A comparison of three methods used for treatment of ranula

Management of Mucoceles, Sialoceles, and Ranulas

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.

Case report of the management of the ranula

Ranula is a mucocele caused by extravasation of the sublingual gland on the floor of the mouth. The most common presentation is a cystic mass in the floor of the mouth. A portion of the sublingual gland could herniate through the mylohyoid muscle, and its extravasated mucin can spread along this hiatus into submandibular and submental spaces and cause cervical swelling. This phenomenon is called plunging ranula. A variety of treatments for ranula has been suggested and include aspiration of cystic fluid, sclerotherapy, marsupialization, incision and drainage, ranula excision only, and excision of the sublingual gland with or without ranula. Those various treatments have shown diverse results. Most surgeons agree that removal of the sublingual gland is necessary in oral and plunging ranula. Four patients with ranula were investigated retrospectively, and treatment methods based on literature review were attempted.

Percutaneous treatment of ranulas: ultrasound-guided drainage with salivary gland chemical ablation

BACKGROUND

Ranulas are salivary pseudocysts in the floor of the mouth adjacent to damaged salivary glands. Current surgical management is drainage of the ranula with removal of the offending gland. An analogous percutaneous procedure could potentially offer similar treatment efficacy in a more minimally invasive way.

OBJECTIVE

To evaluate the outcomes of a cohort of patients with ranulas treated with percutaneous ranula aspiration and chemical ablation of the source salivary gland to see whether this technique could be proposed as a minimally invasive treatment alternative.

MATERIALS AND METHODS

This retrospective single-center study evaluated 24 patients treated percutaneously for ranulas between January 2004 and December 2014. All patients were treated with percutaneous ranula aspiration and chemical ablation of the offending salivary gland. Treatment success and any complications were recorded.

RESULTS

Complete ranula eradication was successfully accomplished in 87.5% of the patients with no complications.

CONCLUSION

Initial results suggest that our technique of percutaneous aspiration of ranulas and chemical ablation of the source salivary gland is safe and effective.

Modified bolster dressing with continuous suction improves skin graft survival for an oral cavity wound

Background

Skin engraftment of intraoral defects is known to be inconsistent due to mobility of the oral structure, uneven wounds, and accumulation of saliva under the skin graft. To improve the success rate of oral skin graft, we proposed a novel and simple dressing technique for intraoral skin graft to control saliva accumulation, in comparison with the conventional bolster dressing.

Methods

We retrospectively reviewed 31 patients reconstructed with skin graft in their intraoral defect. The patients were divided into two groups; conventional bolster group (n = 21) and modified bolster group (n = 10). In the modified bolster group, a polyvinyl alcohol sponge was designed to fit the skin graft and a suction drain was inserted with tagging suture to apply continuous suction. We analyzed the success rate, the size of the skin grafts and clinical variables of each method.

Results

The overall success rate of oral skin graft was not different between the two groups (90.0 and 90.5%). However, partial necrosis in the engrafted skin was observed frequently in the control group (57.1% versus 20.0%). The relative engrafted area was significantly higher in the modified bolster group (55.0 ± 11.6% versus 23.0 ± 18.7%, p = 0.015). The duration of bolster dressing and the time to start an oral diet were shorter in the modified bolster group.

Conclusions

Our modified method could be easily applied for removing saliva accumulation under a skin graft and for enhancing skin engraftment of an oral cavity wound.

Electronic supplementary material

The online version of this article (10.1186/s40463-018-0314-7) contains supplementary material, which is available to authorized users.

Plunging Ranula in a 78- year- old Male - a Rare Case Report

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.

Plunging ranula: surgical management of case series and the literature review

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.

Ranula Decompression Using Stitch and Stab Method: The Aluko Technique

BACKGROUND

A ranula is a cystic lesion in the floor of the mouth, formed either as a retention cyst or pseudocyst as a result of extravasation of mucus in the surrounding tissue. It may be treated by micro-marsupialization, marsupialization or excision of lesion with or without the associated salivary gland. Marsupialization is usually achieved by cutting a slit and thereafter stitching the edges such that the epithelium of the exterior becomes continuous with that of the interior of a cyst. A stitch-and-stab technique of achieving patency of the created slit of marsupialized ranula is hereby presented.

