Introduction
Mucocele and traumatic neuroma are two types of lesions that are usually related to some traumatic events or changes in nerve tissue (Ashkavandi, Nazhvani, & Hamzavi, 2013). There are not many clinical cases when these two diseases occur simultaneously. However, in the majority of cases, the neuroma is defined as one of the possible differential diagnoses of mucocele. In this paper, neuroma and mucocele will be discussed within an oral cavity. The most vulnerable sites where such lesions can be observed include a lip, tongue, cheek, or some small place of the mental nerve area. Mucocele is usually located on the surface of a lower lip (Asdullah, Gupta, & Sachdev, 2015).
Definition
The comparison of two pathologies should begin with giving clear definitions and explanations of what mucocele and neuroma are and are not. Mucocele is a benign cystic lesion that contains mucus (More, Bhavsar, Varma, & Tailor, 2014). This term originated from the Latin word “mucus,” meaning that this lesion introduces an accumulation of mucus that is usually secreted from minor salivary glands in the oral cavity (Asdullah et al., 2015).
There are two frequently occurring mechanisms connected with mucoceles: first, there is mucus extravasation that is caused by traumas and ruptures of the ductal systems, and second, there is mucus retention when a cyst is formed because of the obstruction and dilatation of ductal walls (Ramkumar, Ramkumar, Malathi, & Suganya, 2016). From a clinical point of view, mucocele is a bubble-like shape lesion with saliva that can be colored in regards to the depth of an injury. It is a salivary gland disorder that is observed in an oral cavity in the form of a benign soft tumor (Asdullah et al., 2015).
A Neuroma is a pathology that can be observed in an oral cavity as well. This condition can have different names: pseudo-neuroma, traumatic neuroma, palisaded encapsulated neuroma when solitary lesions are observed in the oral mucosa (Jokinen, Ragsdale, & Argenyi, 2010). A traumatic neuroma can be found in a gingival after a tooth has been extracted. In comparison to mucocele that usually happens to young patients, the neuroma is the health problem of elderly adults (Ashkavandi et al., 2013). A neuroma is defined as a benign nerve proliferation that is caused by traumas or injuries. It is a nerve tumor that can be developed due to a poorly regenerative process.
Etiology
It is known that mucoceles, as well as neuromas, occur as a result of a reactive process. Still, one particular origin is hard to define. Still, one of the main causes of these two pathologies remains to be trauma or the outcomes of traumatic events that lead to certain changes in the oral cavity (Ashkavandi et al., 2013). Though the nature of traumas may vary, the fact that this disease has the same origin. The process of mucocele’s development is not complicated.
Trauma or any other event leads the damage or blockage of the ducts, those tiny tubes through which saliva moves from a salivary gland (Ata-Ali et al., 2010). A patient tries to bite or suck the place of injury in order to remove the source of discomfort. As a result, a cyst-like swelling, known as mucocele, emerges.
The causes of neuroma are connected with the damage of nerves in the oral area. This lesion is a result of trauma or surgery. Besides, such events as a needle puncture or a cat can be the cause of neuromas being developed in a patient’s mouth. As a rule, after a nerve being damaged, it can repair itself due to distal proliferation. However, in some cases, reparation is impossible due to old age or other specific features. This is how neuroma occurs and becomes a health problem that has to be treated in a short period of time in order to avoid complications.
Clinical Manifestations
The identification of clinical manifestations is the possibility to identify the main symptoms of a disease and investigate its history. First, when a patient came to a hospital and is diagnosed with mucocele or neuroma, it is important to talk with a physician and underline all important events which can lead to these diseases. For example, recent traumas, injuries, or infections should be mentioned. If there are recent tooth extractions, occur, they have to be identified as well. The doctor, as well as other medical staff, should have a clear picture of what has happened and lead to this pathology. Second, it is necessary to analyze each symptom and sign that may contribute to the development of diagnosis.
Traumatic neuromas gain a form of a firm nodule. As a rule, there is no discoloration. Sometimes, patients may experience pain or pressure under a tumor simultaneously or irregularly. Mucoceles should be searched inside of a mouth, under a tongue, or on lower lips. These lesions are usually painless and can be moved. Regarding their composition, they are soft and round. Their color may be pearly or blue regarding the level of injury.
Mucocele’s size varies from 2 millimeters to 1-1,5 centimeters in diameter. In general, the symptoms of mucoceles and neuromas differ by the presence/absence of pain, color, and location. In case the signs are combined with a properly introduced history, it is easy for a physician to diagnose a patient and start treatment. Sometimes, a biopsy may be assigned to check the nature of a tumor.
Radiographic Appearance
Both mucocele and traumatic neuroma can be identified using radiography techniques. The radiographic appearance of the two lesions in the oral cavity, however, will be quite different. Since mucocele is essentially a cavity filled with mucus and saliva (More et al., 2014), it has an even color and distinctive borders, which help to distinguish it from the surrounding healthy tissue (Panthula, 2015).
