Oral cavity & oropharynx

Salivary gland tumors & processes


Editor-in-Chief: Debra L. Zynger, M.D.
Nathan Lee, D.M.D.
Tony Ng, M.D., Ph.D.

Last author update: 24 September 2019
Last staff update: 18 August 2022

Copyright: 2019-2024, PathologyOutlines.com, Inc.

PubMed Search: Oral cavity mucocele

Nathan Lee, D.M.D.
Tony Ng, M.D., Ph.D.
Page views in 2023: 52,483
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Cite this page: Lee N, Ng T. Mucocele. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/oralcavitymucocele.html. Accessed July 14th, 2024.
Definition / general
  • Reactive lesion to mucus extravasation that attracts muciphages without any epithelial lining
Essential features
  • Mucus extravasation into the surrounding tissue secondary to salivary gland duct trauma
  • Pseudocyst with epithelioid macrophages (muciphages) forming the periphery
  • Found on oral mucosal sites with minor salivary glands or sublingual gland
  • May recur if feeding salivary gland is not also removed
  • Mucus extravasation phenomenon
  • Ranula (if on the floor of mouth arising from the sublingual gland)
  • Plunging ranula (if the mucin dissects through the mylohyoid muscle to involve the cervical area)
  • Mucus escape reaction
  • Not to be confused with salivary duct cyst / salivary retention cyst / mucus retention cyst / mucus duct cyst / sialocyst
ICD coding
  • ICD-10: K11.6 - mucocele of salivary gland
Clinical features
  • Based on patient reported history and clinical examination with definitive diagnosis made by histopathologic evaluation under light microscopy
Prognostic factors
  • Benign with good prognosis
Case reports
  • Excision along with the feeding salivary gland is curative
    • Iatrogenic intraoperative damage to neighboring salivary gland parenchyma may contribute to recurrence
  • Removal of the sublingual gland with marsupialization of Wharton's duct can reduce the risk of recurrence for large ranulas (J Oral Maxillofac Surg 2008;66:2050)
  • Laser ablation, superpotent topical corticosteroids and gamma-linolenic acid have been reported to be effective in isolated case reports for superficial mucoceles (J Oral Maxillofac Surg 2007;65:855)
Clinical images

Contributed by Nathan Lee, D.M.D.
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Oral cavity mucocele

Gross description
Gross images

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Intact lesions

Microscopic (histologic) description
  • If removed intact
    • Pseudocyst cavity containing mucin, abundant epithelioid foamy histiocytes (muciphages), neutrophils and granulation tissue (Acta Histochem 2014;116:40)
  • If removed ruptured
    • Fragments of granulation tissue containing epithelioid foamy histiocytes (muciphages) and neutrophils, may see mucinous material (Acta Histochem 2014;116:40)
  • Removed salivary gland parenchyma showing obstructive changes
    • Acinar atrophy, ductal dilatation with periductal hyalinization, interstitial lymphoplasmacytic infiltrate and interstitial fibrosis at late stage (J Oral Maxillofac Surg 2008;66:2050)
  • May see ruptured feeding salivary duct with squamous metaplasia (J Oral Maxillofac Surg 2008;66:2050)
  • Long standing lesions organize into fibrosis resembling a fibroepithelial polyp (Acta Histochem 2014;116:40)
  • No epithelial cyst lining, may see overlying surface oral mucosa with variable atrophy in superficial mucoceles (J Oral Maxillofac Surg 2011;69:1086)
Microscopic (histologic) images

Contributed by Vancouver General Hospital
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Early mucocele removed intact

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Late mucocele removed ruptured

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Mucocele mimicking mucoepidermoid carcinoma

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Early mucocele removed intact

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Late mucocele removed ruptured

Positive stains
Negative stains
Sample pathology report
  • Right lower labial mucosa, excision:
    • Mucous extravasation phenomenon (mucocele)
    • Minor salivary gland parenchyma showing chronic sialoadenitis
Differential diagnosis
  • Salivary duct cyst / salivary retention cyst / mucus retention cyst / mucus duct cyst / sialocyst:
    • True salivary gland duct epithelial lining that may show an oncocytic bilayer or squamous metaplasia
  • Mucoepidermoid carcinoma
    • 3 populations of atypical cells (mucous, intermediate, epidermoid) invading the surrounding stroma
  • Autoimmune sialadenitis (Sjögren syndrome)
    • Minimal obstructive changes such as salivary gland duct dilation and the lymphocytic inflammation is not periductal
  • Glandular odontogenic cyst
    • True epithelial cystic lining with goblet cells, no extravasated mucin and this lesion is not within the orofacial soft tissues
  • Oral focal mucinosis
    • No mucin and instead is a well localized non encapsulated collection of myxomatous connective tissue in the stroma
Additional references
Board review style question #1

    A 26 year old man with an upper lip laceration from a motor vehicle accident presented with a localized swelling, biopsy shown above. What immunohistochemical finding would one expect?

  1. CD68 positive
  2. Cytokeratin positive
  3. PAX8 positive
  4. S100 positive
  5. SMA positive
Board review style answer #1
A. CD68 positive (this is a mucocele)

Comment Here

Reference: Mucocele
Board review style question #2
    Among the choices below, what is the most common site to find an oral cavity mucocele?

  1. Gingiva
  2. Intrabony, within the maxillary or mandibular bone
  3. Labial commissure
  4. Parotid gland
  5. Upper labial mucosa
Board review style answer #2
C. Labial commissure

Comment Here

Reference: Mucocele
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