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PubMed1989

The plunging ranula. Pathogenesis, diagnosis and management.

Ranulas are cysts resulting from retention, or extravasation of saliva from the sublingual gland. Two varieties are described: a superficial or oral ranula and a cervical or plunging ranula. The plunging ranula is located below the mylohyoid muscle and may present as a swelling in the upper part of the neck. Four cases are described to illustrate that this condition can be the cause of a neck swelling. Aetiology, differential diagnosis and surgical management are also discussed. Recurrences are mainly due to unfamiliarity with this phenomenon and ignorance of its aetiology. Successful treatment of the plunging ranula consists of excision of the ipsilateral sublingual salivary gland, which is the source of this disorder, and intra-oral evacuation of the pseudocyst of the neck swelling. There is no need for an extensive neck dissection of the cervical extension.

Adolescent↗
PubMed1995

Simple sublingual ranulas: pathogenesis and management.

Simple ranulas in the floor of the mouth usually reflect a mucus escape reaction that develops after disruption of sublingual gland elements. As such, they comprise an accumulation of mucus within connective tissue and lack an epithelial lining. Simple ranulas should be distinguished from cervical, or plunging, ranulas. Recommended treatments for simple ranulas usually involve excision of the ipsilateral sublingual gland, "marsupialization," or simple excision of the cyst. Alternatively, the ranula can be treated with the placement of a silk suture or seton into the dome of the cyst. Four cases using this technique are reported.

Adult↗
PubMed2007

[Congenital ranula in a newborn].

Ranulas are cystic lesions in the floor of the mouth. They are either retention cysts of the excretory duct of the sublingual gland or pseudocysts formed by excretory duct rupture followed by extravasation and accumulation of mucus in the surrounding tissue. We report the case of a premature newborn with a congenital ranula in the floor of mouth. The ranula caused no discomfort or complications, so that immediate intervention was not necessary. The cyst resolved completely by the age of 4 months. Complications in newborns especially include airway obstruction and feeding difficulties. Surgical treatment options are needle aspiration, excision of the ranula, marsupialization, cryosurgery, and--in addition to excision of the cyst--removal of the ipsilateral sublingual gland. Sclerotherapy has shown good results as well. As many congenital cysts resolve or rupture spontaneously, they should be observed for potential resolution for several months in uncomplicated cases.

Female↗
PubMed1997

[Diving ranula. A rare disease picture].

The case of a 24-year-old woman with a plunging ranula is reported. Primarily, the patient noticed extensive swelling of the neck, which had developed 3 months previously. The polycystic, firmly attached tumor and the sublingual and submandibular glands of the right side of the neck were surgically removed. Pathological examination showed a retention cyst by means of a plunging ranula. The etiology, pathogenesis, clinical aspect and diagnostic procedures for the plunging ranula are described. Various therapeutic possibilities are discussed in regard to their value. We prefer surgical treatment with a histological examination to verify the diagnosis. The plunging ranula originates on the sublingual gland; therefore, its simultaneous extirpation is recommended to avoid recurrences. In extensive cases, the additional removal of the submandibular gland can be advised.

Adult↗
PubMed1995

A comparison of three methods used for treatment of ranula.

PURPOSE: This report compares the treatment results for oral and plunging ranulas. PATIENTS AND METHODS: Twenty-seven patients were retrospectively examined concerning treatment methods and recurrence on the basis of their medical records. The surgical specimens were also examined microscopically. RESULTS: Four patients had excision of the ranula only, 22 had marsupialization, and nine had removal of the sublingual gland combined with the excision of the ranula. These treatments showed a 25.0%, 36.4% and 0% recurrence rate, respectively. Histological observation revealed no epithelial lining in any of the examined specimens. CONCLUSIONS: Removal of the sublingual gland combined with the ranula was the most reliable method among the above three used.

Humans↗
PubMed2005

Management of pediatric plunging ranula.

OBJECTIVE: There appears to be a high incidence of ranula in New Zealand. This study was designed to evaluate the diagnosis and surgical treatment of plunging ranula in children at Auckland Starship Children's Hospital, New Zealand. METHODS: A prospective study of 21 pediatric patients with a clinical diagnosis of plunging ranula was conducted. All children underwent clinical assessment and fine needle aspiration cytology. Cytological diagnosis was considered definitive and radiological investigations were not conducted. Surgical treatment comprising intraoral excision of the ipsilateral sublingual gland and pseudocyst was performed. RESULTS: The preoperative diagnosis was unchanged after surgery and histopathological analysis in all cases. There were no recurrences at 24-month follow up. There are no long-term complications to date. CONCLUSIONS: Intraoral removal of the sublingual glands and pseudocyst is an effective and safe method for the treatment of plunging ranula in the pediatric population.

