Surgery for plunging ranula: the lesson not yet learned?

Abstract

Our objective is to review our experience with treatment of plunging ranula and examine the efficacy of transoral excision of sublingual gland as the principal treatment. This study comprises a case series with chart review. A secondary otolaryngology service was used as the setting. Retrospective analysis of patient records was performed for a series of 95 consecutive cases of plunging ranula, which presented to our department between January 2001 and February 2010. Clinical presentation, investigations, diagnosis, treatment, complications and outcome were recorded. Literature search was performed using MEDLINE and OLD MEDLINE. 81 cases of plunging ranula were treated surgically by transoral excision of sublingual gland and evacuation of ranula contents. Mean operating time was 75.3 min. Twelve patients had undergone previous surgery elsewhere. One patient in our series had a recurrence, needing excision of sublingual gland remnant. Two patients had trauma to submandibular duct requiring excision of submandibular gland. Other complications were minor and transient. Review of literature revealed many diverse methods of treating ranula, with varying results. Our series makes a substantial contribution to the number of plunging ranulas reported in the world, and supports the use of transoral sublingual gland excision as first-line treatment of plunging ranula.

The potential impact of highly active antiretroviral therapy on the treatment and epidemiology of ranula in human immunodeficiency virus–positive patients

“…8,9,15,16 The surgical removal of the ipsylateral sublingual salivary gland, with or without the dissection of the pseudo cystic wall remains the most accepted form of treatment for ranula. 1,[3][4][5][6][7] .…”

“…1,2 The surgical approach has also been generally recognized as the main stream of treatment modality for ranula. 1,[3][4][5][6][7] It has emerged from the literature that there is an increase in observations of the clinical association of ranula and HIV infection. [8][9][10][11][12][13][14][15][16][17][18] The causative relationship, as well as the exact 3 prevalence of ranula in HIV-positive patients is still to be established.…”

Cryosurgery for the treatment of pediatric plunging ranula: a conservative management

“…Two patients had trauma to submandibular duct requiring excision of submandibular gland. Other complications were minor and transient 9 .…”

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“…The plunging ranula is suspected clinically and confirmed; radiologically by Ultrasound [2], CT or MRI scan, and by fine needle aspiration for cytology or biochemical analysis confirming presence of salivary amylase in the aspirate. Based on the published literature, transoral excision of the SLG is favoured to treat the plunging ranula [3].…”