Types of Sublingual Gland Herniation Observed During Sonography of Plunging Ranulas

Jain, Prabha; Jain, Ravi

doi:10.7863/ultra.33.8.1491

Cited by 17 publications

(23 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…At surgery, the MH dehiscence was identified and confirmed. This case has also been mentioned previously (Figure , case 2) …”

Section: Resultssupporting

confidence: 87%

“…It is now well accepted that plunging ranula pseudocysts arise as a result of extravasated secretions from the SLS . This extravasated salivary fluid then plunges (or dives) into the superficial SMS, either over the posterior rim or, more commonly in our experience, through an MH dehiscence . A plunging ranula by definition must always have fluid in the SMS.…”

Section: Discussionmentioning

confidence: 72%

“…If this premise is correct, most patients with plunging ranulas should show the following features: (1) some fluid in the posterior SLS; (2) fluid in the posterior SMS and the adjacent inferior PPS, as anatomically all of these spaces are in direct communication; and (3) an MH dehiscence in a very small number of patients. These components should also be readily visible with US, which is well known for its sensitivity for imaging fluid and also for depiction of any MH dehiscence …”

Section: Discussionmentioning

confidence: 99%

“…The method of the US examination has been published previously and is not repeated here. The common US features for plunging ranulas, also published previously, are described as follows: (1) a unilocular SMS fluid collection; (2) an MH muscle dehiscence; (3) SLG herniation through the dehiscence; and (4) less commonly, fluid in the SLS, PPS, or even paralaryngeal space (PLS).…”

Section: Methodsmentioning

confidence: 99%

“…Data from the first 76 patients were also used for 2 previous publications describing the US appearances of plunging ranulas and the various types of SLG herniations seen in these patients . However, those previous studies did not address the specific question of the prevalence of fluid in the posterior SLS to corroborate the findings of the classically described tail sign.…”

Section: Methodsmentioning

confidence: 99%

See 4 more Smart Citations

Plunging Ranulas and Prevalence of the “Tail Sign” in 126 Consecutive Cases

Jain

2019

J of Ultrasound Medicine

Self Cite

View full text Add to dashboard Cite

Objectives Plunging (or diving) ranulas are extravasation pseudocysts arising from the sublingual gland that present as soft submandibular swelling. The “tail sign” has been widely reported as pathognomonic for their diagnosis. It is described as a smooth tapering comet‐shaped unilocular fluid mass with its “tail” in the collapsed sublingual space (SLS) and its “head” in the posterior submandibular space. This sign is based on the premise that extravasated saliva from the sublingual gland in the SLS escapes and plunges, over the posterior edge of the mylohyoid muscle into the submandibular space. Therefore, some fluid must be present in the posterior SLS in almost all patients with plunging ranulas. This study aimed to determine the frequency of fluid seen with ultrasound (US) in the posterior SLS to corroborate the tail sign. Methods A total of 126 consecutive cases of surgically proven plunging ranulas were investigated with US over 13 years. The findings were reviewed retrospectively for the prevalence of fluid in the posterior SLS. Results Thirteen patients (10.3%) showed SLS fluid on US images. Most showed fluid extension through a mylohyoid dehiscence. Only 2 patients (1.6%) showed fluid within the posterior SLS, and 1 patient alone in this entire study showed all of the components of the classically described tail sign. Conclusions This largest ever radiologic study showed low prevalence of the tail sign in 2 of 126 patients. A mylohyoid dehiscence was the more common route for extravasation. Absence of the tail sign does not exclude the diagnosis of a plunging ranula.

show abstract

“…At surgery, the MH dehiscence was identified and confirmed. This case has also been mentioned previously (Figure , case 2) …”

Section: Resultssupporting

confidence: 87%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Plunging Ranulas and Prevalence of the “Tail Sign” in 126 Consecutive Cases

Jain

2019

J of Ultrasound Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

Amylase as a Diagnostic Tool for Plunging Ranula: Clinical Series and Description of the Technique

et al. 2022

Self Cite

View full text Add to dashboard Cite

Objectives This study describes a technique of measurement for neck cyst amylase content and reviews the experience of a tertiary referral center for cases of suspected plunging ranula. Methods A retrospective study was performed at the Manukau Surgical Center in Auckland, New Zealand. Patients with a possible diagnosis of plunging ranula based on clinical presentation and diagnostic aspiration of the cyst contents were included. Demographic data, imaging and laboratory findings were collected, along with findings from surgery and histology. The technique for measuring the amylase of the aspirated cyst contents was also carefully recorded. Results The 37 cases of confirmed plunging ranula included in this study had a submandibular cystic swelling that was aspirated. Imaging features consistent with a plunging ranula were seen in 89% of the study group. All cases had detectable levels of amylase of ≥3 U/L in the ranula contents. There was large variability (range: 5–560 U/L) in the concentration of amylase, with 70% of the cases demonstrating an amylase concentration below 200 U/L. Aspirates were typically described as viscous (87.5%) and yellow or straw‐colored. Conclusion The combination of clinical presentation, imaging and the presence of amylase in the cyst contents is diagnostic for plunging ranula. Level of Evidence 4 Laryngoscope, 133:535–538, 2023

show abstract

Diagnostic Difficulties of Plunging Ranula: A Review of 18 Cases

Yun,

Gidumal,

Saturno

et al. 2024

The Laryngoscope

View full text Add to dashboard Cite

Objective(s)Despite advancements in imaging techniques and cytological analysis, plunging ranula remains a challenging surgical, radiologic, and pathologic phenomenon. Of the 18 patients we evaluated at our institution, we highlight three cases that illustrate the high rate of misleading imaging and cytological results when assessing plunging ranula.MethodsImaging results, biopsy findings, operative techniques, and pathological reports were reviewed from patients who had either a preoperative or postoperative diagnosis of ranula and underwent surgery by a single head and neck surgeon at a tertiary care center.ResultsOf the 18 identified patients, computed tomography was correct on preoperative imaging 73% of the time and magnetic resonance imaging was correct on preoperative imaging 71% of the time. Two patients underwent preoperative ultrasound and their ultrasound reports did not accurately diagnose the presence of a ranula. Two patients underwent preoperative fine needle aspiration biopsy due to inconclusive preoperative imaging, in which results suggested either a ranula or epidermal cyst. Both ultimately did not match the final pathology. Three of eighteen patients (17%) underwent an inappropriate initial surgery due to incorrect imaging diagnoses and/or biopsy findings.ConclusionDespite use of preoperative modalities to distinguish plunging ranula from other cystic floor of mouth lesions, surgeons must be aware that no workup modality is fully precise. The potential for revision surgery must be included in all preoperative discussions for presumed plunging ranula.Level of Evidence4 Laryngoscope, 2024

show abstract

Types of Sublingual Gland Herniation Observed During Sonography of Plunging Ranulas

Abstract: Sublingual gland herniation through mylohyoid defects is easily missed if one is unaware. Prior knowledge of the various types of sublingual gland herniation and their frequencies of occurrence are very helpful during diagnostic sonographic examinations.

Cited by 17 publications

References 11 publications

Plunging Ranulas and Prevalence of the “Tail Sign” in 126 Consecutive Cases

Plunging Ranulas and Prevalence of the “Tail Sign” in 126 Consecutive Cases

Amylase as a Diagnostic Tool for Plunging Ranula: Clinical Series and Description of the Technique

Diagnostic Difficulties of Plunging Ranula: A Review of 18 Cases

Contact Info

Product

Resources

About