What is the role of biopsy in the diagnosis of mucocele and ranula?

Updated: Oct 19, 2020
  • Author: Catherine M Flaitz, DDS, MS; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Mucoceles usually require excisional biopsy and removal of the servicing minor salivary glands. If a vascular lesion cannot be excluded from the differential diagnosis, then aspiration of the lesion is prudent for evaluation of the fluid contents. Large mucoceles may be best treated by marsupialization because of the risk of traumatizing the labial branch of the mental nerve. Dissection of the lesion along with the adjacent salivary glands is indicated for moderate-sized lesions. The micromarsupialization technique and laser removal are additional treatment approaches. [27, 28, 29, 30] Liquid nitrogen cryotherapy has been used to manage mucoceles as an alternative to surgery. [31, 32, 33] Superficial mucoceles may require biopsy, in addition to direct immunofluorescence studies for immunoglobulins and complement, if a mucocutaneous disease is suspected in the differential diagnosis. Laser vaporization may be useful when multiple lesions are present and a diagnosis has been established. [34]

Fine-needle aspiration of the contents of oral and cervical ranulas may be helpful in the diagnosis prior to excision and subsequent surgery. The fluid consists of mucus with muciphages (macrophages with engulfed mucin), as demonstrated by mucicarmine staining, and other inflammatory cells. Analysis of the aspirated fluid shows increased amylase and protein content. The recurrence of other fluid types or a solid mass with the failure to aspirate fluid indicates that a mass other than a ranula may have been encountered.

Oral and cervical ranulas require complete excision of the oral portion of the ranula, in addition to the responsible gland. Usually, the sublingual gland is the origin of the ranula; however, occasionally, the submandibular gland may be affected also and only rarely is the source. Decompression of the oral ranula or the oral portion of a cervical ranula may be indicated. Some authors advocate marsupialization with packing of the pseudocyst with gauze. This technique allows removal of a smaller amount of tissue with better-defined interfaces and less likelihood of injury to the nerve and the Wharton duct. Surgical management of plunging ranula usually involves surgical removal of the sublingual gland with cervical incision and drainage. [25]

Mucus retention cysts require excisional biopsy. If the retention cyst is overlying the Wharton or Stensen duct, the cyst is unroofed, a lacrimal probe is inserted into the duct, and sialodochoplasty is performed.

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