Intraoral Swelling Research Articles

Drain and Treat: A Rubber Dam Technique for Acute Periapical Abscess

Abstract Patients often report to the dental hospital with a complaint of toothache with extraoral swelling. Worried patients visit the dentist with a lot of apprehension. Acute dental infections with intraoral and extraoral swellings can be emergency and challenging to manage. Reduced mouth opening and severe pain may not allow the dentist to create an orthograde access to root canals. It ensues when the bacteria spread from the dental pulp to the surrounding periapical tissues accompanied by the formation of pus. If left untreated, these infections can be excruciatingly painful and pose a severe risk of spreading to facial spaces and finally, they may propagate to deep neck areas a ascend to intracranial sinuses. Hence, knowledge of its clinical management is of utmost importance. An acute periapical abscess has to be accurately diagnosed to render proper management of these maladies. Treating dentists should have a basic understanding of the pathophysiology, the suitable usage of antibiotics, the medical history of the patient, and standard treatment protocols. Therefore, this case report describes the management of an acute periapical abscess which was an emergency, and its conservative management.

Clinicopathologic and imaging features of odontogenic myxomas: a multi-institutional study.

This study aims to report clinicopathologic and imaging features of odontogenic myxomas (OM), highlighting uncommon findings. Clinicopathologic and imaging data of OMs diagnosed in the five Brazilian diagnostic pathology centers were collected and analyzed. The series comprised 42 females (68.9%) and 19 males (31.1%), with a 2.2:1 female-to-male ratio and a mean age of 34.5±15.4 years (range: 4-80). Clinically, most OMs presented as painless intraoral swelling (n = 36; 70.6%) in the mandible (n=37; 59.7%). Multilocular lesions (n=30; 83.3%) were more common than unilocular lesions (n=6; 16.7%). There was no statistically significant difference between the average size of unilocular and multilocular OMs (p=0.2431). The borders of OMs were mainly well-defined (n=24; 66.7%) with different degrees of cortication. Only seven tumors caused tooth resorption (15.9%), while 24 (54.5%) caused tooth displacement. Cortical bone perforation was observed in 12 (38.7%) cases. Morphologically, OMs were characterized mainly by stellate or spindle-shaped cells in a myxoid background (n=53; 85.5%). Surgical resection was the most common treatment modality (n=15; 65.2%), followed by conservative surgery (n=8; 34.8%). Outcomes were available in 20 cases (32.3%). Seven of these patients had local recurrence (35%). Enucleation was the treatment with the highest recurrence rate (4/7; 57.1%). OM has a predilection for the posterior region of the jaws of female adults. Despite their bland morphological appearance, they displayed diverse imaging features. Clinicians must include the OM in the differential diagnosis of osteolytic lesions of the jaws. A long follow-up is needed to monitor possible recurrences.

Rare case of Lingual Nerve Schwannoma Presenting as Submandibular Area Swelling with Parapharyngeal Extension.

Schwannoma is a rare benign encapsulated nerve sheath tumor which originates from Schwann cells. Generally, schwannoma arising from lingual nerve involves the oral tongue and tongue base in the oral cavity. We report a rare case of lingual nerve schwannoma in a 16-year-old girl with complaint of right-side submandibular swelling for last 4-5 years. A diagnosis was established based on computed tomography (CT scan) and fine needle aspiration cytology (FNAC). CT scan showed tumor involving right submandibular region and superiorly reaching up to parapharyngeal space without any intraoral swelling. She underwent excision under general anesthesia (transcervical approach) without any complication. Per operatively, the tumor was found eccentrically placed with relation to the lingual nerve and lingual nerve fibers were splayed over the tumor. The final histopathological results confirmed the diagnosis of schwannoma.

Ranula– A case report and literature review

Ranula, a salivary gland disorder, manifests as a cystic swelling on the floor of the mouth and can arise from various etiologies such as trauma, obstruction, or inflammation. This article explores the diversity of treatment modalities proposed for ranula, including incision and drainage, marsupialization, and sublingual gland removal. The recurrence of ranula is discussed in relation to treatment types, with reported rates varying significantly. This article discusses a case study of intraoral swelling in a 19-year-old male patient, emphasizing the importance of understanding and managing ranula in clinical practice.

Risk factors associated with the severity of pericoronitis of mandibular third molar.

