Recent progress in the treatment of intractable sialolithiasis / 北京大学学报(医学版)

Sialolithiasis occurs in approximately 0.45% to 1.20% of the general population. The typical clinical symptom manifests as a painful swelling of the affected glands after a meal or upon salivary stimulation, which extremely affects the life quality of the patients. With the development of sialendoscopy and lithotripsy, most sialoliths can be successfully removed with preservation of the gland. However, sialoliths in the deep hilar-parenchymal submandibular ducts and impacted parotid stones located in the proximal ducts continue to pose great challenges. Our research center for salivary gland diseases (in Peking University School and Hospital of Stomatology) has used sialendoscopy for 17 years and treated >2 000 patients with salivary gland calculi. The success rate was approximately 92% for submandibular gland calculi and 95% for parotid calculi. A variety of minimally invasive surgical techniques have been applied and developed, which add substantial improvements in the treatment of refractory sialolithiasis. Further, the radiographic positioning criteria and treatment strategy are proposed for these intractable stones. Most of the hilar-parenchymal submandibular stones are successfully removed by a transoral approach, including transoral duct slitting and intraductal basket grasping, while a small portion of superficial stones can be removed by a mini-incision in submandibular area. Impacted stones located in the distal third of parotid gland ducts are removed via "peri-ostium incision", which is applied to avoid a cicatricial stenosis from a direct ostium incision. Impacted parotid stones located in the middle and proximal third of the Stensen's duct are removed via a direct mini-incision or a peri-auricular flap. A direct transcutaneous mini-incision is commonly performed under local anesthesia with an imperceptible scar, and is indicated for most of impacted stones located in the middle third, hilum and intraglandular ducts. By contrast, a peri-auricular flap is performed under general anesthesia with relatively larger operational injury of the gland parenchyma, and should be best reserved for deeper intraglandular stones. Laser lithotripsy has been applied in the treatment of sialolithiasis in the past decade, and holmium ∶YAG laser is reported to have the best therapeutic effects. During the past 3 years, our research group has performed laser lithotripsy for a few cases with intractable salivary stones. From our experiences, withdrawal of the endoscopic tip 0.5-1.0 cm away from the extremity of the laser fiber, consistent saline irrigation, and careful monitoring of gland swelling are of vital importance for avoidance of injuries of the ductal wall and the vulnerable endoscope lens during lithotripsy. Larger calculi require multiple treatment procedures. The risk of ductal stenosis can be alleviated by endoscopic dilation. In summary, appropriate use of various endoscopy-assisted lithotomy helps preserve the gland function in most of the patients with refractory sialolithiasis. Further studies are needed in the following aspects: Transcervical removal of intraglandular submandibular stones, intraductal laser lithotripsy of impacted parotid stones and deep submandibular stones, evaluation of long-term postoperative function of the affected gland, et al.

Sialoendoscopia y abordaje mixto para el manejo dela patología obstructiva de las glándulas salivales / Sialoendoscopy and mixed approach for the management of obstructive pathology of the salivary glands

Introducción. La sialoendoscopia es un procedimiento cuya finalidad es visualizar los conductos salivales. Se utiliza como método diagnóstico y terapéutico de procesos inflamatorios, estenosis de los conductos y procesos obstructivos. Métodos. Describir los procedimientos realizados para el tratamiento de pacientes con patología inflamatoria y obstructiva de las glándulas salivales, de forma única con sialoendoscopia o con abordajes mixtos. Resultados. Un total de 24 pacientes fueron incluidos en el estudio, con edad promedio de 42 años, en su mayoría mujeres y compromiso submaxilar en 58,3 % y de parótida en 41,7 %. Respecto a la intervención, al 29,2 % de los sujetos se le realizó extracción de cálculos, al 29,2 % sialoplastia, al 25 % dilatación de conductos y al 37,5 % lavado de conductos en el mismo momento quirúrgico. Conclusión. La sialoendoscopia y el abordaje mixto es un procedimiento que puede garantizar el manejo de patologías obstructivas y estenosis de los conductos salivales, con buen pronóstico y resultados, preservando la glándula y evitando las complicaciones de la cirugía.

Introduction. Sialoendoscopy is a procedure which purpose is to visualise the salivary ducts. It is used as a diagnostic and therapeutic method for inflammatory and obstructive processes and duct stenosis. Methods. To describe the procedures performed for the management of patients with inflammatory and obstructive pathology of the salivary glands, only with sialoendoscopy or with mixed approaches. Results. A total of 24 patients were included in the study, with mean age of 42 years, mostly female, and 58.3% submaxillary involvement 41.7% parotid involvement. Regarding the intervention, 29.2% of the subjects underwent stone extraction, 29.2%, sialoplasty, 25% duct dilatation, and 37.5% duct lavage at the same surgical time. Conclusions. Sialoendoscopy and the mixed approach is a procedure that can guarantee the management of obstructive pathologies and stenosis of the salivary ducts with good prognosis and results, preserving the gland and avoiding the complications of surgery.

