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Yun J, Gidumal S, Saturno MP, Wein LE, Fan J, Khorsandi AS, Chung D, Chen H, Chai RL. Diagnostic Difficulties of Plunging Ranula: A Review of 18 Cases. Laryngoscope 2024; 134:2689-2696. [PMID: 38217447 DOI: 10.1002/lary.31288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE(S) Despite advancements in imaging techniques and cytological analysis, plunging ranula remains a challenging surgical, radiologic, and pathologic phenomenon. Of the 18 patients we evaluated at our institution, we highlight three cases that illustrate the high rate of misleading imaging and cytological results when assessing plunging ranula. METHODS Imaging results, biopsy findings, operative techniques, and pathological reports were reviewed from patients who had either a preoperative or postoperative diagnosis of ranula and underwent surgery by a single head and neck surgeon at a tertiary care center. RESULTS Of the 18 identified patients, computed tomography was correct on preoperative imaging 73% of the time and magnetic resonance imaging was correct on preoperative imaging 71% of the time. Two patients underwent preoperative ultrasound and their ultrasound reports did not accurately diagnose the presence of a ranula. Two patients underwent preoperative fine needle aspiration biopsy due to inconclusive preoperative imaging, in which results suggested either a ranula or epidermal cyst. Both ultimately did not match the final pathology. Three of eighteen patients (17%) underwent an inappropriate initial surgery due to incorrect imaging diagnoses and/or biopsy findings. CONCLUSION Despite use of preoperative modalities to distinguish plunging ranula from other cystic floor of mouth lesions, surgeons must be aware that no workup modality is fully precise. The potential for revision surgery must be included in all preoperative discussions for presumed plunging ranula. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2689-2696, 2024.
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Affiliation(s)
- Jun Yun
- THANC, (Thyroid, Head and Neck Cancer) Foundation at Mount Sinai, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sunder Gidumal
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael P Saturno
- THANC, (Thyroid, Head and Neck Cancer) Foundation at Mount Sinai, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren E Wein
- THANC, (Thyroid, Head and Neck Cancer) Foundation at Mount Sinai, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jun Fan
- Department of Pathology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Azita S Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Daniel Chung
- Department of Pathology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hua Chen
- FNA Medical Diagnostics, New York, New York, USA
| | - Raymond L Chai
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
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2
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Fiorino A, Staderini E, Diana R, Rengo C, Gallenzi P. New Conservative Approach for the Management of Recurrent Sublingual Ranula-A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2398. [PMID: 36767764 PMCID: PMC9915898 DOI: 10.3390/ijerph20032398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/14/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Ranula is a rare and benign extravasation mucocele that is clinically characterized by asymptomatic sublingual or submandibular masses. Surgical excision is considered the most effective treatment approach, but it has been associated with high invasiveness and several complications (hemorrhage, damage to Wharton's duct, and lingual nerve injury). Over the past decade, more conservative therapies have been rapidly disseminated into clinical practice to seek a more effective and less traumatic approach for young patients. In this report, an 8-year-old female with an asymptomatic, recurrent sublingual ranula was treated using a conservative approach with marsupialization and an intracystic injection of a plaque remover (Hybenx® gel). After incision of the cystic dome, Hybenx® gel was applied into the cystic lumen for 20 seconds and then aspirated; next, the area was rinsed thoroughly with sterile saline solution before suturing. Ultrasound re-evaluation at 10 months and intraoral clinical examination at 24 months confirmed the absence of relapse. Our results support the hypothesis that marsupialization combined with intracystic injection of Hybenx® gel could be an encouraging conservative treatment alternative for recurrent sublingual ranula in children. Further randomized controlled trials are needed to test this hypothesis.
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Affiliation(s)
- Antonino Fiorino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, 80131 Naples, Italy
| | - Edoardo Staderini
- Postgraduate School of Orthodontics, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Rosalba Diana
- Postgraduate School of Orthodontics, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Carlo Rengo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Patrizia Gallenzi
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, 80131 Naples, Italy
- UOC Odontoiatria Generale e Ortodonzia, Dipartimento di Testa-Collo e Organi di Senso, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
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3
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Abstract
Mucoceles are common salivary gland disorders. Mucoceles are benign, mucus-filled extravasation pseudocysts that commonly arise on the lower lip of children and young adults. Although surgical excision is commonly performed to remove these lesions, other treatments include marsupialization, micromarsupialization laser ablation, cryotherapy, intralesional steroid injection, and sclerosing agents. Traumatic sialoceles commonly arise from injury to the parotid duct. Treatment of sialoceles from acute parotid duct injury and for delayed presentations after injury are discussed. Ranulas are a subtype of mucocele from the sublingual gland classified as superficial or plunging. Treatment of ranulas must address the sublingual gland.
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Affiliation(s)
- Eve M R Bowers
- Department of Otolaryngology, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, 3350 Terrace Street, Pittsburgh, PA 15213, USA
| | - Barry Schaitkin
- Department of Otolaryngology, University of Pittsburgh Medical Center, Shadyside Hospital, Suite 211, 5200 Centre Avenue, Pittsburgh, PA 15232, USA.
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Yin T, Jain P, Ahmad Z, Harrison JD, Morton RP. Bilateral Plunging Ranulas in South Auckland: Evidence for a Genetic Basis. Laryngoscope 2020; 131:73-77. [PMID: 32109322 DOI: 10.1002/lary.28593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We present a series of bilateral plunging ranula patients to examine the etiology, diagnosis, treatment, and prognosis of this condition. METHODS A retrospective chart review was performed on all cases of plunging ranula treated at the Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, New Zealand, between 2001 and 2019. RESULTS There were 17 patients with bilateral plunging ranulas from a total of 187 plunging ranula patients. Eight patients were of Pacific Island descent; six were Maori; and three were Asian. There were no European patients with bilateral plunging ranulas. There were three types of bilateral plunging ranula patients: 1) Metachronous plunging ranulas-Five patients presented with a unilateral plunging ranula with no evidence of a contralateral plunging ranula on initial imaging. Despite negative contralateral imaging findings, these patients developed a clinically evident contralateral plunging ranula 21 to 61 months later. 2) Synchronous plunging ranulas detected on imaging-Eight patients presented with a clinically evident unilateral plunging ranula but also had a contralateral plunging ranula detected on imaging. 3) Clinically evident synchronous plunging ranulas-Four patients presented with bilateral clinically evident plunging ranulas, which were also evident on imaging. Twelve patients underwent bilateral transoral sublingual gland excision and plunging ranula evacuation. CONCLUSION All patients with a unilateral plunging ranula should be advised of the potential for developing contralateral disease, and this should be emphasized in patients of Pacific Island, Maori, and Asian descent. LEVEL OF EVIDENCE 4 Laryngoscope, 131:73-77, 2021.
