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Yun J, Gidumal S, Saturno MP, Wein LE, Fan J, Khorsandi AS, Chung D, Chen H, Chai RL. Diagnostic Difficulties of Plunging Ranula: A Review of 18 Cases. Laryngoscope 2024; 134:2689-2696. [PMID: 38217447 DOI: 10.1002/lary.31288] [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] [Received: 10/11/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
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. METHODS Imaging 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. RESULTS Of 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. CONCLUSION Despite 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 EVIDENCE 4 Laryngoscope, 134:2689-2696, 2024.
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Affiliation(s)
- Jun Yun
- THANC, (Thyroid, Head and Neck Cancer) Foundation at Mount Sinai, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sunder Gidumal
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael P Saturno
- THANC, (Thyroid, Head and Neck Cancer) Foundation at Mount Sinai, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren E Wein
- THANC, (Thyroid, Head and Neck Cancer) Foundation at Mount Sinai, New York, New York, USA
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jun Fan
- Department of Pathology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Azita S Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Daniel Chung
- Department of Pathology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hua Chen
- FNA Medical Diagnostics, New York, New York, USA
| | - Raymond L Chai
- Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
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2
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Fauzi FA, Abdullah MF, Samsudin NA, Md Yusoff B. Surgical Management of Huge Ranula Resembling Double Tongue in Pediatric Patients: A Successful Treatment of Two Cases. Cureus 2024; 16:e57884. [PMID: 38725744 PMCID: PMC11079697 DOI: 10.7759/cureus.57884] [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] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Ranula is a fluid collection in a pseudo cystic wall secondary to the damage of the sublingual salivary gland causing blockage of salivary flow, leading to the extravasation phenomena. The growth rate of ranula varies depending on its severity. Due to its tendency to recur, the gold standard management of ranula has yet to be decided. The authors described two cases of young girls with huge ranulas on the floor of the mouth (FOM) resembling double tongue, which caused pain and discomfort during mastication. Following surgical excision of the ranulas along with the affected sublingual glands, both cases demonstrated successful treatment outcomes with no recurrence observed during post-operative follow-up. These cases highlight the importance of surgical excision of ranulas and removal of affected sublingual glands to prevent recurrence.
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Affiliation(s)
- Fattirah Auni Fauzi
- Oral and Maxillofacial Surgery, Hospital Universiti Sains Malaysia, Kota Bharu, MYS
| | - Mohd Faizal Abdullah
- Oral and Maxillofacial Surgery, Hospital Universiti Sains Malaysia, Kota Bharu, MYS
- Oral and Maxillofacial Surgery, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kota Bharu, MYS
| | - Norsamsu Arni Samsudin
- Pediatric Dentistry, Hospital Universiti Sains Malaysia, Kota Bharu, MYS
- Pediatric Dentistry, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kota Bharu, MYS
| | - Bazli Md Yusoff
- Radiology, Hospital Universiti Sains Malaysia, Kota Bharu, MYS
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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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4
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Oral Lesions in Children and Adolescents. Pediatr Dent 2022. [DOI: 10.1007/978-3-030-78003-6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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5
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Chaubal DT, Bapat DR. Ranula: Frog's Belly. Am J Med 2021; 134:e552. [PMID: 34273288 DOI: 10.1016/j.amjmed.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Dr Tanay Chaubal
- MDS (Periodontology and Oral Implantology), Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
| | - Dr Ranjeet Bapat
- MDS (Periodontology and Oral Implantology), Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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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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Abdullahi M, Taiwo A, Iseh K, Amutta S. Ranula: A retrospective clinicosurgical analysis of 29 cases from a tertiary health institution, Northwest, Nigeria. JOURNAL OF CLINICAL SCIENCES 2021. [DOI: 10.4103/jcls.jcls_55_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Than JK, Rosenberg TL, Anand G, Sitton M. The importance of sublingual gland removal in treatment of ranulas: A large retrospective study. Am J Otolaryngol 2020; 41:102418. [PMID: 32087991 DOI: 10.1016/j.amjoto.2020.102418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/03/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Investigate the efficacy of sublingual gland removal for the treatment of simple and plunging ranulas. MATERIALS AND METHODS After IRB approval, a retrospective review was performed on patients treated for a ranula from February 2013 to May 2018 at Texas Children's Hospital in Houston, TX. Clinical data was collected from medical records and patients were contacted in November 2018 to obtain additional information about recurrences or complications. RESULTS This study included 52 patients with ranulas (10 plunging, 42 simple; M:F 21:31) with a