Rare case of giant plunging ranula without intraoral component presenting as a subcutaneous swelling in the neck: A diagnostic dilemma

Gulati, Harveen K; Deshmukh, Sanjay D; Anand, Mani; Yadav, Prashant; Pande, Dilip P

doi:10.4103/0974-2077.101401

Cited by 7 publications

(10 citation statements)

References 3 publications

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“…Reported dimensions range from 4 to 10 cm, and they account for 6% of salivary mucoceles (also called sialocysts), with a prevalence of about 0.2 cases per 1000 persons. 1,5,9 There seems to be a higher frequency among young adults in their second and third decades as well as in children younger than 10 years, with a slight female preponderance. 7,[10][11][12] Sublingual ranulas form above the mylohyoid muscle, within the sublingual space, and are most commonly observed as a bluish cystic lesion below the tongue.…”

Section: Discussionmentioning

confidence: 99%

“…When the fluid pressure of the mucocele ruptures and dissects through the mylohyoid muscle into the submandibular or submental space, it is termed a plunging or diving ranula. [1][2][3][4][5][6]9,[11][12] These extravasation cysts tend to extend into the submandibular triangle but have been observed to extend superiorly into the parapharyngeal space as far as the skull base, inferiorly into the supraclavicular area and upper mediastinum, or posteriorly into the retropharyngeal space. 2,7,12 Some physiologic mechanisms that contribute to plunging ranulas have been proposed [5][6][7]13 : Plunging ranulas are usually seen in conjunction with a sublingual ranula and rarely form independent of the oral component.…”

Section: Discussionmentioning

confidence: 99%

“…If a tail extending into the sublingual space is observed, this feature is almost pathognomonic for plunging ranulas. 3,6,9,12,14,15…”

Section: Discussionmentioning

confidence: 99%

“…If a tail extending into the sublingual space is observed, this feature is almost pathognomonic for plunging ranulas. 3,6,9,12,14,15 Although the floor of the mouth is a small region, a myriad of pathologic processes can occur: cystic lesions, inflammatory conditions, vascular lesions, and benign and malignant neoplasms. Differentials of cystic lesions that manifest within the same region include lymphatic malformation (cystic hygroma), thyroglossal duct cyst, dermoid or epidermoid cyst, lipoma, laryngocele, hemangioma, and lymphadenopathy.…”

Section: • • Marsupialization With or Without Packing Andmentioning

confidence: 99%

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Plunging Ranula: A Case Report

Ayers

2018

Journal of Diagnostic Medical Sonography

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Recognized over 1000 years ago during the Byzantine era, the term ranula is derived from the word rana, which is Latin for frog, as the swollen appearance of the sublingual mucous membranes resembles the translucent underbelly of a frog. 1-7 There are two types of ranulas: simple and plunging. Sublingual ranulas form underneath the mucous membranes of the floor of the mouth above the mylohyoid, whereas plunging ranulas "plunge" by extending below the mylohyoid into the submandibular or parapharyngeal space, presenting as neck masses. 2-3 Multiple surgical techniques have been used, ranging from marsupialization, incision and drainage, excision of the ranula only, excision of the sublingual gland along with ranula, and sclerotherapy. Recurrence rates vary depending on type of procedure performed. It has been noted that because these extravasation cysts originate from the sublingual salivary gland, excision of the sublingual gland along with ranula is the most effective treatment. 1,5,6 Case Report A 25-year-old female patient presented with a 4-month history of a unilateral, nontender, enlarging, soft submental mass, extending to her right submandibular region. There was no history of trauma, infection, or any oral or neck surgical procedures. Physical examination demonstrated a diffuse, oval, soft tissue prominence with normal overlying skin extending from the right mandible to the submental region. A sonogram was ordered to further characterize the mass (see Figures 1 and 2). The patient's area of diffuse swelling was scanned using a submental approach with a high-frequency ML6-15 linear-array transducer (GE Logiq 9; GE Healthcare, Waukesha, WI). Sonographic findings included a large cystic mass with two components. The more superficial component measured 3.6 × 1.3 × 2.9 cm. The deeper component measured 3.7 × 2.9 × 1.3 cm and extended along the medial aspect of the mandible. Communication between the two components was identified during sonography. A portion of the sac plunged through the muscle 767632J DMXXX10.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…If a tail extending into the sublingual space is observed, this feature is almost pathognomonic for plunging ranulas. 3,6,9,12,14,15…”

Section: Discussionmentioning

confidence: 99%

Section: • • Marsupialization With or Without Packing Andmentioning

confidence: 99%

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Plunging Ranula: A Case Report

Ayers

2018

Journal of Diagnostic Medical Sonography

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“…According to the haemodynamic characteristics and the preponderant vascular channels, vascular malformations are divided into low-flow lesions, such as venous, lymphatic and capillary malformations, and high-flow lesions, which comprise arterio-venous malformations and direct arteriovenous fistulas. 10 Many other lesions in the head and neck region, such as congenital cysts, 11 plunging ranulas, 12 cystic mesenchymal tissue tumours and high-blood flow tumours, 13 can appear similar to vascular anomalies. Misdiagnosis and mistreatment can lead to unfavourable results.…”

Section: Discussionmentioning

confidence: 99%

Role of fine needle aspiration cytology in the differential diagnosis of vascular anomalies from other lesions in the head and neck region

Zhu

Zhang

et al. 2016

Phlebology

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Objective To summarise the role of fine needle aspiration cytology in the differential diagnosis of vascular anomalies from other lesions in the head and neck region by presenting five interesting cases reported from our hospital data. Method Five patients ranging in age from 3 months to 25 years old were diagnosed with vascular anomalies based on their histories, clinical examinations, imaging examinations and ultrasonic testing. The previous diagnosis of these patients were corrected by fine needle aspiration cytology in our hospital and the proper treatment was administered. Result Two cases were wrongly treated in a local hospital. All five of the patients underwent operations after excluding vascular anomalies by fine needle aspiration cytology. Conclusion Fine needle aspiration cytology should be used in the following situations to prevent misdiagnoses and the mistreatment as vascular anomalies: when imaging examination and ultrasonic testing lead to a diagnosis of vascular malformation, but the history or clinical examination does not confirm this diagnosis; when lesions are treated as "vascular malformations" by sclerotherapy, and the hydatid fluid is not like blood or lymph fluid; and when propranolol is used to treat the proliferation stage of "haemangiomas" with without any effect.

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