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A case is reported in which the treatment of the ranula consisted of dissection of the cystic wall along with excision of the sublingual gland of origin. The histological picture of the gland was consistent with sarcoidosis. Thereafter, all other examinations were negative for sarcoidosis. However, there remains the possibility that the lesion may be the precursor of widespread sarcoidosis which might occur in the future.
Ranulas or mucoceles of the floor of the mouth are cysts arising from the sublingual glands. Experience with 27 such patients over the past 10 years is reviewed. Successful treatment was achieved by excision of the cyst with the sublingual gland.
Submandibular duct transposition is now a standard surgical procedure for the treatment of severe drooling. However, this is our first experience of a plunging ranula arising as a complication of the technique. In the surgical management of this complication, the single most important step is excision of the sublingual gland to prevent recurrence.
We describe a case of congenital ranula or retention salivary cyst diagnosed at 26 weeks of gestation. The fetal karyotype was obtained by amniocentesis and chorionic villus sampling, and was normal. Follow-up ultrasound scans revealed no changes in the size or the position of the cyst. Surgical treatment was performed 2 days after a normal vaginal delivery, with excellent results.
Plunging ranula, a rare differential diagnosis of cervicofacial masses is presented in two Nigerian patients. The authors highlight the pathophysiology and treatment methods of this condition. It is suggested that clinicians be aware of the various modes of presentation and natural history of the disease to facilitate prompt diagnosis and appropriate treatment.
Ranula is a cystic swelling of the floor of the mouth, which is usually unilateral and relatively uncommon. The cyst arises from the sublingual salivary gland. We reviewed 14 patients operated in the period 1976-April 1998. There was no recurrence after marsupialization and after extirpation of the sublingual gland. Fourteen percent of the patients had recurrence after extirpation of the cyst. At the follow-up time (average 8.1 years) 18.2% had complications. We suggest that marsupialization/extirpation of the cyst should be primary treatment. In case of recurrence the sublingual gland should be extirpated.
A clinical case of nonsurgical treatment of a sublingual ranula in a ten-month-old baby is presented.
A sialocele originating in the duct of the sublingual salivary gland near its opening, close to the lingual frenulum, was observed as a naturally-occurring lesion in a laboratory rabbit. The lesion was assumed during necropsy dissection to be an oral papilloma. Microscopic examination of histologic sections revealed the lesion to have the characteristics of a sialocele (ranula).
A case of congenital bilateral ranula in a one-week-old male baby is reported. At presentation the cyst measured 3.5 x 2.5 cm but did not interfere with feeding. Initial marsupialisation resulted in recurrence of the cyst. It was subsequently re-excised completely together with the associated sublingual salivary gland. The cyst has not recurred six months after treatment. The usually large size of the cyst and its bilateral presentation makes this an interesting case.
The origin of a ranula is due to obliteration of a minor duct of the sublingual gland. The main excretory duct remains patent.
Plunging ranulas are rare. The diagnosis can be made by CT-scan or NMR and can be clinically confirmed by aspiration of saliva. It is now generally accepted that the best treatment exists of resection of the sublingual gland by intra-oral approach and drainage of the cyst content to the oral cavity. In an experimental set-up we treated a patient with ethoxysclerol with excellent result. However, after 6 months, swelling reappeared, followed by the classic therapy, as described above.
A diagnosis of the deep plunging ranula usually is based upon the history and clinical examination of the patient. The case presented here highlights the role of the CT scan in facilitating a definitive diagnosis. Visualization of the anatomic relations of the accumulated secretion, as it dissects its way through the cervical tissue planes, also is made possible.
Evidence in support of the theory that ranulas, with or without cervical extension, are caused by mucus escape from the sublingual gland is discussed. Our experience with 24 patients with large oral and cervical mucoceles is presented. In 2 of these patients a communication between Wharton's duct and the mucocele was demonstrated, presenting visible evidence for the mucus escape theory. Resection of the sublingual gland will cure the majority of large mucoceles of the floor of the mouth. However, the submandibular duct must also be examined in case this gland is also involved. Points in the operative technique are discussed. Although complete removal of the mucocele lining appears to be unnecessary, thorough removal of the mucus content is essential.
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