Managing Recurring Tongue Base Mucoceles: Surgical Options and Alternatives

Q: Managing Recurring Tongue Base Mucoceles: Surgical Options and Alternatives

Hello： The pathology reports from these two surgeries appear to be benign. <br>If the swelling at the base of your tongue does not seem malignant and has not caused any symptoms, it is recommended that you discuss with your attending physician whether surgery is necessary.

The base of the tongue is suspected to have a "mucous cyst."

Hello Doctor: I underwent cyst excision surgery at the base of my tongue in May and July of last year.
The first report indicated "Oral cavity, tongue base, biopsy, consistent with fibroepithelial polyp." The specimen submitted consisted of one tissue fragment measuring 0.1 x 0.1 x 0.1 cm, fixed in formalin.
Grossly, it appeared brown and soft.
All sections were examined.
Microscopically, it showed a fibroepithelial polyp with chronic inflammation and fibrotic stroma lined by squamous epithelium without atypia.
The second report stated "Oral cavity, tongue base, excision, mucocele-like cyst." The specimen submitted consisted of one tissue fragment measuring 1.5 x 0.6 x 0.6 cm, fixed in formalin.
Grossly, it was brown and soft.
All sections were examined.
Microscopically, it showed a cystic lesion with a fibrous wall but no lining epithelium, containing some foamy histiocytes.
A mucocele-like cyst is favored.
However, now (this May), it has swollen again.
Am I destined to repeatedly undergo general anesthesia for microlaryngoscopy? Is there a way to eradicate this or a medication that could help? Thank you.

Mr. Zhang, 40~49 year old female. Ask Date: 2012/05/08

Dr. Hu Kexin reply Otolaryngology

Hello: The pathology reports from these two surgeries appear to be benign.
If the swelling at the base of your tongue does not seem malignant and has not caused any symptoms, it is recommended that you discuss with your attending physician whether surgery is necessary.

Reply Date: 2012/05/08

More Info

Managing recurring tongue base mucoceles can be quite challenging, especially when surgical interventions have not provided a lasting solution. Based on your previous experiences with the excision of fibroepithelial polyps and mucocele-like cysts, it is understandable that you are seeking alternatives to repeated surgeries, particularly given the discomfort and risks associated with general anesthesia.

Mucoceles are typically caused by the obstruction of salivary glands, leading to the accumulation of mucus. In the case of tongue base mucoceles, the location can complicate treatment options. While surgical excision is often the primary method of management, recurrence can occur if the underlying cause is not adequately addressed.

Surgical Options
1. Complete Excision: The most definitive treatment for a mucocele is complete surgical excision, including the cyst wall. However, as you have experienced, this may not always prevent recurrence, especially if the surrounding salivary glands are affected or if the cyst is not fully removed.

2. Marsupialization: This technique involves creating an opening in the cyst and suturing the edges to the surrounding tissue, allowing the cyst to drain and heal from the inside out. This may be less invasive and can be performed under local anesthesia, potentially reducing the need for general anesthesia.

3. Sialendoscopy: If the mucocele is related to a blocked salivary duct, sialendoscopy can be used to visualize and remove obstructions within the duct. This minimally invasive procedure may help in cases where the mucocele is recurrent due to salivary gland issues.

Non-Surgical Alternatives
1. Observation: If the mucocele is not causing significant discomfort or functional issues, a period of observation may be appropriate. Many mucoceles can resolve spontaneously.

2. Medications: While there are no specific medications to treat mucoceles, anti-inflammatory medications may help reduce discomfort. In some cases, corticosteroids may be injected to reduce inflammation, although this is not a common practice for mucoceles.

3. Sialagogues: These are substances that stimulate saliva flow, which may help in cases where the mucocele is related to salivary gland dysfunction. Citrus fruits or sour candies can be used as natural sialagogues.

Follow-Up and Monitoring
Given the recurrent nature of your condition, regular follow-up with your healthcare provider is essential. They may recommend imaging studies, such as ultrasound or MRI, to assess the cyst's characteristics and determine if there are any underlying issues contributing to its recurrence.

Conclusion
While repeated surgical interventions may seem like the only option, exploring less invasive alternatives and addressing any underlying causes is crucial. Discussing these options with your healthcare provider can help tailor a management plan that minimizes discomfort and reduces the likelihood of recurrence. If surgical intervention is necessary, consider discussing the possibility of less invasive techniques, such as marsupialization or sialendoscopy, which may provide relief without the need for general anesthesia. Always ensure that you have a thorough understanding of the risks and benefits of any proposed treatment plan.

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