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Background and ObjectivesZZRanulas, pseudo cysts found on the floor of mouth, develop from the retention or extravasation of saliva from the sublingual gland. The main treatment of ranula is surgical excision but the extent of surgery is controversial. The aim of this study was to evaluate the significance of sublingual gland excision in the surgical treatment of ranula. Subjects and MethodZZWe retrospectively reviewed 112 patients with ranula who had undergone surgical excision from January 2004 to April 2016. Those who underwent any previous treatment such as sclerotherapy, marsupialization, or excision of cyst were excluded in the study. Surgical outcomes including complications and recurrence were compared between the group that went through simple cyst excision and the group that went through cyst and sublingual gland excision. ResultsZZOf 112 patients, 94 were simple ranula and 18 were plunging ranula. Thirty-seven (33%) were male and 75 (67%) were female. Of the 94 simple ranula patients, 23 underwent excision of cyst only; the remaining 71 patients and all other patients with plunging ranula underwent excision of cyst and sublingual gland together. The recurrence rate was significantly lower for the cyst and sublingual gland excision group than for the simple cyst excision group (2.2% vs. 17.4%, p=0.004). The complication rate did not differ between the two groups (4.3% vs. 1.1%, p=0.298). ConclusionZZThe excision of sublingual glands as well as cysts is an important option to reduce recurrence in the surgical treatment of ranula.

IgG4-related sclerosing disease was first discovered when researching autoimmune pancreatitis. It is an autoimmune disease that causes fibrosis on the pancreas, bile duct, gall bladder, salivary glands, and lungs. It is rarely reported in the nasal cavity. The diagnosis of IgG4-related sclerosing disease is based on biopsy findings demonstrating the characteristic histopathologic findings and immunohistochemical staining. IgG4-related sclerosing disease shows good response to high-dose steroid therapy. However, some patients do not respond to this treatment. Azathioprine or rituximab can be helpful in such case. We report our experience with IgG4-related sclerosing disease treated with azathioprine for 2 years, along with a related literature review.

Heterotopic salivary gland tissue (HSGT) consists of salivary tissue in places where it does not normally exist. Usually, HSGT presents as a draining sinus or nodule of the neck. The pathogenesis of HSGT of the neck remains uncertain. But HSGT in the neck is most widely thought to arise from defective closures and ectodermal hetroplasia of the precervical sinus of His. HSGT in the neck is rare and only a few cases have been reported in Korea. We recently experienced a case of HSGT in the neck presenting as a fistula of the anterior lower neck. We thought this as a 2nd brachial cleft anomaly; however, biopsy revealed HSGT. HSGT in the neck should be considered as one of the causes of a neck mass or fistula in children. Herein, we report this case of HSGT with a literature review.