Surgical Treatment of Sublingual Gland Ranulas

Abstract Introduction Ranulas are divided into oral (OR) and plunging (PR) and comprise the most common pathology of the sublingual gland. This study presents a case series of patients operated due to OR and PR within different type of modalities in a 1-year period. Objective The aim of this study is to determine the optimal surgical treatment of ranulas based on our results as well as in the literature review. Methods The medical charts of 7 patients with sublingual gland ranulas treated in 2020 were reviewed. Results The median age of the patients was 19. Three patients with OR were treated by marsupialization, micromarsupialization, and sublingual gland excision. Four patients with PR were operated via cervical approach in three cases and intraoral approach in one case. No recurrence was observed in 14 months of follow-up, on average. Conclusion Micromarsupialization should be consider as the primary treatment for OR. In case of recurrent OR and primary or recurrent PR, the best results might be obtained by radical excision of the sublingual gland, which can be performed without resection of the ranula sac with the intraoral approach.

Técnica de micromarsupialización en ránula oral: reporte de dos casos clínicos en paciente infantil / Técnica de micromarsupialização em rânula oral: relato de dois casos clínicos em paciente infantil / Micromarsupialization technique in oral ranula: report of two clinical cases in child patient

Introducción: Ránulas orales son pseudoquistes resultantes de la retención de mucus o extravasación de saliva que suelen afectar a los niños. Este artículo tiene como objetivo reportar dos casos clínicos de ránulas orales y discutir el tratamiento mediante la técnica de micromarsupialización. Reporte de caso 1: Niña de 6 años de edad, acudió al servicio de urgencia en odontopediatría de la Bebé Clínica de la Universidad Estatal de Londrina refiriendo "bolita debajo de la lengua" de aproximadamente 3 meses de evolución. Clínicamente se observó burbuja rojiza de aproximadamente 1,5 cm de diámetro ubicada en el lado derecho del suelo bucal en forma de cúpula, base sésil y fluctuante. Reporte de caso 2: Niña de 5 años, acudió al mismo servicio con queja de "burbuja en la lengua" de aproximadamente 2 meses de evolución. Clínicamente se observó burbuja de color rosado similar a la mucosa de aproximadamente 1 cm de diámetro ubicada en el lado izquierdo del suelo bucal con forma circunscrita, base sésil y fluctuante. Con base en los aspectos clínicos y la historia actual de las lesiones, el diagnóstico fue ránula oral y el tratamiento quirúrgico realizado fue micromarsupialización. En el seguimiento clínico de 8 y 6 meses, respectivamente, hubo regresión total de las lesiones sin signos clínicos de recurrencia. Conclusión: Con base en dos casos clínicos reportados, se puede concluir que el uso de la técnica de micromarsupialización representa procedimiento quirúrgico efectivo en niños por su rápida ejecución, abordaje conservador, sin el uso de anestesia local infiltrativa, bien tolerado y con buen pronóstico.

Introdução: Rânulas orais são pseudocistos resultantes da retenção de muco ou extravasamento de saliva que frequentemente acometem crianças. Este artigo objetiva relatar dois casos clínicos de rânulas orais e discutir o tratamento utilizando a técnica de micromarsupialização. Relato de caso 1: menina de 6 anos, compareceu ao Pronto-Socorro da Bebê Clínica da Universidade Estadual de Londrina queixando-se de "bola embaixo da língua" com duração aproximada de 3 meses. Ao exame intraoral, notou-se bolha avermelhada de aproximadamente 1,5 cm de diâmetro localizada no lado direito do assoalho bucal em forma de cúpula, base séssil e flutuante. Relato de caso 2: menina de 5 anos, compareceu ao mesmo serviço com queixa de "bolha na língua" com duração aproximada de 2 meses. Clinicamente, notou-se bolha de coloração rósea igual à mucosa de aproximadamente 1 cm de diâmetro localizada no lado esquerdo do assoalho bucal de formato circunscrito, base séssil e flutuante. Com base nos aspectos clínicos e na história atual das lesões, o diagnóstico foi de rânula oral e o tratamento cirúrgico realizado foi a micromarsupialização. Em acompanhamento clínico de 8 e 6 meses, respectivamente, foi observado regressão total das lesões sem sinais clínicos de recidiva. Conclusão: A partir dos casos clínicos relatados, pode-se concluir que a utilização da técnica de micromarsupialização representa um procedimento cirúrgico eficaz em crianças devido à rápida execução, abordagem conservadora, sem uso de anestesia local infiltrativa, bem tolerada e com bom prognóstico.

