Mucocele is a collection of mucin in the submucosa, which&nbsp;occurs mostly due to rupture of the gland proper or the duct of&nbsp;a minor salivary gland. They are most commonly found on the&nbsp;lower lip followed by floor of the mouth and buccal mucosa.&nbsp;Only 9 to 10% of Mucocele are found on the tongue and that&nbsp;they occur exclusively in the anterior lingual salivary glands of&nbsp;Blandin and Nuhn. The following is a case report of mucous&nbsp;extra-vasation phenomenon of lingual glands of Blandin and&nbsp;Nuhn

Fathima, S Shabana

Rajalakshmi, R

Sajeev, R

English

Atharva Scientific Publications (E-Jounals)

R Rajalakshmi et al
230
Case RepoRt
Mucous Extravasation Phenomenon of Lingual Glands of 
Blandin and Nuhn
R Rajalakshmi, S Shabana Fathima, R Sajeev
ABSTRACT
Mucocele is a collection of mucin in the submucosa, which 
occurs mostly due to rupture of the gland proper or the duct of 
a minor salivary gland. They are most commonly found on the 
lower lip followed by floor of the mouth and buccal mucosa. 
Only 9 to 10% of Mucocele are found on the tongue and that 
they occur exclusively in the anterior lingual salivary glands of 
Blandin and Nuhn. The following is a case report of mucous 
extra-vasation phenomenon of lingual glands of Blandin and 
Nuhn.
Keywords: Mucocele, Extravasation Phenomenon, Blandin 
and Nuhn, Glands.
How to cite this article: Rajalakshmi R, Fathima SS, Sajeev 
R. Mucous Extravasation Phenomenon of Lingual Glands of 
Blandin and Nuhn. J Orofac Res 2013;3(3):230-232.
Source of support: Nil
Conflict of interest: None declared
INTRODUCTION
The mucocele is a common lesion of the oral mucosa that 
results from rupture of a salivary gland duct and spillage 
of mucin into the surrounding soft tissues.1 The wall of 
this cavity is made up of a lining of compressed fibrous 
connective tissue and fibroblast.2 
Mucoceles generally appear as soft, painless swelling 
of the mucosa with superficial lesion imparts a bluish 
translucent hue although deeper lesion appear normal in 
color.1 The mucoceles are more commonly found in the 
lower lip but rarely reported on the tongue, upper lip, 
retromolar pad and palate.4 They may occur at any age, they 
are seen most frequently in the second and a third decade of 
life.3 This lesion has no sex predilection and occurs more 
frequently in children, adolescents and young adults.2,4
Glands of Von Ebner, glands of Weber and the glands of 
Blandin and Nuhn are three main groups of minor salivary 
glands found in the human tongue. The glands of Von Ebner 
(located in association with the circumvallate and the foliate 
papillae) are serous glands, the glands of Weber (located 
along the lateral border of the tongue and posterior aspect 
of the dorsum of the tongue) are purely mucous glands, 
Whereas the glands of Blandin and Nuhn (located in the 
musculature of the anterior ventral surface of the tongue) are 
mixed mucous and serous glands. Mucoceles on the tongue 
occur almost exclusively on the ventral surface where the 
glands of Blandin and Nuhn are located.5 
CLINICAL REPORT
A 10-year-old female patient came to the Department 
of Pedodontia and Preventive Dentistry, with a painless 
swelling of 10 days duration in the midline of the ventral 
surface of tongue (Fig. 1). Past medical history was non-
contributory and she gave no history of trauma.
On examination, there was a soft, smooth, single, sessile, 
painless, translucent swelling measuring about 15 × 10 mm 
in the midline of the ventral surface of the tongue, 15 mm 
away from the tip of the tongue. On application of pressure, 
the lesion did not empty. The clinical appearance was that of 
a mucocele (Fig. 1). The lab investigations like Hb, BT and 
CT were conducted and the values are found to be normal.
The lesion was excised, under local anesthesia, 
by dissection down to the muscle layer along with 
associated normal minor salivary glands to avoid recurrence 
(Fig. 2). The wound was closed primarily with sutures. The 
excised tissue was submitted for pathological investigation 
(Fig. 3).
