Ranulas with extension into the neck: so-called plunging ranulas.
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Cysts↗
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Pathologic quiz case 2. Plunging ranula (cervical ranula, cervical mucocele).
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Adolescent↗
Clinical review of 580 ranulas.
OBJECTIVE: The purpose of this paper was to compare clinical features among 3 patterns of ranula and the recurrence rates of each when treated by different surgical methods. METHODS: A retrospective review of clinical and pathologic records in 580 ranulas was undertaken. Ranulas were classified into 3 clinical types according to sites of the primary swelling: oral ranula, plunging ranula, and mixed ranula. Information was collected on age at presentation, sex, history of onset, sites of swelling, surgical methods, histological findings, and outcome of treatment. RESULTS: Ranula was most prevalent in the second decade of life and slightly more common in females (male to female ratio of 1:1.2), but a distinct male predilection was noted for the plunging ranula (male to female ratio of 1:0.74). Oral ranula was most commonly involved in the left side (left to right ratio of 1:0.62), while the plunging and mixed ranula were commonly involved in the right side (left to right ratio of 1:1.38, 1:1.16 respectively). In the plunging ranula group, there were more patients who had the history more than 6 months. The recurrence rates of ranulas were not related to swelling patterns and surgical approaches, but intimately related to the methods of surgical procedures. The recurrent rates for marsupialization, excision of ranula, and excision of the sublingual gland or gland combined with lesion were 66.67%, 57.69%, and 1.20%, respectively. CONCLUSION: Three patterns of ranula have similar clinical and histopathologic findings, although plunging ranula has some different clinical features. Removal of the sublingual gland via an intraoral approach is necessary in the management of various clinical patterns of the ranula. Recurrence rates of ranulas of any type are excessive unless the involved sublingual gland is removed.
Adolescent↗
Ranula: another HIV/AIDS associated oral lesion in Zimbabwe?
AIM: To show that sublingual ranula is associated with HIV/AIDS and as such should be considered an HIV/AIDS associated oral lesion in Zimbabwe. OBJECTIVES: To retrospectively study the prevalence, age and gender distribution, the HIV serostatus of ranula patients and the trend in prevalence of ranula and Kaposi's sarcoma (KS) in patients at the two largest referral Oral and Maxillofacial Surgery specialist centres in Harare, Zimbabwe. To use this information to infer an association between ranula and HIV/AIDS in Zimbabwe. DESIGN: Descriptive study with a retrospective and prospective component. SETTING: Oral and Maxillofacial Surgical clinics at specialist referral hospitals, Harare Central Hospital and Parirenyatwa Government Hospital, Harare, Zimbabwe. SUBJECTS: Eighty-three cases of ranula were studied: 45 cases retrospectively and 38 consecutively. A total of 231 cases of KS were studied retrospectively. METHODS: Histopathologic records of patients who presented with ranula and KS during the period January 1981 to September 2003 were studied. Gender and age were recorded for each case. Thirty-eight ranula patients studied consecutively during the period June 1999 to September 2003 were consented for HIV testing. RESULTS: There were 83 cases of ranula; 43.4% male and 56.6% female. There were 231 cases of KS, 61.2% male and 38.8% female. Male to female ratio was 1:1.3 for ranula and for KS was 1:0.6. Ranula was predominant in the 0-10 year age group (73.5%) while KS was most common in the 21-40 year age group (76.4%). Ranula and KS both had a marked rise in prevalence from 1992 to 2003. A total of 88.5% of the ranula cases tested HIV positive with 95% in the 0-10 year age group. CONCLUSION: There was a rising prevalence of ranula which mirrors that of KS (an HIV/AIDS associated oral lesion) and that 88.5% of ranula patients were HIV positive with 95% of them in the 0-10 year age group. Sublingual ranula should thus be considered another HIV/AIDS associated lesion in Zimbabwe, especially in children.
AIDS-Related Opportunistic Infections↗
Giant ranula of the neck: differentiation from cystic hygroma.
BACKGROUND AND PURPOSE: Occasionally, diving ranulas may attain large dimensions (giant ranula); gross involvement of the submandibular and parapharyngeal spaces makes differentiation from other cystic neck masses, particularly cystic hygroma, difficult. As diving ranula and cystic hygroma are managed with different surgical approaches, avoidance of this pitfall is critical. Our purpose was to review the imaging findings of giant ranula and compare them with those of cystic hygroma to define those features that are helpful in differentiating these different disease entities. METHODS: We conducted a retrospective review of all cases of ranulas that had been surgically treated at our institution in a 15-year period. These were compared with cases of cystic hygroma that involved the same anatomic regions. Images were analyzed for anatomic location and morphology, with specific attention paid to those characteristics that might assist differentiation. Giant ranula was defined as any ranula that significantly involved the paraphyngeal space in addition to the submandibular space. RESULTS: Six patients with giant ranula and fifteen patients with cystic hygroma were reviewed. All giant ranulas retained tapered communication with the sublingual space and were homogeneous, thin-walled, anatomically defined, fluid-containing masses. One infected lesion enhanced, and another previously operated lesion demonstrated mild septation. Cystic hygroma commonly did not communicate with the sublingual space and had features of lobulation, septation and heterogeneity. Additional involvement of spaces not typically involved by ranula further assisted differentiation. CONCLUSION: Although giant ranulas may superficially resemble cystic hygroma, several imaging features allow confident differentiation of these two entities.
