Management Of Ranula Research Articles

S urgical Management of Ranula- F loor of M outh by M arsupialization: A C ase Series.

Abstract Introduction: The extravasation of saliva from the sublingual gland on the floor of the mouth results in a ranula. The most typical presentation is swelling under the tongue. The mylohyoid muscle may allow it to herniate, Causing a plunging ranula. Ranula can be treated in many ways, including ranula excision alone, excision of the sublingual gland with or without ranula, aspiration of cystic fluid, sclerotherapy, marsupialization, incision and drainage. Material and methods: This case study includes six patients with ranula who underwent surgical treatment by marsupialization. The indications, age and sex distribution, Marsupialization methods, pathology reports, recurrence rates, and complications were seen. Results: Out of 6 patients in our case series, no one patient has shown to be any recurrence or complications of marsupialization. Conclusions: Management of Ranula by Marsupialization is a good option, but if it recurs after marsupialization, Excision of the lesion and the affected gland is the best course of action.

Case Report: Ranula and Sublingual Glands Extirpation as Intraoral Ranula Procedures

Ranula is a cystic lesion that develops from saliva extravasation caused by trauma to the sublingual gland or the occurrence of duct blockages. The ranula is divided into intraoral (simple ranula) and plunging ranula. There are several options of methods in the management of ranulas such as sclerotherapy, marsupialization, and extirpation with or without gland removal involved, incision and drainage with intraoral approach, excision lesions with the extra-oral approach. A case of ranula was reported in a girl aged 12 years diagnosed with intraoral ranula (simple ranula). Treatment is done by performing ranula extirpation accompanied by the removal of the sublingual gland and its ducts. The extirpation of the ranula followed by removal of the involved sublingual salivary gland gave satisfactory results with no recurrence until 1 year of follow-up on the management of intra-oral ranula.
 
 Keywords: ranula, simple ranula, intraoral ranula

Management of ranula with a combination of intra-lesional corticosteroid therapy and micro-marsupialization- A case report

Management of ranula with a combination of intra-lesional corticosteroid therapy and micro-marsupialization- A case report - IDJSR- Print ISSN No: - 2394-708X Online ISSN No:- 2278-3784 Article DOI No:- 10.18231/j.idjsr.2020.023, International Dental Journal of Student's Research-Int Dent J Stud Res

Sure Shot Technique for Management of Ranula

Introduction
 Ranula is a pseudocyst in the floor of the mouth originating from the sublingual salivary gland.A variety of surgical procedures have been quoted in the literature. But the main concern is high rate of recurrence. Aim of the present study is to describe a definitive technique for managing ranula and compare the result with review of literature.
 Materials and Methods
 A prospective study was done in the department of ENT in a tertiary care hospital of West Bengal from 1st April, 2014 to 31st March, 2019. Patients presenting with ranula irrespective of age and sex; size of the mass; whether primary or recurrent case were included in the study. Patients presenting with congenital and plunging ranula were excluded. Patients were treated with total excision of ranula along with sublingual salivary gland. Patients were followed up regularly for at least one year post-operatively.
 Results
 We treated thirteen primary and four recurrent cases of ranula. Among them eight were male and nine were female. Patients were from seven to thirty three years of age with most being in the second decade of life. There was no injury to lingual nerve or submandibular duct in any patient. We did not observe any recurrence till date.
 Conclusion
 Successful management of a ranula includes identification of the extent of the cyst and removal of the cyst along with the sublingual salivary gland. When done meticulously, this technique gives 100% success without any complication.