Histopathology Report (Fig. 4)
The given H & E stained soft tissue section shows surface 
epithelium associated with mucous extravasation. The 
lesional connective tissue comprises of haphazardly 
arranged collagen fibers admixed with muscle fibers and 
acini. Deeper down within the connective tissue shows 
empty space suggestive of mucin been washed and walled 
off by granulation tissue, resembling that of a cystic 
10.5005/jp-journals-10026-1101
Fig. 1: The swelling on the ventral surface  
of the tongue
Mucous Extravasation Phenomenon of Lingual Glands of Blandin and Nuhn
Journal of Orofacial Research, July-September 2013;3(3):230-232 231
JoFR
Postoperative Review
The patient was followed for 6 months postsurgically. There 
was no recurrence of the lesion (Fig. 5).
DISCUSSION
Mucous extravasation cysts and mucous retention cysts are 
collectively referred as mucoceles. In mucous extravasation 
cyst, the mucous has extravasated into the connective tissue 
and there is no epithelial lining. The mucous retention cyst, 
occurs as a result of dilatation of the duct due to blockage by 
a sialolith or a mucus plug, usually found in the palate and 
floor of mouth and commonly seen in the older age group.6,7
The extravasation type usually results from local trauma 
such as biting and is found most commonly in the lower lip 
and in younger age groups.7 In the present case, the patient 
revealed no history of trauma which can also been explained 
as per by Daniels et al.8 They describe that, the extravasation 
type mucoceles of Blandin and Nuhn may be reported even 
in the absence of trauma, which would have been so minor 
as to escape the patients’ attention.
Andiran et al, reported that the age of occurrence of 
mucoceles of Blandin and Nuhn ranged from 10 weeks to 
26 years with a peak in the second decade. Jinbu et al pointed 
out extravasation cyst occurs in age range of 5 years to 
36 years. Mucoceles of Blandin and Nuhn seem to have a 
predilection for females as stated by Andiran , Jinbu et al8 
and Saurabh R Joshi et al.9 In our case, it is also a female 
patient in the beginning of second decade of life.
Mucoceles of Blandin and Nuhn are usually less than 
10 mm in diameter.6 Occasionally, they may reach a large 
size of 3 cm or greater. Larger lesions may interfere with 
normal feeding or may cause airway obstruction.10 The 
superficial lesions often imparts a bluish translucent hue, 
although deeper mucoceles may be normal in color. The 
Fig. 2: Excision of the lesion
Fig. 3: Grossed tissue measuring about 15 × 10 mm
Fig. 4: The lower power photomicrograph shows epithelium with 
mucous extravasation 
lining comprising of lymphocytes, flattened fibroblast 
and mucinophages. The histopathological findings were 
suggestive of ‘mucous extravasation phenomenon’.
Fig. 5: Postoperative photograph after a period of 6 months
R Rajalakshmi et al
232
mucoceles characteristically are painless, fluctuant and 
duration varies from few days to several years.1 The current 
case presents a single, soft, smooth, sessile, painless, 
translucent swelling measuring about 15 × 10 mm, which 
coincides with the clinical features of mucous extravasation 
phenomenon of lingual glands of Blandin and Nuhn.
 The majority of the cases of mucoceles of Blandin and 
Nuhn are polypoid, fluid filled masses usually located in 
the tip of the ventral surface of the tongue. Rarely, these 
lesions are presented lateral to the midline.11 Saurabh R Joshi 
et al9 reported that among 30 lesions 24 (80%) lesions were 
located at the midline, only six lesions occurred laterally to 
the midline. In the present case, the lesion is present in the 
midline of the ventral surface 15 mm away from the tip of 
the tongue.
The various differential diagnosis of mucocele are 
ranula, benign or malignant salivary gland neoplasms, 
oral hemangioma, cysticercosis (parasitic infection), oral 
lymphangioma, superficial mucoceles may be confused with 
cicatricial pemphigoid, bullous lichen planus and minor 
aphthous ulcers.1,2,4
Surgical excision with removal of the involved accessory 
