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Kaggare Puttaraju M, Manjunatha BS, Niranjan S. Outlandish manifestation of swelling in early childhood seen in the patient's floor of the mouth. BMJ Case Rep 2024; 17:e255733. [PMID: 38521513 PMCID: PMC10961554 DOI: 10.1136/bcr-2023-255733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
Ranula is a cyst-like growth that occurs in the oral cavity beneath the tongue. It consists of saliva from a ruptured salivary gland or duct. Rather than just flowing directly from the glands into the oral cavity, saliva permeates the nearby connective tissues and creates a bubble. A ranula could indeed appear at any time span in a person's life for inexplicable reasons. A trauma such as an oral operation, a facial blow or nibbling the lower lip may possibly start one. The following is a case study of an early childhood boy who reported with a swelling in the floor of the mouth with unknown aetiology from the last 6 months.
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Affiliation(s)
- Mahesh Kaggare Puttaraju
- Oral Medicine and Radiology, JSS Dental College and Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
| | - Bhari Sharanesha Manjunatha
- Basic Oral Medicine and Allied Dental Sciences, Faculty of Dentistry, Taif University, At'Taif, Saudi Arabia
| | - Sharath Niranjan
- Oral Medicine and Radiology, JSS Dental College and Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
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2
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Fiorino A, Staderini E, Diana R, Rengo C, Gallenzi P. New Conservative Approach for the Management of Recurrent Sublingual Ranula-A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2398. [PMID: 36767764 PMCID: PMC9915898 DOI: 10.3390/ijerph20032398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/14/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Ranula is a rare and benign extravasation mucocele that is clinically characterized by asymptomatic sublingual or submandibular masses. Surgical excision is considered the most effective treatment approach, but it has been associated with high invasiveness and several complications (hemorrhage, damage to Wharton's duct, and lingual nerve injury). Over the past decade, more conservative therapies have been rapidly disseminated into clinical practice to seek a more effective and less traumatic approach for young patients. In this report, an 8-year-old female with an asymptomatic, recurrent sublingual ranula was treated using a conservative approach with marsupialization and an intracystic injection of a plaque remover (Hybenx® gel). After incision of the cystic dome, Hybenx® gel was applied into the cystic lumen for 20 seconds and then aspirated; next, the area was rinsed thoroughly with sterile saline solution before suturing. Ultrasound re-evaluation at 10 months and intraoral clinical examination at 24 months confirmed the absence of relapse. Our results support the hypothesis that marsupialization combined with intracystic injection of Hybenx® gel could be an encouraging conservative treatment alternative for recurrent sublingual ranula in children. Further randomized controlled trials are needed to test this hypothesis.
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Affiliation(s)
- Antonino Fiorino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, 80131 Naples, Italy
| | - Edoardo Staderini
- Postgraduate School of Orthodontics, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Rosalba Diana
- Postgraduate School of Orthodontics, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Carlo Rengo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Patrizia Gallenzi
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, 80131 Naples, Italy
- UOC Odontoiatria Generale e Ortodonzia, Dipartimento di Testa-Collo e Organi di Senso, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
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3
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Jing F, Wu F, Wen Y, Gao Q. Plunging Ranula Presenting as a Giant Anterior Cervical Cystic Mass: A Case Report and Literature Review. Case Rep Oncol 2023; 16:670-675. [PMID: 37933312 PMCID: PMC10625821 DOI: 10.1159/000532010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/04/2023] [Indexed: 11/08/2023] Open
Abstract
Plunging ranula, a subtype of ranula, commonly presents as a submandibular or submental cystic mass without oral counterpart, and its clinical management remains challenging. Herein, the authors report an extremely rare case of 30-year-old female patient with plunging ranula involving the root of the left anterior neck.