mean age of 9.68 years. Eighteen patients provided information in the extended follow-up period. Simple ranulas were treated with intraoral excision of the cyst and the sublingual gland (27 cases), marsupialization (7 cases), intraoral excision of the cyst alone (7 cases), and intraoral excision of the cystic component and subsequent marsupialization after recurrence (1 case); intraoral excision of the sublingual gland was not associated with any recurrence. Plunging ranulas were treated with intraoral excision of the cyst and/or sublingual gland (7 cases) or with a transcervical approach (3 cases). One patient was initially treated with sclerotherapy before undergoing intraoral excision of the sublingual gland. Two patients treated with transcervical excision of the cyst experienced recurrence compared to no recurrence with intraoral excision of the sublingual gland. CONCLUSION Intraoral removal of the sublingual gland is the most effective treatment for both simple and plunging ranulas. Plunging ranulas must be considered in patients presenting with a submandibular and submental cystic mass given intraoral extension may not be apparent.
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Affiliation(s)
- Jeffrey K Than
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States of America.
| | - Tara L Rosenberg
- Department of Otolaryngology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, United States of America
| | - Grace Anand
- Department of Otolaryngology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, United States of America
| | - Matthew Sitton
- Department of Otolaryngology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, United States of America
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Syebele K, Munzhelele TI. The anatomical basis and rational for the transoral approach during the surgical excision of the sublingual salivary gland for the management of plunging ranula. Am J Otolaryngol 2020; 41:102371. [PMID: 31917022 DOI: 10.1016/j.amjoto.2019.102371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to illustrate and confirm that the complete intraoral excision of the sublingual gland alone, is anatomically the most rational approach, for the management of plunging ranula. MATERIAL AND METHODS We retrospectively reviewed clinical charts of diagnosed HIV-infected patients presenting with plunging ranula. The intraoral approach was used for the complete excision of the sublingual gland with evacuation of the pseudocystic content only. Neither extra oral approach, nor ranula dissection / drainage was performed. The surgical procedure was performed using local anesthesia. Pre- and postoperative MRI-scan investigations were recorded. Histological reports were documented to confirm the diagnosis of oral mucocele. Patients were clinically monitored. RESULTS We identified 90 adults presenting with oral mucocele, type ranula. Seventy (77%) of them were diagnosed with HIV infection. Plunging ranula was recorded in 35 (50%) patients from the latter group. The study enrolled 11 operated patients whose files contained useable data, including an acceptable follow-up period. The postoperative follow-up period ranged from three to 15 months. The clinical and postoperative MRI-scans of operated patients demonstrated satisfactory results. There were neither postoperative complications nor recurrence of ranula reported. CONCLUSION The location of the sublingual gland in the floor of the mouth coupled with the physio-pathogenesis of the plunging ranula, makes the transoral complete excision of the offending gland, with the intraoral evacuation of the pseudocyst, anatomically the most rational approach for plunging ranula management. There is no need for cervical approach, ranula dissection and/or postoperative placement of drainage.
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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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11
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Kolomvos N, Kalfarentzos E, Papadogeorgakis N. Surgical treatment of plunging ranula: Report of three cases and review of literature. ORAL AND MAXILLOFACIAL SURGERY CASES 2019. [DOI: 10.1016/j.omsc.2019.100098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Percutaneous treatment of ranulas: ultrasound-guided drainage with salivary gland chemical ablation. Pediatr Radiol 2019; 49:801-807. [PMID: 30815715 PMCID: PMC6614164 DOI: 10.1007/s00247-019-04356-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/20/2019] [Accepted: 02/14/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ranulas are salivary pseudocysts in the floor of the mouth adjacent to damaged salivary glands. Current surgical management is drainage of the ranula with removal of the offending gland. An analogous percutaneous procedure could potentially offer similar treatment efficacy in a more minimally invasive way. OBJECTIVE To evaluate the outcomes of a cohort of patients with ranulas treated with percutaneous ranula aspiration and chemical ablation of the source salivary gland to see whether this technique could be proposed as a minimally invasive treatment alternative. MATERIALS AND METHODS This retrospective single-center study evaluated 24 patients treated percutaneously for ranulas between January 2004 and December 2014. All patients were treated with percutaneous ranula aspiration and chemical ablation of the offending salivary gland. Treatment success and any complications were recorded. RESULTS Complete ranula eradication was successfully accomplished in 87.5% of the patients with no complications. CONCLUSION Initial results suggest that our technique of percutaneous aspiration of ranulas and chemical ablation of the source salivary gland is safe and effective.
