Ránula cervical gigante: a propósito de un caso

La ránula es una lesión pseudoquística causada por la retención de contenido salival de la glándula sublingual en el tejido conjuntivo subyacente, siendo la patología más frecuente de esta glándula. Su localización es a nivel del suelo de la boca, pudiendo en ocasiones extenderse a través del músculo milohioideo hacia la región submaxilar o cervical (ránula plunging o cervical), presentándose clínicamente como una tumoración laterocervical de crecimiento lento. El apoyo de imágenes mediante ecografía, tomografía computarizada, o RM (resonancia magnética) es fundamental para un correcto diagnóstico. Respecto al tratamiento, el procedimiento más aceptado y con menos tasas de recurrencia es la escisión de la ránula cervical por abordaje laterocervical, asociada a la extirpación de la glándula sublingual implicada vía transoral. Aquí presentamos el caso clínico de un varón de 25 años quien presenta una masa laterocervical derecha de seis meses de evolución de crecimiento progresivo e indoloro. La ecografía y RM confirman una ránula cervical gigante de 62x45x101 mm, que se localiza en espacio submandibular derecho, alcanzando el espacio parafaríngeo en su vertiente más craneal. Debido a las características de la lesión y su anatomía se decide tratamiento quirúrgico.

The ranula is a pseudocystic lesion caused by the retention of salivary content of the sublingual gland in the underlying connective tissue, being the most frequent pathology of this gland. Its location is at the level of the floor of the mouth and can sometimes extend through the mylohyoid muscle towards the submaxillary or cervical region (plunging or cervical ranula), clinically presenting as a slow-growing laterocervical tumor. The support of images by ultrasound, computed tTomography or MRI (magnetic resonance imaging) is essential for a correct diagnosis. Regarding treatment, the most accepted procedure, and with the lowest recurrence rates is excision of the cervical ranula by the laterocervical approach, associated with the transoral removal of the involved sublingual gland. Here, we present the clinical case of a 25-year-old man who presented a six-month-old right laterocervical mass of progressive and painless growth. Ultrasound and MRI confirmed a giant cervical ranula measuring approximately 62x45x101 mm, located in the right submandibular space, reaching the parapharyngeal space in its most cranial aspect. Due to the characteristics of the injury and its anatomy, surgical treatment was decided.

Diving ranula- A case report and review

Pathologies developing on the floor of the mouth create difficulty for the patient and pose a challenge to oral physicians both clinically and surgically as this area manifests numerous vital structures. While diagnosing, an accurate differential diagnosis should be established to rule out other lesions that usually occur on the floor of the mouth such as ranula, lipoma, salivary gland tumours, dermoid cyst, and vascular lesions. Cystic lesions developing from the salivary glands are commonly known as "mucoceles", these lesions develop mostly in relation to the minor salivary glands and rarely, in relation to the major salivary glands. Mucoceles basically are of two types: Mucous retention cyst and Mucous extravasation cyst. A Ranula is a form of mucous extravasation cyst which commonly occurs on the floor of the mouth. Deep seated lesions when herniate through mylohyoid muscle give rise to a clinical variant; plunging or cervical Ranula. Various treatment modalities for ranula has been suggested that include excision of lesion with or without excision of ipsilateral sublingual salivary gland, marsupialization, aspiration of cystic fluid, sclerotherapy, incision and drainage and many more. Those various treatments have shown diverse results. Here we present a case report and review of Sublingual Ranula in a 47-year-old female patient, treated with the excision of the Ranula. A follow-up of 3 months revealed no recurrence.

"Ortoglossopelveplastia" e o algoritmo de sua utilização na sequência de Pierre-Robin / "Orthoglossopelveplasty" and the algorithm for its use in the Pierre Robin sequence