salivary gland has been suggested as the treatment. 
Marsupialization will only result in reoccurrence.3 
Reoccurrence of the lesion twice after marsupialization was 
reported by Ellis et al and it was satisfactorily treated only 
by complete excision.12
Large lesions may be marsupialized (unroofing 
procedure) followed by surgical excision to prevent 
significant loss of tissue or to decrease the risk for 
significantly traumatizing the labial branch of the mental 
nerve. The excised tissue should always be submitted to 
the pathological investigations to confirm the diagnosis and 
rule out the salivary gland tumors.4 Alternative method of 
treatment includes laser ablation, cryotherapy, electrocautery 
and intralesional corticosteroid injections.8,13 
CONCLUSION
This is a case report of mucous extravasation phenomenon of 
lingual glands of Blandin and Nuhn. The rate of occurance 
of this lesion is only 9 to 10%. Mucoceles of Blandin and 
Nuhn seem to have a predilection for females and the age 
of occurrence was ranged from 10 weeks to 26 years with a 
peak in the second decade. The present subject exhibited a 
soft, single, sessile, painless, translucent swelling measuring 
about 15 × 10 mm on the ventral surface of the tongue, 
15 mm away from the tip of the tongue. Surgical excision 
with removal of the involved accessory salivary gland was 
done to correct the condition and to prevent recurrence.
REFERENCES
 1. Neville BW, Damm DD, Allen CM, Bouquot JE. Oral 
maxillofacial pathology. 3rd ed; Elsevier; 2009. p.258-269
 2. Sivapathasundharam RB. Shafer’s Textbook of Oral Pathology. 
5th ed. Elsevier; 2009. p. 113-121. 
 3. McDonald, Avery and Dean: dentistry for the child and 
adolescent, 8th ed. Mosby; 2004. p.321-323.
 4. Gupta B, Anegundi R, Sudha P, Mucocele MG. Two case reports. 
J Oral Health Comm Dent 2007;1(3):56-58.
 5. Tandler B, Pinkstaff CA, Riva A. Ultrastructure and histochemistry 
of human anterior lingual salivary glands (glands of Blandin and 
Nuhn). Anat Rec 1994;240:167-177.
 6. Shear M, Speight PM. Cysts of the oral and maxillofacial regions. 
4th ed. Blackwell Munksgaard 2007. p.212-215.
 7. Greenberg MS. Salivary gland disease. In: Lynch MA, editor. 
Burket’s oral medicine: diagnosis and treatment. Lippincott-
Raven: Philadelphia, PA 1997, pp. 415-418.
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Blandin and Nuhn: a report of 5 cases Saudi Dental Journal 
2005;17(3):154-161.
 9. Joshi SR, Pendyala GS, Choudhari S, Kalburge J. Mucocele of the 
glands of Blandin and Nuhn in children: a clinical, histopathologic 
and retrospective study. N Am J Med Sci 2012 Sept;4(9):379-383.
 10. Andiran N, Sarikayalar F, Unal OF, Baydar DE, Ozaydain 
E. Mucocele of the anterior lingual salivary glands from 
extravasation to an alarming mass with a benign course. Int J 
Paediatr Otorhinolaryngol 2001;61:143-147.
 11. Jinbu Y, Kusama M, Itoh H, Matsumoto K, Wang J, Noguchi 
T. Mucocele of the glands of of Blandin and Nuhn: clinical and 
histopathological analysis of 26 cases. Oral Surg Oral Med Oral 
Pathol Oral Radiol Endod 2003;95:467-470.
 12. Ellis E, Scott R, Upton LG. An unusual complication after 
excision of a mucocele of the anterior lingual gland. Oral Surg 
Oral Med Oral Pathol 1983;56:467-471.
 13. Wilcox JW, Hickory R. Nonsurgical resolution of mucocoele. J 
Oral Surg 1978;36:478. 
ABOUT THE AUTHORS
R Rajalakshmi (Corresponding Author)
Senior Lecturer, Department of Pedodontia, Adhiparasakthi Dental 
College, Melmaruvathur, Tamil Nadu, India, Phone: 9894424241 
e-mail: lux_me_laks@yahoo.co.in
S Shabana Fathima
Senior Lecturer, Department of Oral Pathology, Adhiparasakthi Dental 
College, Melmaruvathur, Tamil Nadu, India
R Sajeev
Professor, Department of Pedodontia, Adhiparasakthi Dental College 
Melmaruvathur, Tamil Nadu, India


Mucous Extravasation Phenomenon of Lingual Glands of Blandin and Nuhn

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Mucous Extravasation Phenomenon of Lingual Glands of Blandin and Nuhn

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