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Elnager M, Udeabor SE, Elfadeel ASA, Onwuka CI, Hamid MMM, Alsubaie YMA. Modified micromarsupialization technique as an alternative primary treatment for ranulas: A case series in a resource-challenged economy. Clin Exp Dent Res 2022; 8:1434-1439. [PMID: 36196590 PMCID: PMC9760142 DOI: 10.1002/cre2.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Ranula is one of the commonest salivary gland cysts that mostly occur due to mucus extravasation from the sublingual salivary gland. Treatment of this lesion is still somewhat shrouded in controversy and varies from conservative treatment to surgical excision of the causative gland. MATERIALS AND METHODS This was a case series in quasi-experimental design that evaluated the outcome and complications of the modified micromarsupialization technique as a newly introduced treatment at our center for simple sublingual ranula over a 2-year period. RESULTS Twenty patients were treated by the modified micromarsupialization technique and followed up for 1 year. There was complete resolution following this technique in 17 patients (85%) with no evidence of recurrence or complications, whereas 2 patients (10%) showed partial resolution and the remaining 1 patient (5%) showed a failure and recurrence. The age of the patient, the size of the ranula, and the retention of sutures throughout the study period did not significantly affect the treatment outcome. CONCLUSIONS The modified micromarsupialization technique was a simple and effective treatment that should be used as a primary treatment option for simple ranulas and we recommend it to be the first-choice treatment before surgical excision of the sublingual gland, especially in a resource-challenged economy like ours.
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Affiliation(s)
- Mutassim Elnager
- Department of Oral and Maxillofacial Surgery, College of DentistryKing Khalid UniversityAbhaSaudi Arabia
| | - Samuel E. Udeabor
- Department of Oral and Maxillofacial Surgery, College of DentistryKing Khalid UniversityAbhaSaudi Arabia
| | - Abosofyan S. A. Elfadeel
- Department of Oral and Maxillofacial Surgery, College of DentistryKing Khalid UniversityAbhaSaudi Arabia
| | - Chidozie I. Onwuka
- Department of Oral and Maxillofacial Surgery, College of DentistryKing Khalid UniversityAbhaSaudi Arabia
| | - Mashail M. M. Hamid
- Department of Oral and Maxillofacial Surgery, College of DentistryKing Khalid UniversityAbhaSaudi Arabia
| | - Yassin M. A. Alsubaie
- Department of Oral and Maxillofacial SurgeryKhartoum Teaching Dental HospitalKhartoumSudan
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The piercing-stretching suture technique for the treatment of simple oral floor ranula. The Journal of Laryngology & Otology 2021; 136:68-72. [PMID: 34702397 DOI: 10.1017/s0022215121003327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Oral floor ranulas are pseudocysts located in the floor of the mouth that result from the extravasation of mucus from a sublingual gland. Historically, there has been little consensus on the ideal first-line treatment. Currently, definitive treatment involves sublingual gland excision, which can injure the lingual nerve and submandibular duct. Minimally invasive surgical techniques have been proposed, but so far have been associated with a high rate of recurrence. METHODS The so-called piercing-stretching suture technique was performed in 14 naïve adult and paediatric patients (6 females, with a mean age of 20.3 years (range, 7-55 years)). Clinical and ultrasonographic evaluations were performed in all patients; post-operative sialendoscopy was conducted in two paediatric patients. RESULTS The surgical procedure was successful in all patients, and complete recovery of the ranula was seen in all but one of the patients who underwent suture replacement. No major or minor complications were encountered. CONCLUSION This minimally invasive procedure may be considered a reliable and first-line treatment for management of simple oral floor ranulas.
