Mucocele in a newborn

Mucocele is a benign lesion characterized by an extravasation or retention of mucous in submucosal tissue from minor salivary glands. Mucoceles are known to occur most commonly on the lower lip, followed by the floor of mouth and buccal mucosa being the next most frequent sites. Trauma and lip biting habits are the main cause for these types of lesions. Mucocele is a common oral mucosal lesion but it is rarely observed in the infant. This case highlights the successful management of a rare case of mucocele in an 11-month-old child. Diagnosis and management of mucocele are challenging. 

Oral mucocele represents one of the most common benign lesion of the oral mucosa that means a cavity filled with mucus (muco means mucus and coele means cavity), which is the secretory product of salivary glands. The mechanisms for the development of these lesions are two, mucus extravasation, generally regarded as being of traumatic origin, and mucus retention, resulting from obstruction of the duct of a minor or accessory gland. When located on the floor of the mouth these lesions are called ranulas because the inflammation resembles the cheeks of a frog [1]. The most common site of occurrence of mucocele is the lower lip, the lesion has no sex predilection, and all age groups are susceptible, with the peak frequency reported to be in the second and third decades and rarely observed in infants making the diagnosis and management of mucocele challenging [2]. Mucocele has clinical resemblance with many other swellings and ulcerative lesions of oral cavity and hence needs to be differentiated carefully. Here we report an interesting unusual case of mucocele of the lower lip in an infant, along with emphasis given on its etiopathogenesis, clinical presentation, and various treatment modalities.

Figure 1: Mucocele in the lower lip of baby at 11 months.

Figure 2: Excision of the lesion using electrocautery.

An 11-month-old male patient was referred to our department with the chief complaint of a “little ball” in the lower lip and that he had difficulty in sucking for more than 3 months. The baby was in good general health and no other symptoms were reported. Oral habits or a local trauma was not reported. The clinical examination revealed the presence of a soft tissue nodule on the lower lip mucosa (Figure 1) which was similar in color to the oral mucosa measuring approximately 5 cm at its widest diameter with a sessile base, flaccid consistency, clearly defined limits, and a smooth surface. Based on detailed history and clinical examination a provisional diagnosis of mucocele was made. After medical evaluation, and signed informed consent from the parents, an excisional biopsy was performed under local anesthesia. Due to the lack of baby’s contribution, considering his little age, and as the procedure was simple, a decision was taken in favor of the physical containment (protective stabilization) with consent and aid of the parents: laying the baby on the chair, the mother laying over him holding the hands, and the assistant holding the baby’s head. As the baby was crying continuously, it helped in keeping the mouth open. A local infiltrative anesthesia (2% lignocaine with epinephrine 1 : 80,000; one cartridge) was infiltrated around the lesion. Before infiltration, a topical anesthetic gel for 2 minutes was applied. The lip was then everted with digital pressure to increase the lesion’s prominence. A thick silk thread was passed through the lesion at its largest diameter and a surgical knot was made followed by excisional biopsy using electrocautery (Figures 2 and 3), hence minimizing the chances of pain and postoperative bleeding. An analgesic was prescribed on the first postoperatory day to prevent any possible pain that could result in stress for the baby. The specimen was sent for histopathologic analysis which identified a large central mucous pooled area consisting of mucinophages, mucin containing cells, surrounded by compressed connective tissue wall, and forming granulation tissue (Figure 4) and confirmed the diagnosis as mucocele. After 2 hours, the patient recovered normal breastfeeding. The child reported uneventful recovery and an improved dietary habit one week postoperatively.

Figure 3: Immediate postoperative view.

Figure 4: H&E stained section reveals stratified squamous epithelium with underlying connective tissue consisting of large central mucin pooled area surrounded by granulation tissue and chronic inflammatory cells. The baby was reexamined after 15 days and 6 and 12 months. No recurrence was observed after 12 months (Figure 5). Figure 5: Appearance of the surgical area 12 months after the intervention, no recurrence