Pediatric Dermatology Vol. 25 No.

3 308311, 2008

Mucocele in Pediatric Patients: Analysis of

36 Children
Marcello Menta S. Nico, M.D.,* Jee Hee Park, D.D.S., and Silvia Vanessa
Lourenco, D.D.S., Ph.D.
*Department of Dermatology, Hospital das Clnicas, Department of General Pathology, Dental School, University
of Sao Paulo, Sao Paulo, Brazil

Abstract: Mucoceles are common benign lesions of the oral cavity that
develop following extravasation or retention of mucous material from major
or minor salivary glands. Most series report a higher incidence of mucocele
in young patients but no studies exist for this specific age group. The re-
cords of 104 patients presenting with mucocele who underwent surgery in
the Oral Diseases Clinic of the Department of Dermatology of the University
of Sao Paulo, Brazil, between 1991 and 2006, were reviewed. Of these, 36
(34.6%) were 15 years old or younger, the youngest being 2 years old.
Twenty-six patients were girls, 10 were boys. Lesions were located on the
lower labial mucosa (30 patients), tongue (three), floor of the mouth (one),
buccal mucosa (one), and in one patient the location was unknown. Histo-
pathology revealed an extravasation pattern in 35 patients and a retention
pattern in one. Of the distinct subtypes of mucocele, tongue lesions (mu-
cocele of the glands of Blandin-Nuhn) seem to be more prevalent and
retention mucoceles seem to be very rare in children.

Minor salivary glands are found in most parts of
the oral cavity except the gingiva. Mucoceles are be-
nign soft tissue masses resultant from the retention or
extravasations of mucus in the surrounding tissues of
the lamina propria (1). These benign growths are be-
lieved to be traumatic in origin (1,2). Mucus is the
product of secretion of minor salivary glands and the
sublingual gland. Mucoceles more commonly present
as translucent bluish nodules that arise on the lower
labial mucosa (Fig. 1), but other regions may be rarely
aected (2). The term ranula designates mucoceles
located on the oor of the mouth. These originate
almost always in the body of the sublingual gland and,
less often, in the ducts of Rivini (sublingual gland) or
in the Warthons duct (submandibular gland) (1).
Histopathologic types of mucocele include the com-
mon extravasation and more rarely, retention variants.
Extravasation mucoceles consist of granulation tissue
surrounded by condensed connective tissue with vari-
ous amount of inammation. Salivary gland tissue is
often observed in the vicinity. Demonstration of
sialomucin is diagnostic. In the retention type (also
called salivary duct cyst) trapped mucus is lined by
columnar or cuboidal ductal epithelium (1,3,4).

Address correspondence to Silvia Vanessa Lourenco, D.D.S.,

Ph.D., Disciplina de Patologia Geral, Faculdade de Odontologia da
Universidade de Sao Paulo, Av Prof Lineu Prestes, 2227 Cidade
Universitaria, Sao Paulo, CEP 05508 000, Brazil, or e-mail:
sloducca@usp.br.

DOI: 10.1111/j.1525-1470.2008.00672.x

308  2008 The Authors. Journal compilation  2008 Blackwell Publishing, Inc.
 Nico et al: Mucocele in Pediatric Patients 309