The factors related to pericoronitis severity are unclear, and this study aimed to address this knowledge gap. In total, 113 patients with pericoronitis were included, and their demographic, clinical, and radiographic characteristics were recorded. The Patient-Clinician Pericoronitis Classification was used to score and categorize the severity of pericoronitis. Statistical analysis was conducted to examine the participants' characteristics, validity of the Patient-Clinician Pericoronitis Classification, and risk factors associated with the severity of pericoronitis. The demographic, clinical, and radiographic characteristics of males and females were similar, except for Winter's classification, pain, and intraoral swelling. The constructive validity of the Patient-Clinician Pericoronitis Classification was confirmed with three latent factors, including infection level, patient discomfort, and social interference. Ordinal logistic multivariate regression analysis revealed that upper respiratory tract infection was the sole risk factor associated with pericoronitis severity in males (odds ratio = 4.838). In females, pericoronitis on the right side (odds ratio = 2.486), distal radiolucency (odds ratio = 5.203), and menstruation (odds ratio = 3.416) were significant risk factors. This study demonstrated the constructive validity of the Patient-Clinician Pericoronitis Classification. Among females, pericoronitis in mandibular third molars on the right side with radiolucency in menstruating individuals was more severe. In males, upper respiratory tract infection was the sole risk factor associated with pericoronitis severity. Individuals with risk factors should be aware of severe pericoronitis in the coming future.

Warfarin-induced Sublingual Swelling: A Case of Pseudo-Ludwig Angina

Pseudo-Ludwig angina is a swelling that develops generally due to a cause other than an infection and can lead to fatal conditions such as severe respiratory obstruction. Due to anticoagulant use is rarely reported in the literature. This study presented a patient whose INR value was within the normal range and who developed sublingual swelling after dental treatment (intraoral trauma). A 68-year-old female patient was admitted to the emergency department complaining of increasing intraoral swelling on examination with a sublingual 3x5 cm hematoma. Warfarin was stopped, and she was monitored for possible intubation risk in the service. The patient did not develop respiratory distress and was discharged 4 days later. The INR range within which intraoral interventions can be performed safely is still unclear. The dentist should keep in mind that such complications may develop and be prepared for bleeding complications before treatment using warfarin patients.

Pleomorphic adenoma with lipometaplasia: Rare histology finding of a common entity

We report a rare case of a pleomorphic adenoma with lipometaplasia. A 32-year-old woman presented with intraoral swelling over right side of palate. Computed tomography revealed a heterogeneously enhancing right hard palatal mass without bony erosions. Preoperative diagnosis was offered with intraoral fine needle aspiration cytology following which excision was performed. On histopatholgy, final diagnosis of pleomorphic adenoma with lipometaplasia offered. Though rare it must be kept in mind as differential in cases of fat containing salivary gland lesions.

Eruption of an Uncommon Impacted Mandibular Canine in a Large Inflamed Dentigerous Cyst With the Combined Marsupialization and Orthodontic Treatment: A Case Report

A dentigerous cyst is a benign and asymptomatic lesion that may become extremely large and then interfere with tooth eruption. Marsupialization is known as the best treatment option for large cysts involving an unerupted permanent tooth. A 16-year-old female has been referred with the chief complaint of an unerupted tooth, extraoral and intraoral swelling, and pain. Radiographic examination demonstrated a unilocular, well-defined, and large radiolucent lesion extended from the distal of the right mandibular canine approximately to the left first mandibular molar. The mandibular left canine was also embedded within the lesion. The selected treatment plan was marsupialization, followed by performing orthodontic treatment of the unerupted mandibular canine. This clinical report presented the successful eruption of an impacted mandibular canine over a 4-years follow-up. The findings of this study revealed that the combination of marsupialization and orthodontic treatment is an effective treatment for large jaw cysts with impacted teeth.

