2021, Number 1
Mucocele: frequent lesion of the minor salivary glands in pediatric patients
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ABSTRACT
Introduction: The salivary glands are exocrine glands with a merocrine type of secretion. Their importance lies in the salivary production in the oral cavity, thus contributing to the regulation of oral pH and maintaining the integrity of the oral mucosa and tissues. An affectation in them alters the oral system. The main objective of the present study was to identify and record the most frequent oral salivary gland pathologies in pediatrics in a regional referral health center. Material and methods: This study is a retrospective, observational, analytical, correlational, and cross-sectional study. We reviewed data from admission books to the Anatomic Pathology and Cytology Department of the "Juan Pablo II" Pediatric Hospital in the city of Corrientes, Argentina, including age, gender, and location of the lesion in patients from one month to 15 years of age. Results: Sixty-three cases of salivary gland lesions were identified; forty-seven of them were compatible with mucocele diagnosis being the most frequent lesion, predominantly in females. The age group with the highest number of cases was from 13 to 15 years old, the lower lip being the frequent location. Conclusion: This is the first study of these lesions in the region. The mucocele is the most frequent salivary glands lesion in pediatrics.INTRODUCTION
The salivary glands are exocrine glands, with merocrine type of secretion, which discharge their secretion product (saliva) into the oral cavity, contributing to oral self-cleaning, providing protection and defense (salivary mucins) regulating oral pH (buffer-buffer system) maintaining the integrity and remineralization of tooth enamel. In addition, the digestion begins through the contribution of salivary amylase and ptyalin, and contributes to maintaining the body's water balance, so that the decrease in salivary secretion is an alarm sign for both the oral and general health.1,2
Mucocele are lesions of the minor salivary glands produced by accumulation of mucoid material at the oral connective tissue level. There are two types: true mucocele or mucous retention cysts (formed by occlusion of the glandular lumen) and mucocele by extravasation from the rupture of the excretory duct. They are usually observed in pediatric ages and young adults due to a mechanical trauma during teething changes.3
Bearing in mind that the study and dissemination of pathologies in oral soft tissues are not adequately ranked as hard tissues (dental and bone) and that most epidemiological studies deal with caries, periodontal diseases, malocclusion and tumors, mostly oriented to adulthood, so they are not easily extrapolated to pediatric age.4-6
The Hospital Pediátrico "Juan Pablo II" (reference center in pediatric health in our region, Corrientes, Argentina) cares for children from one month to 15 years old. Pediatric oral pathologies are not very hierarchical due to the limitation in the oral cavity observation, often focusing attention on teeth (hard tissues) with little sign-symptom weighting about the rest of the oral cavity. The importance of identifying pathologies in the minor salivary glands with a mucocele diagnosis is highlighted here, knowing their frequency, percentage and most frequent location correlating them with gender and age of the patients at the diagnosis time, and registering them applying international classifications: ICD-10 y ICD-OE.7
Therefore, the main objective of this study was to identify the histopathological features of corresponding oral lesions diagnosed of mucocele in pediatric patients attended in the Department of Pathological Anatomy and Cytology of the Pediatric Hospital "Juan Pablo II", Corrientes Capital, 1997-2017, as well as to correlate the presence of mucocele in pediatric patiens, patient gender and location within the oral cavity. Additionally, to apply international clasification of ICD-10 diseases, in particular the classification applied in dentistry and stomatology ICD-OE.
MATERIAL AND METHODS
The research presented a retrospective, observational, analytical, correlational, and cross-sectional design. The study was carried out in the SAPyC del Hospital Pediátrico "Juan Pablo II" de Corrientes, Argentina and in the Pathological Anatomy subject of the Medicine School, Universidad Nacional del Nordeste, Corrientes, Argentina. The studied cases corresponded to the pediatric patients (from one month of life to 15 years old) who attended the hospital presenting salivary gland lesions, which were biopsied or surgically excised and cytodiagnosed. The period was from June 1, 1997, to June 1, 2017.
The study sample included biological materials embedded in paraffine processed by conventional histotechnology and staining with the hematoxylin-eosine technique. The stained histological slides allowed their descriptive study with optical microscopy and diagnostic identification and were recorded in the SAPyC admission protocols and books.
The records were statistically analyzed, obtaining the most frequent oral pathology in pediatric salivary glands, mucocele, being the same correlated with the age of presentation and the gender of the patients, and the location of the injury.
The classification was made by applying the criteria of the International Statistical Classification of Diseases and Related-Health Problems, tenth revision (ICD-10) and the International Classification of Diseases Applied to Dentistry and Stomatology (ICD-OE) that includes diseases and disorders of the oral cavity and underlying structures, widely used to develop national morbidity and mortality statistics.
