Plunging ranula presenting as a giant retroauricular mass: A case report / 北京大学学报(医学版)

Plunging ranula is rare and manifests as the submandibular or submental cystic mass, without intra-oral abnormality. It usually causes misdiagnosis and malpractice. This article reported a case of plunging ranula that appeared as a massive mass located behind the left ear. A 6-year-old child presented with recurrent left retroauricular swelling over six months without obvious inducement. The mass showed repeatedly swelling and persistent skin ulcers. Physical examinations described a fluctuant, nontender mass behind the left ear whose size was about 5 cm×5 cm×3 cm. The skin upon the surface of the mass was thin and red, and overflowed yellow slimelike contents. Computed tomography (CT) showed an extensive cystic lesion in the left neck. After local incision and drainage the mass was shrink. With the primary clinical diagnosis of branchial cyst, the patient underwent mass resection through postauricular incision. During the operation, the fistula was traced to the area around the sublingual gland, and the postoperative pathology report demonstrated cystic spaces occurring in soft tissue without lymphoid tissue. One month postoperatively, the patient presented the "egg-white", wire-drawing transparent viscous fluid outflowing from the left external auditory canal, indicating that the fluid in the external auditory canal originated from the sublingual gland and the disease was the plunging ranula presenting as a giant left retroauricular mass. We readmitted the patient to the hospital and the ipsilateral sublingual gland was completely removed in the mouth under general anesthesia. No clinical evidence of recurrence was found at the end of 9 months follow-up. So far, there is no literature reporting plunging ranula behind ear. This case report describes the clinical manifestation, diagnosis, and differential diagnosis and treatment of a case of plunging ranula, and reveals that, other than the submandibular or submental, plunging ranula also could be found in retroauricular region. The plunging ranula is difficult to fully confirm through a clinical character, and usually easy to be misdiagnosed as other tumors, like lymphatic malformation, venous malformations, etc. Radiographic examination and/or puncture fluid observation are required for identification. "Egg-white", wire-drawing mucous secretion is the most important characteristic in clinical diagnosis of sublingual gland cyst. However, if sublingual gland resection, i.e. removal of the source of cyst fluid is performed, a good prognosis can be achieved.

Classification of Sialolithiasis by Location of Stones: Retrospective Review of 534 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To investigate epidemiological features of patients with sialolithiasis and to evaluate the difference in outcomes depending on its location. SUBJECTS AND METHOD: We included in the test 472 patients, or 534 cases, who were admitted to the Hallym University Sacred Heart Hospital between February 2006 and May 2017 with the diagnosis of sialolithiasis. The diagnosis of sialolithiasis was established by CT images; all of the cases were classified by the location of stones (orifice to stone/orifice to hilum: 0–0.25, type I; 0.25–0.5, type II; 0.5–0.75, type III; 0.75–1, type IV). RESULTS: The average size of stone was 7.2±4.8 mm and the mean patient age was 36.1±17.4 years old. According to the method described above, 534 cases were classified into the following: type I consisted of 188 cases (35.2%), type II consisted of 55 cases (10.2%), type III consisted of 92 cases (17.2%) and type IV consisted of 199 (37.2%). When comparing these types, stones in Type I were significantly smaller than other groups. There was a significant difference in the surgical method depending on the location of stones. Different complications such as swelling, bleeding, tongue discomfort, ranula, recurrence, etc. have been reported and, together, they statistically show meaningful differences in the distribution depending on types. CONCLUSION: The position of stone in Wharton's duct is important factor that can determine the method of surgical procedure or postoperative prognosis. We recommend 4 types classification of sialolithiasis and it can provide more specific diagnosis of disease and facilitate approach for treatment.

Diagnosis and treatment of congenital submandibular duct dilatation / 华西口腔医学杂志

OBJECTIVE@#To study the clinical features and treatments of congenital submandibular duct dilatation.@*METHODS@#Seven children with congenital submandibular duct dilatation from January 2008 to March 2018 were included in this study, whose average age was 5 months and 22 days. The clinical manifestations are unilateral swelling of the mouth floor. All seven children underwent sublingual gland resection, submandibular gland dilatation catheter resection, and catheter reroute under general anesthesia. Intraoperatively, the orifice of the submandibular gland was constricted and part of the catheter was dilated.@*RESULTS@#All seven patients had good healing without swelling or cyst formation.@*CONCLUSIONS@#Congenital submandibular duct dilatation occurs at a young age. Early diagnosis and treatment can help prevent further expansion of the catheter and avoid gland atrophy, feeding difficulty, and breathing obstruction. Simultaneous excision of the sublingual gland can avoid the formation of postoperative sublingual cyst.

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.