Primary lung salivary gland-type duct carcinoma: a clinicopathological analysis of two cases and review of literature / 中华病理学杂志

Objective: To investigate the clinicopathological features, diagnostic criteria and differential diagnosis of primary salivary gland-type duct carcinoma of lung(LSDC). Methods: Two patients with LSDC after surgical resection in Shanghai Pulmonary Hospital from 2020 to 2021 were included; their clinical parameters as well as pathological, immunohistochemical and molecular characteristics of the tumors were analyzed. The relevant literature was also reviewed. Results: Both patients were male, aged 49(case 1) and 64(case 2) years, respectively, and with a history of smoking. The chest computed tomography scan showed both lesions to be centrally located. Gross examination showed the maximum diameters were 16 mm and 35 mm, respectively. The histomorphology of LSDC resembled ductal carcinoma of breast, with intraductal islands of neoplastic cells, which also formed solid nests, papillary, micropapillary and cribriform structures. There was frequent accompanying comedo-like necrosis. The neoplasm cells were markedly heteromorphic, possessing large irregular nuclei with prominent nucleoli, abundant eosinophilic or clear cytoplasm, and mitotic figures were common. Both cases of LSDC were immunoreactive for CKpan, CK7, AR, HER2 staining was (2+) and were negative for TTF1, Napsin A, p40, GATA3, mammaglobin, GCDFP15, SOX10, PSA, P504S, ER, PR, vimentin, S-100, SMA, CK5/6 and p63. The tumor showed double-layer cell structure of the duct, and some basal cells/myoepithelial cells expressed p40 and CK5/6. Case 1 had no gene mutation while case 2 harbored TP53 and KMT2A gene mutation detected by next generation sequencing. Conclusions: LSDC is a very rare and highly aggressive salivary-type malignant tumor. The postoperative diagnosis mainly depends on histopathology and immunohistochemistry, attention should be paid to differential diagnosis to prevent missed diagnosis.

Inflammation grading and sialoendoscopic treatment of 131I radioiodine-induced sialadenitis / 北京大学学报(医学版)

OBJECTIVE@#To investigate the inflammation grading of 131I radioiodine-induced sialadenitis based upon sialoendoscopic and sialographic appearances, and to evaluate the results of sialoendoscopic intervention.@*METHODS@#The patients diagnosed with 131I radioiodine-induced sialadenitis and underwent sialoendoscopic exploration and intervention procedures in Peking University Hospital of Stomatology from Nov. 2012 to Oct. 2018 were included in this study. The appearances of sialogaphy and sialoendoscopy were analyzed and classified. The treatment options included irrigation with saline and dexamethasone and mechanical dilatation by sialoendoscope. The patients were followed up after treatment.@*RESULTS@#Forty-two patients with 131I radioiodine-induced sialadenitis were included. There were 5 males and 37 females, with a male-to-female ratio of 1 ∶7.4. Symptoms included recurrent swelling and pain in the parotid glands, and dry mouth. Sialography showed stenosis in the main duct,and in some cases nonvisua-lization of the branches. Sialoendoscopy showed narrowing of the main duct, and the branch duct atresia was seen. The appearances of sialogaphy and sialoendoscopy were analyzed and classified into 3 groups: (1) Mild inflammation: stenosis and ectasia occurred in the main duct, whereas the 0.9 mm sialoendoscope could pass through easily. (2) Moderate inflammation: one point of severe stricture could be seen in the main duct where 0.9 mm sialoendoscope could not be passed through. (3) Severe inflammation: two points or more of severe strictures or diffused strictures occurred in the main duct. Thirty-three patients with 65 affected glands were examined by both sialography and sialoendoscopy. Eight glands were classified as mild inflammation, 23 glands moderate inflammation, and 34 glands severe inflammation. The duration of follow-up ranged from 3-72 months. The clinical results were evaluated as good in 22 glands, fair in 22 glands, and poor in 19 glands, with an overall effective rate of 69.8% (44/63).@*CONCLUSION@#The clinical, sialographic and sialoendoscopic appearances of 131I radioiodine-induced sialadenitis showed their characteristics. We proposed an inflammation grading standard for the 131I radioiodine-induced sialadenitis based on the appearances of sialography and sialoendoscopy. Sialoendoscopy can significantly alleviate the clinical symptoms, which is an effective therapy, and better for early lesions.

