Recurrent multiple superficial mucocele on the palate:

Histopathology and laser vaporization

Yoshinori Jinbu, DDS, PhD,a Keiichi Tsukinoki, DDS, PhD,b Mikio Kusama, DDS, PhD,c and
Yoshihisa Watanabe, DDS, PhD,d Tochigi and Kanagawa, Japan
JICHI MEDICAL SCHOOL AND KANAGAWA DENTAL COLLEGE

A 55-year-old Japanese woman presented with recurrent multiple vesicles on the soft palate. Some vesicles
ruptured spontaneously but soon recurred, and the patient felt mild pain and discomfort. Histopathologically,
intraepithelial mucocele with mucus retention in the salivary ducts was observed. The lesion was successfully treated
with Nd: YAG Contact Laser. There has been no recurrence for 3 years. (Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2003;95:193-7)

Superficial mucoceles present as small, clear vesicles and posterior buccal mucosa are common sites of oc-
on noninflamed mucosa and are often misdiagnosed as currence. Histopathologically, these lesions show sub-
vesiculobullous disorders.1 Soft palate, retromolar pad, epithelial mucus extravasation.2 Clinically, they are
typically asymptomatic with most lesions rupturing in a
a
few hours, leaving a small white pseudomembrane.3
Lecturer, Department of Dentistry, Oral and Maxillofacial Surgery,
Jichi Medical School, Tochigi, Japan.
Generally, no treatment is required for these lesions.
b
Lecturer, Department of Oral Pathology, Kanagawa Dental College, However, if the lesions are multiple, recur frequently,
Kanagawa, Japan. and produce discomfort, treatment is required. We
c
Professor, Department of Dentistry, Oral and Maxillofacial Surgery, treated such a patient with a laser successfully and
Jichi Medical School, Tochigi, Japan.
d
suggest laser vaporization as a useful treatment proce-
Professor, Department of Oral Pathology, Kanagawa Dental Col-
lege, Kanagawa, Japan. dure for recurrent oral superficial mucocele.
Received for publication May 6, 2002; returned for revision May 29,
2002; accepted for publication June 25, 2002.
© 2003, Mosby, Inc. CASE REPORT
1079-2104/2003/$30.00 ⫹ 0 A 55-year-old Japanese woman presented with multiple
doi:10.1067/moe.2003.50 blister formation on the soft palate (Fig 1). When she first

Fig 1. Multiple superficial mucoceles on the soft palate.

193
194 Jinbu et al ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
February 2003

Fig 2. Histopathologic features of superficial mucoceles. Intraepithelial mucocele and dilated salivary ducts were observed
(hematoxylin-eosin stain; original magnification ⫻40).
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY Jinbu et al 195
Volume 95, Number 2

Fig 3. The mucus was stained strongly with mucicarmine staining (original magnification ⫻200).

Fig 4. The day after laser vaporization, the treated area was pain free and covered with a white pseudomembrane.

noticed blister formation about 9 months earlier, she visited she complained of discomfort with mild pain. Some vesicles
an otorhinolaryngologist. She was treated with an antiviral ruptured spontaneously but recurred within a few days. Sig-
agent for 3 weeks without improvement. Subsequently, the nificant mucosal inflammation was not detected, and there
patient visited a dermatologist, who referred the patient to the was no evidence of generalized mucous membrane disease.
Department of Dentistry, Oral and Maxillofacial Surgery at With a clinical diagnosis of superficial mucocele, 1 clear
Jichi Medical School Hospital, for biopsy and histopathologic vesicle was surgically removed. Microscopic features of sec-
diagnosis of suspected autoimmune bullous disease. There tions showed an intraepithelial bulla containing mucus (Fig
were many small, clear, tense vesicles on her soft palate, and 2). The mucus was stained strongly with mucicarmine and
196 Jinbu et al ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
February 2003

Fig 5. Re-epithelization was completed 7 days after the treatment.