Introduction: Oral ranulas are pseudocysts resulting from the retention of mucus or extravasation of saliva that often affect children. This article aims to report two clinical cases of oral ranulas and discuss the treatment using the micromarsupialization technique. Case report 1: 6-year-old girl, attended the Emergency Room of the Baby Clinic of the State University of Londrina complaining of a "ball under the tongue" lasting approximately 3 months. Clinically, reddish bubble of approximately 1.5 cm in diameter was noted located on the right side of the dome-shaped mouth floor, sessile base and fluctuating. Case report 2: 5-year-old girl, attended the same service with a complaint of "bubble on the tongue" lasting approximately 2 months. Clinically, pink-colored bubble similar to the mucosa of approximately 1 cm in diameter was observed located on the left side of the floor of the mouth with a circumscribed shape, sessile base and fluctuating. Based on the clinical aspects and the current history of the lesions, the diagnosis was oral ranula and the surgical treatment performed was micromarsupialization. In a clinical follow-up of 8 and 6 months, respectively, total regression of the lesions was observed, with no clinical signs of recurrence. Conclusion: Based on the reported clinical cases, it can be concluded that the use of micromarsupialization technique represents an effective surgical procedure in children due to its quick execution, conservative approach, without the use of local infiltrative anesthesia, well tolerated and with good prognosis.

Surgical Management of Ranula- Floor of Mouth by Marsupialization: A Case Series.

Introduction: The extravasation of saliva from the sublingual gland on the floor of the mouth results in a ranula. The most typical presenta?on is swelling under the tongue. The mylohyoid muscle may allow it to herniate, Causing a plunging ranula. Ranula can be treated in many ways, including ranula excision alone, excision of the sublingual gland with or without ranula, aspira?on of cys?c fluid, sclerotherapy, marsupializa?on, incision and drainage. Material and methods: This case study includes six pa?ents with ranula who underwent surgical treatment by marsupializa?on. The indica?ons, age and sex distribu?on, Marsupializa?on methods, pathology reports, recurrence rates, and complica?ons were seen. Results: Out of 6 pa?ents in our case series, no one pa?ent has shown to be any recurrence or complica?ons of marsupializa?on. Conclusions: Management of Ranula by Marsupializa?on is a good op?on, but if it recurs a?er marsupializa?on, Excision of the lesion and the affected gland is the best course of act?on.

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.

Pathological Evaluation by Microtomography of Ranula. Clinical Case Report

ABSTRACT: This study aims to demonstrate, through a clinical case report, the applicability of the use of microtomography (µCT) in the histopathological evaluation of a ranula lesion on the oral floor and to evaluate the use of 2 % elemental iodine solution as a contrast agent, in order to obtain a better contrast effect in a tissue sample, thus facilitating the identificat ion of anatomical structures, the histomorphological evaluation and the potential use of µCT in the imaging diagnosis of lesions. Different parameters were evaluated for obtaining images in SkyScan 1172, in a biopsied piece, when impregnated in a 10 % formalin solution and in a 2 % elemental iodine solution, when impregnated for 24h and 48h. Contrast agent impregnation was evaluated using the Hounsfield unit. The use of µCT allowed the identification of sialoliths dispersed inside the biopsy specimen, while the impregnation with Elemental iodine 2 % for 24h resulted in a better contrast when compared to the other conditions. The use of the Hounsfield unit allowed an adequate evaluation of the contrast obtained when the different parameters of impregnation and image acquisition were applied. The comparison between the 3D images with and without a specific marker highlighted a better evidencing of the soft tissues, with an improvement in the contrast of the images, also allowing the ident ification of the glandular duct obstructed by the sialoliths, allowing a conclusive histopathological evaluation of the biopsied lesion.