METHOD

A stitch and stab technique using four parallel consecutive strokes of the needle with attached polyglactin 910 suture material in alternately opposing directions was employed in treatment of 31 consecutive ranula patients.

RESULTS

100 % success was achieved using this technique in 31 ranulas.

CONCLUSION

This stitch-and-stab technique for marsupialization has proven to be very successful. It is recommended for use by the general medical community, as it requires the Clinician to possess only minimal surgical skills. Bartholin's cyst can be so treated.

Micro-marsupialization versus surgical excision for the treatment of mucoceles

Background:

Mucocele is a common disorder of minor salivary glands which arises due to mucous accumulation resulting from their alteration. Several techniques have been described for the treatment. However, most of them are invasive or require costly armamentarium.

Purpose:

The present study was conducted to evaluate the efficacy of micro-marsupialization technique as an alternative to surgical excision for the treatment of mucoceles.

Materials and Methods:

A prospective study was conducted. A total of twenty patients were selected based on clinical diagnosis of mucoceles and were randomly divided into two groups comprising ten patients each. Micro-marsupialization was done in Group 1 patients and surgical excision in Group 2. Patient's gender, age, size, location, duration, complications, and recurrences were evaluated during various visits. Data between the two groups were analyzed by descriptive and analytical (Chi-square tests) statistics.

Results:

The mean age of the patients in Group 1 was 19.6 ± 9.6 years while in Group 2 was 21.9 ± 11 years. The most common location for mucocele in Group 1 as well as Group 2 patients was lower lip (60% and 80%, respectively). In Group 1, two patients had recurrence while in Group 2, one patient had a recurrence. All recurrent cases were subsequently treated by surgical excision. No statistically significant difference was found between the two methods.

Conclusion:

Micro-marsupialization technique is as efficacious as surgical excision for the treatment of mucocele. It is advantageous over surgical excision as it is simple to perform, is less invasive therefore not associated with complications associated with invasive procedure, and is well tolerated by patients.

Clinical evaluation of a two-incision fistula technique for the treatment of oral ranulas

Oral ranulas are caused by extravasation of mucus from the sublingual glands, and the preferred treatment varies. We have developed a two-incision fistula operation for their treatment, and in this clinical study we have evaluated the efficacy and safety of this approach. Twelve patients with oral ranulas confirmed by fine needle aspiration cytology were enrolled and gave their consent to be treated by our new technique. The clinical outcomes and complications were evaluated during a period that ranged from 8-24 months. Nine ranulas became smaller and gradually disappeared, and there were no complications or injury to Wharton's duct. Three ranulas recurred, but disappeared after a second operation. The two-incision fistula operation can be effective and safe as an initial treatment for oral ranulas, and the method may become the preferred management for retention cysts.

The effect of OK-432 (Picibanil) injection on the histopathology of nasal turbinate

OBJECTIVE

This study aimed to assess the histopathological effect of OK-432 (Picibanil) on rabbit nasal turbinates.

METHODS

A total of 21 rabbits were divided into 3 treatment groups and various parts of both nasal turbinates were injected with 0.5 ml OK-432, 0.2 ml OK-432 or 0.6 ml saline (control). Bilateral nasal turbinates were later excised and studied under light microscopy to assess any histopathological changes.

RESULTS

Animals in the 0.2 ml and 0.5 ml OK-432 groups exhibited mild ciliary loss, goblet cell loss and epithelial damage, and a marked increase in inflammatory cell infiltration, submucosal vascularisation and fibrosis. There was a significant difference in histopathological changes between the two OK-432 treated groups. In addition, each OK-432 treated group had significantly more inflammatory cell infiltration, increased submucosal vascularisation and fibrosis compared with controls.

CONCLUSION

The marked fibrosis observed in OK-432-injected turbinates may be responsible for a reduction in turbinate size.

What is new in management of pediatric ranula?

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.

