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Kumar A, Ghai S, Rawat G. Plunging Ranula: A Case Report of a Rare Late Complication After Tongue Cancer Surgery. Cureus 2022; 14:e22423. [PMID: 35371649 PMCID: PMC8942137 DOI: 10.7759/cureus.22423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/25/2022] Open
Abstract
A plunging ranula is a benign cystic lesion in the neck formed due to mucin extravasated from a salivary gland, most commonly the sublingual gland. Ranulas have been described in association with congenital anomalies, trauma, diseases of the sublingual gland, and HIV; however, rarely, they may result as a complication of various oral and neck surgeries. Here, we report a rare case of plunging ranula that developed in an elderly male as a sequalae to surgery for tongue cancer. The patient had undergone a partial glossectomy with supra-omohyoid neck dissection for tongue carcinoma and nine months later presented with cystic swelling on the floor of the mouth that was followed by neck swelling. It was treated successfully by excision, and the histopathology confirmed the diagnosis of ranula. We postulate that the tongue cancer surgery could have caused an inadvertent injury to the ducts of the sublingual salivary gland and mylohyoid muscle, leading to the development of a plunging ranula. Our case reiterates that surgeons need to be aware of the anatomy of the submandibular and submental region to avoid any surgical trauma to the sublingual and submandibular glands and their ducts along with the associated mylohyoid muscle.
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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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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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Övet G, Alataş N, Güzelkara F, Kocacan FN, Övet H, Önal M. A Rare Cause of Acute Respiratory Distress: Cervical Ranula. Turk Arch Otorhinolaryngol 2015; 53:133-135. [PMID: 29391995 DOI: 10.5152/tao.2015.834] [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: 12/11/2014] [Accepted: 05/14/2015] [Indexed: 11/22/2022] Open
Abstract
Plunging or cervical ranula is a mucus extravasation pseudocyst arising from the sublingual gland that is located below the mylohyoid muscle. Clinically, if large enough, cervical ranulas can affect swallowing, speech, chewing, and even breathing. The acute presentation of ranulas, which are clinically known as slow-growing, painless masses, is rare. In this study, we present a case of cervical ranula that grew in a short period of 3 days and resulted in respiratory distress and that was operated in our clinic.
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Affiliation(s)
- Gültekin Övet
- Department of Otorhinolaryngology, Konya Training and Research Hospital, Konya, Turkey
| | - Necat Alataş
- Department of Otorhinolaryngology, Konya Training and Research Hospital, Konya, Turkey
| | - Fatih Güzelkara
- Department of Otorhinolaryngology, Konya Training and Research Hospital, Konya, Turkey
| | - Fatma Nur Kocacan
- Department of Otorhinolaryngology, Konya Training and Research Hospital, Konya, Turkey
| | - Habibe Övet
- Department of Otorhinolaryngology, Konya Training and Research Hospital, Konya, Turkey
| | - Merih Önal
- Department of Otorhinolaryngology, Konya Training and Research Hospital, Konya, Turkey
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Kinoshita M, Kida W, Nakahara H. Plunging ranula intruding into the parapharyngeal space treated with OK-432. Am J Otolaryngol 2012; 33:345-8. [PMID: 21917352 DOI: 10.1016/j.amjoto.2011.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 07/29/2011] [Indexed: 11/18/2022]
Abstract
We report a very rare case of a plunging ranula extending into the parapharyngeal space, which was treated successfully with OK-432. A 27-year-old woman presented with a 4-month history of right submandibular swelling. Based on computed tomography and magnetic resonance imaging findings, we established a diagnosis of plunging ranula intruding into the parapharyngeal space. The patient was treated with an intracystic OK-432 injection that was administered under ultrasonographic guidance. At 6 weeks after the injection, computed tomography showed complete disappearance of the cystic mass. No recurrence was noted during the 10-month follow-up.
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Affiliation(s)
- Makoto Kinoshita
- Department of Otolaryngology, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
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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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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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Gupta A, Karjodkar FR. Plunging ranula: a case report. ISRN DENTISTRY 2010; 2011:806928. [PMID: 21991487 PMCID: PMC3169347 DOI: 10.5402/2011/806928] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 08/30/2010] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Ambika Gupta
- Department of Oral Medicine, Diagnosis, and Radiology, Government Dental College, Pandit B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
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Ascending and plunging ranula in a pediatric patient. Otolaryngol Head Neck Surg 2009; 140:948-9. [DOI: 10.1016/j.otohns.2008.12.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 09/24/2008] [Accepted: 12/18/2008] [Indexed: 11/17/2022]
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Zhi K, Wen Y, Zhou H. Management of the pediatric plunging ranula: results of 15 years' clinical experience. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2009; 107:499-502. [PMID: 19071033 DOI: 10.1016/j.tripleo.2008.09.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 08/28/2008] [Accepted: 09/27/2008] [Indexed: 05/27/2023]
Abstract
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.
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Affiliation(s)
- KeQian Zhi
- Department of Oral and Maxillofacial Surgery/Oncological Head and Neck Surgery, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.