Introdução: Muitos pacientes portadores de sequência de Pierre Robin (micrognatia, glossoptose e obstrução de via aérea) apresentam o músculo genioglosso alterado, encurtado e retrátil, que impede a protração lingual, mantendo a parte anterior da língua verticalizada e seu volume deslocado em direção posterior. Isso pode corroborar para obstrução supraglótica, dificuldade alimentar e inversão das forças de estímulo do crescimento do corpo mandibular. Métodos: Estudo retrospectivo de pacientes com Pierre Robin tratados entre 2012 e 2017 pela equipe, com descrição da "ortoglossopelveplastia", que propõe uma modificação na glossopexia, soltando o genioglosso anômalo da sua inserção, liberando a língua para elevar seu terço anterior e avançar o volume de sua base, sendo auxiliada por ponto de tração da base lingual à sínfise mandibular. Apresentamos um algoritmo de tratamento proposto que prioriza a necessidade desta cirurgia, associada ou não à distração mandibular, de acordo com a gravidade da dificuldade respiratória e/ou alimentar. Resultados: São apresentados 12 casos de obstrução da orofaringe atendidos de 2012 a 2017, discutem-se suas prioridades, a ortoglossopelveplastia e se aplica o algoritmo proposto. Conclusão: A reorganização anatômica da musculatura em uma posição anteriorizada correta proporciona protração e funcionalidade à língua, com desobstrução da via aérea na orofaringe, melhora da função alimentar e do desenvolvimento mandibular, com baixa morbidade cirúrgica e poucas complicações.

Introduction: Several patients with the Pierre Robin sequence (micrognathia, glossoptosis, and airway obstruction) have an altered, shortened, and retractable genioglossus muscle that prevents protraction of the tongue and keeps the anterior part of the tongue vertical and its volume posteriorly displaced. This can contribute to supraglottic obstruction, feeding difficulty, and inversion of the growth stimulation forces of the mandibular body. Methods: A retrospective study of patients with the Pierre Robin sequence treated between 2012 and 2017 with "orthoglossopelveplasty," which includes modification of glossopexy, releasing the anomalous genioglossus of its insertion and releasing the tongue to raise its anterior third and advance the volume of its base using a traction suture of the tongue base to the mandible symphysis. We present a treatment algorithm that prioritizes the need for surgery associated, or not, with mandibular distraction in accordance with respiratory and/or feeding difficulty severity. Results: Twelve cases of oropharyngeal obstruction treated from 2012 to 2017 are presented, their priorities and orthoglossopleoplasty are discussed, and the proposed algorithm is applied. Conclusion: Anatomical reorganization of the musculature in a correct anterior position provides protraction and functionality to the tongue, clears the airway in the oropharynx, and improves the feeding function and mandibular development, with low surgical morbidity rates and few complications.

Clinical report and literature review on the amyloidosis of salivary glands / 口腔疾病防治

@#Amyloidosis of salivary glands is a rare disease. The case of a 62-year-old male patient with 20 years of progressive swelling of the floor of the mouth and raising of the tongue that impacted the swallowing, phonation, and tongue movement of the patient is reported in this paper. Clinical examination revealed a large mass in the floor of the mouth. The lip and cheek mucosae had a considerable number of hard, soybean-sized, light-yellow nodules. The surgical removal of the mass under and in front of the tongue was performed. A pathology examination and Congo red staining confirmed the diagnosis of amyloidosis of the submandibular glands and sublingual glands. No recurrence was observed after 5 years of follow-up. The literature on the relevant problems was reviewed.

Quiste teratoide sublingual. Reporte de un caso / Sublingual teratoid cyst. A case report

Resumen Antecedentes: Los quistes dermoides en el piso de la boca son lesiones que se observan raramente,y se presentan como masas de lento crecimiento causadas por atrapamiento de tejido ectodérmico en la línea media y en la línea de fusión embrionaria de los procesos faciales. Reporte del caso: Varón de 2 años de edad con aumento de volumen sublinqual proqresivo desde el nacimiento, a la exploración con tumor a nivel del piso de la boca de aproximadamente 3 X 4 cm que desplaza la lenqua hacia arriba, blanda, no dolorosa. Se realizó resección quirúrqica de la lesión, y se confirmó quiste teratoide mediante el reporte histopatológico. Conclusión: Los quistes dermoides se caracterizan por su beniqnidad, así como por un lento crecimiento; sin embargo, se recomienda la resección quirúrgica como tratamiento de elección, cuya técnica dependerá de su posición anatómica. Debido a la variedad de patologías en la zona es importante realizar un adecuado diagnóstico diferencial.