The tone and color of the mucocele depend on its contents, but on the radiographic image, it is usually lighter than the surrounding tissue (Ashkavandi et al., 2013). Neuroma, on the other hand, is a nerve proliferation, which means that it has an uneven or grainy texture and no distinctive borders, although it does differ from the surrounding tissue by color, texture, and the loss of normal fibrillation pattern. Usually, a swollen nerve can be distinguished in the mass of the neuroma (Panthula, 2015).
Microscopic Appearance
Similarly, the microscopic appearance of the two types of lesions can help distinguish between a neuroma and a mucocele. Mucocele presents as a pool of mucus or saliva surrounded by connective tissue. The mucus is usually present in the central cavity, which is surrounded by a dense layer of cells. Macrophage lineage cells are normally visible if the degree of magnification is x200 or over (McCabe et al., 2015).
The microscopic features of a traumatic neuroma are described by Ashkavandi et al. (2013). The researchers outline the case of the simultaneous presence of a mucocele and a traumatic neuroma in the lower lip of a 21-year-old patient. The authors provide images of neuroma under an x100 magnification. In the area of the neuroma, a haphazard arrangement of nerve bundles is visible within the stoma; these bundles have a dense fibrous connective tissue, which helps distinguish a neuroma from a mucocele (Ashkavandi et al., 2013).
Diagnostic Techniques and Criteria
Mucocele and traumatic neuroma can be diagnosed in various ways in the first stages of infection and development to the point when the disease has aggravated to the worst possible condition. According to the best method, which is a physical examination, it is diagnosed according to the physical appearance where the superficial lesions tend to be somehow blue, and the deep ones usually have mucosal coloration.
First, the Mucocele diagnosis is identifiable orally because they can form anywhere on the salivary gland (Asdullah et al., 2015). The two types of Mucocele, which are Nuhn and Blandin, usually occur in the anterior ventral, which is the surface of the middle of the tongue.
Since trauma can be experienced against some of the teeth, the surfaces appear to be white, red, granular, or cerotic. The features of the Mucocele may be characterized by growth in size covering the area around the infection, the latter getting increasingly large over time when not given the proper attention. The second method, which is used in most cases, is the differential diagnosis. Mucocele and traumatic neuroma is something that involves the PEN (palisaded encapsulated neuroma), the neurofibroma, and the mucosal neuroma (Ramkumar et al., 2016).
This method is highly applicable in the sense that neuromas and fibromas can grow anywhere as long as there is a salivary gland. However, in most cases, they appear in the hidden parts of the tongue. Since they manifest themselves as a tissue that surrounds the mucin, neuromas and fibromas are easily identifiable and diagnosed. Additionally, a CT scan can be used to capture the reallocation of the lump, no matter how deep the disease may be hidden.
The CT scan involves the use of the computer-operated x-rays, which are usually directed at the patient from all different kinds of angles to produce the best image as possible. These allow the doctors and physiologists to view the entire Mucocele and the traumatic neuroma without necessarily having to perform an incision or similar interventions (Ramkumar et al., 2016).
Current Treatment Modalities
Mucocele and traumatic neuroma are, in most cases, not required to be treated. The identified phenomenon is due to the fact that they can appear and simply disappear without touching on any treatment since many of them are triggered by the presence of bacteria and salivary areas. Some of the exposure to cleanliness and also the use of the various brands of toothpaste to help and keep the mouth and the other areas of the tongue clean contribute to ensuring that they disappear over time gradually. Although this might be over a longer period of time, it is the best method to adopt. When they enlarge, one must not engage in self-treatment since they should visit a doctor for further assistance and also be treated using the best method which is selected after a diagnosis (Asdullah et al., 2015).
Doctors use various methods to treat the Mucocele and traumatic neuroma, as discussed. First, the entire gland can be removed from the mouth and the affected area. The dentist uses a scalpel and sometimes a laser to remove the whole salivary gland. Additionally, it can be gotten rid of by a process called marsupialization in which the doctor can perform the following procedures: disinfection of the area, putting a stitch in the Mucocele and traumatic neuroma, followed by gentle pressing of the saliva, and the stitch is removed within a week (Panthula, 2015).
Clinical Significance
The clinical significance of the issue can be determined after a specific time period once the efficacy of the intervention is proven. The treatment procedures suggested and used on the Mucocele and traumatic neuroma are very useful and have a positive effect on patients of any age. Furthermore, they have proven to be of major importance (Ashkavandi et al., 2013). According to various studies done by various scholars, clinical treatment is the best method to make sure that the effects will not come along again (Ashkavandi et al., 2013; Navez et al., 2016).
From the procedures which are performed by the doctors, therapists make sure that they get rid of the salivary gland that is mostly affected, which prevents further spread thereof or the instances of recidivism in the future (Navez et al., 2016). Whereas the other method of waiting for it to disappear can be termed as good, clinical methods are the best because the issue is handled by a professional.
Conclusion
Mucocele and traumatic neuroma affect the quality of patients’ lives to a considerable extent, creating significant difficulties and contributing to a range of painful experiences for patients. An overview of the existing information has shown that Mucocele and traumatic neuroma are infections that occur around the salivary gland and, in most cases, the mouth. According to the discussion, there are several ways in which they can be diagnosed. After diagnosis, based on the specifics of the condition, they can be managed by various clinical methods.
References
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