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.

Ranula: a narrative review

A ranula is a pseudocystic lesion of the sublingual salivary gland, found in the floor of the mouth. Ranula is classified into types such as simple and plunging type. Plunging ranula arises when a simple ranula extends beyond the floor of the mouth into the neck. A simple ranula is seen above the level of the mylohyoid muscle and is often the result of sublingual gland duct obstruction. A plunging ranula refers to a pseudocyst that develops with salivary duct rupture and is seen below the level of the mylohyoid muscle. Diagnosis of the ranula is difficult even with modern imaging techniques as this mimic to other neck lesions. The correct diagnosis of the ranula is essential for the most effective treatment. The treatment modalities of the ranula currently include marsupialization, excision of the ranula with or without excision of the sublingual gland, cryosurgery, laser excision, sclerotherapy, fenestrations, and continuous pressure. The treatment of the ranula includes complete excision and marsupialization is not a sufficient treatment. Misdiagnosis of a plunging ranula leads to unnecessary and extensive surgery. This review article discussed the epidemiology, etiopathogenesis, clinical features, diagnosis, and current treatment of ranula.

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.

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.

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.

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)

A Submandibular Gland Mucocele Extending to the Skull Base

A case report of Plunging ranula with metastatic adenocarcinoma

The plunging ranula is a kind of ranula that goes over the mouth floor to the neck and other adjacent tissue. Sublingual gland is gently accepted as origin of plunging ranula. Plunging ranula develops commonly because of rupture of sublingual gland duct by trauma and extravasation of salivary secretion to the adjacent tissue. It is not true cyst so that there is no epithelium. And it consisted with thin connective tissue, inflammation cell infiltration and salivary secretion. Left without treatment, it can grow into the 10 cm more huge lesion. This report is a case of 73 years old female who was diagnosed as plunging ranula with review of literature. She presented 5 cm submandibular swelling at first. When surgery was delayed because of patient's condition, the lesion grew into the 12cm huge size. We performed excision of sublingual gland, submandibular gland and plunging ranula and had a good result without recurrence.

Ranula in an infant

PLUNGING RANULA IN A 4-YEAR-OLD CHILD: REPORT OF A CASE

A case report of plunging ranula: an unusual case of mucous extravasation cyst