Retrospective analysis of ranula patients managed with surgical treatment

Objective: We aimed to examine patient characteristics, recurrence rate and efficacy of treatment methods in patients who underwent surgery with the diagnosis of ranula in our department retrospectively. The subject is discussed in the light of current literature. Methods: Twenty-seven patients with ranula managed surgically between 2008 and 2018 were included in this study. The indications, age and sex distribution, surgical pathology reports, surgical methods, complications encountered and recurrence rates were examined retrospectively. Results: The mean age was 27.48±18.66 years. There were 8 (29.6%) male and 19 (70.4%) female cases. The mean size of the ranula was 3.07±0.35 cm. When the symptoms were evaluated, 23 (85.2%) of the patients had a swelling in the floor of the mouth, 3 (11.1%) had a neck swelling and 1 (3.7%) had swelling on the lower surface of the tongue. The treatment method was marsupialization in 11 (40.7%) patients and ranula cyst excision in 16 (59.3%) patients. Four (14.8%) of these patients had a recurrence. The first surgical procedure was marsupialization in 3 (75%) and cyst excision in 1 (25%) of the cases with recurrence. Of the patients with recurrence, 3 subsequently underwent cyst excision and 1 of the patients underwent marsupialization. No complication or additional recurrence was observed in the follow-up of these patients. Conclusions: Concerning our ten years of experience with the management of ranula, we can conclude that ranula can be treated by both marsupialization and cyst excision with a low risk of recurrence.

A 17-year surgical experience of the intraoral approach for ranulas

IntroductionThe aim of this study was to analyze the clinical features and treatment outcomes in order to determine the optimal management of ranulas in our Oral and Maxillofacial Surgery department with long-term results. Patients and methodsA retrospective study was performed to evaluate patients with a final diagnosis of a simple or plunging ranula at Lille Teaching Hospital from May 2000 to January 2017. Clinical data on ranulas that were reviewed included gender, age, symptoms, location of the lesion, surgical procedures, complications, recurrence and follow-up. ResultsThe 26 patients included in the study comprised 18 males and 8 females, ranging from 3-months to 38 years of age. A total of 27 ranulas were managed: 25 oral ranula and 2 plunging ranulas. Twelve patients had undergone marsupialization (44.4%), 7 patients had complete excisions of the ranula (25.9%) or partial excisions combined with marsupialization (14.8%) and 4 patients (14.8%) had undergone excision of the sublingual gland (SLG). Seven ranulas recurred (25.9%). Not a single case recurred following the excision of the SLG. Treatments that included marsupialization were associated with the lowest recurrence rate (16.7%) after SLG excision, followed by combined marsupialization and ranula excision (25%) and by ranula excision alone (57%). There were no major complications. DiscussionLong-term outcomes confirm the different surgical procedures available in the outpatient clinic for the management of ranulas based on our surgical experience. Transoral resection of the SLG should be the optimal treatment, producing the lowest recurrence rate.

Modified micro-marsupialization in pediatric patients: A minimally invasive technique

Surgical management of ranula and mucocele in the pediatric age group is challenging. Various procedures from wide excision with scalpel to laser are associated with few complications. Micro-marsupialization is minimally invasive technique for the management of ranula and mucocele, especially in pediatric age group because it is easy to perform, efficacious, can be performed under topical anesthesia also and lower incidence of complications. This case reports describes the modified micro-marsupialization for the successful management of ranula and mucocele in pediatric age group.

The Pathophysiological Basis and Surgical Management of Ranula are Established

The Pathophysiological Basis and Surgical Management of Ranula are Established

Evolution of the management of ranulas: change in a single surgeon's practice 2001-14

