Salivary Mucocele (Sialocele)

Salivary mucocele is a saliva-filled swelling resulting from damage to and/or obstruction of a salivary gland or duct.  The most commonly affected gland is the submandibular gland, and the most common presentation is a unilateral submandibular mucocele.  Bilateral presentation, pharyngeal or sublingual (aka ranula), or involvement of a different gland (e.g. parotid gland) are also possible.  

Frequently, the underlying cause of a sialocele is unknown.  Trauma to the gland or its associated duct, infection in or near the system, or sialolithiasis are potential etiologies.  Occasionally, medical management with anti inflammatories and/or antibiotics is successful.  Frequently, however, medical management fails or the mucocele is recurrent.  In these cases, surgical correction is indicated.  

For a mandibular salivary mucocele, surgical treatment involves extirpation of the monostomatic and polystomatic portions of the mandibular salivary gland, as well as the duct and its associated accessory glands.  The duct travels dorsomedially from the gland, then runs ventromedially to the digastricus muscle and along the ventromedial aspect of the mandible.  Successful treatment of the condition requires dissection of all structures up to the level of the lingual nerve.  Identification of anatomical landmarks can be challenging because of distention caused by the mucocele, as well as the development of fibrous adhesions to associated structures.  The more chronic the mucocele, the more challenging the procedure becomes.  In very chronic cases, it can be impossible to tell which side is affected, or if both sides are, so I recommend treating sooner rather than later to prevent having to treat bilaterally.

Surgical treatment of salivary mucocele is typically very rewarding, with recurrence being unlikely if performed correctly.  Even in cases of bilateral extirpation, patients do not exhibit evidence of complications associated with reduced saliva production, likely due to significant redundancy in the system.  If you have a case you would like to discuss, please contact me for a consultation.