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Variation in UK Deanery publication rates in the British Journal of Oral and Maxillofacial Surgery: where are the current 'hot spots'? Br J Oral Maxillofac Surg 2021; 59:e48-e64. [DOI: 10.1016/j.bjoms.2020.08.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023]
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Abstract
Ranulas are mucoceles located on the floor of the mouth. The main form of treatment for these lesions is surgical excision, but this can lead to complications such as hemorrhage, recurrence of the lesion, and damage to the lingual nerve. Thus, other therapeutic modalities are indicated, such as modified micromarsupialization, which is a simple technique and not associated with recurrences, and without the need of a new intervention in the postoperative period. An 11-year-old female child, nonwhite, presented with bubble-shaped lesion located on floor of the mouth, on the left side, with exophytic growth, sessile base, bluish coloration, measuring about 4.0 cm in diameter, showing well-defined limits, well-delimited contours and borders, smooth surface, and softened consistency. Under the diagnostic hypothesis of the ranula, a modified micromarsupialization was performed. After 90 days of observation, complete regression and repair of the lesion were observed, without recurrence. Modified micromarsupialization is a simple therapeutic modality, low cost, and well-tolerated by the patient, mainly the pediatric one, being considered very effective in the treatment of lesions of difficult clinical management, as the ranula.
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Matondkar SP, Yavagal C, Mandroli PS. Modified micro-marsupialization as an alternative treatment for the management of ranulas in children. Natl J Maxillofac Surg 2019; 10:95-97. [PMID: 31205396 PMCID: PMC6563644 DOI: 10.4103/njms.njms_3_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The anatomical location of ranulas is challenging to the dental surgeon in terms of their management. The regional complexities of the area call for a skilled approach because of a number of vital structures within. Although complete excision with removal of the sublingual gland continues to be the gold standard of treatment, recent literature highlights successful outcomes by simple modification of the conventional ranular marsupialization technique. This micro-marsupialization option is minimally invasive and advantageous in children due to shorter procedural time, minimal discomfort, and no postoperative complications. The following case report highlights the successful management of a case using a modified micro-marsupialization technique.
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Affiliation(s)
- Sucheta Prabhu Matondkar
- Department of Pedodontics and Preventive Dentistry, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Belagavi, Karnataka, India
| | - Chandrashekar Yavagal
- Department of Pedodontics and Preventive Dentistry, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Belagavi, Karnataka, India
| | - Praveenkumar S Mandroli
- Department of Pedodontics and Preventive Dentistry, Maratha Mandal's Nathajirao G. Halgekar Institute of Dental Sciences and Research Centre, Belagavi, Karnataka, India
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Capaccio P, Canzi P, Gaffuri M, Occhini A, Benazzo M, Ottaviani F, Pignataro L. Modern management of paediatric obstructive salivary disorders: long-term clinical experience. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:160-167. [PMID: 28516980 PMCID: PMC5463525 DOI: 10.14639/0392-100x-1607] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 12/22/2022]
Abstract
Recent technological improvements in head and neck field have changed diagnostic and therapeutic strategies for salivary disorders. Diagnosis is now based on colour Doppler ultrasonography (US), magnetic resonance (MR) sialography and cone beam 3D computed tomography (CT), and extra- and intracorporeal lithotripsy, interventional sialendscopy and sialendoscopy-assisted surgery are used as minimally invasive, conservative procedures for functional preservation of the affected gland. We evaluated the results of our long-term experience in the management of paediatric obstructive salivary disorders. The study involved a consecutive series of 66 children (38 females) whose obstructive salivary symptoms caused by juvenile recurrent parotitis (JRP) (n = 32), stones (n = 20), ranula (n = 9) and ductal stenosis (n = 5). 45 patients underwent interventional sialendoscopy for JRP, stones and stenoses, 12 a cycle of extracorporeal shockwave lithotripsy (ESWL), three sialendoscopy-assisted transoral surgery, one drainage, six marsupialisation, and two suturing of a ranula. Three children underwent combined ESWL and interventional sialendoscopy, and seven a secondary procedure. An overall successful result was obtained in 90.9% of cases. None of the patients underwent traditional invasive sialadenectomy notwithstanding persistence of mild obstructive symptoms in six patients. No major complications were observed. Using a diagnostic work-up based on colour Doppler US, MR sialography and cone beam 3D TC, children with obstructive salivary disorders can be effectively treated in a modern minimally-invasive manner by extracorporeal and intracorporeal lithotripsy, interventional sialendoscopy and sialendoscopy-assisted transoral surgery; this approach guarantees a successful result in most patients, thus avoiding the need for invasive sialadenectomy while functionally preserving the gland.
