Oral Ranula Research Articles

Sublingual Ranula

Ranulas have been managed by various surgical methods, and the optimal treatment is still controversial. The aim of this study was to analyze a group of 124 surgically treated patients with intraoral ranula to assess 3 different methods: sublingual gland removal combined with the ranula excision, conventional marsupialization, and a variant of the marsupialization technique usually performed in our departments. Recurrence rate was 0% after radical treatment, 25.8% after marsupialization, and 12% after modified marsupialization. We suggest that conservative methods should always be considered as treatment of superficial oral ranulas. The modification of the conventional marsupialization by suturing the edges of the pseudocyst before unroofing of the lesion was demonstrated to be a useful technical strategy that simplifies and accelerates the surgical procedures and probably contributed to preventing recurrences.

Ranula: Experience With 83 Cases in Zimbabwe

To document the clinical features, management, and outcome of ranulas in Zimbabwe. A retrospective review of clinical and pathologic records of 83 patients with ranulas who presented during the period of January 1981 to September 2003 was undertaken. Thirty-six (43.4%) of the ranulas were in males and 47 (56.6%) in females. Sixty-one (73.5%) were in the 0 to 10-year-old age group. Oral ranulas (92.8%) were equally distributed on the right and left sublingual region. Six (7.2%) were plunging ranulas. In a study group of 38 patients, 88.5% of ranula patients were HIV-positive with 95% of them in the 0 to 10-year-old age groups. Excision of ranula with sublingual gland removal was done in 80.7% of the cases with 0% recurrence; marsupialization (cavity left open and cavity packed) was done in 12% (n = 10) of the patients with 20% (n = 2) recurrence. Female predominance with no right or left sublingual region predilection was noted. Ranula was most common in the 0 to 10-year-old age group; 95% of this group were HIV positive. HIV salivary gland disease could be an etiologic factor. No recurrence was observed when the ranula was excised along with removal of the sublingual gland. Plunging ranula is uncommon.

A Case Against Sublingual Gland Removal as Primary Treatment of Ranulas

Simple marsupialization or unroofing, the oldest and most widely reported method of surgical management of oral ranula, has fallen into disfavor primarily because of the excessive number of recurrences (approximately 60% to 90%). As a consequence, Catone el al1 and Bridger et al2 recommended that the primary treatment of all ranulas, regardless of size, should be sublingual gland excision. At times, this recommendation is more severe than appropriate (Fig 1).

Clinical review of 580 ranulas.

The purpose of this paper was to compare clinical features among 3 patterns of ranula and the recurrence rates of each when treated by different surgical methods. A retrospective review of clinical and pathologic records in 580 ranulas was undertaken. Ranulas were classified into 3 clinical types according to sites of the primary swelling: oral ranula, plunging ranula, and mixed ranula. Information was collected on age at presentation, sex, history of onset, sites of swelling, surgical methods, histological findings, and outcome of treatment. Ranula was most prevalent in the second decade of life and slightly more common in females (male to female ratio of 1:1.2), but a distinct male predilection was noted for the plunging ranula (male to female ratio of 1:0.74). Oral ranula was most commonly involved in the left side (left to right ratio of 1:0.62), while the plunging and mixed ranula were commonly involved in the right side (left to right ratio of 1:1.38, 1:1.16 respectively). In the plunging ranula group, there were more patients who had the history more than 6 months. The recurrence rates of ranulas were not related to swelling patterns and surgical approaches, but intimately related to the methods of surgical procedures. The recurrent rates for marsupialization, excision of ranula, and excision of the sublingual gland or gland combined with lesion were 66.67%, 57.69%, and 1.20%, respectively. Three patterns of ranula have similar clinical and histopathologic findings, although plunging ranula has some different clinical features. Removal of the sublingual gland via an intraoral approach is necessary in the management of various clinical patterns of the ranula. Recurrence rates of ranulas of any type are excessive unless the involved sublingual gland is removed.

Clinical review of 580 ranulas

Objective The purpose of this paper was to compare clinical features among 3 patterns of ranula and the recurrence rates of each when treated by different surgical methods. Methods A retrospective review of clinical and pathologic records in 580 ranulas was undertaken. Ranulas were classified into 3 clinical types according to sites of the primary swelling: oral ranula, plunging ranula, and mixed ranula. Information was collected on age at presentation, sex, history of onset, sites of swelling, surgical methods, histological findings, and outcome of treatment. Results Ranula was most prevalent in the second decade of life and slightly more common in females (male to female ratio of 1:1.2), but a distinct male predilection was noted for the plunging ranula (male to female ratio of 1:0.74). Oral ranula was most commonly involved in the left side (left to right ratio of 1:0.62), while the plunging and mixed ranula were commonly involved in the right side (left to right ratio of 1:1.38, 1:1.16 respectively). In the plunging ranula group, there were more patients who had the history more than 6 months. The recurrence rates of ranulas were not related to swelling patterns and surgical approaches, but intimately related to the methods of surgical procedures. The recurrent rates for marsupialization, excision of ranula, and excision of the sublingual gland or gland combined with lesion were 66.67%, 57.69%, and 1.20%, respectively. Conclusion Three patterns of ranula have similar clinical and histopathologic findings, although plunging ranula has some different clinical features. Removal of the sublingual gland via an intraoral approach is necessary in the management of various clinical patterns of the ranula. Recurrence rates of ranulas of any type are excessive unless the involved sublingual gland is removed.

Treating oral ranula: another case against blanket removal of thesublingual gland

There are a number of occasions when ranula-like lesions of the oral floor can develop that do not originate from the sublingual gland, or that arise from the gland with no tendency towards recurrence. The author advises that the unconditional removal of the sublingual gland should not be the standard treatment for all ranulas, and present four case reports to illustrate these and describe how they should be treated. All the patients were treated successfully with conservative management and retained normal functioning sublingual glands. Except for the management of plunging ranulas, caution and a close examination of the origin of the lesion are prudent before considering excision of sublingual glands for all ranula-like lesions.

Marsupialization for treatment of oral ranula: A second look at the procedure

Simple marsupialization to manage oral ranula has fallen into disfavor because of excessive failures and the high incidence of iatrogenically caused cervical ranula that may follow this procedure. With the simple addition of packing the entire pseudocystic cavity with gauze after its unroofing, the rate of recurrence is minimized. It is recommended that oral ranula be treated initially by marsupialization with packing and, if recurrence occurs, then the offending sublingual gland should be excised.

The plunging ranula: Pathogenesis, diagnosis and management

Ranulas are cysts resulting from retention, or extravasation of saliva from the sublingual gland. Two varieties are described: a superficial or oral ranula and a cervical or plunging ranula. The plunging ranula is located below the mylohyoid muscle and may present as a swelling in the upper part of the neck. Four cases are described to illustrate that this condition can be the cause of a neck swelling. Aetiology, differential diagnosis and surgical management are also discussed. Recurrences are mainly due to unfamiliarity with this phenomenon and ignorance of its aetiology. Successful treatment of the plunging ranula consists of excision of the ipsilateral sublingual salivary gland, which is the source of this disorder, and intra-oral evacuation of the pseudocyst of the neck swelling. There is no need for an extensive neck dissection of the cervical extension.