Excision Of Sublingual Gland Research Articles

Unraveling the Ayurvedic Protocol in the Management of Ranula

Shalakya tantra is the branch of Ayurveda which deals with Urdhwajatrugata rogas i.e., diseases occurring in supraclavicular region. Acharyas have mentioned various Mukharogas (diseases pertaining to oral cavity) which are further subdivided into various categories. Acharya Sushruta has mentioned five Jihwagata rogas (diseases of tongue) and their management. Upajihwika which is caused by vitiation of Kapha and Rakta, is the Jihwagraroopa shwathu cystic swelling under the ventral aspect of tongue. In modern, it can be correlated with Ranula which is a translucent swelling in the floor of the mouth formed due to sublingual gland trauma or obstruction of the ducts. It further leads to extravasation and accumulation of saliva in the surrounding tissue thus forming a cyst. Case and Intervention- A 49-year-old male patient presented to ENT OPD of Patanjali Ayurveda Hospital with swelling in left submandibular region for 2 months. There was no difficulty in mastication and swallowing with no history of trauma. The patient was diagnosed with plunging Ranula sized 4x3 cm based on USG findings. He underwent three months and 10 days course of Ayurvedic regime and two follow ups showing reduction in size of the cystic swelling. Conclusion: Several surgical techniques have been introduced to treat Ranula ranging from marsupialization, excision of Ranula, excision of sublingual glands, sclerotherapy with varying success and recurrence rate. Ayurvedic protocol aimed at holistic approach by pacifying the vitiated Doshas and showing marked regression in the cystic growth without making the patient undergo the pain and high cost and adverse effect as that of a surgical procedure.

Bilateral submandibular duct relocation for chronic sialorrhea: a 15 years of experience in children with a neurological disorder

Background: Chronic sialorrhea is a troublesome condition for children with neurological disorders that affect swallowing. Various surgical procedures for reflecting drooling cases are helpful. Some of them could be followed by complications or lead to over–dryness of the mouth. This article aims to highlight the safety and effectiveness of bilateral submandibular duct relocation (BSDR) on fifteen years of experience. Material and methods: A retrospective chart review identified 25 patients with chronic sialorrhea who underwent BSDR. Clinical and demographic data were reviewed. Surgical outcomes were assessed with both Wilkie and Brody's criteria and the Teacher drooling (TDS) scale. Results: The mean age of children was 11.7 years. They had neurological disorders and dribbled saliva with an average of 4.28 according to the TDS which falls to an average of 1.12 after surgery. By referring to Wilkie and Brody's criteria, 88% of the results have been labelled as excellent and good for the others. Conclusion: Our 15 years of experience in managing neurologically impaired children with profuse drooling illuminates and supports our trend for BSDR without sublingual gland excision. This surgical procedure is safe, and effective against drooling, protects oral health, and provides a high rate of success.

Surgical Treatment of Sublingual Gland Ranulas.

Introduction Ranulas are divided into oral (OR) and plunging (PR) and comprise the most common pathology of the sublingual gland. This study presents a case series of patients operated due to OR and PR within different type of modalities in a 1-year period. Objective The aim of this study is to determine the optimal surgical treatment of ranulas based on our results as well as in the literature review. Methods The medical charts of 7 patients with sublingual gland ranulas treated in 2020 were reviewed. Results The median age of the patients was 19. Three patients with OR were treated by marsupialization, micromarsupialization, and sublingual gland excision. Four patients with PR were operated via cervical approach in three cases and intraoral approach in one case. No recurrence was observed in 14 months of follow-up, on average. Conclusion Micromarsupialization should be consider as the primary treatment for OR. In case of recurrent OR and primary or recurrent PR, the best results might be obtained by radical excision of the sublingual gland, which can be performed without resection of the ranula sac with the intraoral approach.