504 A Curious Case of a Slow-Growing Intra-Oral Swelling in a Paediatric Patient

Abstract Background A 15-year-old male attended the paediatric dental department as an urgent self-referral. Clinical examination revealed a large, firm lesion in the right maxilla which had been slowly increasing in size for the past year. No altered sensation and facial numbness was detected. The upper right central incisor (UR1) was missing however, a primary central incisor was extracted at the dentist three months prior. Investigations An orthopantomogram (OPG) at initial presentation illustrated a well-defined radiolucency extending from the upper right first molar (UR6) to the upper left central incisor (UL1) with root displacement of adjacent teeth. A subsequent cone beam computed tomography (CBCT) scan identified a well-defined corticated radiolucency with an area of radioopacity of mixed density in the posterior-medial aspect. Buccal expansion and root displacement in the premolar segment were noted. The unerupted UR1 was extremely displaced, lying horizontal and just inferior to the nasal cavity. Diagnosis/Management Differential diagnoses for the anterior right maxilla radiolucency included calcifying epithelial odontogenic tumour, adenomatoid odontogenic tumour and an odontome. The histopathology of the cystic lining taken under general anaesthetic during enucleation and curettage revealed the diagnosis of a calcifying odontogenic cyst. Discussion Calcifying odontogenic cysts are very rare developmental lesions occuring due to proliferation of odontogenic epitheluim and scattered nest cells. As in this case, these cysts are usually associated with unerupted/impacted teeth. Awareness of dental eruption timelines is essential in identifying impacted teeth and associated pathology. Slow growing lesions in the maxilla should be identified early and investigated within multidisciplinary teams.

Fibrosarcoma of Mandible: A Case Report

Fibrosarcomas is an uncommon connective tissue growth that rises from the proliferation of malignant fibroblasts. Local recurrence is frequent, but metastasis is rare. About 0.05% of cases are affected in the head and neck.
 we report a case of mandibular fibrosarcoma in a 30-year-old man who presented with intraoral swelling in the ridge of the left mandibular alveolus. Histopathology showed the proliferation of malignant fibroblast cells arranged in a classic herringbone pattern.

Management of submandibular abscess with candidiasis complications

Submandibular space is part of the deep neck fascial spaces, bordered by the oral mucosa of the mouth floor on the above and the superficial layer on the deep cervical fascia on the bottom, as it extends from the mandible to hyoid bone. Submandibular space frequently involves odontogenic infections, which can cause significant mortality and morbidity. Open surgical incision and drainage are the treatment of choice for submandibular space abscesses. This is a case report of a 47-years-old female with main complaint of mass on the right submandibular that she has experienced for 2 weeks. The mass release pus which is felt flow down the throat. Physical examination revealed a soft, tender mass of 55 mm x 20 mm diameter in the right submandibular region. Oral status of the patient revealed presence of oral candidiasis too. There was no complication of trismus, swallowing pain or paralysis of the lower lip. The patient’s temperature was 38.5⁰C. Laboratory examinations showed a raised white blood cell count and slightly decreased albumin level. Intraoral swelling and redness of gingiva on the right upper middle incisor were observed. The patient was successfully treated by abscess drainage, oral antibiotics and nystatin.

RESECTION OF AMELOBASTOMA AND IMMEDIATE RECONSTRUCTION WITH MICROVASCULARIZED FIBULAR GRAFT: A CASE REPORT

A 35-year-old female presented an intraoral swelling in the right posterior region of the mandible, which was asymptomatic, with two years of evolution. She presented an anatomopathological report with a previous diagnosis of ameloblastoma, but she was unable complete the proposed treatment due to the COVID-19 pandemic. Clinical examination revealed a granulomatous lesion in the right retromolar region, extending to the vestibular mucosa of elements 46 and 47, together with,bone expansion. A facial tomography showed an expansive, cystic, multilocular lesion, with erosion of the adjacent cortical bone in the right body, angle, and mandibular ramus, measuring approximately 4.6 × 2.2 × 3.7 cm. The patient underwent partial resection of the right posterior mandible with immediate reconstruction of a microvascularized fibular graft and fixation with a reconstruction plate. In the postoperative period, the patient evolved with satisfactory mandibular contour, good mouth opening, and preserved masticatory function. A 35-year-old female presented an intraoral swelling in the right posterior region of the mandible, which was asymptomatic, with two years of evolution. She presented an anatomopathological report with a previous diagnosis of ameloblastoma, but she was unable complete the proposed treatment due to the COVID-19 pandemic. Clinical examination revealed a granulomatous lesion in the right retromolar region, extending to the vestibular mucosa of elements 46 and 47, together with,bone expansion. A facial tomography showed an expansive, cystic, multilocular lesion, with erosion of the adjacent cortical bone in the right body, angle, and mandibular ramus, measuring approximately 4.6 × 2.2 × 3.7 cm. The patient underwent partial resection of the right posterior mandible with immediate reconstruction of a microvascularized fibular graft and fixation with a reconstruction plate. In the postoperative period, the patient evolved with satisfactory mandibular contour, good mouth opening, and preserved masticatory function.