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Affiliation(s)
- Tary Yin
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Prabha Jain
- Department of Radiology, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Zahoor Ahmad
- Department of Otolaryngology-Head and Neck Surgery, Manukau Surgery Centre, Counties Manukau District Health Board, Auckland, New Zealand
| | - John D Harrison
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom
| | - Randall P Morton
- Department of Otolaryngology-Head and Neck Surgery, Manukau Surgery Centre, Counties Manukau District Health Board, Auckland, New Zealand
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5
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Chung Y, Cho Y, Kim B. Comparison of outcomes of treatment for ranula: a proportion meta-analysis. Br J Oral Maxillofac Surg 2019; 57:620-626. [DOI: 10.1016/j.bjoms.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/06/2019] [Indexed: 12/20/2022]
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6
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Kolomvos N, Kalfarentzos E, Papadogeorgakis N. Surgical treatment of plunging ranula: Report of three cases and review of literature. ORAL AND MAXILLOFACIAL SURGERY CASES 2019. [DOI: 10.1016/j.omsc.2019.100098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Head and neck cancers comprise 4% of the cancer burden in the United States each year. Many types of head and neck cancers present as an asymptomatic, nontender neck mass or nonspecific symptoms, such as hoarseness, sore throat, and pain. Head and neck cancers are frequently diagnosed incidentally by the primary care physician or dentist. This review summarizes the epidemiology, clinical manifestations, diagnosis, and treatment of several common head and neck cancers in order to provide an increased awareness for the internist to facilitate early detection of these diseases.
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Affiliation(s)
- Kenneth Yan
- Section of Otolaryngology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Nishant Agrawal
- Section of Otolaryngology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Zhen Gooi
- Section of Otolaryngology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
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8
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Yin T, Jain P, Ahmad Z, Morton RP. Patient with synchronous bilateral plunging ranulae. ANZ J Surg 2018; 89:E533-E535. [PMID: 30321905 DOI: 10.1111/ans.14865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Tary Yin
- Department of General Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Prabha Jain
- Department of Radiology, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Zahoor Ahmad
- Department of Otolaryngology-Head and Neck Surgery, Manukau Surgery Centre, Counties Manukau District Health Board, Auckland, New Zealand
| | - Randall P Morton
- Department of Otolaryngology-Head and Neck Surgery, Manukau Surgery Centre, Counties Manukau District Health Board, Auckland, New Zealand
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9
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Chen JX, Zenga J, Emerick K, Deschler D. Sublingual gland excision for the surgical management of plunging ranula. Am J Otolaryngol 2018; 39:497-500. [PMID: 30017374 DOI: 10.1016/j.amjoto.2018.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 05/26/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A plunging ranula is a pseudocystic collection of mucin extravasated from the sublingual gland into the floor of mouth and through the mylohyoid muscle into the neck. While the lining of a ranula is non-secreting and resection of the sublingual gland is adequate for simple sublingual mucoceles, many surgeons attempt to address plunging ranulas with extensive transoral and transcervical dissections. We review our experience managing plunging ranulas with intraoral sublingual gland excision and ranula drainage alone. METHODS This is a case series of patients with plunging ranulas who underwent transoral sublingual gland excision and ranula drainage in the past 10 years at the Massachusetts Eye and Ear. All ranulas were confirmed by radiographic imaging. Data were gathered from the medical record and telephone surveys. RESULTS Twenty-one patients with 22 distinct ranulas underwent this surgical approach. Average ranula size on imaging was 4.3 cm (SD = 1.3). Thirteen patients with 14 ranulas were followed up for greater than 6 months while the remaining 7 patients were lost to follow-up. Median follow-up for the 13 patients was 30 months (range 6 to 80). One ranula recurred requiring excision of residual sublingual gland (7%). One patient developed a local infection that was treated with antibiotics (7%). No long term complications were reported. CONCLUSION Simple transoral excision of the sublingual gland with ranula drainage is sufficient for treatment of plunging ranulas. It is essential to obtain a full resection of the gland to prevent relapse. This limited approach has low rates of complications and ranula recurrence.
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Affiliation(s)
- Jenny X Chen
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States
| | - Joseph Zenga
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States
| | - Kevin Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States
| | - Daniel Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States.
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10
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Affiliation(s)
- R P Morton
- Department of Surgery, University of Auckland, Auckland, New Zealand.
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11
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Kamalakaran A, Jayaraman B, Balasubramaniam S, Thirunavukkarasu R, Ramakrishnan B. Plunging Ranula in a 78- year- old Male - a Rare Case Report. J Clin Exp Dent 2018; 10:e92-e95. [PMID: 29670723 PMCID: PMC5899814 DOI: 10.4317/jced.54114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/12/2017] [Indexed: 11/24/2022] Open
Abstract
The term Ranula is a Latin word meaning frog. It refers to a bluish translucent cystic lesion in the floor of the mouth resembling the underbelly of a frog. Ranulas can be true cysts occurring due to ductal obstruction of the sublingual gland or a minor salivary gland or a pseudocyst as a result of ductal injury leading to extravasation and accumulation of saliva in the surrounding tissues. Clinically ranulas present as intraoral or plunging ranulas. The prevalence of ranula is 0.2% per 1000 patients Ranulas account for 6% of all salivary gland cysts. Ranulas are more common in children and young adults. However the plunging type occurs most commonly in the later third decade. The diagnosis of plunging ranula is based on a combined clinical,radiographic imaging and histologic findings. The treatment of ranulas have always been controversial.The treatment modalities range from simple marsupialisation to excision of the pseudocyst along with sublingual or submandibular gland excision.The purpose of this paper is to present a rare case of plunging ranula and to highlight the importance of considering plunging ranula in the differential diagnosis of lesions of the neck.
Key words:Plunging Ranula,mucus, submandibular gland, transcervical approach.
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Affiliation(s)
- Arunkumar Kamalakaran
- Associate Professor, Department of Oral and Maxillofacial surgery, Tamilnadu government Dental College and Hospital, Chennai, India
| | - Balaji Jayaraman
- Professor, Department of oral and maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai, India
| | | | - Rohini Thirunavukkarasu
- Assistant Professor, Department of oral and maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai, India
| | - Bharathi Ramakrishnan
- Professor, Department of Oral Pathology and Microbiology, Tamilnadu government Dental College and Hospital, Chennai, India
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12
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Abstract
Background There is no consensus opinion on a definitive surgical management option for ranulas to curtail recurrence, largely from the existing gap in knowledge on the pathophysiologic basis. Aim To highlight the current scientific basis of ranula development that informed the preferred surgical approach. Design Retrospective cohort study. Setting Public Tertiary Academic Health Institution. Method A 7-year 7-month study of ranulas surgically managed at our tertiary health institution was undertaken—June 1, 2008–December 31, 2015—from case files retrieved utilising the ICD-10 version 10 standard codes. Results Twelve cases, representing 0.4 and 1.2% of all institutional and ENT operations, respectively, were managed for ranulas with a M:F = 1:1. The ages ranged from 5/12 to 39 years, mean = 18.5 years, and the disease was prevalent in the third decade of life. Main presentation in the under-fives was related to airway and feeding compromise, while in adults, cosmetic facial appearance. Ranulas in adults were plunging (n = 8, 58.3%), left-sided save one with M:F = 2:1. All were unilateral with R:L = 1:2. Treatment included aspiration (n = 2, 16.7%) with 100% recurrence, intra-/extraoral excision of ranula only (n = 4, 33.3%) with recurrence rate of 50% (n = 2, 16.7%), while marsupialisation in children (n = 1, 8.3%) had no recurrence. Similarly, transcervical approach (n = 5, 41.7%) with excision of both the ranula/sublingual salivary gland recorded zero recurrence. Recurrence was the main complication (n = 4, 33.3%). Conclusion With the current knowledge on the pathophysiologic basis, extirpation of both the sublingual salivary gland and the ranula by a specialist surgeon is key for a successful outcome.