Abstract Background: Dermoid cysts at the floor of the mouth are rarely observed lesions; they appear as slow growth masses caused by entrapment of ectodermal tissue at the midline and the embryonic fusion line of the facial processes. Case report: A two-year-old male presents sublingual growth of increasing volume from birth, at the time of the clinica examination corresponds to a soft, non-tender, 3 X 4 cm tսmor at the floor of the mouth that is displacing the tongue upwards. The patient underwent surgical resection of the lesion. A histopathologic report confirmed a teratoid cyst. Conclusion: Dermoid cysts are characterized by their benign characteristics and slowgrowth. However, surgical resection is recommended as the treatment of choice. The surgica technique depends on its anatomical position. It is important to make a proper differential diagnosis due to the different kinds of pathologies in this region.

Dermoid cyst in the floor of the mouth

@#Dermoid cysts are rare developmental benign lesions that arise as a result of ectodermal differentiation of multipotent cells. Histologically the cysts are classified as dermoid, epidermoid and teratoid cysts depending on the presence of adnexal structures and derivatives of germ layers. When dermoid cysts appear in the floor of the mouth they can cause difficulty in deglutition and respiration. The differential diagnosis of dermoid cyst could be infection, ranulaor tumor. Intraoral or extra oral approach for enucleation is the method of treatment. Dermoid cysts have a good prognosis with low malignancy and recurrence rate. A case report of a dermoid cyst in the floor of the mouth is presented in this paper along with clinical, histopathological evaluation and the treatment.

Hemorragia de assoalho de boca durante a instalação de implantes osteointegráveis / Bleeding at the floor of the mouth during dental implant placement

O objetivo deste trabalho foi apresentar um caso clínico de hemorragia transoperatória na região anterior de mandíbula. Um paciente do sexo masculino, 77 anos de idade e portador de hipertensão arterial foi indicado para reabilitação com implantes osteointegráveis na região anterior de mandíbula. No transoperatório, após fresagem para preparação do leito para instalação dos implantes, observou-se hemorragia oriunda do assoalho de boca, ocasionando aumento severo da base de língua associado ao aumento de pressão arterial do paciente. A utilização de medicação anti-hipertensiva e ansiolítica foi a manobra inicial realizada para controle da hemorragia. Na sequência, foram realizadas duas incisões bilateralmente no assoalho de boca, com o intuito de drenar o sangue. O paciente foi mantido em observação por um período de duas horas, com monitorização de seus sinais vitais, estes mantendo-se dentro da normalidade e sem evolução do edema. O paciente foi liberado com as devidas orientações, visto que este acidente foi de difícil controle e os implantes osteointegrados não foram instalados naquele momento. Existe um eminente risco de hemorragias, quando há intervenção na região anterior da mandíbula para a instalação de implantes osteointegráveis. Porém, pacientes com comprometimentos sistêmicos e/ou que fazem uso de medicamentos anticoagulantes são mais predispostos. A fenestração da cortical lingual pode ser uma situação clínica que pode levar a um quadro hemorrágico. Saber aplicar condutas de emergência é um fator que pode salvar a vida dos pacientes, e alterações anatômicas locais podem favorecer o acidente hemorrágico.

The aim of this paper is to describe a clinical case of transoperative bleeding in the anterior mandibular region. A 77 years-old male patient having arterial hypertension was scheduled for dental implant placement. After the osteotomy for implant preparation, abundant bleeding was observed at the fl oor of the mouth, with severe tongue swelling and an increase on blood pressure. The basic management consisted of anti-hypertensive and anxiolytic medication, with two lateral incisions to drain blood, vital signs monitoring. The edema subsided and no airway obstruction or speech problems were observed thereafter. The patient was discarded with appropriate recommendations, and the implants were not installed in the same surgical consultation. There is a considerable risk of bleeding in the anterior mandibular region. However, patients with systemic diseases or under anti-coagulation therapy are more prone. Fenestration of the lingual cortical plate could be a possible reason for profuse bleeding. The clinician must know how to manage these situations to save the patient since local anatomic changes can favor the hemorrhagic accident.

A Huge Lipoma of the Floor of the Mouth: An Unusual Case Report.

Lipomas of the oral cavity are not uncommon, but its location in the floor of the mouth is a rare entity. They are soft tissue mesenchymal neoplasm’s of mature adipose tissues. Its overall incidence of occurrence in the oral cavity is 1-5% of all benign oral lesions. Oral lipomas can occur at various anatomic sites, including buccal mucosa, tongue, major salivary glands, and floor of the mouth. Although benign in nature their progressive growth may cause interference with speech and mastication due to the tumors’ dimension. In this article, the author reports an unusually large lipoma occurring in the floor of the mouth in a 44-year-old female patient. The present case is worth presentation considering the relative rarity with respect to the location and the size of the lesion.

