Journal of Indian Society of Pedodontics and Preventive Dentistry

                                                   Official journal of the Indian Society of Pedodontics and Preventive

Dentistry                           

Year : 2018  |  Volume : 36  |  Issue : 3  |  Page : 315--318

Blandin and Nuhn mucocele in a pediatric patient

Sherin C Jose, K Korath Abraham, Ektah Khosla 
 Department of Pedodontics and Preventive Dentistry, Mar Baselios Dental College, Kothamangalam, Kerala, India

Correspondence Address:
Dr. Sherin C Jose
Department of Pedodontics and Preventive Dentistry, Mar Baselios Dental College, Kothamangalam, Kerala
India

Abstract
Oral mucoceles are benign lesions that may appear in any location on the mucosal surfaces of the oral cavity where
underlying minor salivary glands are found. The lower lip is the most frequently affected and the most widely reported
location. Mucoceles involving the glands of Blandin and Nuhn are infrequent and constitute only about 1.9%–10.3% of the
reported cases. Superficial mucoceles are a rare subtype of the Blandin and Nuhn mucoceles and are found only in 4.3%–
10% of the mucocele excisions. The purpose of this report is to present a case of a superficial mucocele in the ventral
surface of the tongue in a 7-year-old child. The lesion was treated with excisional biopsy.

How to cite this article:

Jose SC, Abraham K K, Khosla E. Blandin and Nuhn mucocele in a pediatric patient.J Indian Soc Pedod Prev Dent 2018;36:315-318

How to cite this URL:

Jose SC, Abraham K K, Khosla E. Blandin and Nuhn mucocele in a pediatric patient. J Indian Soc Pedod Prev Dent [serial online]
2018 [cited 2019 Oct 7 ];36:315-318
Available from: http://www.jisppd.com/text.asp?2018/36/3/315/241957

Full Text

 Introduction

Incidences of pathological conditions of the mouth and perioral structures are common in the oral cavity of children.[1]
Among the soft-tissue pathology, salivary gland pathology was the most common diagnostic category and 87.5% of
diagnoses in this category were mucous extravasation cysts, which was the most commonly diagnosed oral lesion in
children.[2]

The mucocele of the oral mucosa usually results from rupture of a salivary gland duct and results in mucin spillage into the
surrounding soft tissues. The mucin spillage is often associated with local trauma, even though there is no known history
of trauma in some cases.[3] In a series of cases reported by Standish and Shafer, nearly 45% of the mucoceles occurred
on the lower lip.[4] This article presents a case report of a 7-year-old child with an unusual representation of Blandin and
Nuhn mucocele on the ventral surface of the tongue.
 Case Report

A female patient aged 7 years was referred to the department with a chief complaint of a swelling in relation to the ventral
surface of the tongue for 3 months. The patient gave a history of the previous visit to a pediatrician for the same, where
they have attempted to compress the swelling and noticed a minor reduction in the size. Later, the swelling regained its
original size and was hence referred to the dentist.

On examination, a pedunculated growth of size 10 mm × 5 mm was seen on the ventral surface of the tongue. The
superficial mucosa was erythematous with irregular surface and was lobulated. It was mildly tender on palpation, and it
did not bleed on palpation [Figure 1].{Figure 1}

Intraorally, the patient had retained lateral incisors and lingually erupting permanent successors. The growth in the tongue
occupied the space between the two erupting permanent lateral incisors. This led to the provisional diagnosis of
irritational fibroma and the two mandibular deciduous lateral incisors were extracted and the patient was called for
excisional biopsy of the growth.

On the second visit after 3 days, the patient showed a surprising reduction in size of the growth to about 5 mm × 5 mm
after the traumatic etiologic factor was removed [Figure 2]. There was also a reduction in the redness of the growth and it
appeared more similar to normal mucosa. Conservative approach to the growth was planned, and the patient was followed
up for 2 weeks. After 2 weeks, no considerable change in the size of the growth was noticed, and hence, a circumferential
excisional biopsy was performed under local anesthesia and the specimen was subjected to microscopic analysis.{Figure
2}

Histopathological examination showed keratinized stratified squamous epithelium in association with fibrovascular
connective tissue. The subepithelial connective tissue exhibits areas of mucin spillage and moderately dense chronic
inflammatory cells. The section also showed mucous minor salivary gland acini and dilated ducts [Figure 3] and [Figure 4].
Deeper areas also showed muscle fibers, vascular spaces, and extravasated RBC's. The histopathological features were
suggestive of superficial mucocele.{Figure 3}{Figure 4}

Follow-up was done at 3 months interval for 1 year and 6 months interval for the next year and showed no signs of
recurrence.