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Chen JX, Zenga J, Emerick K, Deschler D. Sublingual gland excision for the surgical management of plunging ranula. Am J Otolaryngol 2018; 39:497-500. [PMID: 30017374 DOI: 10.1016/j.amjoto.2018.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 05/26/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A plunging ranula is a pseudocystic collection of mucin extravasated from the sublingual gland into the floor of mouth and through the mylohyoid muscle into the neck. While the lining of a ranula is non-secreting and resection of the sublingual gland is adequate for simple sublingual mucoceles, many surgeons attempt to address plunging ranulas with extensive transoral and transcervical dissections. We review our experience managing plunging ranulas with intraoral sublingual gland excision and ranula drainage alone. METHODS This is a case series of patients with plunging ranulas who underwent transoral sublingual gland excision and ranula drainage in the past 10 years at the Massachusetts Eye and Ear. All ranulas were confirmed by radiographic imaging. Data were gathered from the medical record and telephone surveys. RESULTS Twenty-one patients with 22 distinct ranulas underwent this surgical approach. Average ranula size on imaging was 4.3 cm (SD = 1.3). Thirteen patients with 14 ranulas were followed up for greater than 6 months while the remaining 7 patients were lost to follow-up. Median follow-up for the 13 patients was 30 months (range 6 to 80). One ranula recurred requiring excision of residual sublingual gland (7%). One patient developed a local infection that was treated with antibiotics (7%). No long term complications were reported. CONCLUSION Simple transoral excision of the sublingual gland with ranula drainage is sufficient for treatment of plunging ranulas. It is essential to obtain a full resection of the gland to prevent relapse. This limited approach has low rates of complications and ranula recurrence.
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Affiliation(s)
- Jenny X Chen
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States
| | - Joseph Zenga
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States
| | - Kevin Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States
| | - Daniel Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States.
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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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Abstract
A plunging or diving ranula is a rare mucous fluid collection in the submandibular or parapharyngeal space resulting from damage or rupture of one or more ducts of the sublingual gland. The most common clinical presentation is a painless, slow-growing, pliable mass in the floor of the mouth, sometimes extending below the mandible through a defect in the mylohyoid muscle. This case report presents a young female patient who was suspected of having a plunging ranula. This case also highlights the role that sonography and other diagnostic tools play in the evaluation of this phenomenon.
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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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17
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Abstract
Background There is no consensus opinion on a definitive surgical management option for ranulas to curtail recurrence, largely from the existing gap in knowledge on the pathophysiologic basis. Aim To highlight the current scientific basis of ranula development that informed the preferred surgical approach. Design Retrospective cohort study. Setting Public Tertiary Academic Health Institution. Method A 7-year 7-month study of ranulas surgically managed at our tertiary health institution was undertaken—June 1, 2008–December 31, 2015—from case files retrieved utilising the ICD-10 version 10 standard codes. Results Twelve cases, representing 0.4 and 1.2% of all institutional and ENT operations, respectively, were managed for ranulas with a M:F = 1:1. The ages ranged from 5/12 to 39 years, mean = 18.5 years, and the disease was prevalent in the third decade of life. Main presentation in the under-fives was related to airway and feeding compromise, while in adults, cosmetic facial appearance. Ranulas in adults were plunging (n = 8, 58.3%), left-sided save one with M:F = 2:1. All were unilateral with R:L = 1:2. Treatment included aspiration (n = 2, 16.7%) with 100% recurrence, intra-/extraoral excision of ranula only (n = 4, 33.3%) with recurrence rate of 50% (n = 2, 16.7%), while marsupialisation in children (n = 1, 8.3%) had no recurrence. Similarly, transcervical approach (n = 5, 41.7%) with excision of both the ranula/sublingual salivary gland recorded zero recurrence. Recurrence was the main complication (n = 4, 33.3%). Conclusion With the current knowledge on the pathophysiologic basis, extirpation of both the sublingual salivary gland and the ranula by a specialist surgeon is key for a successful outcome.