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.

Salivary Duct Cancer Metastasis Mimicking Primary Breast Cancer: A Case Report and Review / 한국유방암학회지

Highlights for the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting / 대한두경부종양학회지

The 2019 American Society of Clinical Oncology (ASCO) Annual Meeting, which took place May 31-June 4 in Chicago, drew more than 32,000 oncology specialists from around the world. The theme of 2019 ASCO conference was “Caring for Every Patient, Learning from Every Patient”. Among the topics of interest covered were new approaches to surmount limited access to cancer care and the latest advances in targeted therapies for pancreatic, prostate cancers and soft tissue sarcomas. In the field of head and neck cancer, 8 oral abstracts and 75 poster abstracts were presented at this meeting. In this review, we are going to summarize the eight studies that have been presented orally. The topics are recurrent and/or metastatic head and neck squamous cell carcinoma for two abstracts (#6000, #6002), salivary duct carcinoma for one abstract (#6001), locally advanced nasopharyngeal carcinoma for two abstracts (#6003, #6004), oropharyngeal carcinoma for two abstracts (#6006, #6008), and oral cavity cancer for one abstract (#6007).

Incidentally Diagnosed Asymptomatic Pneumoparotid / 대한두경부종양학회지

Pneumoparotid is a rare cause of parotid gland swelling, and is caused by retrograde air reflux from the oral cavity, into the parotid gland via Stensen's duct. Most patients complained of painless swelling in the parotid region. Herein, we report a rare case of pneumoparotid, incidentally diagnosed without symptoms on CT, for follow-up of parotid lymph node enlargement.

Analysis of PD-L1 expression in salivary duct carcinoma with its efficacy as a tumor marker / 대한두경부종양학회지

BACKGROUND/OBJECTIVES: Despite multiple approaches of treatments for salivary duct carcinoma, there has been a need for more successful treatment methods because of its poor prognosis. Treatment options like immunotherapy using new technologies have been attempted. Based on recent study results indicating that targeting programmed death receptors are effective in treating various cancers, this study aimed to identify the frequency of PD-L1 expression and its impact on survival rate in salivary duct carcinoma.MATERIALS #SPCHAR_X0026; METHODS: We studied 33 patients with salivary gland cancer who were available for histologic specimens. We examined the expression of PD-L1 in the tissues and analyzed the association with the survival rate and the association with various clinical parameters.RESULTS: According to this study and review of similar studies, we discovered that the expression of PD-L1 in salivary duct carcinoma was lower than other types of cancers. The impact of PD-L1 on survival rate also showed inconsistency in salivary duct carcinoma.CONCLUSION: Immunotherapy by PD-1/PD-L1 checkpoint blockade in salivary duct carcinoma needs further evaluation for clinical application.

A fast adaptive active contour model based on local gray difference for parotid duct / 南方医科大学学报

OBJECTIVE@#To establish a fast adaptive active contour model based on local gray difference for parotid duct image segmentation.@*METHODS@#On the basis of the LBF model, we added the mean difference of the local gray scale inside and outside the contour as the energy term of the driving evolution curve, and the local gray-scale variance difference was used to replace and as the control term of the energy parameter value. Two local similarity factors of different neighborhood sizes were introduced to correct the effects of image gray unevenness and boundary blur to improve the segmentation efficiency.@*RESULTS@#During image segmentation, this algorithm allowed for adaptive adjustment of the evolution direction, velocity and the energy weight of the internal and external regions according to the difference of gray mean and variance between the internal and external regions. This algorithm was also capable of detecting the actual boundary in a complex gradient boundary region, thus enabling the evolution curve to approach the target boundary quickly and accurately.@*CONCLUSIONS@#The proposed algorithm is superior to the existing segmentation algorithms and allows fast and accurate segmentation of the parotid duct with well-preserved image details.

