Waiting for Self-Healing as a Primary Management Strategy for Lower Lip Mucoceles

Waiting for Self-Healing as a Primary Management Strategy for Lower Lip Mucoceles | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Waiting for Self-Healing as a Primary Management Strategy for Lower Lip Mucoceles Jian-lin LIU, Yu-nan LIU, Lin WANG, Dian-can WANG This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3929948/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Jun, 2024 Read the published version in Clinical Oral Investigations → Version 1 posted 7 You are reading this latest preprint version Abstract Objectives Oral mucoceles are most frequently encountered on the lower lip. A variety of treatment options are currently employed, including surgical excision, pharmacological injections, and laser therapy. However, each of these approaches may introduce risks and potential complications. Clinical practice has demonstrated a potential for self-healing in lower lip mucoceles, making a conservative observational approach more appealing. This research is a prospective study aimed at evaluating the self-healing capacity of lower lip mucoceles. Methods In this prospective study, patients with mucoceles were encouraged to intentionally delay medical intervention and to wait for self-healing. Disappearance of the mucocele for at least 3 months was defined as self-healing. Results Thirty patients with lower lip mucoceles were included. With no intervention, 24 patients (80%) reported self-healing of lower lip mucoceles. The mean natural duration of the mucoceles was 3.63 (± 4.7; 1–24) months. After self-healing of the mucocele, the patients were followed up for 17.21 (± 9.45; 2–30) months and there were no reported recurrences. Conclusions Lower lip mucoceles have a high potential for self-healing and patients may be routinely encouraged to wait for self-healing. Clinical Relevance The high self-healing rate observed in this study suggests that a conservative, non-interventional approach might be considered as the first-line management for lower lip mucoceles. Mucocele Self-healing Lower lip Surgical excision Figures Figure 1 Figure 2 Introduction Oral mucoceles are the most common non-neoplasm disease in the minor salivary glands. The lower lip is the most commonly affected area[ 1 – 4 ]. They are classified into two pathological types: extravasation and retention, with the extravasation type being more common than the retention type[ 2 , 5 , 6 ]. While the exact etiology remains unknown, trauma and blockage of salivary gland ducts are often considered as probable contributing factors. The primary recommended treatment methods are surgical excision, micromarsupialization[ 7 , 8 ], laser therapy[ 9 ], cryotherapy[ 10 ], and sclerotherapy, which involves the use of agents such as OK-432[ 11 ], promethazine hydrochloride[ 12 ] and polidocanol[ 13 ]. Surgical excision is typically recommended. We have observed that most intraoral ranulas exhibit a high potential for self-healing[ 14 ]. We hypothesized that self-healing of lower lip mucoceles may also be common, and that advising patients to wait for self-healing may be encouraged as routine practice before any clinical intervention. This intentional delay of intervention has few potential consequences because most lower lip mucoceles are benign and asymptomatic, with only a mild influence on quality of life and a low incidence of secondary infection. We report the results of a prospectively designed pilot study, in which patients with lower lip mucoceles were advised to wait for self-healing. Methods Patients The study was conducted at the department of stomatology, Liaocheng People’s Hospital (Shandong China) and the departments of oral and maxillofacial surgery, School and Hospital of Stomatology Peking University (Beijing China) from December 2020 to December 2023. Informed consent was obtained from all patients, and approval for the study was obtained from the institutional review boards of the respective hospitals. The diagnosis of lower lip mucocele was mainly based on clinical manifestations: a painless, superficial, solid or cystic bulge on the lower lip (Fig. 1 ). For some cystic mucoceles, an "egg-white", transparent viscous fluid is present through aspiration or rupture. Because they are superficial and small, radiographic examinations such as ultrasound, computed tomography, or magnetic resonance imaging are not valid or necessary. Patients were advised about the nature of lower lip mucoceles and the management options, including surveillance and waiting for self-healing, conservative intervention, and surgical resection. Waiting for self-healing was recommended to patients. Demographic characteristics of the patients were recorded including age, sex, duration of symptoms, and history of treatment (time of surgery). The patients were followed up in an outpatient clinic or through consultation via internet or telephone. Clear photos of the lesions were taken, indicating the disappearance or appearance of the mucocele. The