Diving ranula- A case report and review

Pathologies developing on the floor of the mouth create difficulty for the patient and pose a challenge to oral physicians both clinically and surgically as this area manifests numerous vital structures. While diagnosing, an accurate differential diagnosis should be established to rule out other lesions that usually occur on the floor of the mouth such as ranula, lipoma, salivary gland tumours, dermoid cyst, and vascular lesions. Cystic lesions developing from the salivary glands are commonly known as "mucoceles", these lesions develop mostly in relation to the minor salivary glands and rarely, in relation to the major salivary glands. Mucoceles basically are of two types: Mucous retention cyst and Mucous extravasation cyst. A Ranula is a form of mucous extravasation cyst which commonly occurs on the floor of the mouth. Deep seated lesions when herniate through mylohyoid muscle give rise to a clinical variant; plunging or cervical Ranula. Various treatment modalities for ranula has been suggested that include excision of lesion with or without excision of ipsilateral sublingual salivary gland, marsupialization, aspiration of cystic fluid, sclerotherapy, incision and drainage and many more. Those various treatments have shown diverse results. Here we present a case report and review of Sublingual Ranula in a 47-year-old female patient, treated with the excision of the Ranula. A follow-up of 3 months revealed no recurrence.

Comparison between Partial versus Complete Excision of Sublingual Gland in Plunging Ranula Management (A Clinical Study)

Objective: To compare the postoperative complications of complete versus partial excision of the sublingual gland (SLG) in the management of plunging ranula.
 Subject and Methods: A total of 24 patients were equally divided into two groups; Group A was treated with partial excision, while Group B was treated with Complete excision. . CT and MRI were used to diagnose the lesions. Postoperatively, complications like pain, hematoma, and temporary numbness of tongue, dysgeusia, dysphgia and recurrence were recorded.
 Results: In both groups, males were in majority as compared to females. 10 males and 2 females, 9 males and 3 females were reported in Group A and B respectively. Mean age of patients in group A was 22.34±3.61, while in group B it was 21.25±3.55. Nearby 25% recurrence rate was found in patients treated with partial excision of SLG, while none of the patient reported with recurrence in complete excision group.
 Conclusion: Complete excision of sublingual gland was found superior management modality as compared with partial excision in terms of postoperative recurrence.

The piercing-stretching suture technique for the treatment of simple oral floor ranula.

Oral floor ranulas are pseudocysts located in the floor of the mouth that result from the extravasation of mucus from a sublingual gland. Historically, there has been little consensus on the ideal first-line treatment. Currently, definitive treatment involves sublingual gland excision, which can injure the lingual nerve and submandibular duct. Minimally invasive surgical techniques have been proposed, but so far have been associated with a high rate of recurrence. The so-called piercing-stretching suture technique was performed in 14 naïve adult and paediatric patients (6 females, with a mean age of 20.3 years (range, 7-55 years)). Clinical and ultrasonographic evaluations were performed in all patients; post-operative sialendoscopy was conducted in two paediatric patients. The surgical procedure was successful in all patients, and complete recovery of the ranula was seen in all but one of the patients who underwent suture replacement. No major or minor complications were encountered. This minimally invasive procedure may be considered a reliable and first-line treatment for management of simple oral floor ranulas.

Coexistence of Sjögren's syndrome and bilateral ranulas: A case report and review of the literature

AbstractSjögren's syndrome and ranulas are relatively frequently occurring diseases. However, when they occur simultaneously, its clinical features and pathogenesis remain unclear. Here, we report a patient with bilateral ranulas. Magnetic resonance imaging at diagnosis revealed a “salt and pepper” appearance in bilateral parotid glands, leading a diagnosis of asymptomatic Sjögren's syndrome. She was successfully treated with excision of the left sublingual gland and sclerotherapy. A literature review suggests that this coexistence may not be very rare. In addition, it may be characterized by a high prevalence of bilateral ranulas.