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13
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Carey RM, Hodnett BL, Rassekh CH, Weinstein GS. Transoral Robotic Surgery with Sialendoscopy for a Plunging Ranula. ORL J Otorhinolaryngol Relat Spec 2017; 79:306-313. [DOI: 10.1159/000481536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/11/2017] [Indexed: 01/28/2023]
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14
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Olojede ACO, Ogundana OM, Emeka CI, Adewole RA, Emmanuel MM, Gbotolorun OM, Ayodele AO, Oluseye SB. Plunging ranula: surgical management of case series and the literature review. Clin Case Rep 2017; 6:109-114. [PMID: 29375848 PMCID: PMC5771944 DOI: 10.1002/ccr3.1272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/06/2017] [Accepted: 10/18/2017] [Indexed: 11/06/2022] Open
Abstract
Plunging ranulas are rare; report of this condition is particularly limited in our environment. We present case series in children; with all cases having both oral and cervical components. It is important to note this type of presentation of plunging ranula and their appropriate management.
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Affiliation(s)
| | | | - Christian Ibesi Emeka
- Department of Oral and Maxillofacial Surgery College of Medicine University of Lagos Lagos Nigeria
| | - Richard Ayodeji Adewole
- Department of Oral and Maxillofacial Surgery College of Medicine University of Lagos Lagos Nigeria
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15
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Packiri S, Gurunathan D, Selvarasu K. Management of Paediatric Oral Ranula: A Systematic Review. J Clin Diagn Res 2017; 11:ZE06-ZE09. [PMID: 29207849 DOI: 10.7860/jcdr/2017/28498.10622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 08/29/2017] [Indexed: 11/24/2022]
Abstract
Introduction Ranula is mucous extravasation cyst that occurs in the floor of the mouth. There are various methods of management of paediatric oral ranula each of which has their own advantage and disadvantage. Aim The aim of this paper was to systematically review the available literature on the management of paediatric oral ranula. Materials and Methods A total of 64 articles were retrieved by electronic search. Based on the preset inclusion and exclusion criteria, a total of 21 articles were retrieved for full text analysis. The following characteristics were assessed from the retrieved articles: author, year of publication, study design, sample size, intervention, adverse effects and follow up period. Results The included studies consisted of the following study design: Seven articles were prospective clinical study, four articles were retrospective review, five articles were case series and five articles were case report. The mode of care varied from surgical excision to drug administration and lasers. Conclusion The data obtained from the review, display a lack of high quality study, with proper sample size and adequate follow up period. Further, randomized clinical trials are required to help the clinicians devise a best treatment approach for the management of paediatric oral ranula.
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Affiliation(s)
- Saraniya Packiri
- Postgraduate Student, Department of Paedodontic and Preventive Dentistry, Saveetha Dental College, Chennai, Tamil Nadu, India
| | - Deepa Gurunathan
- Professor, Department of Paedodontic and Preventive Dentistry, Saveetha Dental College, Chennai, Tamil Nadu, India
| | - Kathiravan Selvarasu
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Chennai, Tamil Nadu, India
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16
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Sublingual gland excision: a dissection carried out following adjacent anatomical structures. Br J Oral Maxillofac Surg 2016; 54:927-929. [DOI: 10.1016/j.bjoms.2016.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
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17
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Chin SJ, Zeng ISL, Morton RP. The epidemiology of plunging ranula in South Auckland. Laryngoscope 2016; 126:2739-2743. [PMID: 27297643 DOI: 10.1002/lary.26088] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/10/2016] [Accepted: 04/22/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Estimate the incidence rate and provide basic descriptive epidemiologic characteristics of plunging ranulas in a multi-ethnic population. STUDY DESIGN Case series with chart review. METHODS The study group comprised all Counties Manukau Health (CMH, Manukau City, Auckland, New Zealand) patients presenting to the CMH Department of Otolaryngology with a diagnosis of plunging ranula from January 2001 to December 2013, as recorded in the departmental case register. Non-CMH domicile patients were excluded. South Auckland comprised the base population, as serviced by CMH. The 2006 New Zealand census data was used for population demographics. RESULTS A total of 134 cases of plunging ranula were identified. The overall annual crude incidence rate was 2.4 per 100,000 person-years. The gender specific incidence rate for males was 3.2 per 100,000 (95% confidence interval [CI]: 2.5. 3.9) and for females was 2.0 per 100,000 (95% CI: 1.5, 2.6). The overall age-adjusted annual incidence rate was 2.6 per 100,000 (95% CI: 2.1, 3.0). The age-adjusted incidence was highest among Maori (6.7 per 100,000, 95% CI 4.9, 8.4), followed by Pacific Island (4.4 per 100,000, 95% CI 3.2, 5.6), Asian (0.7 per 100,000, 95% CI 0.2, 1.2), and European population (0.6 per 100,000, 95% CI 0.3, 0.8). CONCLUSION We have quantified for the first time the age-specific and age-adjusted incidence rates for plunging ranula by gender and ethnicity. The results show a likely underlying genetic predisposition for this condition, possibly with a superimposed environmental acquired factor relating to external, minor blunt trauma to the neck. LEVEL OF EVIDENCE 4. Laryngoscope, 126:2739-2743, 2016.
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Affiliation(s)
- Seung Joon Chin
- Department of Otolaryngology-Head and Neck Surgery, Counties Manukau Health, Auckland, New Zealand
| | - Irene S L Zeng
- Research and Evaluation Office, Health Intelligent and Informatics, Ko Awatea Counties Manukau Health, Auckland, New Zealand
| | - Randall P Morton
- Department of Otolaryngology-Head and Neck Surgery, Counties Manukau Health, Auckland, New Zealand
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18
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Yang HC, Kim SY, Kim SK, Oh CS, Chung IH, Nam KI. A cadaveric study on mylohyoid herniation of the sublingual gland. Eur Arch Otorhinolaryngol 2016; 273:4413-4416. [PMID: 27180250 DOI: 10.1007/s00405-016-4095-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/10/2016] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to document the presence of a sublingual gland (SLG) herniating inferiorly through the mylohyoid muscle into the submandibular area. A total of 100 half-heads of 50 adult Korean cadavers were enrolled in this study. The floor of the mouth was dissected from the neck, and mylohyoid muscle patency and position of the sublingual gland were evaluated. Demographic factors of the donor and characteristics of the herniation were evaluated. Herniation was found in 29 (58.0 %) of the 50 cadavers or 42 of the 100 half-heads. Herniation was more frequently observed in females than in males (p = 0.009). However, no laterality was observed. Classifying the location of SLG herniation from the midpoint of the mandible to the hyoid bone into 3 regions, 32 (63 %) of herniations were found in the anterior one-third. No ranula formation was observed. The size and weight of normal glands tended to be larger than those of herniated glands, but no statistical significance was observed. An SLG hernia is a very common condition and is more frequently observed in females. As such, SLG herniation should be considered when a submental neck mass is evaluated.
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Affiliation(s)
- Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Si Yoen Kim
- Research Institute of Medical Sciences, Chonnam National University, Gwangju, South Korea
| | - Sun Kyung Kim
- Research Institute of Medical Sciences, Chonnam National University, Gwangju, South Korea
| | - Chang Seok Oh
- Department of Anatomy, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - In Hyuk Chung
- Institute of Applied Anatomy, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Kwang Il Nam
- Department of Anatomy, Chonnam National University Medical School, Gwangju, 501-746, South Korea.