RESUMEN: Este estudio tiene como objetivo demostrar, a través de un reporte de caso clínico, la aplicabilidad del uso de la microtomografía (µCT) en la evaluación histopatológica de una lesión de ránula en el piso de la cavidad oral y evaluar el uso de solución de yodo elemental al 2 % como agente de contraste, con el fin de obtener un mejor efecto de contraste en una muestra de tejido, facilitando así la identificación de estructuras anatómicas, la evaluación histomorfológica y el potencial uso de µCT en el diagnóstico por imágenes de lesiones. Se evaluaron diferentes parámetros para la obtención de imágenes en SkyScan 1172, en una pieza biopsiada, cuando se impregna en una solución de formalina al 10 % y en una solución de yodo elemental al 2 %, durante 24 h y 48 h. La impregnación del agente de contraste se evaluó utilizando la unidad Hounsfield. El uso de µCT permitió la identificación de sialolitos dispersos dentro de la muestra de la biopsia, mientras que la impregnación con Yodo Elemental al 2 % durante 24 h resultó en un mejor contraste en comparación con las otras condiciones. El uso de la unidad Hounsfield permitió una adecuada evaluación del contraste obtenido cuando se aplicaron los diferentes parámetros de impregnación y adquisición de imágenes. La comparación entre las imágenes 3D con y sin marcador específico destacó una mejor evidenciación de los tejidos blandos, con una mejora en el contraste de las imágenes, permitiendo además identificar el conducto glandular obstruido por los sialolitos, permitiendo una evaluación histopatológica concluyente de la lesión sometida a biopsia.

Rasgos clínicos e histopatológicos de quistes de retención salival

RESUMEN Introducción: La formación de los quistes de retención salival denominados mucocele y ránula se encuentran entre las afecciones de las glándulas salivales más frecuentes en edades pediátricas. Objetivo: Examinar los rasgos clínico e histopatológico de los quistes de retención salival. Métodos: Estudio descriptivo retroprospectivo de corte trasversal de octubre de 2017 a septiembre de 2019 en 43 pacientes atendidos por consulta externa de maxilofacial del Hospital Pediátrico Universitario "William Soler Ledea" con confirmación histopatológica de quistes de retención salival. Las variables a medir fueron: edad, sexo, etiología, rasgos clínicos, localización y aspecto histopatológico. Resultados: El mucocele fue el diagnóstico en 83 % de los casos y las diferencias por sexo fueron significativas con afectación mayor para el sexo femenino, la etiología más frecuente fue el mordisqueo del labio con 48,8 %, la localización más frecuente el labio inferior con 72,0 %. Hubo relación significativa entre la etiología y las características histopatológicas. Conclusiones: El quiste de retención salival más frecuente es el mucocele con predominio en el sexo femenino, de aspecto nodular, tamaño menor de 5 mm; predominó la localización en el labio inferior y de causa por mordisqueo del labio. Histopatológicamente la ausencia de revestimiento epitelial y presencia de inflamatorio agudo es lo más frecuente.

ABSTRACT Introduction: The formation of salivary retention cysts called mucocele and granula are among the most frequent conditions of the salivary glands in pediatric ages. Objective: Assess the clinical and histopathological features of salivary retention cysts. Methods: A retroprospective, descriptive and cross-sectional study was carried out from October 2017 to September 2019 in 43 patients with histopathological confirmation of salivary retention cysts attended by the maxillofacial outpatient clinic of "William Soler Ledea" University Pediatric Hospital. The variables to be measured were: age, sex, etiology, clinical features, location and histopathological appearance. Results: Mucocele was the diagnosis in 83.0% of the cases and the differences by sex were significant with greater involvement for the female sex, the most frequent etiology was the bite of the lip with 48.8%, and the most frequent location the lower lip with 72.0%. There was a significant relationship between the etiology and histopathological characteristics. Conclusions: The most frequent salivary retention cyst is the mucocele with predominance in the female sex, of nodular appearance, size less than five mm; there was a predominance of localization in the lower lip and caused by the bite of the lip; histopathologically, the absence of epithelial lining and presence of acute inflammation are the most frequent.

Bluish swelling on the foor of the mouth

@#A healthy, six-year-old girl presented to the clinic with a three-day history of swelling on the foor of her mouth (Figure 1). Te swelling was painless and was not associated with discharge or bleeding inside her mouth. She also denied any fever, signifcant loss of weight or appetite, halitosis, dysphagia, and odynophagia. Tere was no other neck or chest swelling. On physical examination, her face and neck appeared normal and symmetrical. Cervical and submandibular lymph nodes were not palpable. However, there was an ill-defned, rounded, bluish swelling approximately 2 cm in diameter on the left foor of the mouth lateral to the frenulum. Te swelling was soft with a smooth surface but non-tender upon palpation. Tere was no bleeding or discharge noted in the oral cavity. Other oral structures appeared normal despite multiple caries on her deciduous teeth.

