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Mucocoeles & Prescription Writing
April 11, 2008
Mucocele
A patient presents with a lesion on
the lip
 The lesion is said to “go up and
down”
 The only thing it can be is a Mucocele
 A mucous cyst (MC) is a benign,
common, mucus-containing cystic
lesion of the minor salivary glands in
the oral cavity-(mucocele)
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Mucocele
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A mucocele can be created by
Trauma
 Ortho Brackets
 Anything that severs the duct of a minor
salivary gland
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The gland continues to produce saliva
yet it has nowhere to go except into
the connective tissue creating a
Mucocele
Mucocele
The mucocele will rupture, then
return
 Surgical removal of a mucocele is
never a guarantee
 You may sever another duct and
create a new mucocele
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Mucocele
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Do not distort the anatomy while
anesthetizing for excision
Lasers will work very well for this type of
procedure
In the absence of a laser:
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Make a wedge-shaped incision around the
mucocele and remove it without causing it to
leak out
“Picking strawberries” you must remove all of
the accessory glands once you’ve removed the
initial large gland
Use the Adson Tissue Pick-ups to do this
Mucocele
A very large mucocele will be too
large to excise completely
 The procedure of choice in this
circumstance is called
Marsupialization
 Open it up inside-out and let it
granulate and destroy itself
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Marsupialization
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The surgical formation of a pouch to treat
a cyst when simple removal would not be
effective.
Under anesthesia, the cyst sac is opened
and emptied.
Its edges are sutured to adjacent tissues,
and a drain is left in place.
Over a period of several months, secretions
will decrease and the sac space will be
reduced until it is completely filled
Marsupialization
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This technique involves the placement of a 4.0 silk
suture through the widest diameter of the lesion
(dome of the lesion) without engaging the
underlying tissue.
A surgical knot is made, and the suture is left in
place for 7 days.
Patients need to be educated about suture
replacement; they must return to have the suture
replaced if it should be lost during the 7-day
period.
The idea behind this alternative treatment for
mucoceles of minor salivary glands is that reepithelization of the severed duct occurs or a new
epithelial-lined duct forms, allowing egress of
saliva from the minor salivary gland.
Hard Palate Lesion
Example of a pedunculated lesion on
the lateral portion of the hard palate
 Place a suture through the lesion and
create tension
 Incise to bone and remove entirely
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Verrucous Carcinoma
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Underside of tongue
Palpate to see how deep it is
When incising, follow the muscle pull (especially in
the tongue)
It is the ONLY place in the mouth where you place
extra knots due to the muscularity of the tongue
Make an Elliptical incision around the lesion 
excise  Use Adson Tissue Pick-ups to remove the
lesion muscular bed  sutures in to close
Only anatomy to be concerned about are the vein,
and nerve in the posterior region
Epulis Fissuratum
Created by the body’s reaction to
stabilize ill fitting dentures
 The bone changes with repeated
wear and the bone resorbs, creating
more give, more space, and the body
tries to fill the space in to make the
denture more stable
 The problem with granulation tissue is
it is movable
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Epulis Fissuratum
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If you remove the epulis the tissue will
relapse
After removal, suture the flap lower and
extend the border of the denture to hold
down the tissue
This will prevent loss of vestibular depth
Anything taken out, biopsy it because there
is a 1% chance that it could be more than
it seems
PDR
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Physician’s Desk Reference (PDR)
Written by the manufacturers
All of the drug inserts placed in one book
Comprehensive indexing (4 sections)
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Manufacturer index (Gray Section)
Generic/chemical index (non-trademark
common drug names
Products/Category index (i.e. antihistamines)
(Gray Section)
Color images of medications
Schedule III
Mix a peripheral acting analgesic with
a central acting analgesic to avoid
addiction
 We don’t use Schedule II drugs in the
clinic
 When a patient comes in with a
bombed out tooth and prefers drugs
to extraction, they are a crack addict
(PC) on the block
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Narcotics
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Schedule 3 drugs can be called in over the
phone
Schedule 2 drugs CANNOT be called in
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PERCODAN, PERCOCET, TYLOX
These are more potent
Narcotics are scheduled based on addiction
potential
Vicodin is the most abused drug in country
Narcotics
Vicodin 5mg Hydrocodone and 500
acetaminophen
 Vicodin ES (Extra Strength) 7.5 mg
and 750 acetaminophen
 If Vicodin 5mg doesn’t “work” take
one and a half (like taking 7.5mg)
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Vicodin 5mg
Vicodin ES 7.5mg
Narcotics
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Tylenol with codeine
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Aspirin and oxycodone
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Percodan
Acetominophen and Oxycodone
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Review the handout
Percocet, Tylox, etc
Synalgos DC
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Aspirin, Caffeine, Dihydrocodeine
Tylenol #2 with Codeine 15mg
Tylenol #3 with Codeine 30mg
Tylenol #4 with Codeine 60mg
Percodan
Percocet
Tylox
Narcotics
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ex: Synalgos DC
A synthetic narcotic
 The only difference to Vicodin is that it is
Tylenol based
 Synalgos DC contains aspirin
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 Be
careful with patients on coumadin or
have bleeding ulcers
 It has little bit of caffeine in it;
DC=dihydrocodeine (synthetic narcotic)
 Same equivalents
Synalgos DC
Narcotics
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If the patient is allergic to codeine and is a drug
addict, what do you give?
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NSAID (like Motrin; Motrin 800-prescription-can only take
1 tab q6h prn pain; equivalent to Tylenol #3)
At night, a patient will call in and give a perfect
academy award on phone to get narcotics
They’ve never been seen in practice
Give no one a narcotic, only a non-steroidal unless
you know them for sure
They can take 4 OTC Motrin (each 200 mg)
They will be fine until can see them in morning
Prescription Writing
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RX: What you are going to give patient
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DISP: How many give patient
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ex: Vicodin-500 mg less problems than with tylenol 3 like
vomiting, diarrhea; this has synthetic codeine), cottage
cheese or something to coat stomach  very FEW
problems with vicodin
For a single tooth extraction  12 -15 enough);
When you go to Highland  write out the number (spell
it!!)
Sig: What pharmacist translates into English for
patient;
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Pain pills dose at 1 tab q3-4h prn pain (q3-4 generally
recommended for pain), dose every 3-4 then patient stay
above the threshold and remains comfortable
Prescription Writing
Alex Isom
Eddy & Leavenworth
Rx: Vicodin 5mg
Disp: 12 (twelve) tabs
Sig: 1 tab p.o. q3-4h prn pain
867-5309
?
Barely Legal
Motrin
3200 mg/day maximum
 Rx: Motrin 800mg
 Disp: 20
 Sig: 1 tab p.o. q6h prn pain
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