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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 200-202

Laser ablation of blandin and nuhn mucocele: A rare case report


Department of Pediatric and Preventive Dentistry, Government Dental College and Hospital, Nagpur, Maharashtra, India

Date of Submission07-Mar-2021
Date of Acceptance10-Jun-2021
Date of Web Publication23-Aug-2021

Correspondence Address:
Henpu Kamki
Government Dental College and Hospital, Government Medical College Premises, Medical Square, Nagpur - 440 003, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_40_21

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  Abstract 


Blandin and Nuhn glands are the mixed type of minor salivary glands located on the anterior ventral surface of the tongue. Mucoceles are rarely associated with Blandin and Nuhn gland. Out of 400 mucoceles reviewed by Harrison, only 9 arose on the tongue. Its differential diagnosis ranges from soft-tissue abscess to pyogenic granuloma, oral hemangioma, lymphangioma, lipoma, and squamous papilloma. This is a rare case report emphasizing the laser ablation of Blandin and Nuhn mucocele. The diagnosis of Blandin and Nuhn mucocele was made based on its anatomical site, size, flaccid nature, and frequent change in size characteristically increasing after consumption of food. Laser ablation was opted for the excision because it enables minimal bleeding, scarring, postoperative discomfort, and low recurrence compared to the conventional surgical excision. Histopathological examination revealed extravasation type of mucocele, suggesting that trauma may be the initiating factor.

Keywords: Blandin and Nuhn mucocele, diode laser, minor salivary gland, mucocele, tongue


How to cite this article:
Kamki H, Kalaskar R, Balasubramanian S. Laser ablation of blandin and nuhn mucocele: A rare case report. J Dent Res Rev 2021;8:200-2

How to cite this URL:
Kamki H, Kalaskar R, Balasubramanian S. Laser ablation of blandin and nuhn mucocele: A rare case report. J Dent Res Rev [serial online] 2021 [cited 2021 Dec 4];8:200-2. Available from: https://www.jdrr.org/text.asp?2021/8/3/200/324415




  Introduction Top


Mucocele is the most common benign minor salivary gland cyst of the oral mucosa.[1] It is mostly observed in the labial mucosa but is rare on the ventral surface of the tongue.[2] Blandin and Nuhn cyst is the mixed type of minor salivary gland mucocele, located on the anterior ventral surface of the tongue. They have a prevalence of 1.9%–10.3%, with higher predilection among females.[3] Out of 400 mucoceles reviewed by Harrison, only 9 arose on the tongue.[2] Various treatment modalities have been used for Blandin and Nuhn mucocele such as surgical excision, excisional biopsy, marsupialization, and intralesional injection of absolute ethanol.[4] However, these treatment modalities are associated with high risk of recurrence, damage to anatomical structures on the ventral surface of the tongue, and bleeding. The present report is a rare case of excision of Blandin and Nuhn mucocele using laser ablation.


  Case Report Top


A 13-year-old female patient reported to the department of pediatric and preventive dentistry with a chief complaint of swelling on the ventral surface of the tongue for 1 month. The patient revealed no history of trauma on the ventral surface of the tongue. The size of lesion was changing frequently and usually increased in size after consumption of food. Intraoral examination revealed pink-colored teardrop-shaped pedunculated growth (6 mm × 5 mm in size) in the midline of the ventral surface of the tongue [Figure 1]. On palpation, the lesion was nontender, soft in consistency with no bleeding or pus discharge. Based on the history and site of lesion, Blandin and Nuhn mucocele was diagnosed and its complete excision was planned using laser. After application of topical anesthesia (Benzocaine I.P. 20% Vishal Care Gel, Artus Pharma, Pvt. Ltd., Ahmadabad), the lesion was excised using diode laser (DenLase-980/7, China Daheng Group Inc.), [Figure 2]. The patient was instructed not to spit, rinse, or consume hot and spicy food for a day. The patient was advised to rinse mouth with chlorhexidine mouthwash (Hexidine, ICPA Health products Ltd., Ankleshwar, India) two times a day for a week. Histopathological examination revealed cavity lined by stratified squamous epithelium which was filled with mucinophages and spilled mucin. The cystic cavity was surrounded by well-organized collagen fibers interspersed with fibroblasts, endothelial lined blood vessels, and chronic inflammatory cell infiltrate (lymphocytes and plasma cells) which had conformed the diagnosis of an extravasation mucocele [Figure 3]. One-week follow-up showed complete healing of the lesion. Six-month follow-up showed no recurrence of the Blandin and Nuhn mucocele [Figure 4].
Figure 1: Intraoral photograph showing Blandin and Nuhn mucocele on the ventral surface of the tongue