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Loney WW, Termini S, Sisto J. Plunging Ranula Formation as a Complication of Dental Implant Surgery: A Case Report. J Oral Maxillofac Surg 2006; 64:1204-8. [PMID: 16860210 DOI: 10.1016/j.joms.2006.04.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Indexed: 11/26/2022]
Affiliation(s)
- Wayne W Loney
- Department of Oral and Maxillofacial Surgery, Cook County Hospital, Chigaco, IL, USA.
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Ozgenel GY, Ozcan M. Bilateral parotid-duct diversion using autologous vein grafts for the management of chronic drooling in cerebral palsy. BRITISH JOURNAL OF PLASTIC SURGERY 2002; 55:490-3. [PMID: 12479422 DOI: 10.1054/bjps.2002.3884] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Chronic drooling is a major problem in patients with cerebral palsy and other neurological dysfunctions. Various treatments, ranging from speech therapy to radical surgery, have been used to overcome this distressing problem, with surgery the most consistently successful. In this study, we used a new surgical technique to manage severe drooling. This involved the dissection of both parotid-duct orifices, and their relocation, via a submucosal tunnel, into the tonsillar pillar using autologous vein grafts. Four patients were treated using this technique together with bilateral submandibular duct rerouting. The results were analysed by subjective judgements of drooling and retrograde sialography at 90 days postoperatively. In all cases, salivary flow was reduced and drooling was significantly improved. Retrograde sialography revealed no signs of obstruction or stricture formation in any of the cases. No postoperative complications occurred. These preliminary results suggest that the bilateral surgical transposition of Stensen's ducts into the tonsillar pillar using autologous vein grafts together with bilateral submandibular duct rerouting can provide effective control of chronic drooling.
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Affiliation(s)
- G Y Ozgenel
- Department of Plastic and Reconstructive Surgery, Medical Faculty of Uludağ University, Bursa, Turkey
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Abstract
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.
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Affiliation(s)
- Rajiv T Pandit
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois 60153, USA
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Iida S, Kogo M, Tominaga G, Matsuya T. Plunging ranula as a complication of intraoral removal of a submandibular sialolith. Br J Oral Maxillofac Surg 2001; 39:214-6. [PMID: 11384119 DOI: 10.1054/bjom.2001.0621] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mucous cysts in the submandibular region--so-called 'plunging' ranula--are relatively uncommon. We report a case of a plunging ranula that complicated excision of an intraductal sialolith of the submandibular gland.
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Affiliation(s)
- S Iida
- The First Department of Oral and Maxillofacial Surgery, Osaka University Faculty of Dentistry, Osaka, Japan
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Ozgenel GY, Ozcan M, Kahveci Z. An experimental study of bilateral repositioning of the Stensen's duct orifices with autologous vein and artery grafts in dogs. BRITISH JOURNAL OF PLASTIC SURGERY 2000; 53:106-8. [PMID: 10878831 DOI: 10.1054/bjps.1999.3221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sialorrhoea is an indication of dysfunction in the coordination of the swallowing mechanism. Disturbance in this coordination results in excess pooling of saliva in the anterior mouth and resultant drooling. Several surgical techniques have been described for the management of sialorrhoea. In this experimental study, we planned to try a more safe and physiologic technique by repositioning of the parotid duct orifices into the glossopalatal arch, using autologous free grafts of vein and artery in dogs. Ten adult dogs were used. In each dog, both of the parotid duct orifices were included in the study. The surgical procedure involved the dissection of both parotid duct orifices and their relocation via a submucosal tunnel into the glossopalatal arch, using a vein graft for the right side and an artery graft for the left side. Functional assessment was based on the clinical observations and retrograde sialography done on the 60th day. Results were excellent. No stricture or obstruction was noted. Histological examinations done on the 90th day showed the replacement of endothelium by multilayered cubic Stensen's duct epithelium in both artery and vein grafts. There was no difference between the results of artery and vein grafts. Surgical transposition of Stensen's duct into the glossopalatal arch with autologous vein or artery graft is a safe technique which may be used in clinical cases of drooling as an alternative to the other techniques described.
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Affiliation(s)
- G Y Ozgenel
- Department of Plastic and Reconstructive Surgery, Medical Faculty of Uludağ University, Bursa, Turkey
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Affiliation(s)
- M A Tavill
- Division of Otolaryngology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, USA
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Mintz S, Barak S, Horowitz I. Carbon dioxide laser excision and vaporization of nonplunging ranulas: a comparison of two treatment protocols. J Oral Maxillofac Surg 1994; 52:370-2. [PMID: 8133368 DOI: 10.1016/0278-2391(94)90439-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A carbon dioxide laser in a defocused beam was used to vaporize four ranulas and four were treated by a combination of focused beam excision of the dome and vaporization of the wall and base. There was no recurrence in any patient at 6 months and no complications were noted.
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Affiliation(s)
- S Mintz
- School of Dentistry, University of Detroit, MI
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