criterion for self-healing was disappearance of the mucocele lasting at least 3 months[ 14 ]. Statistical analysis All statistical analyses were performed with SPSS software version 20.0 (IBM Corp., Armonk, NY, USA). Mean, standard deviation, and range were used to express continuous variables, while categorical variables were defined by the absolute number of cases and corresponding percentage values. Correlations between clinical and demographic characteristics were assessed with the chi-square test and Fisher’s exact test. The duration of the mucocele and potential risk factors, such as age, sex, location, and treatment history, were estimated using Kaplan–Meier survival curves and the Breslow test. Significance was determined by P values < 0.05 and 95% confidence intervals. Results From December 2020 to December 2023, 32 consecutive patients with lower lip mucoceles were encouraged to wait for self-healing. Two patients opted for surgical excision because they doubted the potential for self-healing. The remaining 30 patients were included in this study. The clinical characteristics of 30 lower lip mucoceles are listed in Table 1 . The patients’ ages ranged from 3 to 52 years, with mean of 23.6 years. There was no sex predilection, half male and half female. The duration of the lesions of 63.3% of the patients was within 1 month. Two patients had recurrent mucoceles which were surgically excised at least once. More than half of the lesions were on the left side. Table 1 Clinical characteristics of lower lip mucoceles and self-healing rates Clinical characteristics No. of patients (%) Self-healing Yes(%) Not(%) p Age, y, mean, (SD, range) 23.57(± 11.69; 3–52) 24(80) 6(20) < 10 5 (16.7) 4(80) 1(20) 0.991 10 ~ 19 5 (16.7) 4(80) 1(20) 20 ~ 29 10(33.3) 8(80) 2(20) 30 ~ 39 9 (30.0) 7(77.8) 2(22.2) ≥ 40 1 (3.3) 1(100) 0(0) Sex Male 15 (50.0) 10(66.7) 5(33.3) 0.169 Female 15 (50.0) 14(93.3) 1(6.7) Duration of symptoms (month) ≤1 19 (63.3) 15(78.9) 4(21.1) 0.453 2ཞ3 9 (30.0) 8(88.9) 1(11.1) 4ཞ6 2 (6.7) 1(50.0) 1(50.0) history of treatment None 28 (93.3) 22(78.6) 6(21.4) 0.765 1 surgery 1 (3.3) 1(100) 0(0) ≥2 surgeries 1(3.3) 1(100) 0(0) Side left 16(53.3) 14(87.5) 2(12.5) 0.302 Midline 2(6.7) 2(100) 0(0) Right 12 (40.0) 8(66.7) 4(33.3) Surveillance duration(month) ≤12 13 7(53.8) 6(46.2) 0.007 13ཞ24 7 7(100) 0(0) 25ཞ36 10 10(100) 0(0) Total 30 Without intervention, 24 lower lip mucoceles (80%) resolved spontaneously, lasting at least 3 months. Only six patients (20%) who were observed within 12 months reported that self-healing did not occur. There were no differences in the self-healing rate related to age, sex, history of treatment (time of surgery), or side. The mean duration of the 24 self-healed mucoceles was 3.63 (± 4.7; 1–24) months (Fig. 2 ). There were no significant differences in the duration of healing related to age, sex, duration of symptoms, or history of treatment. To evaluate the recurrence of disease, the 24 patients with self-healed mucoceles were followed up until January 2024. The mean follow-up duration post-self-healing was 17.21 (± 9.45; 2–30) months. There have been no reported recurrences to date. Discussion In this prospective study, 30 patients with lower lip mucoceles followed the strategy of waiting for self-healing. Without any intervention, 24 mucoceles (80%) resolved spontaneously in 3.63 (± 4.7; 1–24) months. After self-healing of the mucocele, the patients were followed up for 17.21 (± 9.45; 2–30) months and no recurrences have been reported. Thus, we confirmed that lower lip mucoceles have self-healing potential. Generally, patients exhibit no significant clinical symptoms, a low incidence of secondary infection, and only a mild influence on quality of life. However, traditional surgical excision remains the predominant treatment modality for oral mucoceles[ 2 ]. In recent years, less invasive treatment options, such as micromarsupialization[ 7 , 8 ], laser therapy[ 9 ], cryotherapy[ 10 ], and sclerotherapy[ 13 ] have been explored. Side effects and limitations are associated with these treatments, including allergic reactions, intense pain, tissue damage, challenges in achieving precise control, financial burden, and variable efficacy. Furthermore, these procedures are not easy for preschool children. The self-repair capability of lower lip mucoceles presents an opportunity to reassess current treatment paradigms. By favoring a natural healing process, the stress of invasive treatments and their associated complications are circumvented, significantly lessening the emotional and psychological distress for patients, particularly those with multiple lower lip mucoceles[ 15 ]. Additionally, this could lead to reduced treatment expenditures, easing the financial load on patients and healthcare systems, and allowing for better resource distribution. Research into the self-healing mechanisms could yield preventative healthcare advances, emphasizing the importance of disease prevention and health maintenance. One risk of waiting for self-healing is that if