Modified Ksharakarma: A Targeted, Minimally Invasive Strategy for Recurrent Traumatic Oral Mucocele

Abstract

Oral mucocele is a common benign lesion of the minor salivary glands and typically results from trauma-induced rupture of the excretory ducts, leading to mucin extravasation and pseudocyst formation. Although the condition is usually harmless, recurrence remains clinically challenging because conventional treatments often fail to eliminate deeper glandular remnants responsible for continued mucin secretion. In Ayurvedic literature, trauma-induced lip swellings are described as Kshataja Oshtakopa, caused by Dantabhigata (tooth bite), wherein Vata vitiation facilitates localized dysfunction, and subsequent Kapha accumulation leads to cystic swelling resembling Jalarbuda. These conceptual parallels justify deeper-acting para-surgical interventions such as Ksharakarma. Case Presentation: A 29-year-old female presented with a recurrent, fluctuant swelling on the inner lower lip, occurring eight months after excision, which had initially reduced the lesion but failed to prevent recurrence. Clinical features-including translucency, softness, and fluctuance-were consistent with an extravasation-type mucocele. The etiology, habitual lip biting, aligned precisely with the Ayurvedic diagnosis of Kshataja Oshtakopa progressing into Jalarbuda. Intervention: After ensuring aseptic preparation, local anesthesia was administered using 2% lignocaine. Through a Sterile needle Teekshna Apamarga Kshara Jala was slowly infiltrated through the needle tract, ensuring direct exposure of the lesion cavity and residual glandular structures to the alkaline agent. The lesion soon developed Pakwajambuphala Varna, indicating effective Kshara action. Neutralization was performed using Nimbu Svarasa to limit the depth of chemical action. Postoperatively, Kanchanara Guggulu and Gandhaka Rasayana were prescribed for 15 days, along with topical Jatyadi Taila to enhance epithelial regeneration. Outcomes: The patient exhibited predictable healing, with slough separation by Day 7 and complete epithelialization by the end of two weeks. Follow-up at one, seven, and six months demonstrated no recurrence and excellent cosmetic results. Conclusion: Kshara Jala infiltration provides a minimally invasive, definitive, and recurrence-preventive alternative for managing recurrent mucoceles. Its deeper chemical penetration offers a therapeutic advantage over conventional methods and aligns with Ayurvedic principles addressing trauma-induced Kapha-Vata pathology.