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Affiliation(s)
- Fangqi Jing
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Fanglong Wu
- State Key Laboratory of Oral Diseases, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuming Wen
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qinghong Gao
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Rare Presentation of Simultaneous Bilateral Oral Ranula Treated by Marsupialization: Case Report and Review of the Literature. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Wendt M, Papatziamos G, Munck-Wikland E, Marklund L. Sclerotherapy of ranulas with OK-432 - a prospective, randomized, double-blinded placebo-controlled study. Acta Otolaryngol 2021; 141:531-536. [PMID: 33775200 DOI: 10.1080/00016489.2021.1889660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ranula is a rare benign cystic lesion in the floor of the mouth, which can herniate through the mylohyoid muscle and become a plunging ranula. Treatment for ranulas is currently surgical excision of the sublingual gland. Sclerotherapy with OK-432 is a well-established treatment of lymphatic malformations, but not yet thoroughly evaluated on ranulas. Objectives: To evaluate sclerotherapy of ranulas with OK-432 in a randomized double-blinded trial. MATERIALS AND METHODS 20 patients with plunging or intraoral ranula were randomized to two double-blinded injections with OK-432 or saline. Effect on the ranula and evaluation of symptoms and QOL were investigated. RESULTS Treatment response differed significantly between OK-432 and placebo, p = .041(student's T-test). All patients with intraoral ranulas had a complete response, but only 1/4 of the patients with plunging ranula. The inflammatory reaction after injection with OK-432 caused a mild to moderate impact on QOL. No serious complications were observed. CONCLUSION This study suggests that sclerotherapy with OK-432 in ranula is a very effective treatment for intraoral ranulas, but possibly less useful in plunging ranulas. SIGNIFICANCE This is a limited study, but we believe that sclerotherapy with OK-432 should be recommended as primary treatment at least for intraoral ranulas.
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Affiliation(s)
- Malin Wendt
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Georgios Papatziamos
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Munck-Wikland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Linda Marklund
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
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Abstract
Simple ranula is a cystic swelling confined to the floor of mouth while plunging ranula presents with extension to the neck. Congenital ranula presenting with symptoms of feeding difficulties is a very rare occurrence. There is paucity of literature regarding the management of large congenital ranula. Varied treatment options are described for the management of ranula with variable recurrence rate. In paediatric and adult patients, ranula is considered as a type of extravasation cyst and removal of sublingual gland is advocated to remove the sources of extravasation. Congenital ranula is usually a variant of retention cyst and should be treated with marsupialisation or simple excision of cyst while cyst excision with sublingual sialadenectomy should be reserved for recurrent cases.
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Affiliation(s)
| | | | - Nighat Hussain
- Department of Pathology, AIIMS, Raipur, Chhattisgarh, India
| | - Rashmi Dubey
- Department of Anesthesia, AIIMS, Raipur, Chhattisgarh, India
| | - Sunita Singh
- Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India
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Chung Y, Cho Y, Kim B. Comparison of outcomes of treatment for ranula: a proportion meta-analysis. Br J Oral Maxillofac Surg 2019; 57:620-626. [DOI: 10.1016/j.bjoms.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/06/2019] [Indexed: 12/20/2022]
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Abstract
Ranula consists of a pathological process induced by ductal disruption of the minor salivary glands followed by extravasation of mucous material surrounding adjacent structures. A swelling causing breathing and feeding problems associated with tongue displacement is frequently observed. It is a disease that generally involves the younger age group. In newborns congenital ranula may occur, an uncommon variance that differs from common ranula by not relate to post-traumatic reactions. There are reports that indicate a salivary gland duct atresia as the main cause of this pathology. The aim of this study is to analyze the clinicopathological characteristics of congenital ranula by reporting a new case report of this salivary cyst and reviewing the case reports previously published in the English literature.
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Carey RM, Hodnett BL, Rassekh CH, Weinstein GS. Transoral Robotic Surgery with Sialendoscopy for a Plunging Ranula. ORL J Otorhinolaryngol Relat Spec 2017; 79:306-313. [DOI: 10.1159/000481536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/11/2017] [Indexed: 01/28/2023]
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Packiri S, Gurunathan D, Selvarasu K. Management of Paediatric Oral Ranula: A Systematic Review. J Clin Diagn Res 2017; 11:ZE06-ZE09. [PMID: 29207849 DOI: 10.7860/jcdr/2017/28498.10622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 08/29/2017] [Indexed: 11/24/2022]
Abstract
Introduction Ranula is mucous extravasation cyst that occurs in the floor of the mouth. There are various methods of management of paediatric oral ranula each of which has their own advantage and disadvantage. Aim The aim of this paper was to systematically review the available literature on the management of paediatric oral ranula. Materials and Methods A total of 64 articles were retrieved by electronic search. Based on the preset inclusion and exclusion criteria, a total of 21 articles were retrieved for full text analysis. The following characteristics were assessed from the retrieved articles: author, year of publication, study design, sample size, intervention, adverse effects and follow up period. Results The included studies consisted of the following study design: Seven articles were prospective clinical study, four articles were retrospective review, five articles were case series and five articles were case report. The mode of care varied from surgical excision to drug administration and lasers. Conclusion The data obtained from the review, display a lack of high quality study, with proper sample size and adequate follow up period. Further, randomized clinical trials are required to help the clinicians devise a best treatment approach for the management of paediatric oral ranula.