Evaluation of alpha-fetoprotein staging system for hepatocellular carcinoma in noncirrhotic patients

The Barcelona Clinic Liver Cancer (BCLC) staging classification is commonly used for staging hepatocellular carcinoma (HCC). This system assumes the coexistence of cirrhosis; however, a significant proportion of patients with HCC present without cirrhosis. Recently, an alternative system was proposed that stratifies patients according to alpha-fetoprotein (AFP) level. The aim of this study was to apply the AFP staging system to noncirrhotic patients with HCC and evaluate its ability to predict overall survival (OS). A prospective hepatopancreatobiliary database was reviewed for all patients with a diagnosis of HCC. Patients were staged based on BCLC classification as well as by AFP stage according to four levels: less than 10 ng/mL, 10 to 150 ng/mL, 150 to 500 ng/mL, and greater than 500 ng/mL. Cirrhotic patients were compared with noncirrhotic patients in terms of patient demographics and HCC stage. Kaplan-Meier (KM) analysis of OS was performed for noncirrhotic patients according to BCLC and AFP staging systems. Cirrhotic and noncirrhotic patients differed significantly in terms of median age at presentation (64 vs 70 years, P < 0.001) and gender (76 vs 65% male, P = 0.006). BCLS staging classification did not distinguish between cirrhotics and noncirrhotics (P = 0.733), whereas AFP staging demonstrated a significant difference between the two groups (P < 0.0001). KM analysis of OS for noncirrhotic patients with HCC was significant for both the BCLC and the AFP staging systems (P = 0.003 vs P < 0.0001, respectively). Patients presenting with HCC in the absence of cirrhosis appear to have different characteristics than patients with cirrhosis. Staging according to AFP level is an appropriate predictor of prognosis in noncirrhotic patients with HCC.

Mucocele of the glands of blandin-nuhn in children: a clinical, histopathologic, and retrospective study

BACKGROUND

The anterior lingual salivary glands (glands of Blandin-Nuhn) are mixed mucous and serous glands that are embedded within the musculature of anterior tongue ventrum.

AIM

The present study was designed to describe the clinical and histopathological features.

MATERIAL AND METHODS

We investigated the clinical and histopathologic features of 30 cases of mucocele of glands of Blandin-Nuhn. All the cases were seen in the department of pedodontics.

RESULTS

All the lesions were located on the ventral surface of the tongue. Lesions were situated at the midline in 24 patients and laterally in 6 patients. All the lesions were surgically treated. There was female predominance, and most patients were younger than 15 years.

CONCLUSION

Histopathological examination showed extravasation type of mucocele, suggesting that trauma may be a frequent initiating factor. All the patients were younger than 15 years.

Clinical and histopathological review of 229 cases of ranula

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.

Modern management and pathophysiology of ranula: literature review

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.

Plunging ranula: a case report

Plunging ranulas, also known as deep, diving, cervical or deep plunging ranula, usually appear in conjunction with oral ranula. Rarely, these ranulas may arise independent of oral swelling. A rare case of plunging ranula without oral swelling is discussed along with review of literature.

Oral and plunging ranulas: What is the most effective treatment?

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.

Management of the pediatric plunging ranula: results of 15 years' clinical experience

OBJECTIVE

This study was designed to evaluate the diagnosis and surgical treatment of the plunging ranula in children.

STUDY DESIGN

A retrospective study of 129 pediatric patients with a clinical diagnosis of plunging ranula was conducted. All children underwent clinical assessment and fine needle aspiration cytology. Cytologic diagnosis was considered to be definitive, and radiologic investigations were not conducted. Intraoral excision of the ipsilateral sublingual gland and partial pseudocyst was performed for all patients.

RESULTS

The preoperative diagnosis was consistent with postoperative and histopathologic analyses in all cases. There were no recurrences at 36 months' follow-up. There were no long-term complications as of writing this report.

CONCLUSIONS

Fine needle aspiration cytology can be used as the routine method to reach a diagnosis for plunging ranula, especially in the absence of floor of mouth involvement. Intraoral excision of the ipsilateral sublingual gland and partial pseudocyst is an effective and safe method for the treatment of the plunging ranula in the pediatric population, with absence of recurrence and low morbidity.

Primary treatment of pediatric plunging ranula with nonsurgical sclerotherapy using OK-432 (Picibanil)

OBJECTIVE

Although surgery is the first choice of therapy for plunging ranula, it is associated with technical difficulties, morbidity and recurrence. Plunging ranula may be also primarily treated with nonsurgical sclerotherapy, but there is little experience in pediatric patients. We, therefore, assessed the efficacy of OK-432 sclerotherapy for pediatric plunging ranula.

METHODS

Nine children with plunging ranula were prospectively treated with intracystic injections of OK-432. At the outpatient clinic, the ranula was punctured in the neck and aspirated mucus was replaced with 0.1-0.2mg OK-432 solution. The size of the ranula was compared before and after sclerotherapy.

