Mucoceles are mucous cysts occurring on the mouth or lip. Ranulas are mucoceles (mucous retention cysts) that develop in the floor of the mouth, arising from obstructed sublingual or submandibular ducts or smaller minor salivary glands. Initially, the cysts are small and barely noticeable, but over time, they can expand outward or deeper into the neck (plunging ranula). Large cysts can displace the tongue forward and upward, making the patient uncomfortable. Unlike those with sialolithiasis, patients with ranulas may not always notice an increase in swelling associated with eating. Mucoceles on the lip typically affect the lower lip. Physical examination reveals a soft, minimally tender, translucent cyst with dilated veins running over its surface. Unlike carcinomas, no ulceration is noted with ranulas, and they are generally softer.
Management and Disposition
Recognition by the physician is essential for proper referral. While most mucoceles resolve spontaneously, definitive treatment for recurrent or chronic mucoceles is excision or marsupialization, although needle aspiration of the cyst can provide temporary relief. Unless there is a secondary infection, no antibiotic coverage is required.
Ranula. Sublingual ranula, or mucocele, lateral to Wharton duct. The patient was asymptomatic except for being aware of the lesion. (Photo contributor: Kevin J. Knoop, MD, MS.)
Most mucoceles are painless and are incidental findings on routine examinations.
Mucoceles often recur, requiring total excision of the offending salivary gland.
Mucocele. Focal swelling of the upper lip that developed months after local trauma consistent with a mucocele. (Photo contributor: Lawrence B. Stack, MD.)
Mucocele. Mucocele in an adult who suffered mild lip trauma 3 weeks prior. (Photo contributor: Lawrence B. Stack, MD.)