromaxillary and submandibular areas. the skin-fat flap is prepared and retracted anteriorly. The parotid-masseteric fascia and the anterior edge of the gland are exposed. When approaching the peripheral branches of the facial nerve, the location of the middle branch is determined: it is located next to the duct of the parotid gland along the line connecting the tragus with the angle of the mouth. The middle branch is dissected to the point of division of the trunk, then the upper and lower branches are isolated from the gland, holding them with threads to reduce trauma. The surface layer of the gland is removed, bandaged and the salivary duct is crossed. By lifting the branches of the nerve, the deep and pharyngeal parts of the gland are dissected and removed along with the tumor, and the external carotid artery is ligated along the way.
In an operation using the Redon method, after removing the skin-fat flap, the posterior edge of the gland is released and the external carotid artery is ligated. Then the trunk of the facial nerve is found deep in the wound between the mastoid process and the posterior edge of the mandibular ramus. The location of the nerve branch is determined and all three main branches are prepared. The further course of the operation is identical to that described.
An operation that involves removing only the superficial layer of the gland along with the tumor located above the branches of the facial nerve is called subtotal resection of the glands in the plane of the nerve branches.
In case of resection of the lower pole of the parotid salivary gland, a skin incision is made bordering the angle and body of the jaw, moving downwards by 1.5-2 cm, so as not to damage the marginal branch of the facial nerve. This must also be remembered during excision of the gland due to its location in this area. Subcutaneous tissue is dissected, m. platysma and fascia. The lower part of the gland, where the tumor is located, is exposed and removed. The wound is sutured in layers.
A mucous retention cyst most often forms in the minor mucosalivary gland of the lower lip, less commonly in the cheek, the anterior floor of the mouth, the lower surface of the apex of the tongue and palate. The predominant localization on the lower lip is associated with biting it.
The cyst is located under the mucous membrane, has the appearance of a hemispherical elevation with clear boundaries, ranging in size from 0.5 to 2 cm, with a bluish tint. Sometimes the mucous membrane over it is whitish in color, which is due to the presence of scar changes due to injury. Palpation of the cyst is of elastic consistency with ripple, painless. Biting the mucous membrane over the cyst can lead to its emptying, releasing a clear, viscous fluid. When the contents become infected, inflammation occurs.
Pathohistologically, the cyst wall is a connective tissue with granulations, turning into fibrous tissue, sometimes the inner side of the wall is partially lined with stratified squamous epithelium.
A mucous retention cyst must be differentiated from tumors of the minor salivary glands, which are less common, have an elastic consistency, sometimes with a bumpy surface, without fluctuation. In some cases, it is necessary to differentiate it from cavernous hemangioma, which is characterized by a purplish-bluish coloration and a symptom of filling.
Treatment consists of removing the cyst. Two converging semi-oval incisions are made in the mucous membrane above the cyst. Using a hemostatic mosquito clamp, the membrane is separated semi-bluntly from the surrounding tissues, the connective tissue bridges are cut with scissors and the cyst is isolated. Injured small glands protruding from under the edges of the wound and interfering with suturing are removed with tweezers or a “mosquito”, each separately and entirely. Using a scalpel for these purposes can lead to their dissection, incomplete removal and recurrence of the cyst. The operation is completed by applying catgut sutures to the mucous membrane.
Cyst of the sublingual salivary gland (ranula). This cyst is located, as a rule, in the anterolateral part of the floor of the mouth near the frenulum of the tongue. Clinically defined as an oval bulge, covered with unchanged mucous membrane or translucent with a bluish tint. The cyst is always intimately associated with one of the areas or the entire sublingual salivary gland. Its former name ranula (“frog tumor”) is determined by the type of cyst and its resemblance to the laryngeal bladder of a frog. It grows slowly, over months, and does not cause pain. When it reaches a significant size, speech is impaired and eating becomes difficult. Sometimes the cyst can extend beyond the midline of the floor of the mouth, displacing the tongue posteriorly or into the submandibular region. In the latter case, it is difficult to differentiate from a cyst of the submandibular salivary gland. On palpation, the cyst often appears as a formation with fluctuation, sometimes it is more elastic. When the membrane breaks through, a viscous transparent fluid is released abundantly from the cyst, and it is not contoured. After time, the cyst fills with fluid again and becomes visible.
Microscopically, the cystic fluid contains protein substances (clumps) and sometimes so-called cystic cells, apparently of epithelial origin.
