Percutaneous treatment of ranulas: ultrasound-guided drainage with salivary gland chemical ablation

Abstract

Background Ranulas are salivary pseudocysts in the floor of the mouth adjacent to damaged salivary glands. Current surgical management is drainage of the ranula with removal of the offending gland. An analogous percutaneous procedure could potentially offer similar treatment efficacy in a more minimally invasive way. Objective To evaluate the outcomes of a cohort of patients with ranulas treated with percutaneous ranula aspiration and chemical ablation of the source salivary gland to see whether this technique could be proposed as a minimally invasive treatment alternative. Materials and methods This retrospective single-center study evaluated 24 patients treated percutaneously for ranulas between January 2004 and December 2014. All patients were treated with percutaneous ranula aspiration and chemical ablation of the offending salivary gland. Treatment success and any complications were recorded. Results Complete ranula eradication was successfully accomplished in 87.5% of the patients with no complications. Conclusion Initial results suggest that our technique of percutaneous aspiration of ranulas and chemical ablation of the source salivary gland is safe and effective.

Sclerotherapy of ranulas with OK-432 – a prospective, randomized, double-blinded placebo-controlled study

“…This could explain why oral ranulas respond so well, since the cystic lesion in that case is right adjacent to the gland. Supporting this theory is a study by Murakami et al, where percutaneous chemical ablation of the sublingual gland with a combination of sodium tetradecyl sulfate and alcohol showed at cure rate of 87,5% in 24 patients with ranulas, both intraoral and plunging [20]. If this explanation holds true, a more effective way of treating plunging ranulas would be to inject OK-432 directly into the sublingual gland.…”

Symptoms accompanying congenital ranula in neonates and infants – three case reports

“…According to Brannan et al, the use of 98% ethanol and 3% sodium tetradecyl sulphate (STS) with drainage was successful in 87.5% of cases. Three patients (12.5%) had to undergo surgical treatment [26]. Wada described successful treatment using OK-432 in an infant with congenital ranula [24].…”

Bleomycin sclerotherapy following doxycycline lavage in the treatment of ranulas: A retrospective analysis and review of the literature

“…2 Though morbidity associated with these lesions is low, associated symptoms such as pain, swelling, and dysphagia can significantly impact on a patient's quality of life. 3 Treatment approaches for ranula include: total excision of the ranula along with the involved gland, exclusive excision of the ranula or involved gland alone, marsupialization (including the decompressive "stitch-and-stab" technique) of the pseudocyst wall, and, more recently, percutaneous drainage and injection of a sclerosant into the pseudocyst lumen with or without sclerosant injection of the culprit gland. 2,4 Surgical excision of the involved gland, with or without the ranula itself, is reported in some studies with recurrence rates as low as 1% and should be considered the first-choice therapy for these lesions.…”

“…Recently, high eradication rates have been achieved when the sclerosant is injected directly into the involved gland, though this can be associated with injury or ablation of adjacent structures such as the lingual artery or nerve. 3 While ethanol and OK-432 have been the most reported sclerosants in the literature, other agents can be considered for use. Bleomycin and doxycycline have been reported as capable sclerosants when employed in the treatment of lymphatic and venous malformations, including in the head and neck.…”