Adolescent↗
PubMed1993

The plunging ranula.

Five cases of "plunging ranula" are reported. In one case, treatment consisted of exteriorization and obturation by a removable, partial-denture-like splint. A second case was treated by total removal of both the ranula and the sublingual gland by a combined extraoral-intraoral approach. In the other three cases, treatment consisted of excision of the sublingual gland and marsupialization of the cyst by an intraoral approach. Since a plunging ranula is due to extravasation from the sublingual gland herniating through the mylohyoid muscle, excision of the sublingual gland followed by transoral drainage of the plunging ranula is regarded as the best treatment.

Adult↗
PubMed2001

Treating oral ranula: another case against blanket removal of the sublingual gland.

There are a number of occasions when ranula-like lesions of the oral floor can develop that do not originate from the sublingual gland, or that arise from the gland with no tendency towards recurrence. The author advises that the unconditional removal of the sublingual gland should not be the standard treatment for all ranulas, and present four case reports to illustrate these and describe how they should be treated. All the patients were treated successfully with conservative management and retained normal functioning sublingual glands. Except for the management of plunging ranulas, caution and a close examination of the origin of the lesion are prudent before considering excision of sublingual glands for all ranula-like lesions.

Contraindications↗
PubMed2002

Management of pediatric ranula.

OBJECTIVE: Many surgical techniques to manage ranulas have been described in the literature. These techniques include excision of the cyst with or without excision of the ipsilateral sublingual gland, marsupialization, cryosurgery, and CO(2) laser excision. Few studies have described the approach toward management in pediatric patients. METHODS: Six patients were treated for intraoral ranulas. Two patients had spontaneous resolution of their lesions. Four patients required dissection of the submandibular duct and lingual nerve to completely excise an oral cavity ranula and an ipsilateral sublingual gland. RESULTS: There were no recurrent lesions. One patient developed a lingual nerve injury but no numbness. The 2 patients with spontaneous resolution did not develop a subsequent lesion. CONCLUSION: Optimal management of pediatric oral cavity ranulas may include observation for 5 months for spontaneous resolution. If the lesion does not resolve or recurs repeatedly, surgical treatment is recommended. Submandibular duct dissection with relocation appears to enhance exposure to the floor of mouth. The pseudocyst and entire sublingual gland should be removed. Identification of the lingual nerve is necessary to accomplish this goal.

Child↗
PubMed2002

Local injection of OK-432 in the treatment of ranula: a case report.

We treated a 57-year-old woman for ranula. After aspirating the cyst's contents, we administered 0.1 KE/ml of OK-432 via local injection. One month later, the cyst had still persisted, so we repeated the procedure. After 2 weeks, the ranula began to shrink markedly, and at 4 weeks it had almost disappeared. No recurrence of the ranula was observed during the subsequent 1 year of follow-up. Following each injection, the patient developed transient fever and local swelling but no serious complications. Our experience suggests that OK-432 injection is an effective treatment for ranula. However, because this treatment causes the cyst to collapse rather than disappear completely, patients should be regularly monitored over the long term.

Antineoplastic Agents↗
PubMed2004

Surgical treatment of ranula with carbon dioxide laser radiation.

Ranula is a mucous extravasation cyst which appears as a swelling in the submental and submandibular regions. Several surgical techniques to manage ranula have been described in the literature, these techniques include the CO2 laser radiation excision. Four patients were treated for intraoral ranula in the floor of the mouth by marsupialization with carbon dioxide laser radiation with defocused beam, continuous mode and 4 watts of power. There were no complications and no recurrences have occurred to date. The results showed that carbon dioxide laser radiation gives optimal results with no need for suture and good wound healing.

Humans↗
PubMed1991

Submandibular cystic hygroma resembling a plunging ranula in a neonate. Review and report of a case.