Doenças de glândulas salivares: estudo epidemiológico em um serviço de Estomatologia do sul do Brasil / Salivary gland diseases: epidemiological study in a Stomatology service in southern Brazil

Objetivo: realizar um levantamento epidemiológico das doenças de glândulas salivares por meio de análise de prontuários registrados em um serviço de Estomatologia do sul do Brasil. Métodos: a amostra foi composta por aproximadamente 24.000 prontuários de pacientes do Serviço de Estomatologia do Hospital São Lucas, atendidos no período de 1977 a 2017. Foram selecionados os prontuários que apresentassem as seguintes enfermidades de glândulas salivares: mucocele, rânula, sialolitíase, sialoadenite infecciosa, síndrome de Sjögren, sialometaplasia necrosante e neoplasias benignas ou malignas. Os dados coletados foram analisados por meio de estatística descritiva e inferencial, utilizando o teste Qui-Quadrado. Resultados: das 817 enfermidades encontradas, 56,2% eram mucoceles, 11,1% sialoadenites infecciosas, 10,3% rânulas, 10,1% sialolitíases, 5,5% neoplasias benignas, 4,3% síndrome de Sjögren, 2,1% neoplasias malignas e 0,4% sialometaplasias necrosantes. O mucocele apresentou predileção pelo sexo masculino, enquanto a rânula e a síndrome de Sjögren foram mais associadas ao sexo feminino. As demais enfermidades não apresentaram predileção por sexo. A localização das lesões, as características clínicas e a idade dos pacientes acometidos foram também avaliadas. Conclusão: as doenças das glândulas salivares merecem destaque entre as enfermidades do sistema estomatognático devido à complexa anatomia dessas estruturas, à importância da saliva na homeostase bucal e ao comportamento clínico indolente das neoplasias malignas que acometem essas glândulas.(AU)

Objective: to perform an epidemiological survey of salivary gland diseases by analyzing medical records from a Stomatology Service in southern Brazil. Methods: the sample consisted of approximately 24,000 medical records of patients assisted at the Stomatology Service of the São Lucas Hospital between 1977 and 2017. The following salivary gland disorders were selected: mucocele, ranula, sialolithiasis, infectious sialadenitis, Sjögren's syndrome, necrotizing sialometaplasia, and benign or malignant neoplasms. The data collected were analyzed by descriptive and inferential statistics using the chi-squared test. Results: from the 817 disorders found, 56.2% were mucocele, 11.1% sialadenitis, 10.3% ranula, 10.1% sialolithiasis, 5.5% benign neoplasms, 4.3% Sjögren's syndrome, 2.1% malignant neoplasms, and 0.4% necrotizing sialometaplasia. Mucocele was more prevalent in men, while ranula and Sjögren's syndrome were more associated with women. The other diseases did not present gender preference. The location of the lesions, clinical characteristics, and age of the patients affected were also assessed. Conclusion: salivary gland diseases deserve special attention among stomatognathic system disorders due to the complex anatomy of such structures, the importance of saliva in the oral homeostasis, and the indolent clinical behavior of the malignant neoplasms affecting these glands.(AU)

Case report of the management of the ranula

Ranula is a mucocele caused by extravasation of the sublingual gland on the floor of the mouth. The most common presentation is a cystic mass in the floor of the mouth. A portion of the sublingual gland could herniate through the mylohyoid muscle, and its extravasated mucin can spread along this hiatus into submandibular and submental spaces and cause cervical swelling. This phenomenon is called plunging ranula. A variety of treatments for ranula has been suggested and include aspiration of cystic fluid, sclerotherapy, marsupialization, incision and drainage, ranula excision only, and excision of the sublingual gland with or without ranula. Those various treatments have shown diverse results. Most surgeons agree that removal of the sublingual gland is necessary in oral and plunging ranula. Four patients with ranula were investigated retrospectively, and treatment methods based on literature review were attempted.