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Affiliation(s)
- Saraniya Packiri
- Postgraduate Student, Department of Paedodontic and Preventive Dentistry, Saveetha Dental College, Chennai, Tamil Nadu, India
| | - Deepa Gurunathan
- Professor, Department of Paedodontic and Preventive Dentistry, Saveetha Dental College, Chennai, Tamil Nadu, India
| | - Kathiravan Selvarasu
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Chennai, Tamil Nadu, India
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A Rare Case of Congenital Ranula in an Infant. Case Rep Otolaryngol 2016; 2016:5874595. [PMID: 27313929 PMCID: PMC4893453 DOI: 10.1155/2016/5874595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/28/2016] [Indexed: 12/03/2022] Open
Abstract
Ranula is a mucus extravasation cyst originating from the sublingual gland on the floor of the mouth. Congenital ranula is very rare. We report a case of a 4-month-old girl with a congenital ranula in the floor of mouth. The ranula was treated first by marsupialization, but the cyst recurred after 1 week. Excision of the ranula was done and was successful.
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Zhang B, Yang Z, Zhang RM, Liu L, Zhang F, Chen J, Zhang K. Are the patients with anatomic variation of the sublingual/Wharton's duct system predisposed to ranula formation? Int J Pediatr Otorhinolaryngol 2016; 83:69-73. [PMID: 26968056 DOI: 10.1016/j.ijporl.2016.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 01/13/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate ranula development according to anatomic variation of the ductal system of sublingual gland (SLG), especially the presence of Bartholin's duct. METHODS The anatomic variation of SLG duct was prospectively investigated and compared between 55 consecutive patients with ranulas treated by SLG excision (group 1) and another 15 consecutive patients undergoing similar surgeries for other conditions (group 2). The ductal structures of SLGs and submandibular glands (SMG) were also compared between the pediatric patients and adult patients with ranulas. RESULTS In 32 of 55 patients with ranulas (58.2%) and 1 of 15 patients without ranulas (6.7%), the SLG showed an anatomic variation of the main duct called Bartholin's duct structure (P<0.01). Seventeen of 22 (77.3%) pediatric patients with ranulas had Bartholin's ducts and 15 of 33 (45.5%) adult patients with ranulas had Bartholin's ducts (0.01<P<0.05), but Bartholin's duct which opens near to the orifice of Wharton's duct was not found in this study population. Plunging ranulas that extravasate deep to the mylohyoid were observed in the 6 patients (4 children and 2 adults). There was no recurrence in all cases with ranulas. CONCLUSIONS Congenital anatomic variation of the ductal system of the SLG might be a possible cause of ranulas in the patients with simple ranulas, especially in pediatric patients. Surgical resection of the SLG is a better treatment choice for ranulas than other conservative treatments.
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Affiliation(s)
- Bo Zhang
- Department of Oral and Maxillofacial Surgery, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, PR China.
