Plunging ranula: Clinical observations

Abstract

Background The plunging ranula is a relatively uncommon phenomenon which represents a mucus escape reaction occurring from disruption of the sublingual salivary gland. We present a series of 20 patients managed at Green Lane Hospital (Auckland, New Zealand) over a 9‐year period. Methods A retrospective review of 13 patients with this condition was undertaken, and a prospective study was conducted on 7 patients. Information was collected on age, sex, ethnic origin, history of onset, predisposing factors, treatment, and outcome of treatment. Results The patients were all young adults with a median age of 31 years. The sex distribution was relatively equal, with 11 men and 9 women. All patients were Maori or Pacific Island Polynesians. Six patients gave a clear history of preceding trauma to the neck or oral cavity. Two recurrences were seen, both in patients who had had the sublingual gland excised via a cervical approach. Five patients sustained lingual nerve damage during surgery. Full function recovered in four patients, but the complication was still present in the fifth patient at 2 years, after which he was lost to follow‐up. Conclusions Plunging ranulas appear to occur with greater incidence in the Maori and Pacific Island Polynesian populations. The precise etiology of their predisposition is unknown, although local trauma or inherent mylohyoid dehiscences may play important roles. Removal of the sublingual gland via either a cervical or intraoral approach is important in the management of this condition. Excision of the pseudocyst is probably unnecessary and places surrounding structures at risk of damage, but a biopsy of the pseudocyst wall is important to confirm the diagnosis. © 1998 John Wiley & Sons, Inc. Head Neck 20: 63–68, 1998.

Surgery for plunging ranula: the lesson not yet learned?

“…It also supports the concept of a disrupted SLG as the source of the cyst [3,6,10]. Residual, disrupted SLG was encountered in all recurrent cases that we treated.…”

“…Although most plunging ranulas appear in second or third decades of life, there have been reports of presentation in infancy [1] which, along with marked preponderance of ranula in peoples of Asian origin [2][3][4], and anatomical anomalies in the mylohyoid muscle [5,6] points toward a congenital etiology [4].…”

Plunging ranulas: high-resolution ultrasound for diagnosis and surgical management

“…Only a few of our cases have an intra-oral component. The clinical diagnosis is based on needle aspiration of mucoid fluid, which is sent for laboratory analysis to confirm the presence of amylase [2].…”

Surgical management of pediatric ranula

“…A simple ranula can be either a mucus retention cyst or more commonly a mucus extravasation pseudocyst, which is confined to the floor of the mouth. A plunging or cervical ranula is a mucus extravasation pseudocyst arising from the sublingual gland and presents as a swelling in the neck [1].…”