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19
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Andrade NN, Aggarwal N, Thomas R, Sahu VV. Management of a mucocoele of the submandibular gland without removal of the gland: a case report. Br J Oral Maxillofac Surg 2016; 54:1131-1133. [PMID: 27086510 DOI: 10.1016/j.bjoms.2016.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 03/18/2016] [Indexed: 10/21/2022]
Abstract
A mucocoele or extravasation of mucus is common in minor salivary glands, but unusual in major ones. Those from the submandibular gland are a diagnostic challenge and conventional management includes excision of the associated gland. We describe a 27-year-old man with a mucocoele of the submandibular gland that presented as a lateral cervical swelling and looked like a plunging ranula. The cystic lesion was completely excised and, to our knowledge, this is the first published case in which the submandibular gland was saved with no recurrence up to two years postoperatively.
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Affiliation(s)
- Neelam N Andrade
- Nair Hospital Dental College, Dr. A.L.Nair Road, Opp. Maratha Mandir, Mumbai Central, Mumbai, 400008.
| | - Neha Aggarwal
- Nair Hospital Dental College, Dr. A.L.Nair Road, Opp. Maratha Mandir, Mumbai Central, Mumbai, 400008.
| | - Roy Thomas
- Nair Hospital Dental College, Dr. A.L.Nair Road, Opp. Maratha Mandir, Mumbai Central, Mumbai, 400008.
| | - Vyankatesh V Sahu
- Nair Hospital Dental College, Dr. A.L.Nair Road, Opp. Maratha Mandir, Mumbai Central, Mumbai, 400008.
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Zhang B, Yang Z, Zhang RM, Liu L, Zhang F, Chen J, Zhang K. Are the patients with anatomic variation of the sublingual/Wharton's duct system predisposed to ranula formation? Int J Pediatr Otorhinolaryngol 2016; 83:69-73. [PMID: 26968056 DOI: 10.1016/j.ijporl.2016.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 01/13/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate ranula development according to anatomic variation of the ductal system of sublingual gland (SLG), especially the presence of Bartholin's duct. METHODS The anatomic variation of SLG duct was prospectively investigated and compared between 55 consecutive patients with ranulas treated by SLG excision (group 1) and another 15 consecutive patients undergoing similar surgeries for other conditions (group 2). The ductal structures of SLGs and submandibular glands (SMG) were also compared between the pediatric patients and adult patients with ranulas. RESULTS In 32 of 55 patients with ranulas (58.2%) and 1 of 15 patients without ranulas (6.7%), the SLG showed an anatomic variation of the main duct called Bartholin's duct structure (P<0.01). Seventeen of 22 (77.3%) pediatric patients with ranulas had Bartholin's ducts and 15 of 33 (45.5%) adult patients with ranulas had Bartholin's ducts (0.01<P<0.05), but Bartholin's duct which opens near to the orifice of Wharton's duct was not found in this study population. Plunging ranulas that extravasate deep to the mylohyoid were observed in the 6 patients (4 children and 2 adults). There was no recurrence in all cases with ranulas. CONCLUSIONS Congenital anatomic variation of the ductal system of the SLG might be a possible cause of ranulas in the patients with simple ranulas, especially in pediatric patients. Surgical resection of the SLG is a better treatment choice for ranulas than other conservative treatments.
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Affiliation(s)
- Bo Zhang
- Department of Oral and Maxillofacial Surgery, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, PR China.
| | - Zongfan Yang
- Department of Oral and Maxillofacial Surgery, Hospital of National University of Defense Technology, Changsha, PR China
| | - Ricardo M Zhang
- Division of International, Hunan Normal University, Changsha, PR China
| | - Li Liu
- Statistical Solutions, Inc. Exton, PA, USA
| | - Feng Zhang
- Department of Physical Therapy, Baltimore City Community College, Baltimore, MD, USA
| | - Jingjing Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Ke Zhang
- Department Family and Preventive Medicine, School of Medicine, University of Utah, UT, USA
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Lee JY, Lee HY, Kim HJ, Jeong HS, Kim YK, Cha J, Kim ST. Plunging Ranulas Revisited: A CT Study with Emphasis on a Defect of the Mylohyoid Muscle as the Primary Route of Lesion Propagation. Korean J Radiol 2016; 17:264-70. [PMID: 26957912 PMCID: PMC4781766 DOI: 10.3348/kjr.2016.17.2.264] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 12/31/2015] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Ji Young Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.; Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Hee Young Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Hyung-Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Han Sin Jeong
- Departments of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Yi-Kyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jihoon Cha
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
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Anterograde excision of a sublingual gland: new surgical technique for the treatment of ranulas. Br J Oral Maxillofac Surg 2016; 54:151-4. [DOI: 10.1016/j.bjoms.2015.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/19/2015] [Indexed: 11/23/2022]
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23
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[Plunging ranula. Review]. ACTA ACUST UNITED AC 2016; 117:84-8. [PMID: 26809598 DOI: 10.1016/j.revsto.2015.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/23/2015] [Accepted: 10/19/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Ranula is a pseudocyst of the sublingual gland, often of unknown etiology. In few cases, it can extend to the neck when passing through the mylohyoid muscle. Diagnosis is not always easy as other cervical cystic lesions may have the same clinical aspect. Some ranulas recur after removal. The aim of our study was to conduct a review about plunging ranulas, with a focus on the most useful paraclinical exams and the most effective treatment. MATERIAL AND METHODS A review of the literature has been conducted in the PubMed database between 2015 and 2010 using following keywords: plunging ranula, recurrent plunging ranula. RESULTS Thirteen articles reporting 37 cases of plunging ranulas have been selected. Among these cases, 3 recurred. Paraclinical exams consisted in US, CT scan and MRI. Main reported treatment was sublingual gland removal, sometime associated with marsupialization. DISCUSSION The most useful paraclinical exam is CT scan. Total sublingual gland removal is the most efficient treatment.
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Abstract
PURPOSE OF REVIEW Ranula is extravasation mucocele arising from the sublingual gland, influencing the swallowing or eating; this review focuses on the most recent literature pertaining to pediatric ranulas and aims to comprehensively describe the methods of diagnosis and management approaches. RECENT FINDINGS Ranulas consist of intraoral ranula and plunging ranula, which are frequently misdiagnosed, so it is vital for the differential diagnosis of pediatric ranulas to depend on the clinical examination, imaging and fine-needle aspiration cytology. Pediatric patients should first be observed for 6 months before other treatments. OK-432 could activate inflammatory reaction to induce shrinkage of pediatric ranulas. Marsupialization, incision with drainage and ranula excision alone, are associated with a high rate of recurrence, even marsupialization with packing and modified micromarsupialization should be prudently applied for primary treatment of intraoral ranula. Laser excision is considered an alternative treatment for intraoral ranula of pediatric patients because of low recurrence rates and surgical complications. Recently, sublingual gland with or without ranula excision is a reasonable and suitable choice for radical treatment in pediatric patients. SUMMARY The principal goal of pediatric ranula management is radical sublingual gland excision, sealing the mucus extravasates and lowest complications.
