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Miyasaka Y, Hiyama T, Kuno H, Shinozaki T, Tomioka T, Sakashita S, Kobayashi T. Imaging of salivary gland cancers derived from a sublingual gland herniated into the submandibular space: a report of three cases. Neuroradiology 2024; 66:931-935. [PMID: 38639791 DOI: 10.1007/s00234-024-03360-9] [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: 01/28/2024] [Accepted: 04/13/2024] [Indexed: 04/20/2024]
Abstract
Sublingual gland herniation into the submandibular space through a mylohyoid muscle defect is a common anatomical variation; however, salivary gland cancers that arise from a herniated sublingual gland have not been described yet. Here, we report three patients with salivary gland cancers originating from a herniated sublingual gland. All tumors were detected as palpable submandibular masses, located anterior to the submandibular gland, medial to the mandible, and lateral to the mylohyoid muscle, with contact with the sublingual gland through a mylohyoid muscle defect. Intraoperative findings confirmed that the masses were derived from herniated sublingual glands. Pathological examination showed one case of mucoepidermoid carcinoma and two cases of adenoid cystic carcinoma. Imaging findings of the tumor location, in addition to the continuity with the sublingual gland through the mylohyoid muscle defect, are crucial for accurately diagnosing the tumor origin, which is essential for determining the appropriate clinical management.
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Affiliation(s)
- Yusuke Miyasaka
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takashi Hiyama
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Hirofumi Kuno
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Toshifumi Tomioka
- Department of Head and Neck Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Shingo Sakashita
- Division of Pathology, Exploratory Oncology Research & Clinical Trial, National Cancer Center, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Tatsushi Kobayashi
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
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Janović A, Bracanović Đ, Antić S, Marković-Vasiljković B. Submandibular swelling, pulsations and otalgia due to sublingual gland and blood vessels herniation through mylohyoid boutonnière: Case report. BALKAN JOURNAL OF DENTAL MEDICINE 2022. [DOI: 10.5937/bjdm2201058j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background/Aim: Mylohyoid boutonnière is a common anatomical variant with extremely rare clinical manifestations. We report two cases of symptomatic unilateral mylohyoid boutonnière with sublingual gland herniation. Case report: The first was a 34-year-old female with a two months history of a left submandibular swelling, intermittent pulsations, and otalgia. The second 67-year-old female presented with a left submandibular pain six months after total thyroidectomy due to papillary carcinoma. After detailed clinical and radiological evaluation by ultrasonography (US) and computed tomography (CT), the mylohyoid gap with sublingual gland herniation was diagnosed in both patients. The dynamic US with a tongue pressed down on the mouth floor revealed blood vessel compression by a herniated sublingual gland in the first patient. Conclusions: This is the first case of a mylohyoid boutonnière related intermittent vascular compression. Dynamic US and CT may help to differentiate intermittent and persistent sublingual gland herniation through the mylohyoid boutonnière from other pathological lesions in the submandibular region.
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Sher ZA, Tan G. Unilateral sublingual salivary gland hypertrophy with herniation through a boutonniére defect and contralateral sublingual gland hypoplasia. BJR Case Rep 2016; 2:20150382. [PMID: 30459974 PMCID: PMC6243368 DOI: 10.1259/bjrcr.20150382] [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: 10/27/2015] [Revised: 02/11/2016] [Accepted: 02/22/2016] [Indexed: 11/05/2022] Open
Abstract
A 74-year-old male attended our ear, nose and throat clinic with left-sided otalgia. MRI highlighted an area of abnormal signal in the region of the right mylohyoid muscle in the floor of the oral cavity. The patient was called back for a post-contrast MRI scan for clarification. Post-contrast MRI demonstrated a left-sided hypoplastic sublingual salivary gland and a hypertrophied right-sided sublingual salivary gland. The left sublingual gland hypoplasia had resulted in compensatory hypertrophy of the contralateral (right) sublingual salivary gland, extending through the mylohyoid gap or "boutonnière defect". This is a common incidental variant often encountered in radiological imaging. This is the only report of a case of contralateral compensatory hypertrophy of sublingual salivary gland, as all the others have reported ipsilateral hypertrophy of either submandibular salivary glands.
