Surgical Treatment of a Plunging Ranula using the Intraoral and Submandibular Approach

ABSTRACT

PURPOSE: A plunging ranula is relatively uncommon and represents a mucus escape reaction occurring from a disruption of the sublingual salivary gland. It is a common condition found in young adults, even though the reported age range is 2 - 61 years. We report our experience of a complete excision of a plunging ranula via the intraoral and submandibular approach. METHODS: A 23-year-old man had a large protruding mass in the right submandibular area. Initially, the protruding mass appeared bilaterally but the left side disappeared spontaneously. The MRI findings revealed a homogenous fluid attenuation mass in the submandibular space, suggesting a ranula. The sublingual gland was extirpated through the intraoral approach and the ranula excised totally via the submandibular approach. RESULTS: The patient had an uneventful postoperative course without infection, paralysis and tongue sensory changes, etc. The pathology findings were characteristic of a pseudocyst without a lining epithelium or endothelium but with a vascular fibro-conective tissue wall filled with mucinous fluid. No recurrence was observed on the submandibular area during the 8 month follow-up period. CONCLUSION: The combined intraoral approach and submandibular approach is an effective and highly recommended method for sublingual gland extirpation and complete excision of a plunging ranula.