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Syawaluddin H, Waseso EH, Yudhasoka KL, Yantisetiasti A. Bilateral plunging ranula: A case report. Radiol Case Rep 2025; 20:460-466. [PMID: 39534749 PMCID: PMC11555243 DOI: 10.1016/j.radcr.2024.10.040] [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: 09/25/2024] [Revised: 10/05/2024] [Accepted: 10/07/2024] [Indexed: 11/16/2024] Open
Abstract
Plunging ranula is the extravasation of saliva from the sublingual gland caused by trauma or obstruction of the duct, extending through a defect in the mylohyoid muscle into the submandibular gland. The prevalence of plunging ranula is estimated to be about 2.6 per 100,000 cases with mostly unilateral lesions. Bilateral plunging ranula are rare, with only a few cases reported. This case report describes an 11-year-old boy who was diagnosed with bilateral plunging ranula by radiologic examination of ultrasound and CT scan. The patient underwent extirpation surgery with the result of ranula on histopathologic examination. Six-month follow-up after extirpation, the patient was asymptomatic and no sign of recurrence.
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Affiliation(s)
- Hilman Syawaluddin
- Department of Radiology, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Central Hospital, Bandung, West Java, Indonesia
| | - Enggar Hestu Waseso
- Department of Radiology, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Central Hospital, Bandung, West Java, Indonesia
| | - Kalia Labitta Yudhasoka
- Department of Oral Maxillofacial Surgery, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Central Hospital, Bandung, West Java, Indonesia
| | - Anglita Yantisetiasti
- Department of Pathology Anatomy, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Central Hospital, Bandung, West Java, Indonesia
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Yankov YG, Yotsova RV, Nikolaev NI, Stoev LL, Plachkov LI, Dimanov SN, Stoeva MG. A Rare Case of a Plunging Ranula in a 42-Year-Old Male Patient: A Case Report. Cureus 2024; 16:e68077. [PMID: 39347182 PMCID: PMC11437352 DOI: 10.7759/cureus.68077] [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: 08/28/2024] [Indexed: 10/01/2024] Open
Abstract
Plunging ranulas are rare retention pseudocysts of the major salivary glands, most often of the sublingual gland, and usually occur in individuals from the first to the sixth decade of life with female predominance. Given their similar location and physical and imaging characteristics to thyroglossal cysts, distinguishing the two lesions is often a differential diagnostic dilemma even for the experienced physician. This case report presents a 42-year-old man for whom a preliminary diagnosis of a thyroglossal duct cyst was made based on a physical examination. A neck ultrasound was performed and the lesion was surgically excised. However, pathological analysis revealed a plunging ranula of a salivary gland. A contrast-enhanced computed tomography (CT) of the neck was performed. It showed close proximity of the lesion to the right sublingual salivary gland. Because of this, it was assumed that the gland was associated with the occurrence of his condition, and the patient was offered a complete sialoadenectomy. However, the patient refused this plan of treatment. Approximately seven months later there was a recurrence for which he was operated on again. Despite the warning of a high probability of recurrence, the patient categorically refused sialadenectomy.