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Affiliation(s)
- Zenab Arooj Sher
- General Surgery, Medway Maritime Hospital, Medway NHS Foundation Trust, Gillingham, UK
| | - Garryck Tan
- Radiology, Darent Valley Hospital, Dartford & Gravesham NHS Trust, Dartford, UK
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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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Lee JY, Lee HY, Kim HJ, Jeong HS, Kim YK, Cha J, Kim ST. Plunging Ranulas Revisited: A CT Study with Emphasis on a Defect of the Mylohyoid Muscle as the Primary Route of Lesion Propagation. Korean J Radiol 2016; 17:264-70. [PMID: 26957912 PMCID: PMC4781766 DOI: 10.3348/kjr.2016.17.2.264] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 12/31/2015] [Indexed: 11/15/2022] Open
Abstract
Objective The purpose of this study was to clarify the pathogenesis of plunging ranulas in regard of the pathway of lesion propagation using CT scans. Materials and Methods We retrospectively reviewed CT scans of 41 patients with plunging ranula. We divided plunging ranulas into two types: type 1 was defined as those directly passing through a defect of the mylohyoid muscle with the presence (type 1A) or absence (type 1B) of the tail sign and type 2 as those through the traditional posterior route along the free edge of the mylohyoid muscle. Images were also analyzed for the extent of the lesion in respect to the spaces involved. As for type 1 lesions, we recorded the location of the defect of the mylohyoid muscle and the position of the sublingual gland in relation to the defect. Results CT scans demonstrated type 1 lesion in 36 (88%), including type 1A in 14 and type 1B in 22, and type 2 lesion in 5 (12%). Irrespective of the type, the submandibular space was seen to be involved in all cases either alone or in combination with one or more adjacent spaces. Of the 36 patients with type 1 lesions, the anterior one-third was the most common location of the defect of the mylohyoid muscle, seen in 22 patients. The sublingual gland partially herniated in 30 patients. Conclusion Our results suggest that the majority of plunging ranulas take an anterior shortcut through a defect of the mylohyoid muscle.
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Affiliation(s)
- Ji Young Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.; Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Hee Young Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Hyung-Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Han Sin Jeong
- Departments of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Yi-Kyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jihoon Cha
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
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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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Yerli H. Dynamic sonography and CT findings of unilateral submandibular gland agenesis associated with herniated hypertrophic sublingual gland. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:176-179. [PMID: 23893549 DOI: 10.1002/jcu.22072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 06/12/2013] [Indexed: 06/02/2023]
Abstract
Congenital agenesis of the submandibular gland is uncommon. We report dynamic sonography and CT findings of the unilateral submandibular gland agenesis associated with herniated hypertrophic sublingual gland tissue through the mylohyoid gap. The dynamic sonography examination applied at rest and during the modified Valsalva maneuver demonstrated hypertrophied sublingual gland prolapsing to the anterior part through the mylohyoid gap. This may be the first reported case describing dynamic sonography findings of this entity. CT confirmed the agenesis of the left submandibular gland and compensatory hypertrophy of the ipsilateral sublingual gland.
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Affiliation(s)
- Hasan Yerli
- Baskent University, Zubeyde Hanim Practice and Research Center, Department of Radiology, 6371 Sk. No. 34 Bostanli/Karsiyaka, Izmir, Turkey, 35590
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Harrison JD, Kim A, Al-Ali S, Morton RP. Postmortem investigation of mylohyoid hiatus and hernia: aetiological factors of plunging ranula. Clin Anat 2013; 26:693-9. [PMID: 23355334 DOI: 10.1002/ca.22212] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 10/31/2012] [Accepted: 11/20/2012] [Indexed: 11/11/2022]
Abstract
The mylohyoid hiatus and hernia were discovered in the nineteenth century and were considered to explain the origin of the plunging ranula from the sublingual gland. This formed the rationale for sublingual sialadenectomy for the treatment of plunging ranula. However, a more recent, extensive histological investigation reported that hernias contained submandibular gland, which supported an origin of the plunging ranula from the submandibular gland and submandibular sialadenectomy for the treatment of plunging ranula. We therefore decided to investigate the occurrence and location of the hiatus and the histological nature of the hernia. Twenty-three adult cadavers were dissected in the submandibular region. The locations and dimensions of mylohyoid hiatuses were measured before taking biopsies of hernias. Hiatuses with associated hernias were found in ten cadavers: unilateral in six; and bilateral in four, in one of which there were three hiatuses. Sublingual gland was identified in nine hernias and fat without gland in six. This investigation supports clinical and experimental evidence that the plunging ranula originates from the sublingual gland and may enter the neck through the mylohyoid muscle. It confirms the rationale of sublingual sialadenectomy for the treatment of plunging ranula.