A comparative clinico-radiographic analysis of regenerative endodontic procedure on immature necrotic permanent teeth using blood clot and PRF as scaffold: A retrospective study

ObjectivesTo evaluate the clinical and radiographic success rate of blood clot and platelet rich fibrin (PRF) as a scaffold system in regenerative endodontic procedure in immature traumatized necrotic teeth.. Materials and methodsThis retrospective study examined the records of 28 subjects with necrotic immature open apex due to trauma treated with blood clot or PRF as a scaffold in regenerative endodontic procedure. The disinfection was carried out with calcium hydroxide as an intra-canal medicament. The clinical outcome was recorded using a binary variable of presence or absence of pain and intra-oral swelling. The radiographic outcome was recorded for periapical healing using Ørstavik’s Periapical Index and apical response using Chen and Chen index. Comparison of frequencies of categories of variables with groups was done using the chi-square test. The pairwise comparison of time intervals was done using Wilcoxon Signed Ranks Test. ResultsIntra-group comparison of pain and intra-oral swelling had highly significant (p = 0.000) results for both groups over a period of 12 months. Inter-group comparison for clinical outcomes was insignificant. For the radiographic outcome, there was a statistically non-significant difference for periapical healing and apical response for both intra-group and inter-group comparisons. ConclusionBoth PRF and blood clot have a favourable outcome for a regenerative endodontic procedure with a disinfectant protocol using calcium hydroxide as intracanal medicament. Considering the cumbersome procedure involved in procuring PRF scaffold, especially in children, inducing bleeding can be considered a recommended method for a regenerative endodontic procedure.

Dermal Cosmetic Migration after Lip Augmentation Procedure: Clinical Management and Histological Analysis in a Case Report with Review of the Literature

Lip augmentation procedures have become gradually more popular and common due to cultural tendencies and an increasing association of the appearance of the lips with both beauty and youth. Different dermal fillers have been proposed for lip augmentation—such as collagen, calcium hydroxylapatite, hyaluronic acid, and polylactic acid—which are used as temporary fillers. The present case report describes the histopathologic and clinical management of one case of HA filler migrating into the intraoral cheek, which caused discomfort by intraoral swelling. There is also a review of the relevant literature. A female patient, V.A., 34 years old, smoker, no allergies to drug and food substances, came to our attention. The patient was referred to the Department of Innovative Technology in Medicine and Dentistry of the University “G. D’Annunzio” of Chieti-Pescara in Italy by her dentist for the removal of a mass present in the right cheek. The clinical examination of the patient revealed a single mobile mass mimicking a soft tissue tumor in the right anterior cheek. The mass was palpable and approximately 2 cm long and was causing pain and swelling. The mucosa appeared healthy without ulcers. The filler, which had migrated into the cheek, was removed by reaching it with a scalped blade. The material was stored immediately in 10% buffered formalin and processed for histological analysis. The literature search was carried out in accordance with the criteria of the PICO guidelines. Observed histologically, the filler was surrounded by fibroblasts and a few inflammatory cells and giant cells without granuloma formation. The clinical diagnosis was swelling and discomfort caused by chewing trauma, while the histological examination excluded discomfort due to a foreign body reaction caused by the HA used for a lip augmentation procedure. In conclusion, the high-pressure and high-volume filler injections probably caused a detachment of the tissues, with the orbicularis oris muscle concurrently acting as a pump and moving the HA implant, causing migration to the area with low-density tissue such as the cheek.

Single-visit regenerative endodontic procedure of necrotic immature lower permanent molar with acute apical abscess

