(1/11) Giant ranula of the neck: differentiation from cystic hygroma.
BACKGROUND AND PURPOSE: Occasionally, diving ranulas may attain large dimensions (giant ranula); gross involvement of the submandibular and parapharyngeal spaces makes differentiation from other cystic neck masses, particularly cystic hygroma, difficult. As diving ranula and cystic hygroma are managed with different surgical approaches, avoidance of this pitfall is critical. Our purpose was to review the imaging findings of giant ranula and compare them with those of cystic hygroma to define those features that are helpful in differentiating these different disease entities. METHODS: We conducted a retrospective review of all cases of ranulas that had been surgically treated at our institution in a 15-year period. These were compared with cases of cystic hygroma that involved the same anatomic regions. Images were analyzed for anatomic location and morphology, with specific attention paid to those characteristics that might assist differentiation. Giant ranula was defined as any ranula that significantly involved the paraphyngeal space in addition to the submandibular space. RESULTS: Six patients with giant ranula and fifteen patients with cystic hygroma were reviewed. All giant ranulas retained tapered communication with the sublingual space and were homogeneous, thin-walled, anatomically defined, fluid-containing masses. One infected lesion enhanced, and another previously operated lesion demonstrated mild septation. Cystic hygroma commonly did not communicate with the sublingual space and had features of lobulation, septation and heterogeneity. Additional involvement of spaces not typically involved by ranula further assisted differentiation. CONCLUSION: Although giant ranulas may superficially resemble cystic hygroma, several imaging features allow confident differentiation of these two entities. (+info)
(2/11) Two cases of plunging ranula managed by the intraoral approach.
Two cases of plunging ranula are reported. Treatment consisted of the total removal of the sublingual gland and evacuation of the cystic contents by the intraoral approach. The cyst remained just after the surgery in both cases, but then gradually regressed and disappeared within two months after the surgery. These findings support total removal of the sublingual gland as being the best method of treatment. We believe that complete dissection of the cyst with cervical incision as well as drainage of the cystic contents are unnecessary when the diagnosis of the plunging ranula is confirmed. (+info)
(3/11) Prenatal diagnosis of ranula at 21 weeks of gestation.
A fetal sublingual cystic lesion was diagnosed by routine prenatal ultrasonography at 21 weeks of gestation and followed up until term in a tertiary care center. Fetal growth was normal as was the amniotic fluid volume. Ex utero intrapartum treatment was performed and the cyst was aspirated to allow breathing and swallowing during planned Cesarean section. The cyst was totally excised when the newborn was 27 days of age and histological examination revealed a mucous cyst of the mouth floor. (+info)
(4/11) Acinic cell carcinoma found by recurrence of a mucous cyst in the sublingual gland.
This case report describes an acinic cell carcinoma found by a recurrence of a ranula in the sublingual gland. A 42-year-old male was admitted to the hospital of the Tokyo Dental College with a swelling in his right oral floor but without pain. The lesion was treated by windowing the same day under the diagnosis of a ranula, but the swelling appeared again at the same area eight months after the first operation. A resection was performed, and the specimen was sent to the clinical laboratory for pathological diagnosis. Proliferating serous cells were seen in part of the wall of an exudative mucous cyst. PAS staining was partially positive, and immunohistochemical staining for S-100 protein, lactoferrin, and amylase were also positive in cytoplasmic granules. This report concludes that the pathological diagnosis is beneficial in clarifying the reasons for the recurrence of a benign lesion. (+info)
(5/11) 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. (+info)
(6/11) OK-432 sclerotherapy of plunging ranula in 21 patients: it can be a substitute for surgery.
BACKGROUND AND PURPOSE: Although first-choice therapy for the ranula is surgery, this choice presents technical difficulties and frequent recurrences because of insufficient surgery. We evaluated the efficacy of OK-432 sclerosis of the plunging ranula as a substitute for surgery. METHODS: Twenty-one patients with plunging ranula were treated with intralesional injection of OK-432. The liquid content of the ranula was aspirated as much as possible, after which OK-432 solution was injected in the same volumes as that drawn out. Patients were followed on sonography or CT. RESULTS: Seven (33.3%) patients with plunging ranulas showed total shrinkage and resolution, and 4 (19%) patients showed near-total shrinkage (more than 90% of the volume). Four (19%) patients revealed marked shrinkage (more than 70% of the volume), and 3 (14.3%) patients showed partial shrinkage (less than 70% of the volume). Three (14.3%) patients showed recurrence after total shrinkage 1 month after injection. The overall recurrence rate after each injection was 47% (16 of 34 injections in 21 patients), but the recurrence rate after the last sclerotherapy was only 14%. There were no serious side effects except for fever lasting 2-3 days (12 patients) and swelling (10 patients) for 3-5 days. Mild odynophagia for 1-2 days was also noted in 7 patients, and there was 1 severe case of odynophagia. CONCLUSION: OK-432 sclerotherapy of plunging ranula is a safe and potentially curative procedure that may be used as a primary treatment for plunging ranula before considering surgery. (+info)
(7/11) Pediatric oral ranula: clinical follow-up study of 57 cases.
OBJECTIVE: To present 57 cases of oral ranula in children, analyzing the clinical characteristics, treatment and outcome of these lesions. METHODS: The clinical histories of patients diagnosed with oral ranula, seen between 1998 and 2008 at the Oral and Maxillofacial Surgery Unit of a reference Children 's Hospital (0-14 years) were reviewed. All patients with clinical diagnosis of oral ranula were included. RESULTS: Fifty-seven patients, 21 boys and 36 girls, with a mean age of 5.1 years were included in the study. Thirty-two cases were located on the left side of the floor of the mouth. The lesion diameter varied between 1 and 3 cm in 27 cases, 22 were less than 1 cm, and 8 were larger than 3 cm. Fifty-four cases were asymptomatic and 3 ranulas had pain on swallowing. Twenty-two cases were resolved by opening with a tract dilator and 35 by marsupialization. Seven cases recurred at a mean of 12 months after treatment, three of these from the marsupialization group. CONCLUSION: The majority of the oral ranulas occurred in females, asymptomatic, on the left side of the floor of the mouth, with a mean size of 1 to 3 cm; all lesions were treated by surgery, of which 7 recurred. (+info)
(8/11) Robotic-assisted transoral removal of a bilateral floor of mouth ranulas.