Sublingual Gland Excision and Sclerotherapy for Plunging Ranula and Management of Recurrence

Background and Objectives For plunging ranula, excision of the sublingual gland has been the major treatment option, with sclerotherapy being widely used as minimal invasive treatment. We compared the outcomes of these two methods as an initial treatment for ranula and investigated the outcomes of salvage procedure in recurred patients.Subjects and Method Patients were classified into the excision group (n=35) and the sclerotherapy group (n=39) according to the type of their initial treatment. The outcomes of the initial and salvage treatment were determined as recurrence or non-recurrence at 3 months after treatment, and statistically compared between the excision and the sclerotherapy groups.Results Recurrence in the sclerothearpy group (n=20, 51.3%) showed a significantly higher rate (p<0.001) than in the excision group (n=3, 8.6%). Recurring patients who received treatment different from the initial treatment (n=7) were cured, while those who had same procedure as the initial treatment (n=11) showed recurrence of 72.7% (n=8). There was no procedure related complication among the patients.Conclusion Sublingual gland excision was more effective than ethanol sclerotherapy for the treatment of plunging ranula. In addition, sublingual gland excision was effective even after the failure of ethanol sclerotherapy.

Ranula: A retrospective clinicosurgical analysis of 29 cases from a tertiary health institution, Northwest, Nigeria

Background: Ranula may grow into a considerable size as to cause obstructive symptoms, especially in infants when neglected. The aim is to describe the clinical presentation, treatment, and outcome of ranulas. Methods: This is a retrospective study of patients with ranulas that presented during the periods of January 2000 to December 2019 in the Department of Otorhinolaryngology, Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Northwest, Nigeria. Results: A total of 29 patients were seen during the review period: twelve (41.4%) males and 17 (58.6%) females. Age ranged from 3 days to 48 years (median 3 years). Most of the patients 19 (65.5%) were below the age of 10 years. Twenty-one (72.4%) patients had simple oral ranulas: 8 (38.1.6%) patients were congenital ranulas characterized by tongue protrusion and dysphagia. Plunging ranulas were seen in 8 (27.5%) patients, and 2 (25%) of these patients were HIV infected. Simple marsupialization was done for 10 (34.5%) patients, and one of these patients had an elective tracheostomy for difficult intubation. Sublingual gland excision and with the evacuation of the cyst were done for 16 (55.2%) patients. One of the patients with plunging ranula opted for conservative management. Only 12 (41.4%) patients came for follow up: a patient had recurrence 2 years after excision of plunging ranula. Conclusion: Ranula, when neglected can cause obstructive symptoms presenting as tongue protrusion in children. Inadequate follow up was seen in the majority of the patients. Adequate follow up to determine the recurrence, especially those who had marsupialization, is most desirable.

Primary sialorrhea and its surgical treatment with denervation of the submandibular glands in combination with sublingual gland excision

ObjectivesThe purpose of this study was to evaluate the effectiveness of ablating postganglionic parasympathetic fibers of the submandibular ganglion in combination with sublingual gland excision in the treatment of primary sialorrhea. Materials and methodsHealthy volunteers were initially chosen to determine a basic saliva flow rate value by saliva collection. Next, unstimulated and stimulated saliva flow rates, and a visual analog scale index for sialorrhea were recorded in all the patients pre- and postoperatively. In addition, the generalized anxiety disorder scale was used to assess preoperative anxiety symptoms. The follow-up durations ranged from 24 to 36 months after surgery. ResultsA total of 10 patients were included in this study. Preoperatively, the mean unstimulated saliva flow rate for the 10 patients was 11.26 ± 4.19 ml/10 min, the stimulated saliva flow rate was 16.76 ± 3.49 ml/6 min, and the visual analog scale index was 66.29 ± 14.86. Postoperatively, the mean unstimulated and stimulated saliva flow rates were significantly reduced to 5.99 ± 1.33 ml/10 min (p = 0.001) and 13.28 ± 1.86 ml/6 min (p = 0.013), respectively, and the visual analog scale index was 25.41 ± 5.6 (p < 0.001). No complications were found after operation. ConclusionThis study demonstrates that ablation of postganglionic parasympathetic fibers of the submandibular ganglion in combination with sublingual gland excision by an intraoral approach is a simple, safe, and efficient approach for treating primary sialorrhea.