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Lyly A, Castrén E, Aronniemi J, Klockars T. Plunging ranula - patient characteristics, treatment, and comparison between different populations. Acta Otolaryngol 2017; 137:1271-1274. [PMID: 28754079 DOI: 10.1080/00016489.2017.1357082] [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] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To review our clinical experience and characteristics of Finnish patients with plunging ranula and compare our results with reports from other populations. DESIGN A retrospective study from the electronic hospital records between 2005 and 2016. SETTING The Department of Otorhinolaryngology and Head and Neck Surgery of Helsinki University Hospital, Finland. RESULTS We describe the characteristics and treatment of 41 patients with MRI-confirmed plunging ranula. Most of our patients were young adults and 88% of them were male. Surgery and sclerotherapy were used for treatment. CONCLUSIONS The vast majority of Finnish plunging ranula patients in our cohort were male, suggesting significant population-related differences in plunging ranula gender distribution. Transoral surgery seemed to result in lowest recurrence rate and was the most common treatment in our clinic.
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Affiliation(s)
- Annina Lyly
- Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eeva Castrén
- Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Aronniemi
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tuomas Klockars
- Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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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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Nguyen MLT, Orloff LA. Successful ablation of plunging ranula by ultrasound-guided percutaneous ethanol injection. Laryngoscope 2017; 127:2239-2241. [DOI: 10.1002/lary.26505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Michelle-Linh T. Nguyen
- Department of Otolaryngology; Stanford University School of Medicine; Stanford California U.S.A
| | - Lisa A. Orloff
- Department of Otolaryngology; Stanford University School of Medicine; Stanford California U.S.A
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Evaluation of OK-432 Injection Therapy as Possible Primary Treatment of Intraoral Ranula. J Oral Maxillofac Surg 2017; 75:336-342. [DOI: 10.1016/j.joms.2016.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/15/2016] [Accepted: 08/15/2016] [Indexed: 11/18/2022]
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Carlini V, Calcaterra V, Pasqua N, Guazzotti M, Fusillo M, Pelizzo G. Plunging Ranula in Children: Case Report and Literature Review. Pediatr Rep 2016; 8:6576. [PMID: 28191301 PMCID: PMC5225824 DOI: 10.4081/pr.2016.6576] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/04/2016] [Indexed: 12/18/2022] Open
Abstract
Few cases of plunging ranulas (PRs) occur during childhood and the lesions are frequently misdiagnosed. Here, a PR in a child is reported along with a literature review. A seven-year-old female complaining of swelling in the midline neck, left-submandibular region, was evaluated. No oral cavity or major salivary glands abnormalities were detected. On palpation, a soft, painless, and fluid-containing mass was observed. The suspicion PR was performed by ultrasound. The diagnosis was confirmed with a histopathological examination. The lesion was removed with a cervical approach, without recurrence. PR is an uncommon condition in children under 10 years of age. Differential diagnosis depends on clinical examination and ultrasonography. A computed tomography-scan and magnetic resonance imaging can be performed if the diagnosis remains uncertain. In pediatrics, the key to success of the treatment may rely on the radical excision of the cyst and sublingual gland, via an intraoral or submandibular approach.