the clinical diagnosis is wrong, appropriate treatment will be delayed. Therefore, the course of self-healing should be monitored. If the clinical manifestations are atypical and the clinical diagnosis is uncertain, surgical excision of the lesion is indicated. The main limitation of this research lies in its execution at only two facilities with a modest sample size. A broader study involving multiple centers and a larger cohort is necessary. We acknowledge that chronic mucoceles persist, necessitating further examination into the dynamics of self-healing. A comprehensive understanding of these mechanisms is essential for advancing mucocele management and prevention strategies. Conclusions Our findings suggest that there is a high potential for self-healing in lower lip mucoceles. It may be advisable to routinely encourage patients with lower lip mucoceles to consider a period of observation as a viable management strategy, allowing natural resolution processes to occur. Declarations Acknowledgments We thank Helen Jeays, BDSc, from Liwen Bianji (Edanz) (www.liwenbianji.cn) for editing the English text of a draft of this manuscript. Author contribution W.D.C. Methodology, Project administration,Collection of cases, Investigation, Data curation, and Writing. L.J.L. Methodology, Project administration, Investigation, Collection of cases, and Writing. L.Y.N. Methodology, Project administration,Collection of cases,Data curation, Statistical analysis. W.L. Methodology, Project administration,Collection of cases, Statistical analysis，Spelling and grammar check, and Editing. All authors reviewed the manuscript. Funding No funding was obtained for this study. Ethics Approval Ethics approval for the study was obtained from the institutional review boards of the Liaocheng People’s Hospital and Hospital of Stomatology Peking University. Informed consent to participate The informed consent obtained from study participants was written. Conflict of interest The authors declare no conflict of interest. References Zahid E, Bhatti O, Zahid MA, and Stubbs M (2022) Overview of common oral lesions. Malays Fam Physician 17: 9–21. https://doi.org/10.51866/rv.37 Bowers EMR, and Schaitkin B (2021) Management of mucoceles, sialoceles, and ranulas. Otolaryngologic Clinics of North America 54: 543–551. https://doi.org/https://doi.org/10.1016/j.otc.2021.03.002 Miranda GGB, Chaves-Junior SC, Lopes MP, Rocha TBD, Colares DF, Ito FA, Cavalcante IL, Cavalcante RB, Andrade BaB, Nonaka CFW, Alves PM, Albuquerque-Júnior RLC, and Cunha JLS (2022) Oral mucoceles: a Brazillian multicenter study of 1,901 cases. Braz Dent J 33: 81–90. https://doi.org/10.1590/0103-6440202204965 De Camargo Moraes P, Bönecker M, Furuse C, Thomaz LA, Teixeira RG, and De Araújo VC (2009) Mucocele of the gland of Blandin-Nuhn: histological and clinical findings. Clin Oral Investig 13: 351–353. https://doi.org/10.1007/s00784-009-0252-x More CB, Bhavsar K, Varma S, and Tailor M (2014) Oral mucocele: A clinical and histopathological study. J Oral Maxillofac Pathol 18: S72-77. https://doi.org/10.4103/0973-029x.141370 Sabarinath B, Murali P, Vijayashree RJ, Sivapathasundharam B, and Kavitha B (2023) Spectrum of salivary gland diseases: A 24-year single-institution retrospective study. Journal of Oral and Maxillofacial Pathology 27. Hashemi M, Zohdi M, Zakeri E, Abdollahzadeh-Baghaei T, and Katebi K (2023) Comparison of the recurrence rate of different surgical techniques for oral mucocele: A systematic review and Meta-Analysis. Med Oral Patol Oral Cir Bucal 28: e614-e621 .https://doi.org/10.4317/medoral.26015 Wang Q, Wu Y, Zhang YOU, Zhang Z, Xu HaO, Jiang Y, and Luo X (2023) Evaluating the outcomes of minimally invasive therapy vs surgery for oral mucoceles: a systematic review and meta-analysis. Journal of Evidence-Based Dental Practice 23: 101841. https://doi.org/https://doi.org/10.1016/j.jebdp.2023.101841 Sadiq MSK, Maqsood A, Akhter F, Alam MK, Abbasi MS, Minallah S, Vohra F, Alswairki HJ, Abutayyem H, Mussallam S, and Ahmed N (2022) The Effectiveness of Lasers in Treatment of Oral Mucocele in Pediatric Patients: A Systematic Review. Materials (Basel) 15. https://doi.org/10.3390/ma15072452 Tsunoda N, Kawai T, Obara M, Suzuki S, Miyamoto I, Takeda Y, and Yamada H (2021) Analysis of effects and indications of cryosurgery for oral mucoceles. Journal of Stomatology, Oral and Maxillofacial Surgery 122: 267–272. https://doi.org/https://doi.org/10.1016/j.jormas.2020.06.013 Ohta N, Fukase S, Suzuki Y, and Aoyagi M (2011) Treatment of salivary mucocele of the lower lip by OK-432. Auris Nasus Larynx 38: 240–243. https://doi.org/https://doi.org/10.1016/j.anl.2010.07.003 Huang Y, Yang C, Wang T, Liu S, and Chen A (2021) Preliminary experience with promethazine hydrochloride injection in the sclerotherapy of oral mucocele. International Journal of Oral and Maxillofacial Surgery 50: 516–521. https://doi.org/https://doi.org/10.1016/j.ijom.2020.06.021 Liu J-L, Zhang A-Q, Jiang L-C, Li K-Y, Liu F-Z, Yuan D-Y, Xu K, Fan Q-C, Liu X-B, Zou B, Meng Z, Feng