Subtotal functional sialoadenectomy vs four-duct ligation for the treatment of drooling in neurologically impaired children: Long-term follow-up.

The best surgical option to treat drooling in neurodisabilities is still under debate. The aim of this study was to describe the technique of subtotal functional sialoadenectomy (SFS) (ie four-duct ligation (4-DL) together with bilateral sublingual gland excision) and its long-term outcomes, in comparison with 4-DL. Retrospective observational cohort study. Unit of Pediatric Surgery of Bambino Gesù Children's Hospital (Rome). Seventy-five patients surgically treated for drooling between 2002 and 2012, with at least five years of follow-up, divided into two groups: 4-DL group (19 patients) underwent four-duct ligation, and SFS group (56 patients) underwent subtotal functional sialoadenectomy. Primary end points were the evaluation of drooling improvement after surgery (parameters: Drooling Severity and Frequency Scale, DSFS; no of bibs/day; no of shirts/day; no of pneumonia/year; use of antidrooling drugs) and the comparison between two different surgical techniques. Median age at surgery was 10years (1-35). Long-term outcomes showed significant improvement in DSFS and in no of shirts/day in both groups. Significantly better results were found in the SFS group than in the 4-DL group as far as DSFS (P value .045), no of bibs/day (P value .041), no of shirts/day (P value .032) are concerned. Reoperation rate for recurrence was 42% in the 4-DL group and 0% in the SFS group (P value<.0001). Six patients (8%; 2 in the 4-DL group and 4 in the SFS group) experienced perioperative complications, while 4 patients (5%; 2 in the 4-DL group and 2 in the SFS group) recorded long-term complications, with no difference between groups neither need for surgical treatment. No surgery-related mortality was recorded. In our experience, subtotal functional sialoadenectomy ensured significantly greater long-term effects than four-duct ligation for drooling treatment in neurologically impaired child, with equal complication rate.

Submandibular dermoid cyst resembling a plunging ranula

Abstract A case of a submandibular dermoid cyst misdiagnosed ranula will be discussed. Sclerotherapy and sublingual gland excision were performed, but, the cyst persisted. A biopsy of the internal surface epithelium was needed for definitive diagnosis, and total cyst and duct excision was performed as the appropriate treatment.

Recurrent Oral Mucocele in a Pediatric Patient: A Case Report

Introduction: A ranula is a pseudocystic collection of mucin extravasated from the sublingual and/or submandibular glands in the floor of the mouth. These intraoral mucoceles may be generated by intraoral activity such as eating, dental instrumentation, or from external blunt trauma. We present a case of a pediatric patient with a recurrent plunging ranula, involving both the sublingual and submandibular glands, who underwent transoral sublingual gland excision and ranula drainage. Case Report: A previously healthy 16-year-old female presented to the emergency department with a one-month history of a growing mass under the left side of …

A 10-year Retrospective Review of Botulinum Toxin Injections and Surgical Management of Sialorrhea.

BackgroundSialorrhea is a common comorbidity among children with neurologic disorders. Botulinum toxin injections and surgical procedures are recommended for the management of pathological sialorrhea in patients who fail conservative management or with concerns for salivary aspiration. The following review evaluates outcomes following botulinum toxin injections and surgical interventions for sialorrhea over a 10-year period with a focus on treatment options and outcomes for patients with anterior and posterior drooling.MethodsThe study included all patients less than 25 years of age who underwent a procedure for drooling (Current Procedural Terminology (CPT) codes 42440, 42450, 42509, 42510, 64611 matched with the International Classification of Diseases (ICD)-9 and ICD-10 codes 527.7 and K11.7) from January 1, 2006 to December 31, 2015. A chart review collected demographics, drooling medication use, and type of drooling (anterior, posterior, both). Outcome variables included pre- and post-procedure number of bibs, parent-reported outcomes, post-intervention drooling medication requirement, post-procedure length of stay, and complications.ResultsSeventy-one patients were included in our analysis, with 88 total procedures performed. The average age at first intervention was 8.9 years; 43 patients were male and 40 patients had cerebral palsy. Thirty-one patients experienced posterior drooling or anterior/posterior drooling. These patients were more likely to undergo surgery as the first invasive intervention. The most commonly performed interventions were botulinum toxin injections (28 patients, 39%) and sublingual gland excision (SLGE) with submandibular duct ligation (SMDL) (36 patients, 51%). Improvement following injections was noted in 56% of patients versus 73% of patients following any surgical intervention.ConclusionManagement of drooling is complex with 18 different procedures performed over 10 years. Surgical interventions, specifically SLGE with SMDL and submandibular gland excision (SMGE), result in substantial improvement; these are commonly performed as the first intervention in patients with posterior drooling. By reviewing our experience, we hope to guide management decisions and help manage patient and caregiver expectations.