Regenerative endodontic procedures (REPs) of immature teeth with necrotic pulp and apical pathosis focus on passive chemomechanical debridement and usually require multiple visits to enhance the antibacterial effect by placing intracanal medications. However, different case reports showed a favorable clinical and radiographic outcome in single-visit REPs of necrotic immature teeth with symptomatic apical periodontitis or chronic apical abscess. To the best of our knowledge, there are no published reports of single-visit REPs on cases with acute apical abscess. Therefore, this case report aimed to present a successful REP performed in a single visit for immature lower molar with necrotic pulp and acute apical abscess. A 9-year-old female patient referred for the management of the lower right molar (#46), with the chief complaint of localized moderate pain with cold drinks in the lower right molar for 1 week. The extraoral clinical examination revealed no significant findings. Intraorally, tooth #46 revealed a deep occlusal caries, with normal response to palpation, mild pain on percussion, and moderate pain to the cold test. The radiographic examination showed deep occlusal caries approaching the pulp, and periapical radiolucency related to the distal root. It was diagnosed as symptomatic irreversible pulpitis with symptomatic apical periodontitis. After accessing the pulp chamber, the radicular pulp on the mesial root was vital, while necrotic in the distal root. Therefore, vital pulp therapy was done for the mesial root, and REPs initiated for the distal root with intracanal medicament placement. However, the patient failed to show up in the scheduled visit to complete the treatment. The father refused to bring her as she was asymptomatic, and he was afraid of the COVID-19 pandemic situation. One month later, she presented to the clinic with pain and facial swelling in the lower right area of her face. Clinical examination revealed extra- and intraoral swelling related to tooth #46 (i.e., acute apical abscess) with severe pain on palpation and percussion. The patient’s parents insist to finish the treatment or extract the tooth on the same visit. Hence, a single-visit REP was done. After 20 months, clinical and radiographic examinations showed that the tooth became asymptomatic, responded to sensibility tests, and the periapical pathosis healed. It was concluded that regenerative endodontic treatment can be done in single visit in cases with acute apical abscess. It should be considered in cases of poor complaint, difficulty in accessing dental care, or pandemic curfew.

Analysis of the Clinical Status and Treatment of Facial Cellulitis of Odontogenic Origin in Pediatric Patients.

The most common cause of the development of odontogenic infection is untreated dental caries, which initially leads to pulpitis. If an odontogenic infection is left untreated, it will pass through the limiting bone plate and will infiltrate deeper structures. Odontogenic infections are different in adults and children. The study was conducted at the Department of Pediatric Otolaryngology and Pediatric Head and Neck Surgery of Upper Silesian Children's Health Center in Katowice in the 2020-2022. We included 27 patients aged 2-16 in the study. Patients were diagnosed with an active, acute odontogenic inflammatory process in the head and neck area. We assessed pain, trismus, extraoral and intraoral swelling and the level of CRP [C Reactive Protein], WBC [White Blood Cells], NLR [Neutrophil Lymphocyte Ratio], D-dimers and Prealbumins. The results were analyzed in terms of the location of the source of inflammation: maxilla or mandible and the type of source of infection: deciduous tooth or permanent tooth. Deciduous teeth are more often the cause of odontogenic infection in the maxilla, while permanent teeth in the mandible. Trismus, extraoral, and intraoral swelling occurred in all infections caused by permanent teeth. The CRP and NLR ratio is statistically higher in infection, which originates from permanent teeth. The mean hospitalization time was also longer for infections from permanent teeth 3.42 days than for deciduous teeth 2.2 days. The varied clinical picture of odontogenic infections in children requires periodic analyzes of statistical data related to epidemiology, etiology, and symptomatology in order to update diagnostic and therapeutic procedures.

RADICULAR CYST : A CASE SERIES WITH REVIEW OF LITERATURE

Radicular cysts are the most common odontogenic cystic lesions of jaws, these are inflammatory in origin. These cysts result from the proliferation of cell rests of Malassez in the periodontal ligament as a consequence of inflammation, following pulpal necrosis of a nonvital tooth. The condition is usually asymptomatic but can result in a slow-growth in the affected region. On radiography the lesion is often seen as a round or oval, well circumscribed radiolucent area involving the apex of the infected tooth. Nonsurgical management should be the treatment of choice of a radicular cyst. However, periapical surgery is often considered, if the lesion is extensive and fails to reply to a nonsurgical approach. The case report is of a 43-year-old male patient with the complaint of swelling in an anterior region of maxilla since past 2 months which was gradually increase in size with no history of any pain or pus discharge. Patient had history of root canal treatment with upper right canine 10 years back. The second case report is of 45-year-old male patient with the complaint of pus discharge from destructed teeth in anterior region since one month. No intraoral and extra oral swelling present. The third case report is of 15 yrs. old male patient with the complaint of pain in upper anterior tooth since 7 days. Patient had history of root canal treatment with right lateral incisor 2 months back. The definitive diagnosis was made based on clinical, radiological and histopathological examination. Both the case reports discusses detailed description of clinical, radiographic, histopathologic features, pathogenesis, and its surgical management.