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Affiliation(s)
- Veronica Carlini
- Pediatric Surgery Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico S.Matteo , Pavia, Italy
| | - Valeria Calcaterra
- Pediatric Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico S.Matteo and Department of Internal Medicine and Therapeutics, University of Pavia , Pavia, Italy
| | - Noemi Pasqua
- Pediatric Surgery Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico S.Matteo , Pavia, Italy
| | - Marinella Guazzotti
- Pediatric Surgery Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico S.Matteo , Pavia, Italy
| | - Mario Fusillo
- Pediatric Surgery Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico S.Matteo , Pavia, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico S.Matteo and Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia , Pavia , and Ospedale dei Bambini "G. Di Cristina", A.R.N.A.S. Palermo, Italy
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Hills A, Holden A, McGurk M. Evolution of the management of ranulas: change in a single surgeon's practice 2001-14. Br J Oral Maxillofac Surg 2016; 54:992-996. [DOI: 10.1016/j.bjoms.2016.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/09/2016] [Indexed: 11/26/2022]
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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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Zhao GR, Ji P, Zhao HW, Li Y, Li Y, Liu P, Zeng L, Zhang FG. Modified L-shaped surgical approach to excision of the sublingual gland. Br J Oral Maxillofac Surg 2015; 53:725-9. [DOI: 10.1016/j.bjoms.2015.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
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Abstract
PURPOSE OF REVIEW Ranula is extravasation mucocele arising from the sublingual gland, influencing the swallowing or eating; this review focuses on the most recent literature pertaining to pediatric ranulas and aims to comprehensively describe the methods of diagnosis and management approaches. RECENT FINDINGS Ranulas consist of intraoral ranula and plunging ranula, which are frequently misdiagnosed, so it is vital for the differential diagnosis of pediatric ranulas to depend on the clinical examination, imaging and fine-needle aspiration cytology. Pediatric patients should first be observed for 6 months before other treatments. OK-432 could activate inflammatory reaction to induce shrinkage of pediatric ranulas. Marsupialization, incision with drainage and ranula excision alone, are associated with a high rate of recurrence, even marsupialization with packing and modified micromarsupialization should be prudently applied for primary treatment of intraoral ranula. Laser excision is considered an alternative treatment for intraoral ranula of pediatric patients because of low recurrence rates and surgical complications. Recently, sublingual gland with or without ranula excision is a reasonable and suitable choice for radical treatment in pediatric patients. SUMMARY The principal goal of pediatric ranula management is radical sublingual gland excision, sealing the mucus extravasates and lowest complications.
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Treatment outcomes of the intraoral approach for a simple ranula. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:e223-5. [DOI: 10.1016/j.oooo.2015.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/15/2015] [Accepted: 01/23/2015] [Indexed: 11/19/2022]
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Affiliation(s)
- Eric R Carlson
- Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, The University of Tennessee Cancer Institute, 1930 Alcoa Highway, Suite 335, Knoxville, TN 37920, USA.
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Minimally invasive treatment of oral ranulae: adaption to an old technique. Br J Oral Maxillofac Surg 2015; 53:332-5. [PMID: 25631396 DOI: 10.1016/j.bjoms.2015.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 01/06/2015] [Indexed: 11/23/2022]
Abstract
Oral ranulas are cysts in the floor of the mouth that result from the extravasation of mucous. Historically there has been little consensus on the ideal first-line treatment, but currently, definitive treatment involves excision of the sublingual gland, which can injure the lingual nerve and submandibular duct. Minimally invasive surgical alternatives such as marsupialisation have been proposed, but so far have been associated with a high rate of recurrence. The aim of this pilot study was to evaluate the success of a simple, modified suture technique for the treatment of oral ranulas that can be done in the outpatient department. We retrospectively analysed outcomes after the technique was used as a first-line treatment in 15 consecutive patients between 2011 and 2013. Although 2 attempts were needed in 4 patients, complete resolution of the ranula was seen in 13. Other than the need for a second attempt, and recurrent failure in 2 cases, there were no complications. This minimally invasive and quick procedure is a suitable first-line alternative to other less successful or higher risk options.
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Symptomatic Floor-of-Mouth Swelling with Neck Extension in a 14-Year-Old Girl. Case Rep Pediatr 2014; 2014:831923. [PMID: 25548707 PMCID: PMC4273473 DOI: 10.1155/2014/831923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/19/2014] [Indexed: 11/17/2022] Open
Abstract
A plunging ranula is a soft-tissue mass stemming from a mucous extravasation cyst of the sublingual gland which can herniate through the mylohyoid muscle. We describe a case in which a 14-year-old girl presented with a rapidly expanding mass on the floor of her mouth affecting her ability to swallow and speak and causing tracheal compression. The patient was initially managed conservatively with antibiotics and steroids; however, the mass continued to expand necessitating emergent bedside incision and drainage and subsequent surgical intervention. The pathophysiology and management options for ranulas are also discussed herein.