Y, and Zhang B (2018) The efficacy of polidocanol sclerotherapy in mucocele of the minor salivary gland. J Oral Pathol Med 47: 895–899. https://doi.org/https://doi.org/10.1111/jop.12764 Liu Y, Wang L, Zhu Y, Lan L, and Wang D (2023) High self-healing rate of oral ranula: A prospective study. The Innovation Medicine 1: 100011. https://doi.org/10.59717/j.xinn-med.2023.100011 Abe A, Kurita K, Hayashi H, and Minagawa M (2019) Multiple mucoceles of the lower lip: A case report. Clin Case Rep 7: 1388–1390. https://doi.org/10.1002/ccr3.2253 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 08 Jun, 2024 Read the published version in Clinical Oral Investigations → Version 1 posted Editorial decision: Revision requested 28 Apr, 2024 Reviews received at journal 28 Apr, 2024 Reviewers agreed at journal 17 Apr, 2024 Reviewers invited by journal 14 Feb, 2024 Submission checks completed at journal 12 Feb, 2024 Editor assigned by journal 12 Feb, 2024 First submitted to journal 04 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3929948","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":272548719,"identity":"ebc83df0-252b-4c00-90db-796cd2b3a736","order_by":0,"name":"Jian-lin LIU","email":"","orcid":"","institution":"Liaocheng People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jian-lin","middleName":"","lastName":"LIU","suffix":""},{"id":272548720,"identity":"89e0e226-b16a-4296-9cff-8ca055988fa9","order_by":1,"name":"Yu-nan LIU","email":"","orcid":"","institution":"Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases","correspondingAuthor":false,"prefix":"","firstName":"Yu-nan","middleName":"","lastName":"LIU","suffix":""},{"id":272548721,"identity":"c31bd986-2c60-456b-be21-7163fc2d8c9b","order_by":2,"name":"Lin WANG","email":"","orcid":"","institution":"Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"WANG","suffix":""},{"id":272548722,"identity":"99235274-bef3-46fe-8f2a-ab4e661a066d","order_by":3,"name":"Dian-can WANG","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAApklEQVRIiWNgGAWjYBACA4YDDBIMFQw8pGo5Q5oWBgYJxjZSHGbOeMbwxs95dTLm7AcYP3zMIUKLZcMZY8vebYd5LHsSmCVnbiPGYQfObpNm3HaAx+BAAhszL/Fa5tTxGJx/QJKWBmYegxvE2mLZcP6zZc+xw0AtD5uJ84u5xLHEGz9q6uwNzicf/PCRGC0MEgdgLMYGYtQDAT+xCkfBKBgFo2DkAgARyjgC/dt/qwAAAABJRU5ErkJggg==","orcid":"","institution":"Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases","correspondingAuthor":true,"prefix":"","firstName":"Dian-can","middleName":"","lastName":"WANG","suffix":""}],"badges":[],"createdAt":"2024-02-05 04:48:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3929948/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3929948/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00784-024-05766-4","type":"published","date":"2024-06-08T14:47:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":51140982,"identity":"05078ef2-ef5a-4398-9d62-e568c15e2a96","added_by":"auto","created_at":"2024-02-14 20:11:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":303767,"visible":true,"origin":"","legend":"\u003cp\u003eLower lip mucocele\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3929948/v1/5b13e7f11148a64fca9e7b66.png"},{"id":51140980,"identity":"bf07515e-e1ae-4cda-8bce-c116fb14a625","added_by":"auto","created_at":"2024-02-14 20:11:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":125316,"visible":true,"origin":"","legend":"\u003cp\u003eSelf-healing of lower lip mucoceles\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-3929948/v1/d1f99d5d98d1684a62c2230b.png"},{"id":58822088,"identity":"f3725396-ab02-43f5-8e2c-6ee3f79be812","added_by":"auto","created_at":"2024-06-21 16:30:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":880726,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3929948/v1/776984f2-cda7-4cc1-ad53-6cb2393906a3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Waiting for Self-Healing as a Primary Management Strategy for Lower Lip Mucoceles","fulltext":[{"header":"Introduction","content":"\u003cp\u003e Oral mucoceles are the most common non-neoplasm disease in the minor salivary glands. The lower lip is the most commonly affected area[\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. They are classified into two pathological types: extravasation and retention, with the extravasation type being more common than the retention type[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. While the exact etiology remains unknown, trauma and blockage of salivary gland ducts are often considered as probable contributing factors.\u003c/p\u003e \u003cp\u003eThe primary recommended treatment methods are surgical excision, micromarsupialization[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], laser therapy[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], cryotherapy[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and sclerotherapy, which involves the use of agents such as OK-432[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], promethazine hydrochloride[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and polidocanol[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Surgical excision is typically recommended.