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Figure 2: Immediate postoperative photograph after laser ablation of Blandin and Nuhn mucocele

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Figure 3: H and E section of Blandin and Nuhn mucocele showing the fibrous connective tissue capsule lined by stratified epithelial cells

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Figure 4: Six-month follow-up photograph showing no recurrence

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  Discussion Top


Mucocele of the Blandin and Nuhn gland is an uncommon variant occurring on the ventral aspect of the tongue. The glands of Blandin and Nuhn are located near the ventral aspect of tip of the tongue and are embedded in the muscles of the tongue on the ventral aspect near the midline. Jinbu et al. observed 73.1% mucoceles in the midline of the tongue in their series of 26 cases of Blandin and Nuhn mucoceles.[5] This mucocele is commonly attributed to local mechanical trauma, hence most cases are of extravasation type.

The mucocele of Blandin and Nuhn shows a tendency to be misdiagnosed due to its low prevalence. The differential diagnosis ranges from soft-tissue abscess to pyogenic granuloma, oral hemangioma, lymphangioma, lipoma, and squamous papilloma.[2] However, in this case, the diagnosis of Blandin and Nuhn mucocele was made based on its anatomical site, size, flaccid nature, and frequent change in size characteristically increasing after consumption of food.

These lesions may succumb to delayed diagnosis due to its asymptomatic nature. However, if left untreated, it has a tendency to cause discomfort, interference with speech, and mastication owing to its increased size.[6] Various treatment modalities have been employed for Blandin and Nuhn mucocele. These include surgical excision,[3] marsupialization,[7] laser ablation,[8] cryosurgery,[9] and injection of intralesional steroids.[10] Till date, surgical excision of the lesion has been the most opted treatment modality.[1],[3],[4],[5] However, this method shows few intra- and postoperative complications such as damage to anatomical structures, bleeding, scarring, and prolonged discomfort.

However, post the advent of laser, it was possible to achieve minimal bleeding, scarring, postoperative discomfort, and low recurrence compared to the conventional surgical excision.[8] Therefore, keeping these advantages in mind, laser ablation using diode laser was opted for excision. This is a rare case report using laser ablation of Blandin and Nuhn mucocele, and the patient reported no postoperative discomfort or pain. The patient was followed up for 1 week and thereafter for 6 months, and no recurrence was observed. Therefore, laser ablation can be used effectively for excision and overcome the disadvantages of conventional modalities.

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.



 
  References Top

1.
Khalekar YJ, Sande AR, Zope A, Suragimath A. Mucocele of tongue: A rare case report. J Indian Acad Oral Med Radiol 2016;28:462.  Back to cited text no. 1
  [Full text]  
2.
Konsulov S, Markov S, Topalova A. Mucocele originating from the blandin-nuhn glands. A case report. Int Bull Otorhinolaryngol 2020;13:20-4.  Back to cited text no. 2
    
3.
Jose SC, Abraham KK, Khosla E. Blandin and Nuhn mucocele in a pediatric patient. J Indian Soc Pedod Prev Dent 2018;36:315-8.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Zhang J, Wang C. The application of absolute ethanol in the treatment of mucocele of the glands of Blandin-Nuhn. J Craniofac Surg 2016;27:e641-2.  Back to cited text no. 4
    
5.
Jinbu Y, Kusama M, Itoh H, Matsumoto K, Wang J, Noguchi T. Mucocele of the glands of Blandin-Nuhn: Clinical and histopathologic analysis of 26 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:467-70.  Back to cited text no. 5
    
6.
Baurmash HD. Mucoceles and ranulas. J Oral Maxillofac Surg 2003;61:369-78.  Back to cited text no. 6
    
7.
Garcia Leon N, Marrugo Pardo GE. Mucocele of the glands of Blandin-Nuhn: A case report. Colomb Med (Cali) 2013;44:46-7.  Back to cited text no. 7
    
8.
Bagher SM, Sulimany AM, Kaplan M, Loo CY. Treating mucocele in pediatric patients using a diode laser: Three case reports. Dent J (Basel) 2018;6:13.  Back to cited text no. 8
    
9.
Katta NR, Arekal S, Mani SK, Basavarajaiah JM. Case report on management of oral mucocele in paediatric patients using cryosurgery and surgical excision. J Dent Probl Solut 2018;5:016-9.  Back to cited text no. 9
    
10.
Sinha R, Sarkar S, Khaitan T, Kabiraj A, Maji A. Nonsurgical management of oral mucocele by intralesional corticosteroid therapy. Int J Dent 2016;2016:2896748.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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