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Iro H, Zenk J. Salivary gland diseases in children. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc06. [PMID: 25587366 PMCID: PMC4273167 DOI: 10.3205/cto000109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Salivary gland diseases in children are rare, apart from viral-induced diseases. Nevertheless, it is essential for the otolaryngologist to recognize these uncommon findings in children and adolescents and to diagnose and initiate the proper treatment. The present work provides an overview of the entire spectrum of congenital and acquired diseases of the salivary glands in childhood and adolescence. The current literature was reviewed and the results discussed and summarized. Besides congenital diseases of the salivary glands in children, the main etiologies of viral and bacterial infections, autoimmune diseases and tumors of the salivary glands were considered. In addition to the known facts, new developments in diagnostics, imaging and therapy, including sialendoscopy in obstructive diseases and chronic recurrent juvenile sialadenitis were taken into account. In addition, systemic causes of salivary gland swelling and the treatment of sialorrhoea were discussed. Although salivary gland diseases in children are usually included in the pathology of the adult, they differ in their incidence and sometimes in their symptoms. Clinical diagnostics and especially the surgical treatment are influenced by a stringent indications and a less invasive strategy. Due to the rarity of tumors of the salivary glands in children, it is recommended to treat them in a specialized center with greater surgical experience. Altogether the knowledge of the differential diagnoses in salivary gland diseases in children is important for otolaryngologists, to indicate the proper therapeutic approach.
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Affiliation(s)
- Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, Germany
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Zielinski R, Zakrzewska A. Submental epidermoid cysts in children. Open Med (Wars) 2014; 10:77-81. [PMID: 28352681 PMCID: PMC5152962 DOI: 10.1515/med-2015-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 06/26/2014] [Indexed: 12/21/2022] Open
Abstract
Epidermoid cysts are lesions, which form as a result of implantation of the epidermis in the layers of the dermis or the mucous membrane. The lesions are rare in adults with 7% occurring in the head and neck area and most often located in the submental region. In children population submental epidermoid cysts are extremely rare. The differential diagnosis of the lesions is necessary as it affects the choice of treatment methods. Among the pathological conditions occurring in that region, salivary retention cyst (ranula), thyroglossal duct cyst, vascular lymphatic malformation (cystic hygroma), median neck cyst, lymphadenopathy, thyroid gland tumor, laryngeal cyst, epidermoid and dermoid cysts, submental abscess, sialolithiasis and salivary gland inflammation should be considered. The authors of the present report demonstrate two cases of submental epidermoid cysts in children. Differential diagnosis in case of suspected submental epidermoid cyst in a child with proposed clinical practice and literature review is provided.
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Affiliation(s)
- Rafal Zielinski
- Department of Pediatric Otolaryngology, Medical University of Lodz, ul. Sporna 36/50, 91-738 Lodz, Poland, tel./fax: +48-426177720
| | - Anna Zakrzewska
- Department of Pediatric Otolaryngology, Medical University of Lodz, ul. Sporna 36/50, 91-738 Lodz, Poland
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Abstract
This article provides an overview of common color changes and soft tissue oral nodular abnormalities in children and adolescents. The clinical presentation and treatment options to address these conditions are presented in a concise approach, highlighting key features relevant to the oral health care professional.
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Affiliation(s)
- Andres Pinto
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, University Hospitals Case Medical Center and Case Western Reserve School of Dental Medicine, 2124 Cornell Road, Rm 1190, Cleveland, OH 44106, USA.
| | - Christel M Haberland
- Yale Hamden Dental Center, Yale School of Medicine, Yale-New Haven Hospital, 2560 Dixwell Avenue, Hamden, CT 06514, USA
| | - Suher Baker
- Pediatric Dentistry Residency Program, Department of Dentistry, Yale School of Medicine, Yale-New Haven Hospital, 1 Long Whart Drive, Suite 403, New Haven, CT 06511, USA
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