Pathologic quiz case 2. Plunging ranula (cervical ranula, cervical mucocele).
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Adolescent↗
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Ranulas and their mimics: CT evaluation.
The spectrum of computed tomographic (CT) findings in ten patients with pathologically proved simple and diving ranulas is reviewed. These retention cysts originate within the sublingual space from obstruction of the sublingual or minor salivary glands; when they enlarge, the cysts herniate to involve the submandibular and inferior parapharyngeal spaces (the so-called diving or plunging ranula). CT findings in 38 additional patients with a variety of cystic lesions in the floor of the mouth are contrasted with findings in cases of ranulas. The relevant anatomy is reviewed. This experience indicates that a unilocular, cystic mass emanating from the sublingual space and extending into the adjacent submandibular and/or inferior parapharyngeal spaces can be considered a diving ranula in virtually all cases. A unilocular, cystic mass entirely within the sublingual space can be considered a simple ranula in most instances, although absolute distinction between a simple ranula and an epidermoid cyst cannot be made radiographically.
Diagnosis, Differential↗
Plunging ranula: a report of three cases and review of the literature.
Three cases of plunging ranula are reported and the literature reviewed. Extravasation of saliva from the sublingual gland due to trauma or obstruction of its ducts appears to be the most likely cause of plunging ranula. Available data suggest that the submandibular gland is usually not involved, although at the time of surgery it may be extremely difficult to exclude a submandibular origin of the cyst in the neck. Communication between the oral and cervical components of the plunging ranula probably occur via a hiatus in the mylohyoid muscle. Such communication passing directly into the submandibular compartment may simulate submandibular gland involvement. Since 1910, 139 procedures in 89 patients with plunging ranula have been reported in the English literature. The recurrence rate was 70 per cent after incision and drainage of the cyst, 53 per cent after marsupialization, 85 per cent after excision of the cyst in the neck and 2 per cent after excision of the sublingual gland via the cervical or intra-oral route. This review suggests that excision of the sublingual gland with intra-oral drainage of the cervical swelling appears to be the treatment of choice for the plunging ranula.
Adolescent↗
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.
Adolescent↗
Submandibular cystic hygroma resembling a plunging ranula in a neonate. Review and report of a case.
Cystic hygromas are large lymphangiomas that are most often found in the posterior triangle of the neck and the axilla in children. They are most frequently found before age 2 and may be massive. After upper respiratory infection, they may become infected and enlarged, causing dysphagia and toxemia. The diagnosis can usually be made by history and physical examination and confirmed by biopsy. Treatment is by surgical excision of small lesions and staged debulking excisions in more severe cases. A patient with a cystic hygroma having many clinical characteristics of a plunging ranula is presented. The cyst fluid was aspirated and analyzed for its amylase, sodium, potassium, chloride, urea nitrogen, glucose, and total protein content. The characteristics of the fluid were also compared with those of lymph and saliva. This report demonstrates the difficulty in determining the diagnosis of a tumor that has the clinical features of a cystic hygroma, as well as a plunging ranula. The necessity of a proper presurgical diagnosis is essential since the form of therapy for each is different and conflicting. A method that distinguishes between the cervical cystic hygroma and a plunging ranula by means of aspirated fluid is discussed.
Cleft Lip↗
Plunging ranula: a case report and a literature review.
The plunging ranula is a mucous extravasation cyst of the sublingual gland. It is slightly more common in females, shows no side preference, and is more prevalent in the second and third decades of life. It typically manifests as a painless, nonmobile swelling in the neck and in four of five cases is associated with an intraoral ranula or swelling. If there is no history of an oral ranula the clinical diagnosis is difficult, and it may be left to the reporting pathologist to give the correct diagnosis. The histologic appearance is characteristically of a cyst, devoid of epithelium or endothelium, with a vascular fibro-connective tissue wall containing some chronic inflammatory cells and macrophages stuffed with mucin. The correct diagnosis is essential for the most effective treatment, which is excision of the sublingual gland.
Child↗
Cervical ranula arising from a projection of the sublingual gland through the mylohyoid muscle.
A case of cervical ranula is presented, which originated from a projection of the sublingual gland into the suprahyoid region. A diagnosis of cervical ranula could not be established preoperatively because there was no intraoral involvement of the ranula. A cervical approach was used, and the correct diagnosis was made during the operation.
