What is the role of surgery in the treatment of mucocele and ranula?

Updated: Apr 17, 2018
  • Author: Catherine M Flaitz, DDS, MS; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Answer

Surgical excision of the mucocele along with the adjacent associated minor salivary glands is recommended. The risk for recurrence is minimal when appropriate surgical excision has been performed. Aspiration only of the mucocele's contents often results in recurrence and is not appropriate therapy, except to exclude other entities prior to surgical excision. Large lesions may be marsupialized to prevent significant loss of tissue or to decrease the risk for significantly traumatizing the labial branch of the mental nerve. If the fibrous wall is thick, moderate-sized lesions may be treated by dissection. If this surgical approach is used, the adjacent minor salivary glands must be removed.

The use of a micromarsupialization technique for mucoceles in pediatric patients has been reported in a case series. [39] This technique involves the placement of a 4.0 silk suture through the widest diameter of the lesion (dome of the lesion) without engaging the underlying tissue. A surgical knot is made, and the suture is left in place for 7 days. Patients need to be educated about suture replacement; they must return to have the suture replaced if it should be lost during the 7-day period. The idea behind this alternative treatment for mucoceles of minor salivary glands is that re-epithelization of the severed duct occurs or a new epithelial-lined duct forms, allowing egress of saliva from the minor salivary gland. This technique is not indicated for lesions larger than 1 cm in diameter.

Laser ablation, cryosurgery, and electrocautery are approaches that have also been used for the treatment of the conventional mucocele with variable success. [40, 41, 42]


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