Prevalence Of Oral Mucocele In Patients Attending Private Dental Hospital - A Retrospective Study

Keywords

Oral Mucocele; Ranula; Salivary Gland.

Introduction

Mucoceles are defined as mucus filled cavities which can appear in the oral cavity,appendix gallbladder,paranasal sinus,and lacrimal sac [1, 2]. The term “mucocele” is derived from a Latin word mucus and “cocele”means cavity [3]. It is the 17th most common salivary gland lesion seen in the oral cavity [4]. Mucocele is usually painless and have a tendency to relapse [5, 6]. Accumulation of liquid or mucous materials due to alteration of minor salivary gland which causes mucocele with a limited swelling [7, 8]. They are classified as extravasation or retention cyst [8, 9]. Patients are often anxious on visiting a dentist and receiving treatment so treatment is not taken on time which leads to further complication [10]. General dentist must have awareness regarding the signs and symptoms so,that it will be easy for them to educate the patient [10]. Patients with poor oral hygiene and immunocompromised must be taken care and their specific treatment protocol [11]. The two main etiological factor are trauma and obstruction of salivary gland.The main reason will be physical trauma which causes silage of salivary secrecy ion into surrounding submucosal tissue,Due to stagnate mucous inflammation may become obvious [12, 13]. Habit of lip biting and tongue thrusting are also one of the aggravated factor [13, 14]. Clinically there are two types ,extravasation and retention types extravasation and retention type and Extravasation this due to the leaks of fluid from the damaged salivary gland and acini into surrounding soft tissue,mostly seen commonly in major salivary gland ducts [12, 13]. Retention Mucocele appears dude to a decreases or absence of glandular secrecy ion produced by blockage of salivary gland ducts [12]. When located in the floor of the mouth these lesions are called ranulas because the inflammation resembles the cheek of frog [15, 16].

The incidence of mucocele of generally high 2.5 lesion per 1000 patients, frequently in the second decade of life [3, 17, 18] no clinical difference between extravasation and retention Mucocele. Mucocele present a bluish, soft and transparent cystic swelling which frequently resolves spontaneously. The blue color is caused by vascular congestion and tissue cyanosis of tissue above and the accumulation of fluid below. Coloration can also vacancy depending on the size of the lesion ,proximity to the surface and upper tissue elasticity [1, 18, 19]. Mucocele found in the minor salivary gland are rarely larger than 1.5 cm in diameter and are always superficial.Mucocele found in deeper areas are usually larger. Mucocele can cause a convex swelling depending on the size and location ,as well as difficulties in speaking or chewing [1]. The lower lip is the most frequent site for a Mucocele as Otis the most probable place for a trauma,especially at premolar level. There is a prevalence 2.5 lesion per 1000 population in America .0.11% in Sweden and 0.08% in Brazil [20]. In India the highly prevalent age group of 15-24 years p,were seen at 51,72% males and 48.28% of females with a ratio of 1.07:1. Previously our team has a rich experience in working on various research projects across multiple disciplines [21-35]. The aim of this study is to find the prevalence rate of oral mucocele.

Materials And Methods

Study design and study setting

The study was retrospective data analysis.The data was collected from the hospital based patient case records of 86000 patients, during June 2019-March 2020

Participants

All patients with oral mucocele were included in the study.All the diagnosis parameters were satisfied

Inclusion criteria

1. Patients with oral mucocele

Exclusion criteria

1. Syndrome patients

2. Physical disabilities

3. HIV-AIDS

4. Mentally challenged patients

Study size

The sample size was 34 patients

Ethical approval

The ethical approval for the research (SDC/SIHEC/2020/DIASDATA/ 0619-0320) was issued by the ethical committee of Saveetha Dental college, Saveetha Institute of medical and Technical science, Saveetha University, Chennai.

Data Analysis

The data was collected from patient reports in hospitals,The obtained data was entered in microsoft excel 2012. Then exported to statistical package for social science for windows (version 20.0.SPSS Inc.,Chicago III,USA)and all subjected to statistical analysis.Chi square test was employed with a level of significance set at P 0.05.

Results

In our study there are total of 34 patient in which .Female patients showed 32.4%.patients showed 67%(figure 1).So,high prevalence is seen among male population when compared to females.Distribution of age of the patients affected with mucocele is depicted in figure 2.Patients aged between less than 10-20 years old accounts for 11.7%,patients aged between 21-30 years old accounts for 20.5%,patients aged between 31-40 years old accounts for 17.6%,patients aged between 40 years old and above accounts for 50%.Figure 3-Duration Of the oral Mucocele.>1month was 32.4%, > 6months-23.5%,1 year and above was 26.5%,unknown -17.6%.So, people with a duration of less than a month were found to be more. Figure 4 shows the association of age and mucocele, less than 10-20 years showed 11% of prevalence, 21- 30 years old patients showed 20%, 31-40 years old showed 17% and 49 and above patients showed 50%.So,high prevalence was seen among 40 and above age groups when compared to others. In our present study by comparing the duration and age of the patient the obtained P value is 0.104 which is less than 0.05.Hence statically not significant. (Pearson Chi-Square correlation).Figure 5: By comparing the association between duration of mucocele and gender of the patient, results show that in male patients the duration of less than one month, one year and more than a year is more when compared to females. In females less than six months was found to be more when compared to male, however there is no significant difference between both the groups. The obtained P value is 0.208 which is less than 0.05. Hence not statically significant (Pearson Chi-Square correlation).