RESULTS

Total or nearly total shrinkage was observed in 6 of 9 patients; marked reduction (>50% of original size) in 2; and partial reduction (<50% of original size) in 1. At a mean follow-up of 26 months after last sclerotherapy, recurrence was observed in only 1 patient; this patient showed complete response after reinjection of OK-432 solution. No significant complications were observed, with only fever and mild local pain observed in 4 patients for 2-4 days after treatment.

CONCLUSIONS

OK-432 sclerotherapy is safe and effective in the treatment of pediatric plunging ranula. Sclerotherapy may become a primary treatment modality prior to surgery.

Management of infant ranula

OBJECTIVE

Many surgical techniques to manage ranulas have been described in the literature. Ranula of infant patients was rare. Few studies have described the approach toward management in infant patients.

METHODS

Eleven infant patients were treated for intraoral ranulas. The methods of treatment included aspiration of mucus, marsupialization and excision of the ranula and the ipsilateral sublingual gland. All cases were performed aspiration of mucus and observed for 6 months; and the marsupialization were recommended if the ranula recurred; the surgical resection of ipsilateral sublingual gland were performed if the ranula recurred when infant patients was about 1-year-old. These patients were followed up at least 24 months.

RESULTS

Age of presentation ranged from 2 days to 3 months. There were six females (54.55%) and five males (45.45%). All cases presented simple (introral) ranula. Excision ranula with sublingual gland was performed on seven patients (63.64%) while marsupialization was performed on two patients (18.18%) and two patients (18.18%) were aspiration of the mucus of ranula and no recurrence. There were no recurrent lesions in all cases.

CONCLUSION

Conservative treatment of infant ranula maybe includes observation for 6 months for spontaneous resolution. The methods for observation is performed the aspiration of mucus and marsupialization. The resection of ipsilateral sublingual gland is recommended if ranula recurred for infant patients about 1-year-old. We believe that it is safe that the submandibular duct and complete sublingual nerve are dissected before the sublingual gland is removed.

Ranula successfully treated by botulinum toxin type A: report of 3 cases

The conventional treatment of ranula is surgical procedure. We report an innovative method for ranula by using botulinum toxin type A on 3 patients. All 3 cases of ranula resolved after this minimally invasive therapy. The treatment complication was minimal.

Congenital lingual cysts

Congenital lingual cysts are rare congenital tumors of the oropharynx, which should be suspected when the tongue appears enlarged by a mass. Prenatal diagnosis by ultrasound allows for an optimal management at the time of delivery because the mass can obstruct the airways. Unless the cyst enlarges and hinders feeding or breathing, surgical treatment is indicated only a few months after birth because spontaneous regression can sometimes be observed.

Management of pediatric plunging ranula

OBJECTIVE

There appears to be a high incidence of ranula in New Zealand. This study was designed to evaluate the diagnosis and surgical treatment of plunging ranula in children at Auckland Starship Children's Hospital, New Zealand.

METHODS

A prospective study of 21 pediatric patients with a clinical diagnosis of plunging ranula was conducted. All children underwent clinical assessment and fine needle aspiration cytology. Cytological diagnosis was considered definitive and radiological investigations were not conducted. Surgical treatment comprising intraoral excision of the ipsilateral sublingual gland and pseudocyst was performed.

RESULTS

The preoperative diagnosis was unchanged after surgery and histopathological analysis in all cases. There were no recurrences at 24-month follow up. There are no long-term complications to date.

CONCLUSIONS

Intraoral removal of the sublingual glands and pseudocyst is an effective and safe method for the treatment of plunging ranula in the pediatric population.

Treatment of a Ranula Using an Er,Cr:YSGG Laser

A ranula is an extravasational cyst arising from the sublingual gland. The "cyst" cavity does not have an epithelial lining, and because of this is notoriously difficult to eliminate. Usual treatment requires complete excision of the sublingual gland, exteriorizing the gland through establishment of a secondary ductal structure by placement of a long-term indwelling catheter, or packing, all requiring patient compliance. Unroofing alone is often followed by recurrence via resealing or closure with formation of a new roof. The accompanying scarring and damage to additional ducts may also result in recurrence. Combining unroofing with a technique that would prevent resealing of the remaining portion, scarify the base of the ranula to eliminate residual glandular acini, and be more comfortable and non-interfering with the daily activity of the patient, is an acceptable object of treatment of a ranula. The use of a water-based laser system to accomplish these goals appears to be a desirable and simple method.

