Cystic Swellings of the Anterior Triangle: Plunging Ranulas

Abstract

A plunging (cervical) ranula is a non-epithelial-lined salivary gland cyst that forms as a result of the escape (extravasation) of mucus from the sublingual gland and its subsequent herniation via the mylohyoid muscle into the submandibular space and beyond. It clinically presents as an asymptomatic, progressively expanding swelling on the lateral side of the neck; it may or may not have an intraoral component. Plunging ranulas have been found to spread into the submental area, the contralateral side of the neck, the nasopharynx, the retro-pharynx, and, sometimes, the upper mediastinum. Complications include infection, repeated trauma, bursting and reformation, and dysphagia. Imaging studies to investigate plunging ranulas include ultrasonography (US), computed tomography (CT) scanning, and magnetic resonance imaging (MRI). The methods used for the treatment of plunging ranulas include surgical excision, cryosurgery, marsupialization, and excision of the oral portion and associated sublingual gland or, rarely, the submandibular gland. Other reported procedures include excision of the sublingual gland through an intraoral approach and drainage of the lesion and excision of the swelling via a cervical approach, sometimes combined with excision of the sublingual gland. This chapter discusses the classification, etiological theories, epidemiology, clinical presentation, complications, workup and diagnosis, differential diagnosis, and different treatment options of plunging ranulas.