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Affiliation(s)
- Yanko G Yankov
- Maxillofacial Surgery, University Hospital St. Marina, Varna, BGR
- General and Operative Surgery, Мedical University - Varna Prof. Dr. Paraskev Stoyanov, Varna, BGR
| | - Ralitsa V Yotsova
- Oral Surgery, Мedical University - Varna Prof. Dr. Paraskev Stoyanov, Varna, BGR
| | - Nikolay I Nikolaev
- Maxillofacial Surgery, Мedical University - Varna Prof. Dr. Paraskev Stoyanov, Varna, BGR
| | - Lyuben L Stoev
- General and Clinical Pathology, Forensic Medicine, and Deontology, Мedical University - Varna Prof. Dr. Paraskev Stoyanov, Varna, BGR
| | - Lachezar I Plachkov
- Imaging Diagnostics and Interventional Radiology, Мedical University - Varna Prof. Dr. Paraskev Stoyanov, Varna, BGR
- Imaging Diagnostics, University Hospital St. Marina, Varna, BGR
| | - Simeon N Dimanov
- Oral Surgery, Мedical University - Varna Prof. Dr. Paraskev Stoyanov, Varna, BGR
| | - Martina G Stoeva
- General and Clinical Pathology, Forensic Medicine, and Deontology, Мedical University - Varna Prof. Dr. Paraskev Stoyanov, Varna, BGR
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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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Abdullah MF, Abdul Rahman S, Fauzi FA. Concurrent Perioperative Diagnosis of HIV in a Patient With Plunging Ranula: A Case Report. Cureus 2023; 15:e44832. [PMID: 37809267 PMCID: PMC10559642 DOI: 10.7759/cureus.44832] [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: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Oral manifestations may be the earliest indicators of HIV infection as it has strong association with oral candidiasis, hairy leukoplakia, linear gingival erythema, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis, Kaposi sarcoma, and lymphoma. Other conditions such as diffuse infiltrative lymphocytosis syndrome, benign lymphoepithelial cyst, and salivary gland neoplasm have also been reported in HIV patients. Ranulas are caused by salivary leakage from the sublingual gland as a result of ductal obstruction or trauma. At the present time, there is no clear evidence of a link between plunging ranula and HIV. The authors described a case of plunging ranula of the right floor of the mouth with a concurrent perioperative diagnosis of HIV. Surgical excision of ranula and associated salivary glands via submandibular and intraoral approach was successfully done with no recurrence over a period of one year. This case also highlights the importance of taking a thorough clinical history from patients and always practicing universal precautions, especially during surgical interventions.
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Affiliation(s)
- 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
| | - Shaifulizan Abdul Rahman
- 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
| | - Fattirah Auni Fauzi
- 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
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A Giant Diving Ranula Extending to the Skull Base in Pediatric Age. J Craniofac Surg 2021; 32:e515-e517. [PMID: 34319685 DOI: 10.1097/scs.0000000000007527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Ranula is a retention cyst that develops from the salivary glands. It has 2 subtypes, oral and diving. There are differences in the clinical features of ranula subtypes. In particular, diving ranula is more prone to extend in the neck spaces than oral ranula. The enlargement of the diving ranula is generally downward in the neck. If the opposite occurs, we may encounter very interesting and difficult cases. Diving ranula should be kept in mind in the differential diagnosis of cystic neck masses in the pediatric age group and its treatment should be done surgically.A 15-year-old girl admitted to our clinic with the complaint of swelling in the floor of the mouth and neck. In physical examination of the patient, a mass with cystic content was observed adjacent to the left Wharton canal. In addition, a 4 × 3 cm, soft, fluctuant, nonfixed, painless mass was palpated in the left submandibular area. Magnetic resonance imaging revealed that the neck mass was a diving ranula extending from the parapharyngeal space to the skull base. In the surgery, submandibular and sublingual salivary glands were removed together with the diving ranula. We observed no complications in the postoperative period.Magnetic resonance imaging should be used to confirm the diagnosis of diving ranula. In the treatment of diving ranula, excision of the ranula alone is not enough surgically. We also recommend excision of the submandibular and/or sublingual salivary glands associated with ranula to reduce the recurrence rate.
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Bertrand B, Chimeli-Ormonde L, Ormonde JB. Plunging ranula in a 7-year-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Mucoceles are common salivary gland disorders. Mucoceles are benign, mucus-filled extravasation pseudocysts that commonly arise on the lower lip of children and young adults. Although surgical excision is commonly performed to remove these lesions, other treatments include marsupialization, micromarsupialization laser ablation, cryotherapy, intralesional steroid injection, and sclerosing agents. Traumatic sialoceles commonly arise from injury to the parotid duct. Treatment of sialoceles from acute parotid duct injury and for delayed presentations after injury are discussed. Ranulas are a subtype of mucocele from the sublingual gland classified as superficial or plunging. Treatment of ranulas must address the sublingual gland.
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Affiliation(s)
- Eve M R Bowers
- Department of Otolaryngology, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, 3350 Terrace Street, Pittsburgh, PA 15213, USA
| | - Barry Schaitkin
- Department of Otolaryngology, University of Pittsburgh Medical Center, Shadyside Hospital, Suite 211, 5200 Centre Avenue, Pittsburgh, PA 15232, USA.
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The mystery of the misunderstood plunging ranula: Commentary on ‘Surgical treatment of plunging ranula: Report of three cases and review of literature’. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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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: 1.0] [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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