Analysis of Clinical Symptoms and Biochemical Parameters in Odontogenic Cellulitis of the Head and Neck Region in Children.

Many cases of cellulitis in the head and neck region among hospitalized pediatric patients are related to odontogenic infections. C-reactive protein (CRP), white blood cell (WBC) count, neutrophils to lymphocytes ratio (NLR), D-dimer, and prealbumin can be used to assess the severity of odontogenic inflammation. The aim of the study is to evaluate the biochemical parameters as a predictor factor of the severity of odontogenic cellulitis in children. This study was conducted from 2020 to 2021 on patients admitted to the Department of Pediatric Otolaryngology and Pediatric Head and Neck Surgery of the Upper Silesian Children's Health Center in Katowice. We included 40 patients aged 2-16 in the study, who were divided into two groups: research (SS-Study subject) (n = 20) and control (CS-Control subject) (n = 20). The patients underwent an interview and physical examination to assess the presence of intraoral and extraoral swelling and the presence of trismus. The patients who qualified for the study had blood taken to determine the level of CRP, WBCs, NLR, D-dimers, and prealbumin. Differences in biochemical test results in the SS and CS were statistically significant (p < 0.05). In the SS group, the mean values of biochemical parameters exceeded the clinical norm. A statistically significant positive relationship was found between CRP and extraoral swelling. The NLR correlates significantly with extraoral swelling and the length of hospitalization. D-dimer statistically correlated with trismus, extraoral swelling, and the number of anatomical spaces involved. The NLR and CRP ratio can be considered a prognostic marker of the course of infection and hospitalization time.

A Clinical, Radiological and Histopathological Review of 74 Ossifying Fibromas

BackgroundOssifying fibroma (OF) is a fibro-osseous lesion of the jaws and craniofacial bones. Accurate diagnosis can be challenging due to significant overlap of clinicopathological features. This study aimed to evaluate the clinical, radiological and histological features that can aid in diagnosis and identify characteristics that allow categorisation into the three subtypes: juvenile trabecular, psammomatoid and cemento-ossifying OF.MethodsA total of 74 cases of OF were systematically reviewed for their principle features. Of these, 46 cases were evaluated for their radiographic features including size, location and relationship to the teeth. Histological assessment and stereological point counting were performed in 69 cases to assess the pattern, type and proportion of calcification, the nature of the stroma, the border of the lesion and the presence of secondary changes. Fisher’s exact test and Chi-squared tests were used to determine associations between clinicopathological parameters and maxillary, mandibular, odontogenic, non-odontogenic and psammomatoid or trabecular lesions.ResultsOF showed a female predilection (F: M; 2:1) and a slight bimodal age distribution with peaks in the second (23%) and fourth decades (27%) (Mean age: 32.4 years). 83% of cases presented as an intra-oral swelling, with the mandible being the most common site (73%). Histologically, a range of morphological patterns were seen, with 50% of cases showing mixed trabecular and psammomatoid features. However, there were no significant differences between the variants of OF in terms of age, gender or histological features.ConclusionHistological features of OF cannot be used to differentiate between the subtypes.

Imaging Implications in Plunging Ranula- A Rare Case Report

Plunging ranula is an intraoral swelling plunging deep into neck and extending beyond the floor of the mouth. Clinical diagnosis is challenging to the clinician as, they mimic other neck lesions like reactive lymphadenopathy, cystic hygroma, thyroglossal duct cyst, abscess and so on. Herein, the authors presented a case of a 34-year-old male with history of swollen neck for past three months reported to the outpatient ward. On examination apart from the extraoral swelling in the left side of the neck, there was also an evidence of dome-shaped fluctuant deep seated swelling in the floor of the mouth. Biochemical analysis of the patient was within the normal limits. Further two-dimensional (2D) radiographs findings also, were non contributory. An anechoic presentation indicating fluid-filled sac was evident on ultrasound imaging. Sialogram of the case revealed the classic tail sign indicating a defect beyond the mylohyoid muscle; thus, three-dimensional (3D) imaging paves the way for deriving a final diagnosis. Furthermore, patient has been enlightened about the available treatment options and is under regular follow-up. Adding as a novelty, the present case is discussed with complete clinical, videographic and radiographic presentation of plunging ranula.