Resolution of painful refractory soft palate mucoceles following post-surgical onset of satellite lesions: a rare three-year course.

Painful refractory mucoceles erupting along the soft palate are uncommon and management pathways are not well established. In general, oral mucoceles represent common non-neoplastic, non-infectious lesions of the minor/accessory salivary glands and are categorized histopathologically as mucus extravasation phenomena or mucus-retention cysts. We report a rare 3-year treatment-resistant course of painful soft palate mucocele clusters in an adult male causing significant impairment in quality of life, affecting speaking, swallowing, and psychological well-being. The case began as two isolated soft palate mucoceles bilateral to the midline. Excision with biopsy and suture closure was performed and resulted in severe satellite lesion development around the operative fields. Histopathology diagnosed salivary gland mucocele, showing extravasated mucin with neutrophils, macrophages, chronically inflamed granulation tissue, and no dysplasia or malignancy. Corrective medical attempts via corticosteroid therapy were followed by black hairy tongue and lingual candidiasis. Revision surgery with electrocautery ablation (no sutures) produced marked yet incomplete lesion reduction. After 3 years of approximately daily lesion eruption, complete resolution for 9 months to date was achieved with off-label use of intralesional and submucosal sclerosant injections combined with electrocauterization and followed by red/near-infrared light therapy (photobiomodulation or PBM). This case highlights an uncommon presentation of chronic painful salivary gland mucoceles on the soft palate with post-surgical onset of satellite lesions. Relatively non-invasive, corticosteroid-free therapies incorporating sclerotherapy with electrocautery and adjunctive PBM could be considered in related cases. To our knowledge, this multimodal approach to a rare presentation has not been previously reported.