Macroscopically, the cyst shell is thin, bluish-white. In terms of its microstructure, it is fibrous and granulation tissue associated with the interlobar connective tissue layers of the gland. The inner lining of the membrane rarely has cubic or columnar epithelium.
Diagnosis of a sublingual salivary gland cyst is usually not difficult. It should be differentiated from a cyst of the submandibular salivary gland, a dermoid cyst and vascular tumors (lymphangiomas and hemangiomas) localized at the bottom of the oral cavity.
Treatment: given the close connection of the cyst with the parenchyma of the gland, they are completely removed. The previously recommended cystotomy has limited use due to the frequent development of relapses. A cyst of the sublingual salivary gland, which spreads in the lower part of the floor of the oral cavity in the form of an hourglass, is operated on in two approaches: through an incision in the submandibular triangle, the lower part is bandaged and removed; from the side of the oral cavity, the sublingual gland with the remaining part of the cyst is excised.
A cyst of the submandibular salivary gland is much less common than a ranula. It is located in the submandibular triangle and is a painless formation of soft consistency. It grows slowly and is detected by chance when a swelling is detected in the submandibular region. A large cyst pierces the mylohyoid muscle (m. mylohyoideus) or bends around it from behind and spreads to the upper part of the floor of the mouth. In these cases, its bulging into the sublingual area is also determined. The salivary function of the gland is not affected.
Diagnosis of a cyst of the submandibular salivary gland is sometimes difficult. To clarify the diagnosis, a puncture is used: obtaining a yellowish mucous fluid suggests the presence of a cyst.
A cyst of the submandibular salivary gland is differentiated from lymphangioma, lipoma, lateral neck cyst, dermoid cyst.
To determine the topography of the cyst, a double contrast method is used: cystography and sialography. Different X-ray projections allow you to determine the relationship between the cyst and the gland
Treatment. The cyst of the submandibular salivary gland is removed along with the gland.
Parotid salivary gland cyst. This is a rare disease, localized in the superficial and deep layers of the gland, mainly in the lower pole. The cyst grows slowly. It is often discovered by accident.
The cyst is a limited, painless swelling in the parotid region of soft elastic consistency. The skin over the cyst is of normal color and gathers loosely into a fold. Unchanged saliva is released from the gland duct. The contents of the cyst are yellowish liquid, sometimes cloudy, mixed with mucus. Histologically, the walls of parotid salivary gland cysts do not differ from the walls of cysts of other salivary glands.
A parotid salivary gland cyst is differentiated from organ-specific tumors, lipomas, vascular tumors of the gland, as well as from a branchial cyst caused by pathology of the first branchial cleft.
Treatment consists of removing the cyst. Due to the close connection of the cyst shell with the parenchyma of the parotid gland, the adjacent section of the latter is excised. The complexity of the operation is related to the location of the branches of the facial nerve. Surgical access to the gland is the same as when removing benign tumors of the parotid salivary gland.
"Surgical Dentistry" edited by Robustova T.G.
Fourth edition. Moscow "Medicine" 2010
Clinical cases:
Pleomorphic adenoma of the left parotid salivary gland.
How does the disease progress?
A cyst on the tonsils does not bother the patient for a long time. But as it grows, it begins to compress the surrounding soft tissues and can cause breathing problems, even asphyxia. Therefore, it is so important to contact specialists in a timely manner and carry out scheduled preventive examinations, especially in the presence of chronic ENT diseases.
Patients with cysts in the tonsil area present the following complaints:
- decreased quality of nasal breathing;
- feeling of a lump in the throat;
- pain and discomfort when swallowing food;
- sore throat;
- hoarseness of voice;
- frequent exacerbations of chronic diseases of the ENT organs and respiratory tract.
If you often suffer from respiratory viral diseases, tonsillitis, laryngitis, you need to consult a specialist who will conduct an examination using innovative equipment that allows you to examine the tissues of the hypopharynx with maximum efficiency. Based on the diagnostic data, the doctor makes a diagnosis and prescribes treatment.
If the tumor is often injured by rough food, it may begin to bleed. As a result, the patient will detect traces of blood in the saliva. This is an alarming sign that requires immediate consultation with a specialist. Cysts on the tonsils also occur in childhood. The child begins to complain of discomfort when swallowing saliva, sore throat on one side, and a change in voice. Often children begin to chew food poorly, clear their throats and are afraid of short-term breath holding.
If the tonsil cyst is small and not prone to active growth, a wait-and-see approach can be used. But when the tumor rapidly increases in size, it is necessary to undergo surgery as soon as possible.