Significance of Sublingual Gland Excision in Surgical Treatment of Ranula / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ranulas, pseudo cysts found on the floor of mouth, develop from the retention or extravasation of saliva from the sublingual gland. The main treatment of ranula is surgical excision but the extent of surgery is controversial. The aim of this study was to evaluate the significance of sublingual gland excision in the surgical treatment of ranula. SUBJECTS AND METHOD: We retrospectively reviewed 112 patients with ranula who had undergone surgical excision from January 2004 to April 2016. Those who underwent any previous treatment such as sclerotherapy, marsupialization, or excision of cyst were excluded in the study. Surgical outcomes including complications and recurrence were compared between the group that went through simple cyst excision and the group that went through cyst and sublingual gland excision. RESULTS: Of 112 patients, 94 were simple ranula and 18 were plunging ranula. Thirty-seven (33%) were male and 75 (67%) were female. Of the 94 simple ranula patients, 23 underwent excision of cyst only; the remaining 71 patients and all other patients with plunging ranula underwent excision of cyst and sublingual gland together. The recurrence rate was significantly lower for the cyst and sublingual gland excision group than for the simple cyst excision group (2.2% vs. 17.4%, p=0.004). The complication rate did not differ between the two groups (4.3% vs. 1.1%, p=0.298). CONCLUSION: The excision of sublingual glands as well as cysts is an important option to reduce recurrence in the surgical treatment of ranula.

Marsupialización modificada de ránula gigante intraoral: reporte de caso / Modified marsupialisation of a giant intraoral ranula: case report

La ránula intraoral es una enfermedad benigna seudoquística de extravasación que tiene su origen en las glándulas salivales sublinguales. Es una entidad poco prevalente. Es más frecuente en niños y adolescentes, con características clínicas propias que la diferencian de otras entidades de la boca. Su tratamiento es quirúrgico y varias técnicas han sido descritas en la literatura: marsupialización simple y modificada, enucleación de la lesión, extirpación de la glándula junto con enucleación de la ránula. Si bien la extirpación de la glándula junto con la enucleación de la lesión es el tratamiento definitivo radical y más aceptado, la marsupialización modificada puede ser útil como alternativa de tratamiento quirúrgico conservador en casos de ránulas intraorales gigantes, disminuyendo los riesgos de morbilidad quirúrgica y presentando bajos índices de recurrencia, mientras su aplicación sea cuidadosa. El siguiente reporte de caso describe el manejo clínico de forma quirúrgica conservadora mediante marsupialización modificada, con un seguimiento de 12 meses sin signos de recidiva.

The intraoral ranula is a benign pseudo-cystic extravasation with its origin in the sublingual salivary glands. It is an infrequent disease. It is more common in children and adolescents, with its own clinical characteristics that differentiate it from other entities in the mouth. The treatment for this condition is surgical, and several techniques have been described in the literature: simple and modified marsupialisation, enucleation of the lesion, and removal of the gland with enucleation of the ranula. While the removal of the gland with enucleation of the lesion is the widely accepted radical and definitive treatment, marsupialisation may be useful as an alternative to conservative surgical treatment in cases of giant intraoral ranula, reducing the risk of surgical morbidity, and presenting with low rates of recurrence, while its application should be performed with care. The case is presented that describes the conservative surgical treatment with marsupialisation in its clinical management, with a 12 months follow up without signs of recurrence.

Epidemiological survey of mucus extravasation phenomenon at an oral pathology referral center during a 43 year period / Levantamento epidemiológico de fenômeno de extravasamento de muco de um centro de referência em patologia oral por um período de 43 anos

ABSTRACT INTRODUCTION: Mucoceles are common benign pseudocystic lesions of the oral cavity; their main etiological factors are trauma and ductal obstruction. Two histological patterns are found: mucus retention phenomenon (MRP) and mucus extravasation phenomenon (MEP). Mucus extravasation phenomenon is the more common histological subtype and it mainly affects the lower lip. The knowledge of its main clinical features and management is important to assist health professionals in clinical practice. OBJECTIVE: This study aimed to determine the relative frequency and distribution of oral mucoceles in an oral pathology reference center. METHODS: Cross-sectional historical study that analyzed all cases pathologically diagnosed as mucus extravasation phenomenon by the department of anatomic pathology of an oral pathology referral center from June of 1970 to May of 2014, considering the clinical characteristics of the lesion and those relating to the patient. SPSS v. 20.0 software for Windows was used for descriptive analysis. RESULTS: During 43 years, 719 cases of mucus extravasation phenomenon (54.7% men and 45.3% women) were registered, with the lower lip as the most commonly affected site (n = 484; 67.3%). The average age of patients was 20.8 years (SD ± 14.4) with a peak occurrence in the second decade of life. Most professionals had oral mucocele/ranula (n = 606; 84.3%) as the initial clinical impression. CONCLUSION: Mucus extravasation phenomenon is a lesion that primarily affects young patients, affecting mainly the lower lip, and is commonly found in oral diagnostic services.