Adult↗
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.
Adult↗
Plunging or cervical ranula. Review of the literature and report of 4 cases.
A review of the literature pertaining to plunging ranula is presented with special emphasis on the historical development of the various aetiological theories and treatment recommendations. Also 4 cases of plunging ranula are presented; three were treated by extirpation of the sublingual gland and one was treated by exteriorization of the ranula into the oral cavity. The treatment methods used here are discussed in relationship to the accepted aetiological theory.
Adult↗
Plunging ranula: literature review and report of three cases.
Three cases of plunging ranula are described and the literature is reviewed. In many cases, a plunging ranula is iatrogenic and follows surgery to an oral ranula. In the cases presented, the cervical swelling was associated with prolongations of sublingual gland into or through the mylohyoid muscle. All patients were cured by partial or total excision of the sublingual gland.
Adult↗
Pathogenesis and treatment of plunging ranulas.
Three patients with plunging ranula, two of which occurred spontaneously and one of which followed removal of the submandibular gland, were treated by excision of the sublingual gland. The sublingual gland is removed through the mouth or through a cervical submandibular incision. No dissection of the cervical ramifications associated with the ranula is undertaken, and these disappear once the source of the extravasating saliva has been removed. Results of considerable experimental work reported by others, support the concept that plunging ranulas are extravasations of saliva from the sublingual glands.
Adolescent↗
Ranula and the sublingual salivary glands.
The term "ranula" is poorly understood and is frequently applied to a variety of cystic structures in the head and neck. Ranulas classically are cysts of salivary gland origin, usually the sublingual glands, of which two varieties are described: a simple, epithelial lined cyst resulting from ductal obstruction, and a pseudocyst without epithelial lining resulting from extravasation of saliva that dissects through the tissue planes of the neck and may appear as a neck mass. Four cases are presented that illustrate the difficulties in diagnosis; treatment consists of meticulous dissection of the thin-walled sac in continuity with the excision of the sublingual glands that are the origin of these lesions.
Adult↗
Squamous cell carcinoma arising in a plunging ranula.
A case report of a 36-year-old man with a plunging ranula of 15 years' duration, in which squamous cell carcinoma arose from the cyst wall, is presented. Pathogenesis and treatment of ranulas is briefly discussed.
Adult↗
Giant ranula causing mandibular prognathism.
This is a case report of a 20-year-old man with ranula, the size of an orange, in the floor of the mouth causing mandibular prognathism with fan-shaped mandibular teeth anterior to the premolars. The tumor was extirpated. The pathogenesis, differential diagnosis and treatment of ranulas are discussed.
Adult↗
Cervical ranula.
Ranulas are mucous extravasation cysts, and usually originate from the sublingual salivary gland. They may occasionally infiltrate the tissue planes of the neck and present as a cervical tumour. The literature is reviewed, and four personal cases of cervical ranula presented. Successful treatment may be achieved in the vast majority of cases by removal of the sublingual salivary gland.
Adult↗
Fibrin glue in the surgical treatment of ranulas.
The essential treatment of a ranula is meticulous dissection of the thin wall of the cyst in continuity with the sublingual gland of origin. We have used a technique of fibrin glue injection into the cystic space of the ranula after it had been evacuated by aspiration. The fibrin glue within the cystic cavity prevents collapse of the wall of the cyst during surgery and facilitates and simplifies the surgical procedure by clearly outlining the involved area and by sharply delineating its thin wall.
Fibrin Tissue Adhesive↗
Plunging ranula localized in the parapharyngeal space.
Plunging ranulas are a mucous extravasation and usually originate from the sublingual gland. They dissect between the facial planes and muscle of the base of the tongue to the submandibular triangle. We report here a rare case of plunging ranula localized in the parapharyngeal space. The relevant anatomy is reviewed and discussed.
Humans↗
Cervical ranulas.
Cervical ranulas, known also as plunging or burrowing ranulas, are an outcome of extravasated sublingual gland mucin that has gained access to the soft tissues of the neck. These pseudocystic lesions may be localized or extensive, and they require surgical excision of the sublingual gland for effective management.
Humans↗