Occurrence of dermoid cyst in the floor of the mouth: the importance of differential diagnosis in pediatric patients

Abstract Lesions in the floor of the mouth can be a challenging diagnosis due to the variety of pathological conditions that might be found in this area. Within a broad range of lesions, attention has to be addressed to those that require specific management, such as a dermoid cyst (DC) and a ranula. Especially in pediatric patients, in whom the failure of diagnosis can postpone the correct treatment and cause sequelae later in life. DC, a developmental anomaly, is managed primarily by surgical resection. On the other hand, ranula is a pseudocyst that may be treated by marsupialization. This article reports a large and painful lesion in the floor of the mouth in a pediatric patient. With a diagnostic hypothesis of ranula, two surgical interventions were performed, but there were recurrences of the lesion. Subsequently, the patient was referred to the Oral and Maxillofacial Surgery Unit for re-evaluation. Computed tomography showed a semi-transparent image suggesting a cystic formation. Another surgical procedure was performed where the lesion was completely removed. Anatomopathological analysis confirmed the diagnosis of DC. The five-year follow-up showed no signs of recurrence. This article indicates that although DC in the floor of the mouth is rare, it should be considered in the differential diagnosis of other diseases in this area. This precaution may be particularly important in the following circumstances: 1) Similar lesions that have different therapeutic approaches and, 2) To prevent future sequelae in pediatric patients.

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.

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.

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.

Rânula Mergulhante Recidivante: relato de caso / Recurrent Plunging Ranula: case report

Rânula é uma patologia não hereditária, indolor, caracterizada por formação de uma bolsa preenchida geralmente por líquido mucinoide, frequentemente resultante de trauma ou obstrução da glândula associada. Geralmente, essas lesões são facilmente identificáveis a partir de um exame clínico minucioso, apesar de existirem outras entidades clínicas com aspectos semelhantes. A variante mergulhante disseca o músculo milohióideo, podendo causar tumefação na região cervical correspondente. Existem várias formas de tratamento, sendo as mais usadas a marsupialização concomitante ou não à excisão cirúrgica da lesão e da glândula salivar envolvida. A proposta deste relato de caso é mostrar ao colega cirurgião-dentista uma visão de plano de tratamento para esse tipo de alteração e as prováveis condutas de acordo com a apresentação e mudanças que, porventura, podem ocorrer, além da importância da proservação e acompanhamentos posteriores a partir de uma experiência do nosso serviço... (AU)

Ranula is a non-hereditary disease, painless, characterized by forming a generally liquid-filled mucina, often resulting from trauma or obstruction associated gland. Generally, these lesions are easily identifiable from a thorough clinical examination, although there are others clinical entities with similar aspects. The variant plunging mylohioideo dissects the muscle, causing swelling in the neck accordingly. There are several forms of treatment, of which the most used are the marsupialization or without concomitant surgical excision of the lesion and the salivary gland involved. The purpose of this case report is to show the dentist colleague of vision treatment plan for this type of change and the likely behavior according to the presentation and changes that may occur, and the importance of proactive observation and subsequent follow from experience of our service... (AU)

Sublingual epidermoid cyst resembling sublingual ranula: a case report

Dermoid cysts are anatomic embryonic abnormalities that are rarely seen in the oral cavity. Histologically, they are further classified as epidermoid, dermoid or teratoid. We report a case in which an 18-year-old girl who developed an epidermoid cyst presenting as a large sublingual swelling occupying the entire floor of the mouth causing snoring and speech difficulty. We emphasized on the clinical steps in achieving an accurate diagnosis, possible differential diagnosis, necessary imaging techniques and management of epidermoid cyst.

A Case of Acinic Cell Carcinoma Associated with Ranula in Sublingual Gland / 대한이비인후과학회지

Acinic cell carcinoma (ACC) is a low-grade malignancy of salivary gland that constitutes approximately 17% of primary salivary gland malignancies. ACC predominantly occurs in the parotid gland. The higher incidence in the parotid gland seems to be related with the serous acinar cells of the glands, while the sublingual gland is a mixed gland, predominantly mucinous. Therefore, ACCs which originated in the sublingual gland are very rare and till now only 8 cases have been reported in the literature. Recently, we experienced a case of ACC which was found incidentally in the surgical specimen of a ranula arising in the sublingual gland. The finding of this case suggests that the early pathological diagnosis is needed to clarify the reasons for the recurrence of a ranula.

Ultrasound-guided sclerotherapy for benign non-thyroid cystic mass in the neck

Surgical excision has traditionally been the treatment of choice for benign non-thyroid cystic neck masses, including lymphatic malformation, ranula, branchial cleft cyst, thyroglossal duct cyst, and parathyroid cyst. However, there is a tendency toward recurrence after surgery, and surgery may be accompanied by complications, including nerve injuries, vascular injuries, and scar formation. Ultrasound-guided sclerotherapy using various agents has been challenged and successfully applied as an alternative treatment for benign non-thyroid cystic neck masses. This report reviews the available sclerosing agents and describes the applications of sclerotherapy to the treatment of benign cystic masses in the neck.

