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Mouth Diseases

Lump Under Tongue Back, Despite 2 Surgeries

02/12/2010

Question:

I had a lump under my tongue, that sometimes looks clear, sometimes white. Its almost water filled and has increased in size as time past (2/3 months). I then had it removed by an oral surgeon and the report came back as pyogenic granuloma. Then just one day after the removal of the stitches, another lump appeared where the pervious lump was, similar apperance, only samller and white instead of clear. So I went back to my oral surgeon and he removed it again, along with that white thing, he also removed some of my salivary glands. Now, just three days after the removal of the stitches from the second surgery, its back again, this time, much bigger. Its clear and seems water filled. Should I go back to the oral surgeon and have it removed again? What should I do? Why is it back again, despite 2 surgeries? Is it reactive? Shall I just live with it?

Answer:

What you describe certainly sounds like a reactive process and may have been associated with your salivary glands all along. A pyogenic granuloma is also a reactive, tumor-like growth that may occur following minor tissue injury. In a few cases, the injury can affect the salivary (spit) glands under the surface of the skin lining the mouth. Injured salivary glands then may leak or spill spit (saliva, mucus) under the surface lining, creating a clear bubble or bump of tissue termed a mucocele or mucus extravasation phenomenon.

In reaction to the same injury, then, the tissues can develop a mixture of pyogenic granuloma (made up of small capillary blood vessels or granulation tissue), spilled mucus (mucocele) and even some scar tissue over time. One of the known complications with mucocele, however, is the tendency for local recurrence (to come back). That is why treatment usually entails complete removal of the mucus spill plus the leaky salivary gland. But even with adequate surgery, inadvertent injury to nearby salivary glands cannot always be completely avoided, and and additional surgery may be necessary.

If you have a good relationship with your oral surgeon, I would recommend you go back and start again. If not, a second opinion from another oral surgeon is the next reasonable option.

Good luck!

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Response by:

John R Kalmar, DMD, PhD John R Kalmar, DMD, PhD
Clinical Professor of Pathology
Associate Dean of Dentistry Administration
College of Dentistry
The Ohio State University