Quiste dermoide verdadero en piso de boca / True dermoid cyst in the floor of the mouth

Los quistes dermoides son lesiones benignas de origen embrionario, con una incidencia del 0,01 por ciento de todos los quistes de la cavidad bucal. No presenta predicción por sexo y alrededor del 60 por ciento de los casos se desarrollan entre los 15 y 35 años de edad. El conocimiento de los hallazgos clínicos de este tipo lesiones es vital para un diagnóstico definitivo, sin embargo, este siempre debe ser corroborado mediante exámenes histopatológicos, especialmente, al realizar un diagnóstico diferencial entre los diferentes tipos de quiste dermoides u otras alteraciones a nivel oral con manifestaciones clínicas similares. El propósito de esta presentación reportar un caso clínico para ampliar conocimientos sobre el diagnóstico y tratamiento de este tipo de lesión debido a su infrecuencia en cavidad oral. La ubicación inusual de estos quistes en cavidad oral hace que, aún con una buena valoración clínica e imaginológica, el diagnóstico prequirúrgico preciso sea difícil. Es por esto que el tratamiento quirúrgico no sólo evita el riesgo de una complicación infecciosa y eventual malignización sino que permite obtener un diagnóstico definitivo mediante estudios histopatológicos(AU)

Dermoid cysts are benign lesions of embryonic origin, with an incidence of 0.01 percent of all cysts in the oral cavity. There is no prediction by sex and about 60 percent of cases develop at the age of 15 to 35 years old. Knowledge of the clinical findings of such injuries is vital for a definitive diagnosis; however, this should always be confirmed by histopathological examination, especially when making a differential diagnosis between different types of dermoid cyst or other pathologies with similar clinical manifestations. The purpose of this article is to expand knowledge about the diagnosis and treatment of this type of injury because of it is not frequent in the oral cavity. The unusual location of these cysts in the oral cavity makes hard the precise preoperative diagnosis, even with good clinical and radio-graphical assessment. The surgical treatment not only prevents the risk of infectious complications and possible malignancy but also, allows obtaining a definitive diagnosis by a histopathological study(AU)

Oxyphilic Adenoma Involving Floor of The Mouth : A Case Report.

Oxyphilic adenomas are unusual neoplasm of the head and neck region affecting the glandular epithelial tissue. They were first called as oncocytoma, which is composed of oncocytes and were first described by Schaffer and Hamperl. Oncocytes are polyhedral cells and contain abundant cytoplasm filled with eosinophilic granules. Oxyphilic adenomas are benign neoplasm and represent approximately less than 1% of all salivary gland tumors. They are found generally in the parotid gland, affecting parotid gland region extraorally and rarely encountered in various other sites. Involvement of floor of the mouth is very rare. Presented in this article is a case report of patient suffering from neoplasm, which was histopathologically diagnosed as oxyphilic adenoma.

Cervical Lymph Node Metastasis of Squamous Cell Carcinoma of the Oral Tongue and Floor of Mouth / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Squamous cell carcinoma of the oral cavity is a well known tumor with frequent nodal metastases, but reports on detailed prevalence of nodal metastases by primary subunits and neck level are lacking. PATIENTS AND METHOD: A retrospective review of 63 previously untreated patients (who visited the hospital from 1992 to 2001) with primary squamous cell carcinoma of the oral tongue and floor of the mouth, were undertaken to ascertain the prevalence of ipsilateral neck node metastases by neck level; of elective dissection in cN0 neck (n=43), and of therapeutic dissection in cN+ neck (n=20). RESULTS: Overall incidence of neck metastases, cancer of the oral tongue, and cancer of the floor of the mouth were 44.4%, 50% (24/48) and 26.7% (4/15), retrospectively. False negative and false positive rates were 27.9% and 20%, respectively. Neck metastasis was predominantly revealed in levels I, II, and III. Metastases at level IV and V were exclusively accompanied with metastases to other levels. CONCLUSION: Squamous cell carcinomas of the oral tongue and floor of the mouth metastasized to the neck frequently and neck metastasis correlated to T-stage. Elective treatment is needed to ipsilateral neck level I, II, and III. However, comprehensive neck dissection is needed for cN+ neck.