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George MM, Mirza O, Solanki K, Goswamy J, Rothera MP. Serious neonatal airway obstruction with massive congenital sublingual ranula and contralateral occurrence. Ann Med Surg (Lond) 2015; 4:136-9. [PMID: 25984300 PMCID: PMC4430706 DOI: 10.1016/j.amsu.2015.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 03/28/2015] [Accepted: 04/08/2015] [Indexed: 11/28/2022] Open
Abstract
Background Congenital ranulas seldom occur, with bilateral presentation and prenatal diagnosis reported very rarely. We believe this is the first reported case of a neonate with a antenally diagnosed massive congenital ranula, who went on to develop a non-contiguous contralateral ranula, both contributing to obstruction in a complex paediatric airway. Case report A female neonate was born to a non-primagravid mother via a planned elective caesarean section due to a lower facial defect and oral cyst. Antenatal aspiration of the pseudocyst was performed under ultrasound guidance with limited success. In the immediate post-natal period a poor airway was observed and the cyst was subsequently marsupialised. With the development of macroglossia secondary to oedema and tongue base collapse the airway was secured through surgical tracheostomy. A subsequent ultrasound scan revealed the presence of a second solitary cystic mass on the contralateral side. After careful excision of the contralateral pseudocyst, tongue function improved, with the resolution of a safe airway which permitted successful decannulation. A planned definitive procedure antenatally did not result in the anticipated improvement in function. However the subsequent development of a second non-contiguous pseudocyst and further surgical management resulted in a safe airway, improved masticator function and the ability to thrive. Conclusions The prenatal diagnosis of congenital ranulas have been seldom reported, with no reported cases of contralateral occurrence and airway obstruction from an intraoral ranula. This rare case highlights the need for a well considered contingency plan when surgery is required for a neonatal airway at risk. A well considered plan is required when a neonatal surgical airway is required. Intra-oral ranulas can be initially managed with marsupialisation or cyst excision. Sublingual gland excision is more reliable but associated with higher risk. Sublingual gland excision should be reserved for recalcitrant cysts.
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Affiliation(s)
- Manish M George
- Department of Otolaryngology-Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, M13 9WL, UK
| | - Omar Mirza
- Department of Otolaryngology, Royal Manchester Children's Hospital, Oxford Road, M13 9WL, UK
| | - Kohmal Solanki
- Epsom and St. Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton, Surrey SM5 1AA, UK
| | - Jay Goswamy
- Department of Otolaryngology, Royal Manchester Children's Hospital, Oxford Road, M13 9WL, UK
| | - Michael P Rothera
- Department of Otolaryngology, Royal Manchester Children's Hospital, Oxford Road, M13 9WL, UK
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26
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Chen CJ, Guo P, Chen XY. Recurrent Sublingual Ranula or Saliva Leakage From the Submandibular Gland? Anatomical Consideration of the Ductal System of the Sublingual Gland. J Oral Maxillofac Surg 2015; 73:675.e1-7. [DOI: 10.1016/j.joms.2014.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
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27
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Treatment outcomes of the intraoral approach for a simple ranula. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:e223-5. [DOI: 10.1016/j.oooo.2015.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/15/2015] [Accepted: 01/23/2015] [Indexed: 11/19/2022]
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28
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Heller M, Faustini A. Hemorrhagic transformation of a plunging ranula: an unusual cause of a rapidly enlarging neck mass. Am J Emerg Med 2015; 33:597.e3-4. [PMID: 25727166 DOI: 10.1016/j.ajem.2014.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 03/22/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- Michael Heller
- Emergency Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel Medical center, New York, NY 10003.
| | - Anthony Faustini
- Emergency Medicine Residency, Beth Israel Medical Center, New York, NY 10003
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Abstract
CONCLUSIONS The intraoral approach for removal of the plunging ranula is a safe and effective surgical approach as a primary treatment modality for plunging ranula. OBJECTIVES Although sclerotherapy is applied for plunging ranula, it can be primarily treated with surgery such as marsupialization, simple excision, and transcervical excision. This study was performed to assess the results of the intraoral approach for the treatment of plunging ranula. METHODS This prospective clinical study comprised a total of 23 patients with plunging ranula treated by the intraoral approach. RESULTS All patients had complete removal of the sublingual gland with evacuation of cystic fluid. The cystic wall of the ranula could be dissected completely in only four patients, and in eight patients it was only possible to drain the cystic fluid. However, in 11 patients we could not dissect the cystic wall completely. Rupture of ranula developed in all patients during the intraoral dissection. Recurrence was not detected in any of the patients during the median follow-up period of 14 months after the intraoral excision. There were no complications or external scarring.
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Affiliation(s)
- Yunsu Yang
- Department of Otolaryngology - HNS, Chonbuk National University, Medical School, Chonju , Chonbuk , Republic of Korea
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31
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Mun SJ, Choi HG, Kim H, Park JH, Jung YH, Sung MW, Kim KH. Ductal variation of the sublingual gland: A predisposing factor for ranula formation. Head Neck 2013; 36:540-4. [DOI: 10.1002/hed.23324] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 11/05/2022] Open
Affiliation(s)
- Sue Jean Mun
- Department of Otolaryngology-Head and Neck Surgery; Seoul National University Boramae Hospital
| | - Hyo Geun Choi
- Department of Otolaryngology-Head and Neck Surgery; Seoul National University Boramae Hospital
| | - Heejin Kim
- Department of Otolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul South Korea
| | - Joo Hyun Park
- Department of Otolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul South Korea
| | - Young Ho Jung
- Department of Otolaryngology-Head and Neck Surgery; Seoul National University Boramae Hospital
| | - Myung-Whun Sung
- Department of Otolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul South Korea
| | - Kwang Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul South Korea
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O'Connor R, McGurk M. The plunging ranula: diagnostic difficulties and a less invasive approach to treatment. Int J Oral Maxillofac Surg 2013; 42:1469-74. [PMID: 23726274 DOI: 10.1016/j.ijom.2013.03.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 03/22/2013] [Accepted: 03/26/2013] [Indexed: 11/18/2022]
Abstract
Plunging ranulas arise when a simple ranula extends beyond the floor of the mouth into the neck. Diagnosis is difficult even with modern imaging techniques as they mimic other neck lesions, and traditional treatment involves enucleation of the cyst from the neck. Despite this invasive surgery they tend to recur. We describe a less invasive approach to treatment and review the diagnostic pitfalls. From 2002 to 2011, eight patients presented with a plunging ranula. They were split into two groups: those for whom an incorrect diagnosis was made and those where a less invasive treatment approach was employed. Three patients were misdiagnosed with cervical lymphangioma and had inappropriately invasive surgery. Five patients with established plunging ranulas were treated using an intraoral approach alone, eliminating the need for a cervical incision. Misdiagnosis of a plunging ranula leads to extensive and unnecessary surgery. We propose an algorithm to simplify investigation that employs a low threshold for fine-needle aspiration cytology. The cases presented indicate that these lesions can be managed by a less invasive procedure than currently practised.