| | - Zongfan Yang
- Department of Oral and Maxillofacial Surgery, Hospital of National University of Defense Technology, Changsha, PR China
| | - Ricardo M Zhang
- Division of International, Hunan Normal University, Changsha, PR China
| | - Li Liu
- Statistical Solutions, Inc. Exton, PA, USA
| | - Feng Zhang
- Department of Physical Therapy, Baltimore City Community College, Baltimore, MD, USA
| | - Jingjing Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Ke Zhang
- Department Family and Preventive Medicine, School of Medicine, University of Utah, UT, USA
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Value of sialendoscopy-assisted transoral sublingual gland resection for a plunging ranula: case report and review. The Journal of Laryngology & Otology 2015; 129:509-12. [PMID: 25877148 DOI: 10.1017/s0022215115000948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To highlight the value of sialendoscopy during transoral resection of the sublingual gland for a plunging ranula to prevent iatrogenic injury to the submandibular duct. METHOD AND RESULTS The clinical course of a 20-year-old male with a plunging ranula was analysed. The patient underwent transoral resection of the affected sublingual gland and pseudocyst. Sialendoscopy was used to confirm patency of the submandibular duct with placement of a Marchal dilator to aid in preservation of the duct during sublingual gland dissection. The sublingual gland was successfully removed, with no injury to the submandibular duct or lingual nerve. During follow up, the patient had slight numbness to the tip of the tongue, which resolved after 2-3 days. Post-operative examination showed the submandibular duct to be intact and there was no swelling of the submandibular area. CONCLUSION Sialendoscopy-assisted transoral sublingual gland resection for a plunging ranula is a safe and effective technique. Sialendoscopy aids in skeletonisation and preservation of the submandibular duct.
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George MM, Mirza O, Solanki K, Goswamy J, Rothera MP. Serious neonatal airway obstruction with massive congenital sublingual ranula and contralateral occurrence. Ann Med Surg (Lond) 2015; 4:136-9. [PMID: 25984300 PMCID: PMC4430706 DOI: 10.1016/j.amsu.2015.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 03/28/2015] [Accepted: 04/08/2015] [Indexed: 11/28/2022] Open
Abstract
Background Congenital ranulas seldom occur, with bilateral presentation and prenatal diagnosis reported very rarely. We believe this is the first reported case of a neonate with a antenally diagnosed massive congenital ranula, who went on to develop a non-contiguous contralateral ranula, both contributing to obstruction in a complex paediatric airway. Case report A female neonate was born to a non-primagravid mother via a planned elective caesarean section due to a lower facial defect and oral cyst. Antenatal aspiration of the pseudocyst was performed under ultrasound guidance with limited success. In the immediate post-natal period a poor airway was observed and the cyst was subsequently marsupialised. With the development of macroglossia secondary to oedema and tongue base collapse the airway was secured through surgical tracheostomy. A subsequent ultrasound scan revealed the presence of a second solitary cystic mass on the contralateral side. After careful excision of the contralateral pseudocyst, tongue function improved, with the resolution of a safe airway which permitted successful decannulation. A planned definitive procedure antenatally did not result in the anticipated improvement in function. However the subsequent development of a second non-contiguous pseudocyst and further surgical management resulted in a safe airway, improved masticator function and the ability to thrive. Conclusions The prenatal diagnosis of congenital ranulas have been seldom reported, with no reported cases of contralateral occurrence and airway obstruction from an intraoral ranula. This rare case highlights the need for a well considered contingency plan when surgery is required for a neonatal airway at risk. A well considered plan is required when a neonatal surgical airway is required. Intra-oral ranulas can be initially managed with marsupialisation or cyst excision. Sublingual gland excision is more reliable but associated with higher risk. Sublingual gland excision should be reserved for recalcitrant cysts.
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Affiliation(s)
- Manish M George
- Department of Otolaryngology-Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, M13 9WL, UK
| | - Omar Mirza
- Department of Otolaryngology, Royal Manchester Children's Hospital, Oxford Road, M13 9WL, UK
| | - Kohmal Solanki
- Epsom and St. Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton, Surrey SM5 1AA, UK
| | - Jay Goswamy
- Department of Otolaryngology, Royal Manchester Children's Hospital, Oxford Road, M13 9WL, UK
| | - Michael P Rothera
- Department of Otolaryngology, Royal Manchester Children's Hospital, Oxford Road, M13 9WL, UK
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Chen CJ, Guo P, Chen XY. Recurrent Sublingual Ranula or Saliva Leakage From the Submandibular Gland? Anatomical Consideration of the Ductal System of the Sublingual Gland. J Oral Maxillofac Surg 2015; 73:675.e1-7. [DOI: 10.1016/j.joms.2014.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
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