\u003c/p\u003e \u003cp\u003eWe have observed that most intraoral ranulas exhibit a high potential for self-healing[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. We hypothesized that self-healing of lower lip mucoceles may also be common, and that advising patients to wait for self-healing may be encouraged as routine practice before any clinical intervention. This intentional delay of intervention has few potential consequences because most lower lip mucoceles are benign and asymptomatic, with only a mild influence on quality of life and a low incidence of secondary infection. We report the results of a prospectively designed pilot study, in which patients with lower lip mucoceles were advised to wait for self-healing.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003e The study was conducted at the department of stomatology, Liaocheng People\u0026rsquo;s Hospital (Shandong China) and the departments of oral and maxillofacial surgery, School and Hospital of Stomatology Peking University (Beijing China) from December 2020 to December 2023. Informed consent was obtained from all patients, and approval for the study was obtained from the institutional review boards of the respective hospitals.\u003c/p\u003e \u003cp\u003eThe diagnosis of lower lip mucocele was mainly based on clinical manifestations: a painless, superficial, solid or cystic bulge on the lower lip (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). For some cystic mucoceles, an \"egg-white\", transparent viscous fluid is present through aspiration or rupture. Because they are superficial and small, radiographic examinations such as ultrasound, computed tomography, or magnetic resonance imaging are not valid or necessary.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePatients were advised about the nature of lower lip mucoceles and the management options, including surveillance and waiting for self-healing, conservative intervention, and surgical resection. Waiting for self-healing was recommended to patients. Demographic characteristics of the patients were recorded including age, sex, duration of symptoms, and history of treatment (time of surgery).\u003c/p\u003e \u003cp\u003eThe patients were followed up in an outpatient clinic or through consultation via internet or telephone. Clear photos of the lesions were taken, indicating the disappearance or appearance of the mucocele. The criterion for self-healing was disappearance of the mucocele lasting at least 3 months[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed with SPSS software version 20.0 (IBM Corp., Armonk, NY, USA). Mean, standard deviation, and range were used to express continuous variables, while categorical variables were defined by the absolute number of cases and corresponding percentage values. Correlations between clinical and demographic characteristics were assessed with the chi-square test and Fisher\u0026rsquo;s exact test. The duration of the mucocele and potential risk factors, such as age, sex, location, and treatment history, were estimated using Kaplan\u0026ndash;Meier survival curves and the Breslow test. Significance was determined by P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and 95% confidence intervals.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFrom December 2020 to December 2023, 32 consecutive patients with lower lip mucoceles were encouraged to wait for self-healing. Two patients opted for surgical excision because they doubted the potential for self-healing. The remaining 30 patients were included in this study.\u003c/p\u003e \u003cp\u003eThe clinical characteristics of 30 lower lip mucoceles are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The patients\u0026rsquo; ages ranged from 3 to 52 years, with mean of 23.6 years. There was no sex predilection, half male and half female. The duration of the lesions of 63.3% of the patients was within 1 month. Two patients had recurrent mucoceles which were surgically excised at least once. More than half of the lesions were on the left side.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of lower lip mucoceles and self-healing rates\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClinical characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo. of patients (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eSelf-healing\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y, mean, (SD, range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.57(\u0026plusmn;\u0026thinsp;11.69; 3\u0026ndash;52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.991\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026thinsp;~\u0026thinsp;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026thinsp;~\u0026thinsp;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026thinsp;~\u0026thinsp;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of symptoms (month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (63.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(78.