Analysis of the factors influencing cervical lymphatic metastasis of the floor of mouth carcinoma / 中国癌症杂志

Purpose:To investigate the local factors that influenced cervical lymphatic metastasis and prognosis of the floor of mouth carcinoma.Methods:A retrospective study was undertaken of 65 patients with squamous cell carcinoma of floor of mouth, who were treated between 1983 and 1998. Local factors including the tumor location, the tumor size, local invasion and pathological differentiation were investigated for the correlation with cervical lymphatic metastasis and prognosis of the disease.Results:Cervical lymphatic metastasis was 46.2% (30/65) for these 65 patients, and 96.6% of the involved lymph nodes were located in level Ⅰ(submandibular region) of the neck. Of these 65 patients, cervical lymphatic metastasis was 62.2% and 40.0% for 45 anterior and 20 posterior floor of mouth carcinoma, respectively ( P = 0 .096).Cervical metastasis was 59.5% and 21.7% for tumor size greater than or less than 3 cm, respectively ( P = 0.003).Cervical metastasis was 46.8% and 44.4% for tumors invading the tongue or not, respectively.Cervical metastasis was 60 0% and 42 0% for tumors invading the gum or not, respectively.Cervical metastasis was 76.5% for the poorly differentiated and was 42.1% for the moderately and well differentiated squamous cell carcinoma ( P = 0.018). The overall 5 years survival was 46.4% for the 65 patients. The 5 years survival was 61.4% for these without cervical metastasis and 28.9% for these with cervical metastasis ( P = 0.0013).Conclusions:The local factors such as the tumor size greater than 3 cm, tumor invasion to the tongue and the gum, and the poorly differentiated squamous cell carcinoma of floor of mouth increased the incidence of cervical metastasis, and therefore adversely influenced the prognosis.

Unsuccess Cause Analysis of Pedunculated Flaps Reconstructed the Defect of Floor of the Mouth / 中国医师杂志

Objective To analyze the reason of necrosis for pedunculated skin flaps repaired after floor of the mouth defect repair.Methods 56 cases of pedunclated-flaps restoring the floor of the mouth from 1996 to 2001 were reviewed, and pedunclated-flap repair was performed after operation in 11 cases suffering from malignant tumors in the floor of the mouth, and 5 kinds of pedunculated flaps were compared.Results Five kinds of pedunculated flaps were used to reconstruct the floor of the mouth defects. Its successful sequence was as following: forehead flap, pectoralis major myocutaneous flap, sternocleidomastoid flaps,trapezius myocutaneous flaps, and subhyoid flap.Conclusions Causes of those flaps necrosis might relate to furnishing blood with supplied-flaps region and structure of anatomy in received-flaps region, also it is related to operater's skill.So the reason of repair failure of skin flaps with pedicle needs comprehensive analysis.

Dermoid Cyst Of The Floor Of The Mouth

Dermoid cyst has evolved to represent any cyst filled with sebumlike and with evidence of specialized skin derivatives from defective embryonic development. Approximately 7% of all dermoid cyst arise in the head and neck region and 0.01% of all oral cysts. The anterior region of the floor of the mouth is the most common site of occurrence in the oral cavity. There is no sex predilection and the age at presentation is usually in the second or third decades. Clinically, the lesions present as a rubbery or doughy mass that vary in size from a few millimeters to 12 cm. An intraoral dermoid cyst usually presents as a slowly growing, painless swelling in the anterior floor of the mouth which may eventually cause elevation and displacement of the tongue resulting in dysphonia, dysphagia and dyapnea. Treatment involves surgical removal and recurrences have not been reported. We report three cases of dermoid cyst that were cared successfully in the department of dentistry, Kyung-pook National University. One case is a sublingual type, another case is a geniohyoid type, and the other is a lateral type.

A Case of Cystic Teratoma on the Floor of the Mouth in Neonate

Cystic teratoma on the floor of the mouth is infrequent disease and known as congenital origin. Teratoma has no sex distribution. Treatrnent of the cystic teratoma is completely surgical excision and recurrence is rare. The authors have experienced a case of cystic teratoma on the floor of the mouth in neonate. We reported this case with review of literatures.