Bilateral Plunging Ranulas in South Auckland: Evidence for a Genetic Basis.

We present a series of bilateral plunging ranula patients to examine the etiology, diagnosis, treatment, and prognosis of this condition. 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. 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. 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. 4 Laryngoscope, 131:73-77, 2021.

MANAGEMENT OF PEDIATRIC PLUNGING RANULA: CASE REPORT

Plunging ranula (PR) is a mucus extravasation pseudocyst arising from the sublingual glands that forms following mucus escape that herniates through the mylohyoid muscle along the fascial planes into the cervical, submandibular, or submental space. They are rare in children, and surgical management is the most common performed therapy. We report a case of an 11-year-old female patient who sought dental treatment after a 3-year history of swelling in the right sublingual gland and the floor of the mouth, which was asymptomatic. The patient's medical history was unremarkable. Computed tomography image showed a well-defined ovoid lesion with hypoattenuation in the right sublingual gland measuring 4.5 × 4 cm. The initial diagnosis was PR, which was later confirmed by anatomopathologic analysis. Surgical excision of the right sublingual gland was performed intraorally under general anesthesia, followed by floor of the mouth marsupialization. The patient is currently being followed-up with no signs of local recurrence. Plunging ranula (PR) is a mucus extravasation pseudocyst arising from the sublingual glands that forms following mucus escape that herniates through the mylohyoid muscle along the fascial planes into the cervical, submandibular, or submental space. They are rare in children, and surgical management is the most common performed therapy. We report a case of an 11-year-old female patient who sought dental treatment after a 3-year history of swelling in the right sublingual gland and the floor of the mouth, which was asymptomatic. The patient's medical history was unremarkable. Computed tomography image showed a well-defined ovoid lesion with hypoattenuation in the right sublingual gland measuring 4.5 × 4 cm. The initial diagnosis was PR, which was later confirmed by anatomopathologic analysis. Surgical excision of the right sublingual gland was performed intraorally under general anesthesia, followed by floor of the mouth marsupialization. The patient is currently being followed-up with no signs of local recurrence.

Sublingual Gland Sialolithiasis: A Case Report

Sublingual gland sialolithiasis is rare and may be misdiagnosed as submandibular gland sialolithiasis, which is more common. It is important to preoperatively determine which gland is involved, because they require different surgical approaches. Computed tomography (CT) is useful for distinguishing between sublingual gland and submandibular gland sialolithiasis. In this paper, we report the case of a 50-year-old man with left sublingual gland sialolithiasis that was treated with excision of the left sublingual gland and the stone via a transoral approach, 6 weeks after the infection was controlled. The differential diagnosis between sublingual gland and submandibular gland sialolithiases, by use of CT images, is discussed from an anatomic viewpoint.

Submandibular gland botulinum neurotoxin A injection for predicting the outcome of submandibular duct relocation in drooling: a retrospective cohort study.