Excision of the sublingual gland is the traditional cure for ranulas, but is invasive with considerable morbidity. We report techniques that have been developed to minimise this by targeting their specific pathophysiology, which include an intraoral approach to plunging ranulas, and gland-preserving selective excision with a highly conservative suture technique for simple ranulas. Fifty-four ranulas in 53 (20 male and 33 female, mean age 29 (range 7-57) years) consecutive patients were treated by a single surgeon between 2001-14 and their records reviewed retrospectively. Their personal details, operations, types of ranula, and outcomes were recorded. Follow up was for a minimum of six months without recurrent disease before discharge. Of the 54 ranulas treated, 26 had standard traditional sublingual gland excision (17 simple and 9 plunging), nine simple ranulas were selectively excised, 10 were treated with the new suture technique, and nine plunging ranulas were aspirated, after which they were ligated and the sublingual gland excised. Two of the 10 treated by the new suture technique had residual ranulas. The procedure was repeated in both cases, and one had a small residual ranula for which further intervention was declined. One complication developed after excision of a plunging ranula using the traditional intraoral and extraoral approaches, and two developed after aspiration of the sac, ligation, and excision of the gland. Traditional excision of simple ranulas was followed by three complications, but none were reported after simple ranulas had been treated with selective excision or suture. Minimally invasive techniques offer cure, with a lower risk of morbidity.

Evolution in the management of Ranulas – a single surgeons change in practice between 2001–2014

Evolution in the management of Ranulas – a single surgeons change in practice between 2001–2014

Cryosurgery for the treatment of pediatric plunging ranula: a conservative management

Several methods of treatment for plunging ranulas have been described in the literature, such as: surgical treatment including the excision of the sublingual gland followed by transoral drainage of the pluging ranula, needle aspiration, excision of the ranula, cryosurgery and CO(2) laser excision. Marsupialization and micro-marsupialisation can be also recommended primarily to treat oral ranulas. The aim of this paper is to present the treatment of pediatric ranula with liquid nitrogen cryosurgery performed in a 8 year, 6-month-old male, without local anesthesia. We have outlined the current protocol of cryosurgery recommended in the management of ranulas, both clinical advantages and disadvantages, with emphasis on the clinical outcomes and also pediatric patients' safety. At the 1year follow-up visit, the lesion had disappeared completely. There was no recurrent lesion. Liquid nitrogen cryosurgery for management of ranulas may become a primary treatment modality prior to surgery in children.

Management of Ranula: 9 Years' Clinical Experience in Pediatric and Adult Patients

The aim of the present study was to evaluate the long-term results in the authors' department in the management of patients with oral and plunging ranulas. A specific diagnostic and therapeutic approach is suggested based on these data and data from the literature. A retrospective analysis of 65 patients with a final diagnosis of ranula was carried out. The medical records were evaluated for the principal demographic, clinical, diagnostic, and therapeutic data. Statistical analysis was used to compare outcomes of the different treatments. Treatments that included complete sublingual gland excision were associated with the lowest recurrence rate (3.6%), followed by partial sublingual gland excision (9.1%), marsupialization (13%), and ranula excision (36.7%). Nine patients (13.8%) had recurrences. A statistically significant difference was observed (P = .01) in the recurrence rate between complete sublingual gland excision and ranula excision alone. Complications developed in 7 patients (10.8%). Ultrasonography performed in all patients showed an intimate relation among the cyst, mylohyoid muscle, and sublingual gland. Dehiscence of the mylohyoid muscle was noted in some cases. The surgical experience in the authors' department confirms the different treatments that are offered for ranula. Sublingual gland excision should be the preferred treatment, but marsupialization may be useful as an alternative minimally invasive procedure, with a success rate higher than 85% and no risk of increased complications if revision surgery is needed. Ultrasound is the recommended diagnostic tool, in addition to the clinical examination, for the differential diagnosis and during follow-up.

Upgrading of the micro-marsupialisation technique for the management of mucus extravasation or retention phenomena

This study evaluated the performance of an upgrading of the micro-marsupialisation technique for the management of mucus extravasation or retention phenomena. This study presents a prospective case series of management of ranulas and mucoceles, with a follow-up ranging from 6 to 18 months. Data included the age and gender of patients, as well as the type, size, and site of lesions, and number of punctures. The treatment performance was evaluated according to: postoperative pain, oedema, secondary infection, clinical healing, retreatment, and recurrence of the lesions. All patients showed clinical healing of the lesions within 30 days after the micro-marsupialisation technique. None of patients presented a recurrence or required retreatment, there was no oedema or infection. No pain, or mild pain was reported by the majority of patients (58.81%). Micro-marsupialisation proved to be a simple, low cost, relatively non-invasive, painless, effective, and low recurrence technique to treat mucus extravasation or retention phenomena. Micro-marsupialisation can be recommended primarily to treat oral ranulas and selected mucoceles.