RESULTS
In the studied period (1997-2017), 14,186 samples were received and processed; from them, sixty-three corresponded to salivary gland lesions. Forty-seven had a histopathological diagnosis of mucocele (Figures 1 and 2), representing 74.6% of the salivary gland lesions; therefore, it is the most frequent pathology in the studied population (Table 1).
Within the analyzed period, 2005 and 2017 years were those with the highest number of mucocele cases, corresponding to 29.8% of the total. In contrast, in 2003 and 2012, no minor salivary gland lesions were recorded (Figure 3).
Regarding gender variables, 29 cases (62%) were females and 18 males (38%). The female-male ratio was 2:1 (29:18). The age group with the highest percentage of mucocele diagnosed patients corresponded to the group from 13 to 15 years old, corresponding to 34%. It should also be noted that the highest number of cases (9) was specifically at 14 years old (Table 2), with no particular difference regarding gender. The median age was nine years. The most frequent location of the lesion was the lower lip with 33 cases (70%) and the jugal mucosa with 14 cases (30%).
When applying the ICD-10 and ICD-OE classifications for the analyzed and recorded oral lesions, the results were: Mucocele ICD-10: K 11.6, ICD-OE: K 11.69.
DISCUSSION
In this study, the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10) was applied; it is a systematic classification of diseases subject to agreements between governments and it provides a common language that allows health professionals to share information worldwide, which greatly favors the development of national morbidity and mortality statistics. Likewise, the Classification of Diseases Applied to Dentistry and Stomatology (ICD-OE) which derives directly of the ICD-10 was applied; this one was conceived as a part of classifications of diseases and problems related to health, including all diseases and disorders that occur in the oral cavity and underlying structures. Both classifications were used for their advantages in terms of disclosure of the subject and they are also under constant review, which provides greater security and updating.7
A similar study was carried out by Camilo Qqueccaño and Sindi Deysi,8 who determined the frequency of histopathological diagnoses of oral and maxillofacial lesions in pediatric patients performed in the oral pathology laboratory of the Facultad de Estomatología "Roberto Beltrán" de la Universidad Peruana Cayetano Heredia from 1992 to 2012. They detected salivary gland lesions (19.3%) being mucocele the most frequent diagnosis (16.5%) and female the most affected (54.4%).8 These results are similar to those obtained in this research, where salivary gland lesions diagnosed with mucocele represent 74.6% and female present a higher percentage of cases (62%) and the most frequent location was at the level of the lower lip.
CONCLUSION
The interest of this scientific work lies in the fact that there is no previous study of these characteristics in the region. Its results make it clear that mucocele is the most frequent salivary gland lesion in pediatric patients. However, through the study it was possible to discover that the mucocele is the most common oral lesion in salivary glands, predominantly in female, and whose most frequent pathological location is the lower lip, so it can be assumed that it is related to mixed dentition (between 6 and 12 years) in pediatric patients, the median being at 9 years.
Although our study has limitations, like other retrospective studies, it is similar to other studies carried out by the aforementioned researchers. In the analyzed records there were no differences between retention and extravasation mucocele so it was not possible to calculate their incidence, which would be very valuable to discern in future research.
REFERENCES
Qqueccaño C, Sindi D. Frecuencia de diagnósticos histopatológicos de lesiones orales y maxilofaciales de pacientes pediátricos realizados en el Laboratorio de Patología Oral de la Facultad de Estomatología "Roberto Beltrán" de la Universidad Peruana Cayetano Heredia (1992-2012) [Tesis de pregrado]. Perú: Universidad Peruana de Cayetano Heredia; 2013. Disponible en: https://hdl.handle.net/20.500.12866/1306
AFFILIATIONS
1 Cátedra Anatomía y Fisiología Patológica. Carrera de Medicina. Facultad de Medicina. Universidad Nacional del Nordeste. Corrientes, Argentina.
2 Servicio de Anatomía Patológica y Citología del Hospital Pediátrico "Juan Pablo II". Universidad Nacional del Nordeste. Corrientes, Argentina.
3 Cátedra Clínica Estomatológica. Facultad de Odontología. Universidad Nacional del Nordeste. Corrientes, Argentina.
4 Cátedra Histología y Embriología. Facultad de Odontología. Universidad Nacional del Nordeste. Corrientes, Argentina.
CORRESPONDENCE
Rocío del Carmen Dynia. E-mail: merodynia@gmail.comReceived: Mayo 2020. Accepted: Junio 2020.