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Affiliation(s)
- R O'Connor
- Department of Oral and Maxillofacial Surgery, Guy's, King's and St. Thomas' Hospitals, London, UK
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Kim SH, Huh KH, An CH, Park JW, Yi WJ. Giant plunging ranula: a case report. Imaging Sci Dent 2013; 43:55-8. [PMID: 23525726 PMCID: PMC3604372 DOI: 10.5624/isd.2013.43.1.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 01/12/2013] [Accepted: 01/15/2013] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Seong-Ha Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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Harrison JD, Kim A, Al-Ali S, Morton RP. Postmortem investigation of mylohyoid hiatus and hernia: aetiological factors of plunging ranula. Clin Anat 2013; 26:693-9. [PMID: 23355334 DOI: 10.1002/ca.22212] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 10/31/2012] [Accepted: 11/20/2012] [Indexed: 11/11/2022]
Abstract
The mylohyoid hiatus and hernia were discovered in the nineteenth century and were considered to explain the origin of the plunging ranula from the sublingual gland. This formed the rationale for sublingual sialadenectomy for the treatment of plunging ranula. However, a more recent, extensive histological investigation reported that hernias contained submandibular gland, which supported an origin of the plunging ranula from the submandibular gland and submandibular sialadenectomy for the treatment of plunging ranula. We therefore decided to investigate the occurrence and location of the hiatus and the histological nature of the hernia. Twenty-three adult cadavers were dissected in the submandibular region. The locations and dimensions of mylohyoid hiatuses were measured before taking biopsies of hernias. Hiatuses with associated hernias were found in ten cadavers: unilateral in six; and bilateral in four, in one of which there were three hiatuses. Sublingual gland was identified in nine hernias and fat without gland in six. This investigation supports clinical and experimental evidence that the plunging ranula originates from the sublingual gland and may enter the neck through the mylohyoid muscle. It confirms the rationale of sublingual sialadenectomy for the treatment of plunging ranula.
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Affiliation(s)
- John D Harrison
- Department of Oral Pathology, King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, London, England.
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Sigismund PE, Bozzato A, Schumann M, Koch M, Iro H, Zenk J. Management of ranula: 9 years' clinical experience in pediatric and adult patients. J Oral Maxillofac Surg 2012; 71:538-44. [PMID: 23010374 DOI: 10.1016/j.joms.2012.07.042] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 07/10/2012] [Accepted: 07/12/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the long-term results in the authors' department in the management of patients with oral and plunging ranulas. A specific diagnostic and therapeutic approach is suggested based on these data and data from the literature. MATERIALS AND METHODS A retrospective analysis of 65 patients with a final diagnosis of ranula was carried out. The medical records were evaluated for the principal demographic, clinical, diagnostic, and therapeutic data. Statistical analysis was used to compare outcomes of the different treatments. RESULTS Treatments that included complete sublingual gland excision were associated with the lowest recurrence rate (3.6%), followed by partial sublingual gland excision (9.1%), marsupialization (13%), and ranula excision (36.7%). Nine patients (13.8%) had recurrences. A statistically significant difference was observed (P = .01) in the recurrence rate between complete sublingual gland excision and ranula excision alone. Complications developed in 7 patients (10.8%). Ultrasonography performed in all patients showed an intimate relation among the cyst, mylohyoid muscle, and sublingual gland. Dehiscence of the mylohyoid muscle was noted in some cases. CONCLUSIONS The surgical experience in the authors' department confirms the different treatments that are offered for ranula. Sublingual gland excision should be the preferred treatment, but marsupialization may be useful as an alternative minimally invasive procedure, with a success rate higher than 85% and no risk of increased complications if revision surgery is needed. Ultrasound is the recommended diagnostic tool, in addition to the clinical examination, for the differential diagnosis and during follow-up.
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Affiliation(s)
- Paolo Enrico Sigismund
- Department of Specialized Surgical Sciences, Università degli Studi di Milano, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Choi HJ, Kim SG, Kim JD, Kim JH, Kim JH, Kim SM. A case of bilateral submandibular gland mucoceles in a 16-month-old child. KOREAN JOURNAL OF PEDIATRICS 2012; 55:215-8. [PMID: 22745647 PMCID: PMC3382703 DOI: 10.3345/kjp.2012.55.6.215] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 10/19/2011] [Accepted: 11/30/2011] [Indexed: 11/27/2022]
Abstract
Mucoceles are common benign cystic lesions of the oral cavity that develop following extravasation or retention of mucous material from the major or minor salivary glands. Mucoceles are usually located in the lower lip (60 to 70% of cases), and the floor of the mouth is only involved in 6 to 15% of cases. Submandibular gland mucocele is extremely rare but should be considered in the differential diagnosis of swelling at the submandibular triangle in young children. We present the rare case of a 16-month-old child who was diagnosed with bilateral submandibular gland mucocele, presenting as serial swellings in both submandibular regions. We removed the cystic mass with the submandibular and sublingual glands to prevent recurrence.
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Affiliation(s)
- Hye Jung Choi
- Department of Pediatrics, Busan St. Mary's Medical Center, Busan, Korea
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McNamara A, Wong M, Pruthi A, Gilbert ML, Blanas N, Enepekides D, Klieb HBE. A lateral neck mass. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:5-8. [PMID: 22732843 DOI: 10.1016/j.oooo.2011.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 09/07/2011] [Accepted: 09/29/2011] [Indexed: 11/18/2022]
Affiliation(s)
- Audrey McNamara
- Department of Dentistry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Felstead A, Patel P, Revington P. Submandibular gland mucocele presenting as a lateral neck swelling. J Surg Case Rep 2012; 2012:8. [PMID: 24960677 PMCID: PMC3862607 DOI: 10.1093/jscr/2012.6.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mucus extravasation cysts or mucoceles are an extremely rare occurrence in the major salivary glands. We report upon an unusual case of a submandibular gland mucocele presenting as a neck lump. It should therefore be considered in the differential diagnosis of swellings in the lateral neck. Diagnosis and management are complicated by their similarity to the plunging or cervical ranula and differentiation may be potentially difficult. Detailed imaging often reveals the plunging ranula as being characterised by a so –called ‘tail’ sign. In our case this sign was absent and subsequent excision confirmed origin from the submandibular gland. We discuss potential treatment modalities and propose a rationale for definitive management.
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Clinical and histopathological review of 229 cases of ranula. ACTA ACUST UNITED AC 2011; 31:717. [PMID: 22038368 DOI: 10.1007/s11596-011-0589-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Indexed: 10/16/2022]
Abstract
The purpose of this paper was to evaluate the relationship between the thrombosis and secretory duct dilation, lesion size, clinical types, nature (primary or recurrent) and duration of illness in the development of ranula. A total of 229 cases of sublingual gland cysts were treated with surgical resection from Jan. 1990 to Feb. 2010. The patients' data were investigated on histopathological findings, size of ranula, the clinical types, nature of ranula (primary or recurrent) and duration of illness. Sections from the paraffin-embedded blocks were HE-stained. CK expression was immunohistochemically detected. Among 229 cases the incidence of venous thrombosis was 58.52%. The incidence of venous thrombosis with or without duct dilation was 73.25% and 26.39% respectively, with a significant difference between the two groups (P<0.005). The incidence of venous thrombosis of ranulas with diameter larger or less than 3 cm was 72.22% and 46.28% (P<0.005). The incidence of venous thrombosis of oral ranula, plunging ranula and mixed ranula was 49.37%, 77.19% and 85.71% respectively, with a significant difference found between oral and plunging or mixed ranula (P<0.01). The incidence of venous thrombosis in ranula patients with duration of illness longer or less than 3 months was 69.77% and 51.75% (P<0.01). The incidence of venous thrombosis with recurrent and primary ranulas was 51.85% and 64.85%, without a significant difference noted between them (P>0.05). It is concluded that the formation of venous thrombosis was related to the dilation of secretory duct, lesion size, clinical types, duration of lesion but formation of venous thrombosis was not related to the nature (primary or recurrent) of ranulas.