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.453\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2ཞ3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4ཞ6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehistory of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;2 surgeries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eleft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.302\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMidline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurveillance duration(month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13ཞ24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25ཞ36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWithout intervention, 24 lower lip mucoceles (80%) resolved spontaneously, lasting at least 3 months. Only six patients (20%) who were observed within 12 months reported that self-healing did not occur. There were no differences in the self-healing rate related to age, sex, history of treatment (time of surgery), or side.\u003c/p\u003e \u003cp\u003eThe mean duration of the 24 self-healed mucoceles was 3.63 (\u0026plusmn;\u0026thinsp;4.7; 1\u0026ndash;24) months (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). There were no significant differences in the duration of healing related to age, sex, duration of symptoms, or history of treatment. To evaluate the recurrence of disease, the 24 patients with self-healed mucoceles were followed up until January 2024. The mean follow-up duration post-self-healing was 17.21 (\u0026plusmn;\u0026thinsp;9.45; 2\u0026ndash;30) months. There have been no reported recurrences to date.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e In this prospective study, 30 patients with lower lip mucoceles followed the strategy of waiting for self-healing. Without any intervention, 24 mucoceles (80%) resolved spontaneously in 3.63 (\u0026plusmn;\u0026thinsp;4.7; 1\u0026ndash;24) months. After self-healing of the mucocele, the patients were followed up for 17.21 (\u0026plusmn;\u0026thinsp;9.45; 2\u0026ndash;30) months and no recurrences have been reported. Thus, we confirmed that lower lip mucoceles have self-healing potential.\u003c/p\u003e \u003cp\u003eGenerally, patients exhibit no significant clinical symptoms, a low incidence of secondary infection, and only a mild influence on quality of life. However, traditional surgical excision remains the predominant treatment modality for oral mucoceles[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In recent years, less invasive treatment options, such as micromarsupialization[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], laser therapy[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], cryotherapy[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and sclerotherapy[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] have been explored. Side effects and limitations are associated with these treatments, including allergic reactions, intense pain, tissue damage, challenges in achieving precise control, financial burden, and variable efficacy. Furthermore, these procedures are not easy for preschool children.\u003c/p\u003e \u003cp\u003eThe self-repair capability of lower lip mucoceles presents an opportunity to reassess current treatment paradigms. By favoring a natural healing process, the stress of invasive treatments and their associated complications are circumvented, significantly lessening the emotional and psychological distress for patients, particularly those with multiple lower lip mucoceles[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, this could lead to reduced treatment expenditures, easing the financial load on patients and healthcare systems, and allowing for better resource distribution. Research into the self-healing mechanisms could yield preventative healthcare advances, emphasizing the importance of disease prevention and health maintenance.\u003c/p\u003e \u003cp\u003eOne risk of waiting for self-healing is that if the clinical diagnosis is wrong, appropriate treatment will be delayed. Therefore, the course of self-healing should be monitored. If the clinical manifestations are atypical and the clinical diagnosis is uncertain, surgical excision of the lesion is indicated.\u003c/p\u003e \u003cp\u003eThe main limitation of this research lies in its execution at only two facilities with a modest sample size. A broader study involving multiple centers and a larger cohort is necessary. We acknowledge that chronic mucoceles persist, necessitating further examination into the dynamics of self-healing. A comprehensive understanding of these mechanisms is essential for advancing mucocele management and prevention strategies.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur findings suggest that there is a high potential for self-healing in lower lip mucoceles. It may be advisable to routinely encourage patients with lower lip mucoceles to consider a period of observation as a viable management strategy, allowing natural resolution processes to occur.