Adolescent↗
Pediatric intraoral ranulas: an analysis of nine cases.
An intraoral ranula is a retention cyst arises from the sublingual gland on the floor of the mouth as a result of ductal obstruction and fluid retention. Many techniques for management of ranulas have been described in the literature. The purpose of this study was to analyze our surgically treated pediatric patients with intraoral ranulas and to discuss the results in the light of the literature. Nine pediatric patients (six females and three males) with intraoral ranulas surgically treated were analyzed retrospectively regarding their treatment methods and results. The surgical specimens were also re-examined histologically. Seven cases of superficial, protruded and smaller than 2 cm ranulas were treated with marsupialization (unroofing). Two cases who were previously operated and then recurred had bigger than 2 cm ranulas. In these two cases, marsupialization of the ranula plus removal of the sublingual gland was performed. The most common complication was intraoperative cyst rupture of the ranula, which was noted in four cases. A recurrence was observed in only one case in the 16th months of follow up period. Our findings show that marsupialization is a suitable and effective method for pediatric intraoral ranulas, whereas in recurrent cases marsupialization of the ranula combined with total excision of sublingual gland may be preferred.
Adolescent↗
[Plunging ranula].
Saliva extravasation from the sublingual gland causes ductal lesion or obstruction and results in the formation of a ranula. It spreads through or behind the mylohyoid muscle situated on the neck. Most frequently it is located in the submandibular or submental region. The diagnosis of plunging ranula is simple if the signs of ranula are present in the intraoral cavity, whereas in case of a ranula localized on the neck definite diagnosis is made by histologic analysis of the pseudocyst that has been surgically excised in toto. Cases are presented of both types of plunging ranula treated by various surgical approaches. Plunging ranula in the submental region was treated by transoral approach, marsupialization and aspiration of the content, whereas the ranula in the submandibular region was treated by exterior cervical approach. In both cases, sublingual gland was removed. During the 3.5-year follow-up, neither recurrence of the disease in the neck area nor the occurrence of simple ranula in the intraoral region was observed.
Adult↗
[Cervical ranula].
Three patients, 2 men aged 21 and 39 years, respectively, and 1 woman aged 29 years, presented with a unilateral swelling of the neck, with no accompanying symptoms. In the youngest man the diagnosis of a 'plunging ranula' was made after repeated fine needle aspiration yielded viscous yellowish mucus with a high amylase content. In the oldest man the diagnosis was made during the operation and in the woman the diagnosis was finally made after two surgical explorations in the neck. In all 3, no recurrence occurred after removal of the involved salivary glands. A cervical ranula is an extension of a pseudocyst of the glandula sublingualis. Important clues for the diagnosis of a 'plunging ranula' are: the simultaneous presence of a ranula in the floor of the mouth (or a history of one), a characteristic cystic mass in the submandibular space with an extension into the sublingual space on CT and/or MRI, and the aspiration of amylase-containing mucus. Excision of the sublingual gland as the source of salivary leakage is the therapy of choice in a case of 'plunging ranula', with drainage of mucus from the ranula into the oral cavity. As the 'plunging ranula' represents a pseudocyst without an epithelial lining, excision is not indicated.
Adult↗
[Plunging ranula].
The plunging ranula is a relatively uncommon phenomenon which represents a mucus escape reaction occurring from disruption of the sublingual salivary gland. We present a retrospective study over a 10 years period on patients suffering of plunging ranula treated in Oral and Maxillo-Facial Clinic, resumed by a clinical example. These 7 patients with plunging ranula are related to all the patients operated for ranula in the same period of time in our clinic and were analyzed on age, sex, imaging exploration technique, treatment, and outcome. We found this kind of lesion both in children and young adults, between 10 to 40 years, more frequent on male (1.33/1). Two patients presented only the cervical form of ranula instead of the other five patients (both oral and cervical ranula). Only two of them received IRM examination. All of them received surgical treatment, the approach being cervical; it was removed both the cyst and the sublingual salivary gland. The surveying period, except the last case, was 1 year and includes no recurrences. We consider, besides esthetic loss that the cervical approach of plunging ranula seems to be the optimal access both on lesion and sublingual gland.
Adolescent↗
Complications associated with surgical management of ranulas.