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Abstract
We report two cases of plunging ranula, which had recurred after marsupialization. Both were successfully treated by removal of the ipsilateral sublingual gland. A brief review of the literature regarding the treatment options is presented.
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Affiliation(s)
- Pavai Arunachalam
- Department of Paediatric Surgery, PSG Institute of Medical Science & Research, Peelamedu, Coimbatore, Tamil Nadu, India
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Abstract
Plunging ranulas are rare cystic masses in the neck that are mucous retention pseudocysts from an obstructed sublingual gland. They "plunge" by extending inferiorly beyond the free edge of the mylohyoid muscle, or through a dehiscence of the muscle itself, to enter the submandibular space. Imaging demonstrates a simple cystic lesion in the characteristic location and can be used to delineate relevant surgical anatomy. Surgical excision of the collection and the involved sublingual gland is performed for definitive treatment. We present a case of plunging ranula in a 44 year old female who presented with a painless, slowly enlarged neck mass. Plunging ranulas should be considered in the differential diagnosis of cystic neck masses, specifically when seen extending over, or through, the mylohyoid muscle.
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Affiliation(s)
- Vivek Kalra
- Department of Diagnostic Radiology, Yale University, 333 Cedar St, New Haven, CT 06520-8042, USA.
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Dietrich EM, Vasilios B, Maria L, Styliani P, Konstantinos A. Sublingual-plunging ranula as a complication of supraomohyoid neck dissection. Int J Surg Case Rep 2011; 2:90-2. [PMID: 22096692 DOI: 10.1016/j.ijscr.2011.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 02/15/2011] [Accepted: 02/17/2011] [Indexed: 10/18/2022] Open
Abstract
Ranulas are rare cystic lesions resulting from damage or rupture of one or more of the ducts of the sublingual gland, that lead to mucus extravasation or dilatation of the gland's duct. Extravasation cysts are more common than retention cysts. We present a case of a 45-year-old male with a squamous cell carcinoma of the ventral surface of the tongue that was treated with excision of the oral lesion and bilateral supraomohyoid neck dissection without supplementary radiotherapy. A left myocutaneous platysma flap was raised for defect closure. Ten months postoperatively he presented complaining of swelling of the right submandibular region. The diagnosis, based on his medical anamnesis and the CT imaging, was a sublingual-plunging ranula. It is postulated that the ranula resulted from damage to the ducts of the sublingual gland during selective neck dissection. One year postoperatively there are no signs of recurrence either of the ranula or of the cancer. We suggest that sublingual gland excision and intraoral cyst marsupialization is a logical treatment for sublingual-plunging ranulas.
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Affiliation(s)
- Eva-Maria Dietrich
- Dept. of Oral and Maxillofacial Surgery, General Hospital G. Papanikolaou, 57010, Eksoxi, Thessaloniki, Greece
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Surgery for plunging ranula: the lesson not yet learned? Eur Arch Otorhinolaryngol 2011; 268:1513-8. [PMID: 21328001 DOI: 10.1007/s00405-011-1509-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 01/20/2011] [Indexed: 10/18/2022]
Abstract
Our objective is to review our experience with treatment of plunging ranula and examine the efficacy of transoral excision of sublingual gland as the principal treatment. This study comprises a case series with chart review. A secondary otolaryngology service was used as the setting. Retrospective analysis of patient records was performed for a series of 95 consecutive cases of plunging ranula, which presented to our department between January 2001 and February 2010. Clinical presentation, investigations, diagnosis, treatment, complications and outcome were recorded. Literature search was performed using MEDLINE and OLD MEDLINE. 81 cases of plunging ranula were treated surgically by transoral excision of sublingual gland and evacuation of ranula contents. Mean operating time was 75.3 min. Twelve patients had undergone previous surgery elsewhere. One patient in our series had a recurrence, needing excision of sublingual gland remnant. Two patients had trauma to submandibular duct requiring excision of submandibular gland. Other complications were minor and transient. Review of literature revealed many diverse methods of treating ranula, with varying results. Our series makes a substantial contribution to the number of plunging ranulas reported in the world, and supports the use of transoral sublingual gland excision as first-line treatment of plunging ranula.
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Harrison JD. Modern management and pathophysiology of ranula: literature review. Head Neck 2011; 32:1310-20. [PMID: 20054853 DOI: 10.1002/hed.21326] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is a lack of consensus about the appropriate treatment of ranula. The objective of the present investigation was to produce a scientific basis for treatment. METHODS A review of the relevant literature is interpreted in the light of improved knowledge about the local anatomy and the pathophysiology of the salivary glands. RESULTS The oral and plunging ranulas are cystic extravasation mucoceles that arise from the sublingual gland and usually from a torn duct of Rivinus. The sublingual gland is a spontaneous secretor and the salivary flow is resistant to obstruction, which is caused by fibrosis induced by the extravasation. The submandibular gland is not a spontaneous secretor, is less resistant, and does not give rise to ranulas. CONCLUSIONS Effective treatment is removal of the involved unit of the sublingual gland or inducing sufficient fibrosis to seal the leak through which the mucus extravasates.
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Affiliation(s)
- John D Harrison
- Department of Oral Pathology, King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, London, United Kingdom
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A retrospective study of ranula in two centres in Malaysia. J Maxillofac Oral Surg 2010; 8:316-9. [PMID: 23139535 DOI: 10.1007/s12663-009-0077-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 11/02/2009] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Ranula is a mucous extravasation cyst which occurs as a result of trauma or obstruction of the sublingual or minor salivary gland or the duct itself. PATIENTS AND RESULTS 14 patients were seen at Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur and Hospital Tunku Ampuan Afzan, Kuantan, Malaysia between 2000 to 2006. There were six cases of intra-oral ranula and eight plunging ranula. Twelve patients underwent surgical intervention while two refused surgery. Four patients (33.3%) from those who had surgical intervention returned with recurrence; two (16.7%) had marsupialization and the other two (16.7%) had excision of the pseudocyst intraorally. CONCLUSION Excision and marsupialization remain as the treatment of choice in our centres.
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Seo JH, Park JJ, Kim HY, Jeon SY, Kim JP, Ahn SK, Hur DG, Kim DW, Lee JS. Surgical management of intraoral ranulas in children: an analysis of 17 pediatric cases. Int J Pediatr Otorhinolaryngol 2010; 74:202-5. [PMID: 20005579 DOI: 10.1016/j.ijporl.2009.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Revised: 11/12/2009] [Accepted: 11/20/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The preferred treatment of pediatric intraoral ranulas remains controversial. We present our experience with ranulas at the Gyeongsang National University Hospital and review the literature. METHODS The study involved 17 children under 15 years of age who visited our hospital from 2001 to 2008 and were diagnosed with a ranula exceeding 2 cm in diameter. The age and gender of the patients, the surgical procedures, presurgical observation period, postsurgical follow-up period, and complications of each case were determined. The unruptured specimens were all subjected to detailed pathological analysis. RESULTS The patients were on average 9.3 years and there were 10 girls and 7 boys. Spontaneous resolution was not detected in any of the cases during the presurgical observation period. Indeed, in two cases, the ranula had increased in size. The ranula and sublingual gland (SG) were resected in all cases. The average operation time was 1h. Recurrence and complications were not detected in any of the cases. Pathological analyses revealed that there was no communication of the ranula with the SG in any of the cases. CONCLUSIONS Our experiences suggest that the presurgical observation period need not be longer than 3 months and that the resection of ranulas along with the ipsilateral SG is a safe and effective primary treatment for symptomatic pediatric intraoral ranulas that exceed 2cm in diameter.