Development of the Three-Dimensional Perfusion Culture Technology for the Salivary Ductal Cells

BACKGROUND AND OBJECTIVES: Salivary hypofunction is one of the common side effects after radioiodine therapy, and its pathophysiology is salivary ductal stenosis resulting from ductal cell injury. This study aimed to develop the functional culture environment of human parotid gland ductal cells in in vitro three-dimensional perfusion culture system. MATERIALS AND METHODS: We compared plastic dish culture method and three-dimensional culture system containing Matrigel and nanofiber. Morphogenesis of reconstituted salivary structures was assessed by histomorphometry. Functional characteristics were assessed by immunohistochemistry and reverse transcription polymerase chain reaction (aquaporin 5, CK7, CK18, connexin 43, and p21). In addition, we designed the media perfusion culture system and identified higher rate of cell proliferation and expression of connexin 43 in perfusion system comparing to dish. RESULTS: Human parotid ductal cells were well proliferated with the ductal cell characters under environment with Matrigel. In the presence of Matrigel, aquaporin 5, CK18 and connexin 43 were more expressed than 2D dish and 3D nanofiber setting. In the media perfusion culture system, ductal cells in 3D culture media showed higher cells count and connexin 43 expression compared to 2D dish. CONCLUSION: This in vitro ductal cell perfusion culture system using Matrigel could be used to study for radioiodine induced sialadenitis model in vivo.

Stensen's duct sialolith in a geriatric patient

No abstract available.

Endoscopy-assisted sialodochoplasty for the treatment of severe sialoduct stenosis / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the effects of endoscopy-assisted sialodochoplasty for the treatment of severe sialoduct stenosis with concurrent megaducts.@*METHODS@#From Jul.2010 to Dec. 2016, 8 patients presenting with severe parotid duct stenosis and 3 patients with occlusion of the Wharton's duct underwent endoscopy-assisted sialodochoplasty.All these patients had concurrent severe ductal ectasiaand manifested a painful swelling of the involved salivary glands.The diameter of ectasia and length of stenosis of the sialoducts were measured preoperatively by sialography, computed tomography, or ultrasonography. The megaducts were opened transorally and sutured to the buccal or oral floor mucosa, therefore creating a neo-ostium. All the patients were followed up periodically after operation. The treatment effects were evaluated by clinical signs, sialogram and sialometry.@*RESULTS@#The length of the Stensen's duct stenosis was 5-12 mm, and the diameter of the concurrent ectasia was 8-16 mm. The length of the Wharton's duct stenosis was 10-20 mm, and the diameter of the concurrent ectasia was 6-8 mm.The neo-ostiums healed uneventfully 2 weeks after operation. The duration of the follow-up varied from 6 to 78 months (median: 24 months). Among the 8 patients with Stensen's duct stenosis, two experienced re-obliteration of the neo-ostium, but the buccal bulge and clinical symptoms disappeared; one reported recurrent clinical symptoms after initial alleviation, which could be controlled with self-massaging; the remaining 5 patients had satisfactory clinical results, i.e., disappearance of the obstruction symptoms and buccal bulge, patent ostium,clean saliva and improvement of the ductal ectasia on sialogram. Three patients with Wharton's duct occlusion were asymptomatic with clear saliva and patent ostium;two exhibited approximately normal appearance and one showed improvement of the sialogram.Sialometry was performed in 9 patients with patent neo-ostium of the involved glands,the resting saliva flow rate of the affected glands showed no differences compared with the normal side, and stimulated flow rate showed a significant increase, though less than the control side.The clinical results included good in 5 patients, fair in 4 patients, and poor in 2 patients, with a total effective rate of 82% (9/11).@*CONCLUSION@#Endoscopy-assisted sialodochoplasty appears to be effective and can be a viable option for patients presenting with severe sialoducts tenosis and concurrent ectasia.

A 20-year study on microvascular autologous transplantation of submandibular gland for treatment of severe dry eye / 北京大学学报(医学版)

Severe dry eye is a refractory ophthalmologic disease. Our multidisciplinary research group treated severe dry eye by microvascular autologous transplantation of submandibular gland (SMG) during the past 20 years. The SMG, with its blood vessels and Wharton's duct, was harvested from the submandibular triangle and transferred to the temporal area. The blood vessels in the SMG were anastomosed with the temporal blood vessels using a microsurgical technique. Then, the distal end of Wharton's duct was sutured to form an opening in the upper lateral conjunctival fold. The tear was replaced by the secretion of the transplanted SMG to lubricate the ocular surface. In our study, the surgical techniques of blood vessel management were continuously modified to increase the survival rate of the transplanted SMG. A novel surgical modality of partial transplantation of SMG was established to prevent postoperative epiphora. A clinical study with the largest case number in the world was conducted and the effectiveness of transplantation of SMG for severe dry eye was fully confirmed. In order to resolve two main clinical problems including ductal obstruction resulted from low secretion rate during the latent period, and epiphora due to over secretion of the transplanted SMG in the later term of transplantation, the regulation of the secretion mechanism of the normal and transplanted SMG were investigated. New opinions on mechanisms of saliva secretion were provided. Based on the priniciple of translational medicine, the results of related basic research were applied in the clinic. The clinical guidelines for secretion regulation of transplanted SMG were established. A concept of chronic obstructive sialadenitis of transplanted SMG was provided and its diagnostic criteria, diagnostic technique of sialography, and therapeutic regimen were established. As a result, the surgical success rate was obviously elevated, the surgical complications were decreased, and life quality of the patients was greatly improved.

