A Blandin–Nuhn mucocele is a benign, mucus-filled lesion arising from the anterior ventral glands of the tongue, known as the glands of Blandin–Nuhn.
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✅ Etiology
The primary etiological factor is mechanical trauma to the ventral surface of the tongue, which leads to rupture of the minor salivary gland ducts. Common contributing factors include:
▪️ Chronic tongue biting
▪️ Sharp incisal edges or orthodontic appliances
▪️ Accidental trauma
▪️ Parafunctional habits
Unlike retention cysts, Blandin–Nuhn mucoceles are classified as mucus extravasation phenomena, lacking an epithelial lining.
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Clinically, these lesions present as:
▪️ Soft, fluctuant nodules on the ventral surface of the tongue
▪️ Bluish, translucent, or normal-colored appearance
▪️ Sessile or pedunculated morphology
▪️ Variable size, often increasing with trauma
▪️ Usually painless, though discomfort may occur during speech or mastication
Recurrent rupture and refilling is a characteristic clinical behavior that may complicate diagnosis.
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Diagnosis is primarily clinical, supported by lesion location and appearance. Key diagnostic considerations include:
▪️ History of trauma or oral habits
▪️ Typical ventral tongue localization
▪️ Fluctuant consistency
Definitive diagnosis is established through histopathological examination, which reveals:
▪️ Pools of extravasated mucus
▪️ Surrounding granulation tissue
▪️ Absence of epithelial lining
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The treatment of choice is complete surgical excision, including removal of the involved minor salivary glands to prevent recurrence.
Treatment Options
▪️ Conventional surgical excision (gold standard)
▪️ Laser excision (CO₂ or diode lasers)
▪️ Cryosurgery (less commonly used)
Key surgical principles include:
▪️ Adequate depth of excision
▪️ Removal of adjacent glandular tissue
▪️ Careful hemostasis due to tongue vascularity
Recurrence is uncommon when the lesion and associated glands are completely removed.
📊 Comparative Table: Differential Diagnosis of Ventral Tongue Lesions
| Lesion | Key Clinical Features | Diagnostic Considerations |
|---|---|---|
| Blandin–Nuhn mucocele | Soft, fluctuant ventral tongue lesion | History of trauma; extravasation phenomenon |
| Hemangioma | Bluish-red lesion, blanching on pressure | Positive diascopy; vascular origin |
| Pyogenic granuloma | Rapidly growing, ulcerated mass | Inflammatory response to irritation |
| Salivary gland neoplasm | Firm, persistent mass | Requires biopsy to rule out malignancy |
Blandin–Nuhn mucoceles are often underdiagnosed due to their unusual ventral tongue location and resemblance to vascular lesions. Misdiagnosis may lead to inappropriate management, such as aspiration or incomplete excision, resulting in recurrence. Awareness of this entity is essential for accurate diagnosis and effective treatment, particularly in pediatric dentistry and oral medicine.
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Blandin–Nuhn mucoceles are benign but clinically significant lesions that require accurate diagnosis and definitive management. Surgical excision with removal of the affected glands remains the most effective treatment, offering excellent prognosis and low recurrence rates.
🎯 Clinical Recommendations
▪️ Include Blandin–Nuhn mucocele in the differential diagnosis of ventral tongue lesions
▪️ Avoid simple aspiration as definitive treatment
▪️ Perform complete excision including adjacent glandular tissue
▪️ Submit all excised lesions for histopathological analysis
📚 References
✔ Chi, A. C., Lambert, P. R., & Neville, B. W. (2018). Oral mucoceles: Clinical and histopathologic review. Oral and Maxillofacial Pathology, 125(2), 138–145. https://doi.org/10.1016/j.oooo.2017.09.011
✔ Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2023). Oral and maxillofacial pathology (5th ed.). Elsevier.
✔ Yagüe-García, J., España-Tost, A. J., Berini-Aytés, L., & Gay-Escoda, C. (2009). Treatment of oral mucoceles with CO₂ laser. Journal of Oral and Maxillofacial Surgery, 67(2), 391–395. https://doi.org/10.1016/j.joms.2008.06.061
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