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Affiliation(s)
- Ji Hyun Seo
- Department of Pediatrics, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, South Korea
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Huang SF, Liao CT, Chin SC, Chen IH. Transoral approach for plunging ranula--10-year experience. Laryngoscope 2010; 120:53-7. [PMID: 19877177 DOI: 10.1002/lary.20674] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE/HYPOTHESIS Plunging ranulas (PRs) are infrequently encountered. The origin of PRs is mostly from the sublingual gland (SLG). Different routes to manage PRs include marsupialization, simple SLG excision, and combined SLG and submandibular gland (SMG) excision either transcervically or transorally. In this study, we demonstrated our experience managing PRs via transoral excision of the SLG with marsupialization. STUDY DESIGN Retrospective study. METHODS We retrospectively reviewed 20 patients at Chang Gung Memorial Hospital, Linkou, between January 1999 and April 2009. All patients received preoperative computed tomography or magnetic resonance imaging and were clinically diagnosed with PR. At surgery, the SLG was excised transorally with preservation of Wharton's duct and lingual nerve. The mucus contents of the PRs were drained through the posterior edge of the mylohyoid muscle. RESULTS Two patients were found to have final diagnosis of lymphangioma. Eighteen patients were eligible for analysis. The age distribution ranged from 6 to 48 years old. Sexual distribution was equally distributed. The successful rate was 17/18 (94.4%) with a lingual nerve paresthesia rate of 2/18 (11.1%). The paresthesia persisted for 3 and 6 months, respectively. One recurrent patient was salvaged by excision of the SMG and ranula. The other two recurrent patients received excision of the SMG and cyst and had a final diagnosis of lymphangioma. CONCLUSIONS Transoral approach with excision of the SLG alone provides a high success rate (94.4%) with minor complications and could be the first choice in managing PRs. The results of this study confirm PRs mostly originate from the SLG.
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Affiliation(s)
- Shiang-Fu Huang
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan
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Morton RP, Ahmad Z, Jain P. Plunging Ranula: Congenital or Acquired? Otolaryngol Head Neck Surg 2010; 142:104-7. [DOI: 10.1016/j.otohns.2009.10.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Revised: 09/03/2009] [Accepted: 10/14/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE: To review our clinical experience with plunging ranula and examine the evidence in support of our impression that plunging ranula has a genetic basis. STUDY DESIGN: Case series with chart review. SETTING: Secondary otolaryngology service. SUBJECTS AND METHODS: Review of the medical records of a clinical series of 80 consecutive plunging ranulas in 77 patients was conducted, with recording of clinical and radiological findings, surgical treatment, and outcome. A literature review using MEDLINE and OLD MEDLINE was performed. RESULTS: The majority of plunging ranulas had no intraoral component on clinical examination, although evidence of mucus extravasation from the sublingual gland could be found both radiologically and histologically in all cases. There were four patients with bilateral plunging ranula and one instance of siblings with unilateral plunging ranula. Maoris and Polynesians comprised more than 82 percent of our cases; this was a significant overrepresentation of these ethnic groups ( P < 0.0001). A very strong predominance of cases of Chinese origin was also evident in the literature. CONCLUSION: The clinical findings and the supporting data from the literature, when viewed in light of information relating to the known anatomical anomaly of a dehiscence in the mylohyoid muscle and ectopic sublingual gland lying below the plane of the mylohyoid, appear to support the case for a genetic basis for this unusual clinical entity.
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Affiliation(s)
- Randall P. Morton
- Department of Otolaryngology–Head and Neck Surgery (Drs Morton and Ahmad), Counties-Manukau DHB, Manukau City, New Zealand
| | - Zahoor Ahmad
- Department of Otolaryngology–Head and Neck Surgery (Drs Morton and Ahmad), Counties-Manukau DHB, Manukau City, New Zealand
| | - Prabha Jain
- Department of Radiology (Dr Jain), Counties-Manukau DHB, Manukau City, New Zealand
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Jain P, Jain R, Morton RP, Ahmad Z. Plunging ranulas: high-resolution ultrasound for diagnosis and surgical management. Eur Radiol 2009; 20:1442-9. [PMID: 19943050 DOI: 10.1007/s00330-009-1666-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Revised: 08/30/2009] [Accepted: 09/07/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We see a high incidence of plunging ranulas, particularly in Maori and Polynesian populations. We have investigated the usefulness of ultrasound in the diagnosis and management of plunging ranulas and present our findings. METHODS Thirty-three new cases were examined over 4 years (June 2004 to October 2008). RESULTS High-resolution ultrasound was very successful in determining the extent of the plunging ranula, confirming the cystic nature of the lesion, assessing the status of the mylohyoid muscle (a defect demonstrated in 100% of our cases) and evaluating the sublingual gland for rupture or herniation. Correlation with surgical findings was available for 30 cases. There was excellent ultrasonographic and surgical correlation, particularly with respect to submandibular space cystic collection (29 of 30 cases, 96.7%) and mylohyoid defects (27 of 30 cases, 90%). CONCLUSIONS With the considerations of cost, accessibility and the fact that many of our patients are young (median of 20 years), ultrasound is recommended as the preferred examination for plunging ranula.
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Affiliation(s)
- Prabha Jain
- Department of Radiology, Middlemore Hospital, Counties Manakau, PO Box 93311, Private Bag, Otahuhu, Auckland, New Zealand.
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Patel MR, Deal AM, Shockley WW. Oral and plunging ranulas: What is the most effective treatment? Laryngoscope 2009; 119:1501-9. [PMID: 19504549 DOI: 10.1002/lary.20291] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Preferred treatment of oral/plunging ranulas remains controversial. We present our experience with ranulas at the University of North Carolina (UNC) and review the literature. METHODS Retrospective review. From 1990 to 2007, 16 oral ranulas and 10 plunging ranulas were treated at UNC. Combining the UNC series with the literature identified 864 cases for review. An online survey was conducted to identify current treatment patterns. RESULTS In the UNC series, procedures for oral ranulas varied from ranula excision (50%), combined ranula and sublingual gland excision (44%), excision of the ranula along with the sublingual gland and submandibular gland (6%). A cervical approach was used in nine plunging ranula cases. One case was treated transorally with sublingual gland removal and evacuation of the ranula. Otherwise, the plunging ranula was removed along with the sublingual gland (20%), submandibular gland (50%), or both (20%). One hundred fifty-one complications were identified from the literature. Recurrence was considered a complication and was most prevalent (63%). Nonrecurrent complications included tongue hypesthesia (26%), bleeding/hematoma (7%), postoperative infection (3%), and Wharton's duct injury (1%). Sublingual gland excision yielded the fewest complications (3%). Procedures and associated complication rates were: transoral excision of sublingual gland (3%); transoral excision of sublingual gland and ranula (12%); marsupialization (24%); transcervical excision of sublingual gland, submandibular gland, and ranula (33%); OK-432 (49%); and aspiration (82%). CONCLUSIONS Based on our review, definitive treatment yielding lowest recurrence and complication rates for all ranulas is transoral excision of the ipsilateral sublingual gland with ranula evacuation.
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Affiliation(s)
- Mihir R Patel
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, 27599, USA
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