This study evaluated whether the effect of submandibular gland botulinum neurotoxin A (BoNT-A) injection can predict the outcome of submandibular duct relocation with sublingual gland excision (SMDR) in children with drooling. Furthermore, we compared the effectiveness of both procedures. A retrospective cohort study was performed in 42 children and adolescents (25 males, 17 females; mean [SD] age at BoNT-A injection 11y [4], range 4-20y; mean [SD] age at SMDR 15y [4], range 7-23y) with cerebral palsy or another non-progressive developmental disability who had undergone both BoNT-A injection and SMDR for drooling. Main outcomes were the drooling quotient and the visual analogue scale (VAS) on drooling severity at 8 weeks and 32 weeks follow-up. Failure or success of previous BoNT-A injections had no influence on success of consecutive SMDR. Relative change in main outcomes showed no significant relation between BoNT-A injection and SMDR for any follow-up measurement. After 8 weeks, SMDR was more successful than BoNT-A injection in diminishing VAS (VAS 80.0% vs 54.3%; drooling quotient 56.2% vs 51.0%). After 32 weeks, both drooling quotient (64.3% vs 29.5%) and VAS (75.7% vs 37.1%) showed significantly higher proportions of success for SMDR. The effect of submandibular BoNT-A injection does not predict subsequent SMDR success in drooling. Furthermore, SMDR has a larger and longer-lasting positive effect on drooling than BoNT-A injections. Submandibular botulinum neurotoxin A (BoNT-A) injection effect does not predict submandibular duct relocation with sublingual gland excision outcome. Submandibular duct relocation is more effective and more permanent than BoNT-A injection.

Long-term impact of saliva control surgery in children with disability

Sialorrhea is a common problem in children with disability, often negatively affecting socialization, self-esteem, and burden of care. Saliva control surgery is an available option to manage this problem, particularly when other conservative methods have failed. As little is known about the long-term impact of surgery, we followed up 62 patients who had combined bilateral submandibular duct translocation and bilateral sublingual gland excision at our pediatric hospital between 1994 and 2014. Eligible individuals were identified through a search of ICD procedure codes. When families of patients were contacted successfully, they were invited to complete a 14-item questionnaire designed specifically for this study. The results indicated that long-term outcomes of surgery were very good; 13/62 (21%) individuals no longer had a drooling problem and another 30 (48%) experienced only mild to moderate drooling. Although 84% families reported some or major improvement in drooling, 9 families reported that they would not go through the experience again because of a difficult recovery period, lack of effectiveness of the intervention, changes in saliva consistency that caused coughing and gagging, and dental decay. None of the collected variables were predictive of good or poor outcome. The study indicated that surgical intervention is effective in the long term in the majority of cases and can be recommended to other families who attend our saliva control clinic.

Pediatric Sialorrhea: Submandibular Duct Rerouting and Intraparotid Botulinum Toxin A Injection With Literature Review.

The aim of this study was to assess the effectiveness of bilateral submandibular duct relocation and bilateral sublingual gland excision in combination with botulinum toxin A injection into the parotid glands in children with sialorrhea. Previously in the literature, either surgery or botulinum toxin injection but not their combination has been reported. Preoperative and at least 6-month postoperative assessments using the Drooling Severity Scale and Drooling Frequency Scale (Thomas-Stonell and Greenberg classification) and the Teacher Drooling Scale and by interviewing parents and caregivers face to face or via telephone were performed. Also, decreases in the daily number of bib changes and hourly frequency of saliva wiping were recorded as success. Complications were recorded. The Drooling Frequency and Severity Scale, the Teacher Drooling Scale, daily number of bib changes, and hourly frequency of saliva wiping decreased significantly in 21 patients (95.5%) and remained unchanged in 1 patient (4.5%). Postoperative bleeding was observed in 1 patient (4.5%). Drooling is a complex problem that benefits from a multidisciplinary approach. Many treatment methods exist, each with advantages and disadvantages. In this study botulinum toxin A injection was applied in conjunction with bilateral submandibular duct relocation and bilateral sublingual gland excision surgery, achieving a success rate of 95.5%. Moreover, minimal complications and no recurrence after at least 6-month follow-up were observed. The authors therefore recommend further use of this combination treatment. Larger and longer term studies may also help clarify its effectiveness.