 Discussion

The mucocele is a salivary gland lesion that originates when the main duct of the minor salivary gland is torn due to
trauma and results in mucus extravasation into the connective tissue.[5] Unlike the salivary duct cyst, the mucocele is not
a true cyst as it lacks an epithelial lining.[3]

They are common in children and young adults because younger people are more likely to experience trauma that induces
mucin spillage. However, mucoceles have been reported in patients of all ages, including newborn infants and older
people. The lower lip is the most common site for the mucocele, accounting for over 60% of all cases. Less common sites
include the buccal mucosa, anterior ventral tongue, and floor of mouth (ranula).[3],[4]

Mucoceles that arise on the ventral surface of the tongue, situated on both sides of the midline, are known as mucocele of
the glands of Blandin and Nuhn. They are embedded in the muscles of the ventral aspect and re-covered by a thin layer of
mucosa.[6],[7],[8]

The superficial mucocele is a variant of the extravasation type mucocele and is located under the mucous membrane
whereas classical mucoceles are seen in the upper submucosa.[9] Its location as suggested by Jensen was attributed to
the fact that increased pressure caused by mucous plugs in the intraepithelial squamous cell lined portion of the duct
might cause the duct to rupture, creating superficial mucoceles. This also explains the close proximity of subepithelial
blisters to the salivary gland and ducts that is characteristic of these mucoceles.[10]

Ordinary mucoceles are more common in patients <30 years of age, in both men and women, whereas superficial
mucoceles are found more frequently in patients over the age of 30 and are found commonly in women.[11] These lesions
are asymptomatic and numerous, occurring most often in the retromolar area, soft palate, and posterior buccal mucosa.
[12] Their etiology may be closely related to the mechanism and tartar control toothpaste may be a contributory factor in
the onset.[13]

Superficial mucoceles are a rare subtype and are found in only 4.3%–16% of mucocele excisions.[14],[15] The true
incidence of superficial mucoceles is difficult to assess because some lesions spontaneously resolve, or are short-lived, or
are asymptomatic and thus affected individuals might not seek medical attention.

Histopathologically, superficial mucoceles featured a dome-shaped, thin epithelial roof with extravasated mucin directly
beneath and admixed with granulation tissue and composed of a lamina propria with a mild inflammatory cell infiltrate.[16]

If the clinician does not directly observe the eruptions or is unaware of their existence, this disease can be easily
misdiagnosed. The most common misdiagnoses are bullous lichen planus and mucous membrane pemphigoid. In bullous
lichen planus, the bullae are usually large, flaccid, and opaque, when compared to the translucent and tense vesicle of
mucocele. The blister of a mucous membrane pemphigoid is easily ruptured and tends to extend at the periphery.[17]

Several modalities of treatment have been instituted for superficial mucoceles, the most likely being surgical excision. For
the management of moderate-to-large Blandin–Nuhn mucoceles, Baurmash suggested to completely unroof the lesion
along its entire periphery to visualize and remove all of the glands present and complete excision for smaller ones.[18]

Other treatment options include cryosurgery,[19] diode laser,[20] CO2 laser ablation,[21] intralesional corticosteroid
injections,[22],[23] micromarsupialization, marsupialization, and electrocautery. The use of alginate impression material to
define the outline of the lesion in treating an anterior lingual salivary gland mucocele has also been reported.[24]

 Conclusion

Mucoceles of the glands of Blandin and Nuhn are considered to be rare. According to Jinbu et al., Blandin–Nuhn
mucoceles comprise 9.9% of all oral mucoceles studied by them.[6] Mucoceles of the glands of Blandin and Nuhn are self-
limiting, and with excision including the margins of the swelling and by avoiding future trauma to the site, the chances of
recurrence of the swelling are minimized.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given
his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients
understand that their names and initials will not be published and due efforts will be made to conceal their identity, but
anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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