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Helen Jeays, BDSc, from Liwen Bianji (Edanz) (www.liwenbianji.cn) for editing the English text of a draft of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eW.D.C. Methodology, Project administration,Collection of cases, Investigation, Data curation, and Writing.\u003c/p\u003e\n\u003cp\u003eL.J.L. Methodology, Project administration, Investigation, Collection of cases, and Writing.\u003c/p\u003e\n\u003cp\u003eL.Y.N. Methodology, Project administration,Collection of cases,Data curation, Statistical analysis.\u003c/p\u003e\n\u003cp\u003eW.L. Methodology, Project administration,Collection of cases, Statistical analysis，Spelling and grammar check, and Editing.\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval for the study was obtained from the institutional review boards of the Liaocheng People\u0026rsquo;s Hospital and Hospital of Stomatology Peking University.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent to participate\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe informed consent obtained from study participants was written.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZahid E, Bhatti O, Zahid MA, and Stubbs M (2022) Overview of common oral lesions. 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Clin Case Rep 7: 1388\u0026ndash;1390.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/ccr3.2253\u003c/span\u003e\u003cspan address=\"10.1002/ccr3.2253\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Mucocele, Self-healing, Lower lip, Surgical excision","lastPublishedDoi":"10.21203/rs.3.rs-3929948/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3929948/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003e Oral mucoceles are most frequently encountered on the lower lip. A variety of treatment options are currently employed, including surgical excision, pharmacological injections, and laser therapy. However, each of these approaches may introduce risks and potential complications. Clinical practice has demonstrated a potential for self-healing in lower lip mucoceles, making a conservative observational approach more appealing. This research is a prospective study aimed at evaluating the self-healing capacity of lower lip mucoceles.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this prospective study, patients with mucoceles were encouraged to intentionally delay medical intervention and to wait for self-healing. Disappearance of the mucocele for at least 3 months was defined as self-healing.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThirty patients with lower lip mucoceles were included. With no intervention, 24 patients (80%) reported self-healing of lower lip mucoceles. The mean natural duration of the mucoceles was 3.63 (\u0026plusmn;\u0026thinsp;4.7; 1\u0026ndash;24) months. After self-healing of the mucocele, the patients were followed up for 17.21 (\u0026plusmn;\u0026thinsp;9.45; 2\u0026ndash;30) months and there were no reported recurrences.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eLower lip mucoceles have a high potential for self-healing and patients may be routinely encouraged to wait for self-healing.\u003c/p\u003e\u003ch2\u003eClinical Relevance\u003c/h2\u003e \u003cp\u003eThe high self-healing rate observed in this study suggests that a conservative, non-interventional approach might be considered as the first-line management for lower lip mucoceles.\u003c/p\u003e","manuscriptTitle":"Waiting for Self-Healing as a Primary Management Strategy for Lower Lip Mucoceles","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-14 20:11:40","doi":"10.21203/rs.3.rs-3929948/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-28T15:30:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-28T13:32:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13ef5c22-a41b-47cc-9c7b-deb3f8bd1d3b","date":"2024-04-17T14:37:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-02-14T09:17:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-13T02:20:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-02-13T02:20:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Oral Investigations","date":"2024-02-05T04:46:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"0ef61d26-a9f0-4217-a109-a09c36f19e98","owner":[],"postedDate":"February 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-06-21T14:47:58+00:00","versionOfRecord":{"articleIdentity":"rs-3929948","link":"https://doi.org/10.1007/s00784-024-05766-4","journal":{"identity":"clinical-oral-investigations","isVorOnly":false,"title":"Clinical Oral Investigations"},"publishedOn":"2024-06-08 14:47:58","publishedOnDateReadable":"June 8th, 2024"},"versionCreatedAt":"2024-02-14 20:11:40","video":"","vorDoi":"10.1007/s00784-024-05766-4","vorDoiUrl":"https://doi.org/10.1007/s00784-024-05766-4","workflowStages":[]},"version":"v1","identity":"rs-3929948","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3929948","identity":"rs-3929948","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}