periodic acid–Schiff staining (Fig 3). Neither squamous cell ple, often rupturing and leaving slightly painful ero-
ballooning degeneration nor acanthocytosis were observed. sions that usually heal within a few days. Superficial
Mild chronic inflammatory cell infiltration of lymphocytes mucoceles are more frequent in females over the age of
was noted in the cystic space and surrounding soft tissue,
30, and common sites of involvement include the soft
including the minor salivary gland. Moderately dense lym-
phocytic infiltration in the subepithelial connective tissue was palate and retromolar and buccal mucosa.1-3,5 Our case
observed. Periductal fibrosis with marked dilation and mild showed a unique clinical feature of recurrent multiple
fibrosis of stroma was evident. These dilated ducts were vesicles on the soft palate. Our patient first visited an
located deep to the cystic space. Acinar cells of the adjacent otorhinolaryngologist, who suggested a diagnosis of
minor salivary gland were unremarkable. The histopathologic viral infection, and then she visited a dermatologist,
diagnosis was intraepithelial mucocele. Treatment of the le- who suspected an autoimmune bullous disease. As su-
sion with Contact Laser (Nd: YAG Contact Laser, 1064nm
perficial mucocele is not widely recognized, the condi-
wavelength, 10W, CL50 laser system; Contac LASE; SLT
Japan, Tokyo, Japan) was provided. Initially, vesicles on the
tion may often be clinically misinterpreted.1 His-
left side of the soft palate were vaporized under a local topathologically, superficial mucocele represents
anesthesia with 2% lidocaine. One day after treatment the subepithelial extravasation of sialomucin occurring at
patient was pain-free, and the treated area of mucosa was the epithelial-connective tissue interface.2 Minor sali-
covered with a white pseudomembrane (Fig 4). Re-epithe- vary gland ducts are often seen in the immediate vicin-
lization was complete 7 days after laser treatment, and no ity of mucoceles. In our case, the lesion was histopatho-
recurrence of mucocele was observed (Fig 5). Subsequently, logically observed as an intraepithelial mucocele, with
vesicles located on the central and right sides of the soft
mucus accumulation in adjacent salivary ducts.
palate were vaporized in 2-week intervals. There has been no
recurrence of mucocele for 3 years. Some authors report that no treatment is required for
superficial mucocele.1,3 As the described patient pre-
DISCUSSION sented recurrent multiple vesicles on the soft palate and
Mucocele is a very common disease of the oral complained of discomfort with mild pain, we chose
cavity.4 Some mucoceles are very superficial and are laser treatment. The Nd: YAG Contact Laser system
termed superficial mucocele.1 These may be caused by proved useful for superficial vaporization of the oral
extravasation of mucus into the subepithelial tissues. mucosa. This system produces destruction of tissue to
Generally, the lesion consists of small subepithelial the depth of 250 ␮m. Clinical observations suggest
vesicles filled with mucus that are typically only a few laser treatment to be effective in eliminating recurrent
millimeters in diameter. They may be single or multi- superficial mucocele. Re-epithelization was completed
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY Jinbu et al 197
Volume 95, Number 2

7 days following laser therapy, and the patient did not 5. Navazesh M. Tartar-control toothpaste as a possible contributory
factor in the onset of superficial mucocele: A case report. Spec
experience severe postoperative pain. Care Dentist 1995;15:74-8.

REFERENCES
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scopic diagnosis. Oral Surg Oral Med Oral Pathol 1988;66:318-
Yoshinori Jinbu, DDS, PhD
22.
Department of Dentistry
2. Jensen JL. Superficial mucoceles of the oral mucosa. Am J Der-
Oral and Maxillofacial Surgery
matopathol 1990;12:88-92.
3. Bermejo A, Aguirre JM, Lopez P, Saoz MR. Superficial mucocele. Jichi Medical School
Report of 4 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Yakushiji 3311-1
Endod 1999;88:469-72. Minamikawachi-machi, Kawachi-gun
4. Harrison JD. Salivary Mucoceles. Oral Surg Oral Med Oral Pathol Tochigi 329-0498
1975;39:268-78. Japan

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