Resumo Introdução: Mucoceles são lesões pseudocísticas benignas comuns da cavidade oral, que possuem como principais fatores etiológicos trauma ou obstrução ductal. Dois padrões histopatológicos são encontrados: fenômeno de retenção de muco (FRM) e fenômeno de extravasamento de muco (FEM). O FEM é o subtipo histológico mais comum e tem como principal local de acometimento o lábio inferior. O conhecimento acerca de suas principais características clínicas e formas de tratamento se faz importante para auxiliar profissionais da saúde na prática clínica. Objetivo: Este trabalho objetivou determinar a frequência relativa e a distribuição das mucoceles orais em um centro de referência em patologia oral. Método: Estudo transversal de caráter histórico, no qual foram analisados os casos diagnosticados histopatologicamente como FEM pelo serviço de anatomia patológica de um centro de referência em patologia oral no período de junho de 1970 a maio de 2014, considerando-se variáveis clínicas da lesão e relativas ao paciente. O programa estatístico SPSS 20.0 for Windows foi utilizado para a análise descritiva dos dados. Resultados: Durante 43 anos foram observados 719 casos de FEM (54,7% homens e 45,3% mulheres), sendo o lábio inferior (n = 484; 67,3%) o local de principal acometimento. A média de idade dos pacientes foi de 20,8 anos (DP ± 14,4), com pico de ocorrência na segunda década de vida. A maioria dos profissionais teve mucocele oral/rânula (n = 606; 84,3%) como primeira hipótese clínica. Conclusão: O FEM é uma lesão que afeta principalmente pacientes jovens, acometendo preferencialmente o lábio inferior, sendo comumente encontrada nos serviços de diagnóstico oral.

Ranula – threefold habituation.

Intraoral swellings present as a diagnostic challenge to the clinician, the most bourgeois being mucocele & ranula. An intraoral ranula has been defined as a retention cyst due to ductal obstruction & fluid retention of the sublingual salivary gland on the floor of the mouth. The name “ranula” has been derived from the latin word “Rana” meaning “Frog.” We hereby report a case of triennial recurrent ranula located in the floor of mouth, treated successfully by surgical excision by injecting an irreversible impression material to delineate the cystic lining of the lesion, after which the patient recovered unvariedly.

A Large Superficial Dissecting Sublingual Ranula Crossing the Midline: Our Experience.

Ranula is a cystic lesion arising in the oral cavity in relation to the sublingual gland. Typically ranulas are unilateral although there has been a report of superficial dissecting ranula crossing the midline thus presenting as a bilateral lesion. This article is about our experience with a similar large right sided sublingual ranula crossing the midline in a 17 year old female who underwent a complete excision of the lesion along with removal of ipsilateral sublingual gland which is the accepted treatment at present.

Plunging Epidermoid Cyst of the Floor of the Mouth Mimicking a Ranula

Plunging epidermoid cyst of the floor of mouth is indeed an uncommon entity. A 34-year old Malay gentleman had presented to our centre with a floor of mouth lesion that extended into the submental region. Clinical findings and imaging studies pointed towards the impression of a plunging ranula. Histopathological examination of a completely excised mass via intraoral approach, confirmed the diagnosis of an epidermoid cyst. He was well on follow up with no subsequent recurrence. We discuss the nature of epidermoid cyst and its surgical management.

Pathophysiology and Management of the Ranula / 대한이비인후과학회지

Ranulas are pseudocysts on the floor of the mouth resulting from the retention or extravasation of saliva from the sublingual gland (SLG). The etiology of ranulas is unknown, but they have been associated with local trauma or previous surgery. The anatomic variation of the ductal system of the SLG such as Bartholin's duct might be a possible cause of ranulas. Treatment modalities range from conservative to various surgical techniques, including sclerotherapy, marsupialization, excision of the ranulas with or without excision of the SLG and botox injection. Recently, less invasive treatment modality such as micro-marsupialization has been introduced. It was able to easily and safely treat the ranulas. But it also has the possibility of recurrence, especially in cases having anatomic variation of the ductal system of the SLG. A definitive and reliable treatment choice is surgical resection of the SLG with or without marsupialization than other, more conservative treatments.