Mucocele is a clinical term used to describe a swelling caused by pooling of saliva from a severed or obstructed minor salivary gland duct [8]. The self limiting Mucocele containing yet of salivary salivary gland commonly occurring in the oral cavity with relatively rapid onset and with fluctuating size [21]. The decrease in size may be due to rupture of lesion and subsequent mucin accumulation or re-absorption of saliva deposits may causes the lesion to reform [36]. Oral mucoceles can be single or multiple often rupturing and leaving slightly painful ersonion that usually healed within few days [15]. The duration of the lesion is not constant from a few days to 3 years.The clinical presentation may vary depending on the depth of the lesion.The lesion are located under the mucosa membrane (superficial Mucocele) or in upper submucosa (clamical Mucocele) [20]. Sometimes patients who undergo trauma during road traffic accidents causes damage to the soft tissues mucosa of the lip and henceforth rupuring ducts of salivary gland which lead to oral mucocele [35, 37-40].

In our study oral mucocele has affected mostly the 4th and 5th decade of life.Where as there are few studies which support by saying that there is a high incidence is the second decade of life. Teenger and children are most commonly affected by menta et al [41] yamosoba et al [15] and Oliveira et al [42]. reported that more than 65% of their patients with Mucocele less the 20 years of age. However, this may be asymptomatic in nature may delay the patient in seeking treatment. In our present study age and duration of mucocele was compared and it shows that patients above 40 years had mucocele duration of more than one month and less than one year. This shows the negligence by the higher age population in treating mucocele.

Our present study shows that male population with 67% higher prevalence than the female population.This is in regard with the studies of Yamaoba et al [15] Menta et al [41].studies of oliveira et al [42] with ratio of 1.071:1.Oral mucocele rarely causes significant problems.Discomfort interference with speech,mastication,swelling and external swelling may occur depending on the size and location [36].Oral mucocele is differentiated from lipoma, oral hemangioma, oral lymphangioma, benign or malignant salivary gland neoplasm, gingival systemic of adults, soft tissue abscess, cysticercosis. Mucocele may be confused with cicatricial pemphigoid,bullous lichen Planus etc [43].

The treatment shall be complete excision, marsupialization, dissection, cryosurgery, CO2 laser, Intralesional injection of sclerosing agent Ok432 or steroid injection [15]. Post surgery antibiotics and mouth wash are administered to the patients to prevent further infection in the surgical site [11, 44-49].Our institution is passionate about high quality evidence based research and has excelled in various fields [50-60].

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Figure 1:

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Figure 1: Distribution of gender. X axis denotes the gender of the patient and Y-axis denotes total number of patients. Male (67.65%) population was more when compared to the female population (32.35%).

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Figure 2:

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Figure 2: Association of age and mucocele. X axis showing the age of the patient and Y axis total number of patients. Mucocele was seen in 50 % of patients above the age of 40 years.

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Figure 3:

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Figure 3: Bar graph represents duration of mucocele and total number of patients. X axis showing the duration of mucocele and Y axis denotes total number of patients. The mucocele with more than one month of duration is more in our study population.

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Figure 4:

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Figure 4: Bar graph represents association of age and duration of mucocele.X axis denotes the age of the patient.Y axis denotes the total number of patients affected with mucocele. By comparing the duration and age of the patient the obtained P value is 0.104 which is less than 0.05. Hence not statically significant (Pearson Chi-Square correlation). From this graph it is evident that patients with 40 years and above had longer duration (17.65%) of mucocele when compared to other age groups.

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Figure 5:

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Figure 5: Bar graph represents association of gender and duration of mucocele.X axis denotes the gender of the patient.Y axis denotes the total number of patients affected with mucocele. By comparing the duration and gender of the patient the obtained P value is 0.208 which is less than 0.05. Hence not statically significant (Pearson Chi-Square correlation). It is evident that in male patients the duration of mucocele of less than one month, one year and more than a year is more when compared to females. There is no significant difference between both the groups.

Conclusion

From this study it is evident that the prevalence of oral Mucocele is more common among male population when compared to female and mostly seen among the 4th and 5th decade of life. This study helps in understanding the prevalence of mucocele in a limited population. Further studies are required in a larger population to assess its risk factors which will aid in proper diagnosis and treatment planning.

Author’s Contribution

Author1(Amanthi Ganapathi) Carried out the retrospective study by collecting the data and drafting the manuscript after performing the necessary statistical analysis. Author 2 (Dr. Jagadis. V) aided in the conception of the topic,participated in the study design,statistical analysis and supervised the preparation of the manuscript and helped in study design and has coordinated in developing the manuscript. All the authors have equally contributed in developing this manuscript.

Acknowledgement

The authors of the study thank everyone who enabled us to carry out this study.