PURPOSE: We present the intraoperative and postoperative complications associated with 606 procedures for ranulas in a series of 571 patients. PATIENTS AND METHODS: Clinical records of 606 procedures in 571 patients with ranulas operated on in the Hospital of Stomatology, Wuhan University, China between 1962 and 2002 were retrospectively reviewed. The methods of surgery and intraoperative and postoperative complications were documented and analyzed. RESULTS: The most common complications were recurrence of the lesion (5.78%) and sensory deficit of the tongue (4.89%), followed by damage of Whartons duct (1.82%). Postoperative hematoma, infection, or dehiscence of the wound were seldom seen. Temporary numbness of the tongue resolved within 2 to 7 months postoperatively. Recurrences were often seen after marsupialization and excision of the ranula, with few recurrences after excision of the ranula and sublingual gland or excision of the sublingual gland alone. CONCLUSION: Complications associated with ranula surgery are minor and self-limiting. Transoral excision of the sublingual gland has the least possibility of ranula recurrence.
Humans↗
Ranulas and their mimics: CT evaluation.
The spectrum of computed tomographic (CT) findings in ten patients with pathologically proved simple and diving ranulas is reviewed. These retention cysts originate within the sublingual space from obstruction of the sublingual or minor salivary glands; when they enlarge, the cysts herniate to involve the submandibular and inferior parapharyngeal spaces (the so-called diving or plunging ranula). CT findings in 38 additional patients with a variety of cystic lesions in the floor of the mouth are contrasted with findings in cases of ranulas. The relevant anatomy is reviewed. This experience indicates that a unilocular, cystic mass emanating from the sublingual space and extending into the adjacent submandibular and/or inferior parapharyngeal spaces can be considered a diving ranula in virtually all cases. A unilocular, cystic mass entirely within the sublingual space can be considered a simple ranula in most instances, although absolute distinction between a simple ranula and an epidermoid cyst cannot be made radiographically.
Diagnosis, Differential↗
Plunging ranula: a report of three cases and review of the literature.
Three cases of plunging ranula are reported and the literature reviewed. Extravasation of saliva from the sublingual gland due to trauma or obstruction of its ducts appears to be the most likely cause of plunging ranula. Available data suggest that the submandibular gland is usually not involved, although at the time of surgery it may be extremely difficult to exclude a submandibular origin of the cyst in the neck. Communication between the oral and cervical components of the plunging ranula probably occur via a hiatus in the mylohyoid muscle. Such communication passing directly into the submandibular compartment may simulate submandibular gland involvement. Since 1910, 139 procedures in 89 patients with plunging ranula have been reported in the English literature. The recurrence rate was 70 per cent after incision and drainage of the cyst, 53 per cent after marsupialization, 85 per cent after excision of the cyst in the neck and 2 per cent after excision of the sublingual gland via the cervical or intra-oral route. This review suggests that excision of the sublingual gland with intra-oral drainage of the cervical swelling appears to be the treatment of choice for the plunging ranula.
Adolescent↗
MRI of ranulas.
We reviewed the MRI of 20 patients with a ranula (8 simple and 12 plunging) and ten with other cystic masses in the floor of the mouth and/or suprahyoid portion of the neck (three haemangiomas, two neuromas, one monomorphic adenoma, one lipoma, two lateral cervical cysts and one dermoid cyst). Histological diagnoses were obtained in all cases with the exception of one presumed haemangioma. Ranulas were all well-defined, homogeneous masses giving low signal on T1- and markedly high signal on T2-weighted images. While simple ranulas were all confined to the sublingual space, plunging ranulas were centered on the submandibular space and tended to spill into one or more adjacent spaces. They extended into the sublingual space anteriorly (producing a so-called tail sign) in eight of 12 cases and into the parapharyngeal space superiorly in five. Although they sometimes filled a considerable part of the parapharyngeal space, displacement of surrounding muscles or vessels was usually slight, which was thought to reflect the nature of extravasation pseudocysts. All other cystic masses in our study had one or more MRI finding different from those of ranulas and could be easily differentiated from them.
Adolescent↗
Treatment of ranula--excision of the sublingual gland versus marsupialization.
The purpose of this work is to estimate optimum surgical treatment of ranula according to the type of the lesion. Nine patients with ranula surgically treated between 1989 and 2000 were investigated retrospectively. Six patients had sublingual type ranula and three had submandibular type. In five cases including recurrence cases, the sublingual gland was excised. Marsupialization was performed for four cases, which were superficial, protruded and within 2 cm of diameter. In all cases, histopathological diagnoses were pseudocysts without epithelial lining and there was no recurrence. Almost all ranulas are pseudocysts from the sublingual gland, therefore excision of the sublingual gland is considered to be a reasonable and radical treatment. For the small sublingual type, which is superficial, protruding and smaller than 2 cm in diameter, marsupialization is also a useful modification of surgical treatment of ranula.
Adolescent↗
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↗
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↗
[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↗
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↗