Plunging Ranulas Revisited: A CT Study with Emphasis on a Defect of the Mylohyoid Muscle as the Primary Route of Lesion Propagation

OBJECTIVE: The purpose of this study was to clarify the pathogenesis of plunging ranulas in regard of the pathway of lesion propagation using CT scans. MATERIALS AND METHODS: We retrospectively reviewed CT scans of 41 patients with plunging ranula. We divided plunging ranulas into two types: type 1 was defined as those directly passing through a defect of the mylohyoid muscle with the presence (type 1A) or absence (type 1B) of the tail sign and type 2 as those through the traditional posterior route along the free edge of the mylohyoid muscle. Images were also analyzed for the extent of the lesion in respect to the spaces involved. As for type 1 lesions, we recorded the location of the defect of the mylohyoid muscle and the position of the sublingual gland in relation to the defect. RESULTS: CT scans demonstrated type 1 lesion in 36 (88%), including type 1A in 14 and type 1B in 22, and type 2 lesion in 5 (12%). Irrespective of the type, the submandibular space was seen to be involved in all cases either alone or in combination with one or more adjacent spaces. Of the 36 patients with type 1 lesions, the anterior one-third was the most common location of the defect of the mylohyoid muscle, seen in 22 patients. The sublingual gland partially herniated in 30 patients. CONCLUSION: Our results suggest that the majority of plunging ranulas take an anterior shortcut through a defect of the mylohyoid muscle.

Cryosurgery for the treatment of pediatric plunging ranula: a conservative management / Criocirurgia para tratamento de rânula mergulhante em criança: uma abordagem conservadora

Several methods of treatment for plunging ranulas have been described in the literature, such as: surgical treatment including the excision of the sublingual gland followed by transoral drainage of the pluging ranula, needle aspiration, excision of the ranula, cryosurgery and CO(2) laser excision. Marsupialization and micro-marsupialisation can be also recommended primarily to treat oral ranulas. The aim of this paper is to present the treatment of pediatric ranula with liquid nitrogen cryosurgery performed in a 8 year, 6-month-old male, without local anesthesia. We have outlined the current protocol of cryosurgery recommended in the management of ranulas, both clinical advantages and disadvantages, with emphasis on the clinical outcomes and also pediatric patients' safety. At the 1year follow-up visit, the lesion had disappeared completely. There was no recurrent lesion. Liquid nitrogen cryosurgery for management of ranulas may become a primary treatment modality prior to surgery in children.

Muitas modalidades de tratamento têm sido propostas para o tratamento da rânula mergulhante, dentre elas: tratamento cirúrgico incluindo a excisão da glândula sublingual seguida da drenagem transoral da rânula mergulhante, aspiração, e criocirurgia e excisão com laser de CO2. Além dessas modalidades, a marsupialização e micro-marsupialização também podem ser recomendadas para o tratamento de rânulas intraorais. O objetivo deste trabalho será apresentar um caso clínico de rânula mergulhante em um paciente infantil de 8 anos e 6 meses de idade. A lesão foi tratada por meio do uso da criocirurgia, realizada com nitrogênio líquido e sem a aplicação de anestesia local. Serão destacados o protocolo de utilização, vantagens e desvantagens, resultados alcançados e a segurança para o paciente durante o tratamento. Após um ano de acompanhamento, observou-se que a lesão desapareceu completamente e não houve recidiva. Pode-se concluir que o uso da crioterapia com nitrogênio líquido pode ser o tratamento de escolha em relação à cirurgia convencional em pacientes pediátricos.

Ránula en niños: presentación de caso clínico / Ranula in children: report of a clinical case

Se presenta una situación clínica de una paciente de sexo femenino, de 12 años de edad, quien concurre al Servicio de Cirugía y Traumatología Bucomaxilofacial del Hospital Zonal General de Agudos General Manuel Belgrano, presentando un aumento de volumen en el piso de boca, renitente, delimitado, de color azulado, indoloro y asintomático (Fig. 1) compatibles con una lesión de la glándula sublingual denominada ránula. Se solicita a la paciente, como estudio por imagen de preferencia, una resonancia magnética con y sin contraste (Fig. 2, Fig. 3). Se procede a su resolución quirúrgica extirpando la lesión conjuntamente con la glándula sublingual, presentando una evolución favorables a corto y largo plazo. Se realiza una búsqueda bibliográfica exponiendo los diferentes tipos de tratamiento posibles, estudios por imágenes de preferencia y posibles complicaciones según tratamiento.