Oral foregut cyst in the ventral tongue: a case report

An oral foregut cyst is a rare congenital choristoma lined by the respiratory and/or gastrointestinal epithelium. The exact etiology has not been fully identified, but it is thought to arise from misplaced primitive foregut. This lesion develops asymptomatically but sometimes causes difficulty in swallowing and pronunciation depending on its size. Thus, the first choice of treatment is surgical excision. Surgeons associated with head and neck pathology should include the oral foregut cyst in the differential diagnosis for ranula, dermoid cyst, thyroglossal duct cyst and lymphangioma in cases of pediatric head and neck lesions.

Clinical and Histological Analysis of Oral Mucocele / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucoceles usually occur as asymptomatic, dome-shaped, translucent cysts in the lower lip and oral cavity containing mucin. Mucoceles are usually associated with the minor salivary glands and are classified histologically into the extravasation type and the retention type. The objective of the present study was to establish the prevalence of these lesions according to age, gender, histologic type, and site of occurrence. SUBJECTS AND METHOD: We retrospectively reviewed the medical records from January 2008 to February 2013 pertaining to age, sex, clinical history, and other findings of 52 patients who underwent operation and confirmed as mucocele histologically. We re-evaluated all mucocele cases by an experienced pathologist. RESULTS: Of the 52 cases analyzed, 32 (61.5%) were females and 20 (38.5%) were males. Age ranged from 2 to 77 years (mean age 20.6 years), with 78.8% occurring between the ages of 0 and 30 years with peak incidences in the twenties for female patients and in the thirties for male (34%). There was a more predominance among women (61.5%). The lower lip was the site most frequently affected by the lesions (59.6%), whereas the lowest prevalence was observed for the soft palate (2%), and buccal mucosa (2%). Tongue (15.4%) and floor of mouth (21.2%) were not uncommonly affected sites. Histologically mucous extravasation type (96.2%) was more predominant than the retention type (3.8%). CONCLUSION: In this study, mucocele was found predominant in younger age groups, with the lower lip being the most frequently affected site. Histologically, the mucus extravasation type was the most common.

Recurrent plunging ranula of the neck

The reported case describes a mismanaged extensive recurrent plunging ranula that occupied a large portion of the neck. The ranula is usually clinically diagnosed. However, absence of visible intra-oral signs may mislead the diagnosis and leads to improper surgical management. Presence of amylase in the aspirated fluids is an important aid in the differential diagnosis. Thereby confirming the salivary origin of the fluids and thus avoiding extensive investigations. The recurrence rate varies according to the procedure performed. Diverse methods of treating ranula have been reported in the literature with variable results. These include marsuplization, excision of the ranula, incision of the ranula and drainage of the contents, excision of the sublingual gland and drainage. The successful procedure to treat plunging ranula depends on complete excision of the affected sublingual gland and drainage of its contents. In this paper, the useful diagnostic investigations and the recommended surgical intervention procedure were described

Giant plunging ranula: a case report

A ranula is a bluish, transparent, and thin-walled swelling in the floor of the mouth. They originate from the extravasation and subsequent accumulation of saliva from the sublingual gland. Ranulas are usually limited to the sublingual space but they sometimes extend to the submandibular space and parapharyngeal space, which is defined as a plunging ranula. A 21-year-old woman presented with a complaint of a large swelling in the left submandibular region. On contrast-enhanced CT images, it dissected across the midline, and extended to the parapharyngeal space posteriorly and to the submandibular space inferiorly. Several septa and a fluid-fluid level within the lesion were also demonstrated. We diagnosed this lesion as a ranula rather than cystic hygroma due to the location of its center and its sublingual tail sign. As plunging ranula and cystic hygroma are managed with different surgical approaches, it is important to differentiate them radiologically.

Rânula em paciente com HIV: relato de caso / Ranula in HIV patient: a case report

Objetivo: Relatar um caso de tratamento de rânula em paciente portador do HIV/AIDS. Discussão: Paciente de 21 anos, sexo feminino, leucoderma, HIV positivo de transmissão vertical, sem hábitos deletérios, não fazia uso de drogas ilícitas, com lesão de rânula indolor, em tratamento há três meses com clindamicina, receitada pelos médicos. A paciente não está na faixa etária mais prevalente da doença, sua contagem de CD4 + estava normal e, pela possível dificuldade de cicatrização, optou-se pela micromarsupialização. Conclusão: Os cirurgiões-dentistas precisam encarar as rânulas e os mucoceles como entidades que podem surgir em pacientes infectados pelo HIV e que o tratamento deverá ser o mais conservador possível.

Objective: Report the treatment of a ranula in a patient with HIV infection. Discussion: A 21-year-old female, caucasian, with HIV infection of vertical transmission, without harmful habits and with no use of illicit drugs, presenting painless ranula lesion from three months ago being treated with clindamycin by doctors. The patient is not in the most prevalent age group, and its CD4+ counting was normal, and for the possible difficulty of healing, micro-marsupialization technique was chosen. Conclusion: Although there are few studies involving this matter, dentists must face ranulae and mucole as entities that can develop in HIV/AIDS infected patients, and treatment should be as conservative as possible.