Removal of submandibular calculi by surgical method and hydraulic power with curved needle: a case report

Sialolithiasis, the most common salivary gland pathology, is caused by calculi in the gland itself and its duct. While patients with small sialoliths can undergo conservative treatment, those with standard-size or larger sialoliths require sialolithotomy. In the present case study, we removed two sialoliths located beneath the mucosa in the posterior and anterior regions of Wharton's duct, respectively. For the posterior calculus, we performed sialolithotomy via an intra-oral approach; thereafter, the small anterior calculus near the duct orifice was removed by hydraulic power. This method has not previously been reported. There were no complications either during the operation or postoperatively, and the salivary function of the gland remained normal.

Squamous cell carcinoma of the buccal mucosa involving the masticator space: a case report

Squamous cell carcinoma of the buccal mucosa has an aggressive nature, as it grows rapidly and penetrates well with a high recurrence rate. If cancers originating from the buccal mucosa invade adjacent anatomical structures, surgical tumor resection becomes more challenging, thus raising specific considerations for reconstruction relative to the extent of resection. The present case describes the surgical management of a 58-year-old man who presented with persistent ulceration of the mucosal membrane and a mouth-opening limitation of 11 mm. Diagnostic imaging revealed a buccal mucosa tumor that had invaded the retroantral space upward with involvement of the anterior border of the masseter muscle by the lateral part of the tumor. In this report, we present the surgical approach we used to access the masticator space behind the maxillary sinus and discuss how to manage possible damage to Stensen's duct during resection of buccal mucosa tumors.

Usefulness of Magnetic Resonance Sialography for Diagnosis of Idiopathic Chronic Sialadenitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The symptoms of salivary diseasess are often nonspecific, and a variety of investigative methods can be employed. Conventional sialography, which is still widely used for diagnosis of salivary ductal pathologies, has the withdrawback of invasiveness and radiation exposure, and thus ultrasound and magnetic resonance (MR) sialography can replace the conventional tools. This study was performed to evaluate the usefulness of MR sialography for the diagnosis of idiopathic chronic sialadenitis. SUBJECTS AND METHOD: From November 2013 to June 2014, we have retrospectively analyzed 26 patients who have had swelling and pain of salivary glands and undergone MR sialography for further diagnosis of the idiopathic salivary obstructive symptom. We analyzed the symptom scores, salivary flow rate (SFR) and parameters of salivary gland scintigraphy. Then we evaluated correlation among MR sialography findings (duct visualization, grade of stenosis at main duct, degree of sialectasis and glandular volume size). RESULTS: Among the 26 patients, stenosis of salivary duct was observed in 14 patients (53.8%), chronic sialadenitis without stenosis in 6 patients (23.1%), Sjogren's syndrome in 3 patients (11.5%), Juvenile reccutent parotitis in 1 patient (3.8%), and 2 patients were norma (7.7%). The degree of sialectasis was significantly correlated with Tmin (time interval, in minutes, from stimulation to minimum count), maximum secretion (p<0.05), and glandular volume size was also significantly correlated with unstimulated SFR (p<0.05). But others did not show any significant correlations. From these findings, we report three cases that were useful to diagnose the gland disease using MR sialography. CONCLUSION: Resutls show that MR sialogarphy indirectly reflects the salivary gland function. Therefore MR sialography can be helpful when the differential diagnosis of idiopathic chronic sialadenitis is difficult with conventional tools.

A Case of Fish Bone-Induced Submandibular Gland Stone / 대한이비인후과학회지

Sialolithiasis is the most common disorder associatd with major salivary glands. It may form in any salivary glands or ducts, but is reported to occur more often in the submandibular gland than in the parotid or sublingual gland. Although the pathogenesis is not perfectly revealed, there appear to be several factors that predispose the submandibular gland duct to be a common site of sialolithiasis. Sialolithiasis occurs as a consequence of the precipitation of calcium salts around a central nidus of desquamated epithelial cells, inflammatory cells, mucoid gels or foreign body. However, it is not a common thing that foreign body entered into the salivary duct through duct orifice may act as the initiating factor. We have recently experienced a case in a 52-year-old female, in which sialolithiasis seems to have formed due to a a foreign body, a fish bone, in the right submandibular gland duct.

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.