Prenatal diagnosis and management of a ranula

Prenatal Detection of a Sublingual Lymphatic Malformation in a Fetus: A Rare Case

BACKGROUND

Lymphatic malformations are benign cystic lesions that, while rare, tend to affect the pediatric age group. There are no reported cases diagnosed prenatally.

CASE

A 28-year-old G1 woman at 34 weeks gestation was scanned for placental localization at a community ultrasound clinic. A fetal cystic, sublingual structure was identified. The patient was referred to our tertiary care centre, where a small (1.3 cm) avascular, cystic structure under the tongue of the fetus was confirmed. Antenatal course and delivery were unremarkable. The lesion resolved spontaneously with time.

CONCLUSION

This report highlights a unique case in which a sublingual lymphatic malformation was detected prenatally during a third-trimester ultrasound.

Prenatal diagnosis of lingual cyst and spontaneous regression before birth: A rare case report and literature review

RATIONALE

We report a case of fetal lingual cyst that was diagnosed prenatally using 2-dimensional and 3-dimensional images during routine second trimester screening. To the best of our knowledge, this is the first description of a cystic lesion disappearing before birth.

PATIENT CONCERNS

A 36-year-old woman at 22 weeks' gestation showed the presence of an oral cystic lesion in routine second trimester ultrasound screening. The lesion measured 18 × 15 × 15 mm.

INTERVENTIONS

A follow-up ultrasound examination was performed every 4 to 6 weeks.

OUTCOMES

The cyst disappeared in a follow-up ultrasound examination at 35 and 37 weeks of gestation. A male newborn who weighed 3480 g was delivered with no feeding difficulties. The boy was followed to 6 years after birth. The child had normal growth and development, and there was no recurrence of the cyst.

LESSONS

Prenatally diagnosed lingual cysts are uncommon findings that can include many different pathologies with a wide spectrum of severity. Lingual cysts usually have a good prognosis.

Congenital Ranula: A Case Report and Literature Review

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.

Serious neonatal airway obstruction with massive congenital sublingual ranula and contralateral occurrence

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.

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A well considered plan is required when a neonatal surgical airway is required.

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Intra-oral ranulas can be initially managed with marsupialisation or cyst excision.

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Sublingual gland excision is more reliable but associated with higher risk.

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Sublingual gland excision should be reserved for recalcitrant cysts.

A congenital mucocele of the anterior dorsal tongue

We report on a new-born with a congenital mucocele on the anterior dorsal side of the tongue. The presentation as well as the differential diagnosis of congenital oral swellings is discussed. Because of breastfeeding problems the mucinous swelling was incised and drained two days after birth. Immediately after drainage the swelling disappeared. Congenital oral swellings are rare. Most of them are mucoceles. Post-partum treatment is surgically, but spontaneous remission has been described. High incidence of recurrence should be taken into account when (micro-)marsupialization or incision as sole treatment is performed.

Prenatal ultrasound and magnetic resonance imaging depiction of a small sublingual ranula

Prenatal diagnosis of a congenital ranula has rarely been reported. We describe the case of a small ranula depicted on prenatal sonogram and magnetic resonance imaging, in which we could confirm the intact airway. Although the size of the ranula noted in our fetus was the smallest among the cases reported in the English literature, both of these imaging modalities clearly presented typical diagnostic features present on both ultrasound and magnetic resonance imaging.