Cystic hygromas are large lymphangiomas that are most often found in the posterior triangle of the neck and the axilla in children. They are most frequently found before age 2 and may be massive. After upper respiratory infection, they may become infected and enlarged, causing dysphagia and toxemia. The diagnosis can usually be made by history and physical examination and confirmed by biopsy. Treatment is by surgical excision of small lesions and staged debulking excisions in more severe cases. A patient with a cystic hygroma having many clinical characteristics of a plunging ranula is presented. The cyst fluid was aspirated and analyzed for its amylase, sodium, potassium, chloride, urea nitrogen, glucose, and total protein content. The characteristics of the fluid were also compared with those of lymph and saliva. This report demonstrates the difficulty in determining the diagnosis of a tumor that has the clinical features of a cystic hygroma, as well as a plunging ranula. The necessity of a proper presurgical diagnosis is essential since the form of therapy for each is different and conflicting. A method that distinguishes between the cervical cystic hygroma and a plunging ranula by means of aspirated fluid is discussed.

Cleft Lip↗
PubMed1992

Plunging ranula: a case report and a literature review.

The plunging ranula is a mucous extravasation cyst of the sublingual gland. It is slightly more common in females, shows no side preference, and is more prevalent in the second and third decades of life. It typically manifests as a painless, nonmobile swelling in the neck and in four of five cases is associated with an intraoral ranula or swelling. If there is no history of an oral ranula the clinical diagnosis is difficult, and it may be left to the reporting pathologist to give the correct diagnosis. The histologic appearance is characteristically of a cyst, devoid of epithelium or endothelium, with a vascular fibro-connective tissue wall containing some chronic inflammatory cells and macrophages stuffed with mucin. The correct diagnosis is essential for the most effective treatment, which is excision of the sublingual gland.

Child↗
PubMed1992

Marsupialization for treatment of oral ranula: a second look at the procedure.

Simple marsupialization to manage oral ranula has fallen into disfavor because of excessive failures and the high incidence of iatrogenically caused cervical ranula that may follow this procedure. With the simple addition of packing the entire pseudocystic cavity with gauze after its unroofing, the rate of recurrence is minimized. It is recommended that oral ranula be treated initially by marsupialization with packing and, if recurrence occurs, then the offending sublingual gland should be excised.

Adult↗
PubMed2004

Surgical management of pediatric ranula.

OBJECTIVE: Many surgical techniques have been described in the literature and their recurrence rates have been compared. Few studies have compared the results of the most popular techniques such as excision and marsupialization in pediatric population. METHODS: Sixteen children were operated for ranula. Total excision with sublingual gland was performed on 10 patients while marsupialization was performed on 6 patients. These patients were followed up at least 3 years. Their charts were investigated retrospectively. RESULTS: The age range was between 17 days and 16 years old. The mean age was 9 years. There were 12 females and 4 males. One patient (6.25%) had recurrence after excision and marsupialization was performed on this patient. The recurrence rates for marsupialization and excision were 0 and 10%, respectively. Ranulas were ruptured during surgery in 11 cases (68.75%) while a defect on the floor of the mouth had occurred in 1 patient. Only one of the cases among ruptured cases (9%) had reoccurred. The most common complication was rupture of the ranula in 11 patients (68.75%) followed by a defect on the floor of the mouth in one case. CONCLUSION: Rupture of the cyst during surgery does not increase the risk of recurrence. Besides marsupialization or excision do not make any difference in terms of success of surgery.

Adolescent↗
PubMed2006

Treatment of a ranula using an Er,Cr:YSGG laser.

A ranula is an extravasational cyst arising from the sublingual gland. The "cyst" cavity does not have an epithelial lining, and because of this is notoriously difficult to eliminate. Usual treatment requires complete excision of the sublingual gland, exteriorizing the gland through establishment of a secondary ductal structure by placement of a long-term indwelling catheter, or packing, all requiring patient compliance. Unroofing alone is often followed by recurrence via resealing or closure with formation of a new roof. The accompanying scarring and damage to additional ducts may also result in recurrence. Combining unroofing with a technique that would prevent resealing of the remaining portion, scarify the base of the ranula to eliminate residual glandular acini, and be more comfortable and non-interfering with the daily activity of the patient, is an acceptable object of treatment of a ranula. The use of a water-based laser system to accomplish these goals appears to be a desirable and simple method.

Child↗
PubMed1978

Plunging or cervical ranula. Review of the literature and report of 4 cases.

A review of the literature pertaining to plunging ranula is presented with special emphasis on the historical development of the various aetiological theories and treatment recommendations. Also 4 cases of plunging ranula are presented; three were treated by extirpation of the sublingual gland and one was treated by exteriorization of the ranula into the oral cavity. The treatment methods used here are discussed in relationship to the accepted aetiological theory.

Adult↗