Robotic-assisted transoral removal of a bilateral floor of mouth ranulas

ObjectiveTo describe the management of bilateral oral ranulas with the use of the da Vinci Si Surgical System and discuss advantages and disadvantages over traditional transoral resection.Study DesignCase Report and Review of Literature.ResultsA 47 year old woman presented to our service with an obvious right floor of mouth swelling. Clinical evaluation and computerized tomography scan confirmed a large floor of mouth ranula on the right and an incidental asymptomatic early ranula of the left sublingual gland. After obtaining an informed consent, the patient underwent a right transoral robotic-assisted transoral excision of the ranula and sublingual gland with identification and dissection of the submandibular duct and lingual nerve. The patient had an excellent outcome with no evidence of lingual nerve paresis and a return to oral intake on the first postoperative day. Subsequently, the patient underwent an elective transoral robotic-assisted excision of the incidental ranula on the left sublingual gland.ConclusionWe describe the first robotic-assisted excision of bilateral oral ranulas in current literature. The use of the da Vinci system provides excellent visualization, magnification, and dexterity for transoral surgical management of ranulas with preservation of the lingual nerve and Wharton's duct with good functional outcomes. However, the use of the robotic system for anterior floor of mouth surgery in terms of improved surgical outcomes as compared to traditional transoral surgery, long-term recurrence rates, and cost effectiveness needs further validation.

Abstract No. 256: Management of Ranula: Sclerotherapy and Gland Ablation

Abstract No. 256: Management of Ranula: Sclerotherapy and Gland Ablation

Management of the Ranula

One of the factors that limits an informed discussion on the management of ranulas is the relative rarity not only of this condition but salivary gland disease in general. For example, the incidence of salivary stones, reported as the commonest salivary condition, only occurs in 6 cases per 100,000 population. Benign salivary gland tumors have an incidence of 8 per 100,000 and malignant salivary tumors as little as 0.7 annually. Salivary ranulas occur much less frequently than salivary stones. In our salivary gland clinic, 570 of the 2,200 patients seen in the last 10 years had salivary stones.

Pediatric Intraoral Ranulas: An Analysis of Nine Cases

An intraoral ranula is a retention cyst arises from the sublingual gland on the floor of the mouth as a result of ductal obstruction and fluid retention. Many techniques for management of ranulas have been described in the literature. The purpose of this study was to analyze our surgically treated pediatric patients with intraoral ranulas and to discuss the results in the light of the literature. Nine pediatric patients (six females and three males) with intraoral ranulas surgically treated were analyzed retrospectively regarding their treatment methods and results. The surgical specimens were also re-examined histologically. Seven cases of superficial, protruded and smaller than 2 cm ranulas were treated with marsupialization (unroofing). Two cases who were previously operated and then recurred had bigger than 2 cm ranulas. In these two cases, marsupialization of the ranula plus removal of the sublingual gland was performed. The most common complication was intraoperative cyst rupture of the ranula, which was noted in four cases. A recurrence was observed in only one case in the 16th months of follow up period. Our findings show that marsupialization is a suitable and effective method for pediatric intraoral ranulas, whereas in recurrent cases marsupialization of the ranula combined with total excision of sublingual gland may be preferred.

Complications associated with surgical management of ranulas

We present the intraoperative and postoperative complications associated with 606 procedures for ranulas in a series of 571 patients. 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. 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. Complications associated with ranula surgery are minor and self-limiting. Transoral excision of the sublingual gland has the least possibility of ranula recurrence.