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Affiliation(s)
- P Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - P Canzi
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - M Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Occhini
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - M Benazzo
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - F Ottaviani
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano Ospedale Fatebenefratelli San Giuseppe, Milano
| | - L Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Torres Y, Brygo A, Ferri J. A 17-year surgical experience of the intraoral approach for ranulas. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:172-176. [PMID: 29501804 DOI: 10.1016/j.jormas.2018.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/25/2018] [Accepted: 02/21/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of this study was to analyze the clinical features and treatment outcomes in order to determine the optimal management of ranulas in our Oral and Maxillofacial Surgery department with long-term results. PATIENTS AND METHODS A retrospective study was performed to evaluate patients with a final diagnosis of a simple or plunging ranula at Lille Teaching Hospital from May 2000 to January 2017. Clinical data on ranulas that were reviewed included gender, age, symptoms, location of the lesion, surgical procedures, complications, recurrence and follow-up. RESULTS The 26 patients included in the study comprised 18 males and 8 females, ranging from 3-months to 38 years of age. A total of 27 ranulas were managed: 25 oral ranula and 2 plunging ranulas. Twelve patients had undergone marsupialization (44.4%), 7 patients had complete excisions of the ranula (25.9%) or partial excisions combined with marsupialization (14.8%) and 4 patients (14.8%) had undergone excision of the sublingual gland (SLG). Seven ranulas recurred (25.9%). Not a single case recurred following the excision of the SLG. Treatments that included marsupialization were associated with the lowest recurrence rate (16.7%) after SLG excision, followed by combined marsupialization and ranula excision (25%) and by ranula excision alone (57%). There were no major complications. DISCUSSION Long-term outcomes confirm the different surgical procedures available in the outpatient clinic for the management of ranulas based on our surgical experience. Transoral resection of the SLG should be the optimal treatment, producing the lowest recurrence rate.
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Affiliation(s)
- Y Torres
- Department of Oral and Maxillofacial Surgery, Lille Teaching Hospital, Roger Salengro Hospital, Lille Teaching Hospital, 59000 Lille, France.
| | - A Brygo
- Department of Oral and Maxillofacial Surgery, Lille Teaching Hospital, Roger Salengro Hospital, Lille Teaching Hospital, 59000 Lille, France.
| | - J Ferri
- Department of Oral and Maxillofacial Surgery, Lille Teaching Hospital, Roger Salengro Hospital, Lille Teaching Hospital, 59000 Lille, France; Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Roger Salengro Hospital, Lille Teaching Hospital, 59000 Lille, France.
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Zhao Q, Li M, Lai R, Wang S. Treatment of intraoral ranulas with a two-incision fistula technique: the management of recurrence. Br J Oral Maxillofac Surg 2018; 56:129-133. [PMID: 29338892 DOI: 10.1016/j.bjoms.2017.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Abstract
The two-incision fistula technique for the treatment of oral ranulas has recently been introduced to clinical practice. We reviewed 52 patients who had recurrences after this treatment, and explored the possible causes and underlying mechanisms. A total of 13/53 ranulas had recurred, so we repeated the operation, and one patient had the ranula and the sublingual gland resected. We found that the thin mucous membrane cracked at the double incisions, which led to the formation of a fistula and promoted the drainage of cystic fluid. The results indicated that the recurrence of ranulas after the two-incision fistula technique can be reduced further. To avoid recurrence, the technique should be adjusted slightly, depending on the type of ranula present.
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Affiliation(s)
- Qingtong Zhao
- Department of Oral Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China
| | - Mengyu Li
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, National Clinical Research Center of Stomatology, Shanghai 200011, China
| | - Renfa Lai
- Department of Oral Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510632, China
| | - Shaoyi Wang
- Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, National Clinical Research Center of Stomatology, Shanghai 200011, China.
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