A B

C D

E F

Figure 1. Clinical and histopathologic examples of the mucoceles examined. (A) Typical translucent mucocele on the lower lip
mucosa (patient 4). (B) Mucocele of the glands of Blandin-Nuhn (patient 29). (C) Extravasation mucocele: mucous material
surrounded by a pseudo-capsule. Notice salivary ducts in the vicinity (patient 4) (hematoxylin and eosin, original magnification
150). (D) Extravasation mucocele, detailthe fibrous pseudo-capsule mostly surrounded by numerous histiocytes and foamy
macrophages (patient 4) (hematoxylin and eosin, original magnification 250). (E) Retention mucocelemucous material lined
by an epithelial capsule (patient 1) (hematoxylin and eosin, original magnification 150). (F) Retention mucocele, detail.
Capsule composed of eosinophilic cuboidal cells (patient 1) (hematoxylin and eosin, original magnification 400).
310 Pediatric Dermatology Vol. 25 No. 3 May June 2008
Excluding irritation bromas, mucoceles are the most
common soft tissue lesions of the oral cavity.
Mucoceles are believed to arise equally in both sexes
and aect patients of all ages, with the highest incidence
in the second decade (4). Although frequent in children
and adolescents, no studies of mucocele in this specic
population have been performed. Our study presents the
clinical and histopathologic ndings of mucoceles in
pediatric patients observed during a 16 year period at the
Oral Diseases Clinic at the Department of Dermatology
of the University of Sao Paulo, Brazil.
METHODS
Clinical and histopathologic data were gleaned from the
records of patients presenting with mucocele who were
examined and surgically treated at the Oral Diseases
Clinic of the Department of Dermatology of the Uni-
versity of Sao Paulo between 1991 and 2006. Patients
with ages up to 15 years at the date of mucocele surgery
were included. Clinical features analyzed included sex,
age, and location of lesions. Histopathologic slides of the
excised lesions were stained with routine hematoxylin
and eosin, and histochemical stains of periodic acid-
Schi and alcian blue were reviewed by two observers.
Histopathologic analysis focused on the classication of
lesions in extravasation and retention mucoceles.
RESULTS
During the period between 1991 and 2006, 104 patients
with mucocele were treated in our service. Ages varied
from 2 to 70 years. Data of patients under 15 years old
are illustrated in Table 1. Thirty-six patients were aged
15 years old or younger (34.6%), 68 patients (65.4%)
were older. Of the 36 pediatric patients, 26 were women
(72.2%) and 10 were men (27.8%). Mucoceles were
present in the lower labial mucosa (30 patients, 83.3%),
ventral aspect of the tip of the tongue (3, 8.3%), oor of
the mouth (1, 2.7%), buccal mucosa (1, 8.3%), and
in one patient the location of the lesion had not been
TABLE 1. Pediatric Patients with Mucocele
Localization Age (yrs) and patient sex
Lower lip 2f*, 4f, 5f, 5f, 6f, 6f, 6f, 6f, 6f, 7f, 7f,
7m, 7m, 8f, 8m, 9f, 9f, 9m, 9m, 19f,
10m, 11f, 11f, 11f, 11m, 11m, 13m,
14m, 15f, 15f
Tongue 12f, 13f, 14f
Buccal mucosa 9m
Floor of the mouth 9m
Unknown 9f
f, female; m, male.
*Retention mucocele on histopathology.
recorded (3.7%). Figures 1A and 1B illustrate mucoceles
located on the lower labial mucosa and on the ventral
surface of the tongue.
Histopathology of excised lesions revealed a pattern
of extravasation mucocele in 35 patients. Histopatho-
logic aspects of these lesions ranged from acute inam-
mation intermingling with the mucus collection to
patterns of mature lesions with scarce amounts of mucus
and connective tissue brosis. In most instances a mixed
inammatory inltrate rich in foamy macrophages and a
thick brous capsule surrounding the mucus collection
were observed. Retention mucocele (salivary duct cyst)
was diagnosed in one patient. This lesion was located on
the lower labial mucosa.
DISCUSSION
Mucoceles are common benign oral lesions and several
case series have discussed the subject (46). Young pa-
tients seem to develop mucoceles more commonly than
older patients (46) but no published series deals specif-
ically with the pediatric population. Yamasoba et al re-
ported 70 patients with lower labial mucosa mucoceles
whose ages varied from 2 to 63 years, 70% of these pa-
tients were less than 20 years of age (5). Oliveira et al
reported 112 patients, 62% were under 20 years of age
(6). In our series of 104 patients, 52 were less than
20 years old (50%) and 36 patients (34.6%) were less
than 15. Of these, 22 were under 10 years old. This
nding may have some importance in preparing these
patients for surgery: younger patients may require
additional measures in terms of anesthesia and sedation.
Most series of patients had an even distribution be-
tween the sexes (4,5). We noted a much higher incidence
of mucoceles in girls26 (72.2%) girls versus 10 (27.8%)
boys.
Mucoceles are known to arise more commonly on the
lower labial mucosa. Harrison (7) studied 400 patients
with mucocele, and these lesions were located mostly in
this site. Yamasoba et al studied 70 lower labial mucosa
mucoceles, these represented 75% of their total of lesions
(5). Jimbu et al reported on 263 occurrences; of these, 205
(77.9%) were on the lower labial mucosa (2). In pediatric
patients this proportion seems to be repeated, as we
found 30 lesions (83.3%) on the lower labial mucosa.
Mucoceles arising on the ventral surface of the tongue
are known as mucocele of the glands of Blandin-Nuhn.
These glands are located near the ventral tip of the tongue
and are arranged in a mass with a horseshoe shape. They
are embedded in the muscles of the ventral aspect near
the midline (2). Mucoceles of the glands of Blandin-
Nuhn are considered to be rare. Jinbu et al reported
26 (9.9%) among 263 patients of all ages. Of these 26

patients, 13 were 15 years old or younger and no patient
was more than 36 years old (2). Harrison (7) reviewed
400 mucoceles and of these, only nine arose from the
tongue salivary glands. We found three patients with
mucocele of the glands of Blandin-Nuhn (8.3%) among
our 36 pediatric patients; they were 9, 12, and 14 years of
age. Only two other tongue mucoceles were found in our
remaining 68 nonpediatric patients, both were 19 years
old. Mucoceles of the glands of Blandin-Nuhn really
seem to be more prevalent in young people.
One mucocele (2.7%) was located on the oor of the
mouth and was diagnosed as a ranula. These lesions
acquire importance in the pediatric population because
they have to be dierentiated from deeper and more
serious conditions such as dermoid cyst, hemangioma,
and cystic higroma from the oor of the mouth.
Histopathology revealed an extravasation mucocele
in 35 of our 36 patients. Harrison (7) reported that in
younger patients most mucoceles are of the extravasation
type. Jimbu et al hypothesized that mechanical trauma
may be more pronounced in younger patients, favoring
extravasation mucoceles (thought to be posttraumatic),
while retention mucoceles (salivary duct cyst) are more
commonly found in older patients and are rare on the
lower lip (2). Yamasoba et al studied 70 lower labial
mucosa mucoceles, only two of which were of the
retention type (5). Our patient who presented with the
histopathologic aspect of a retention mucocele was a
2-year-old girl. This might suggest a cystic malformation
rather than a retention cyst caused by obstruction.
Mucoceles are best treated by excision followed by
careful dissection of the aected minor salivary gland.
Nico et al: Mucocele in Pediatric Patients 311
Variations in technique do exist and depend mostly on
the size and location of the lesion in the oral cavity. These
variations have been thoroughly discussed elsewhere (1).
Mucoceles in children are not rare. These lesions are
probably induced by local trauma, although most of our
patients or their relatives could not recall any episode of
trauma when asked. This report highlights the clinical
and histopathologic presentation of mucocele in a pop-
ulation of patients seen at the University of Sao Paulo
Dermatology Department. Series reported in Dental or
Oral Medicine service may highlight dierent features
and our ndings seem to coincide with those previously
published.
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