Complications associated with surgical management of ranulas

PURPOSE

We present the intraoperative and postoperative complications associated with 606 procedures for ranulas in a series of 571 patients.

PATIENTS AND METHODS

Clinical records of 606 procedures in 571 patients with ranulas operated on in the Hospital of Stomatology, Wuhan University, China between 1962 and 2002 were retrospectively reviewed. The methods of surgery and intraoperative and postoperative complications were documented and analyzed.

RESULTS

The most common complications were recurrence of the lesion (5.78%) and sensory deficit of the tongue (4.89%), followed by damage of Whartons duct (1.82%). Postoperative hematoma, infection, or dehiscence of the wound were seldom seen. Temporary numbness of the tongue resolved within 2 to 7 months postoperatively. Recurrences were often seen after marsupialization and excision of the ranula, with few recurrences after excision of the ranula and sublingual gland or excision of the sublingual gland alone.

CONCLUSION

Complications associated with ranula surgery are minor and self-limiting. Transoral excision of the sublingual gland has the least possibility of ranula recurrence.

Surgical treatment of ranula with carbon dioxide laser radiation

Ranula is a mucous extravasation cyst which appears as a swelling in the submental and submandibular regions. Several surgical techniques to manage ranula have been described in the literature, these techniques include the CO2 laser radiation excision. Four patients were treated for intraoral ranula in the floor of the mouth by marsupialization with carbon dioxide laser radiation with defocused beam, continuous mode and 4 watts of power. There were no complications and no recurrences have occurred to date. The results showed that carbon dioxide laser radiation gives optimal results with no need for suture and good wound healing.

Treatment of ranula--excision of the sublingual gland versus marsupialization

The purpose of this work is to estimate optimum surgical treatment of ranula according to the type of the lesion. Nine patients with ranula surgically treated between 1989 and 2000 were investigated retrospectively. Six patients had sublingual type ranula and three had submandibular type. In five cases including recurrence cases, the sublingual gland was excised. Marsupialization was performed for four cases, which were superficial, protruded and within 2 cm of diameter. In all cases, histopathological diagnoses were pseudocysts without epithelial lining and there was no recurrence. Almost all ranulas are pseudocysts from the sublingual gland, therefore excision of the sublingual gland is considered to be a reasonable and radical treatment. For the small sublingual type, which is superficial, protruding and smaller than 2 cm in diameter, marsupialization is also a useful modification of surgical treatment of ranula.

Two cases of plunging ranula managed by the intraoral approach

Two cases of plunging ranula are reported. Treatment consisted of the total removal of the sublingual gland and evacuation of the cystic contents by the intraoral approach. The cyst remained just after the surgery in both cases, but then gradually regressed and disappeared within two months after the surgery. These findings support total removal of the sublingual gland as being the best method of treatment. We believe that complete dissection of the cyst with cervical incision as well as drainage of the cystic contents are unnecessary when the diagnosis of the plunging ranula is confirmed.

Management of pediatric ranula

OBJECTIVE

Many surgical techniques to manage ranulas have been described in the literature. These techniques include excision of the cyst with or without excision of the ipsilateral sublingual gland, marsupialization, cryosurgery, and CO(2) laser excision. Few studies have described the approach toward management in pediatric patients.

METHODS

Six patients were treated for intraoral ranulas. Two patients had spontaneous resolution of their lesions. Four patients required dissection of the submandibular duct and lingual nerve to completely excise an oral cavity ranula and an ipsilateral sublingual gland.

RESULTS

There were no recurrent lesions. One patient developed a lingual nerve injury but no numbness. The 2 patients with spontaneous resolution did not develop a subsequent lesion.

CONCLUSION

Optimal management of pediatric oral cavity ranulas may include observation for 5 months for spontaneous resolution. If the lesion does not resolve or recurs repeatedly, surgical treatment is recommended. Submandibular duct dissection with relocation appears to enhance exposure to the floor of mouth. The pseudocyst and entire sublingual gland should be removed. Identification of the lingual nerve is necessary to accomplish this goal.