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Affiliation(s)
- John D Harrison
- Department of Oral Pathology, King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, London, England.
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Sigismund PE, Bozzato A, Schumann M, Koch M, Iro H, Zenk J. Management of ranula: 9 years' clinical experience in pediatric and adult patients. J Oral Maxillofac Surg 2012; 71:538-44. [PMID: 23010374 DOI: 10.1016/j.joms.2012.07.042] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 07/10/2012] [Accepted: 07/12/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the long-term results in the authors' department in the management of patients with oral and plunging ranulas. A specific diagnostic and therapeutic approach is suggested based on these data and data from the literature. MATERIALS AND METHODS A retrospective analysis of 65 patients with a final diagnosis of ranula was carried out. The medical records were evaluated for the principal demographic, clinical, diagnostic, and therapeutic data. Statistical analysis was used to compare outcomes of the different treatments. RESULTS Treatments that included complete sublingual gland excision were associated with the lowest recurrence rate (3.6%), followed by partial sublingual gland excision (9.1%), marsupialization (13%), and ranula excision (36.7%). Nine patients (13.8%) had recurrences. A statistically significant difference was observed (P = .01) in the recurrence rate between complete sublingual gland excision and ranula excision alone. Complications developed in 7 patients (10.8%). Ultrasonography performed in all patients showed an intimate relation among the cyst, mylohyoid muscle, and sublingual gland. Dehiscence of the mylohyoid muscle was noted in some cases. CONCLUSIONS The surgical experience in the authors' department confirms the different treatments that are offered for ranula. Sublingual gland excision should be the preferred treatment, but marsupialization may be useful as an alternative minimally invasive procedure, with a success rate higher than 85% and no risk of increased complications if revision surgery is needed. Ultrasound is the recommended diagnostic tool, in addition to the clinical examination, for the differential diagnosis and during follow-up.
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Affiliation(s)
- Paolo Enrico Sigismund
- Department of Specialized Surgical Sciences, Università degli Studi di Milano, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Law CP, Chandra RV, Hoang JK, Phal PM. Imaging the oral cavity: key concepts for the radiologist. Br J Radiol 2011; 84:944-57. [PMID: 21933981 DOI: 10.1259/bjr/70520972] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The oral cavity is a challenging area for radiological diagnosis. Soft-tissue, glandular structures and osseous relations are in close proximity and a sound understanding of radiological anatomy and common pathways of disease spread is required. In this pictorial review we present the anatomical and pathological concepts of the oral cavity with emphasis on the complementary nature of diagnostic imaging modalities.
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Affiliation(s)
- C P Law
- Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Otonari-Yamamoto M, Nakajima K, Tsuji Y, Curtin HD, Hanyuda H, Okano T, Sano T. Mylohyoid muscle defects: comparison of CT findings and dissected specimens. Oral Radiol 2011. [DOI: 10.1007/s11282-011-0066-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Surgery for plunging ranula: the lesson not yet learned? Eur Arch Otorhinolaryngol 2011; 268:1513-8. [PMID: 21328001 DOI: 10.1007/s00405-011-1509-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 01/20/2011] [Indexed: 10/18/2022]
Abstract
Our objective is to review our experience with treatment of plunging ranula and examine the efficacy of transoral excision of sublingual gland as the principal treatment. This study comprises a case series with chart review. A secondary otolaryngology service was used as the setting. Retrospective analysis of patient records was performed for a series of 95 consecutive cases of plunging ranula, which presented to our department between January 2001 and February 2010. Clinical presentation, investigations, diagnosis, treatment, complications and outcome were recorded. Literature search was performed using MEDLINE and OLD MEDLINE. 81 cases of plunging ranula were treated surgically by transoral excision of sublingual gland and evacuation of ranula contents. Mean operating time was 75.3 min. Twelve patients had undergone previous surgery elsewhere. One patient in our series had a recurrence, needing excision of sublingual gland remnant. Two patients had trauma to submandibular duct requiring excision of submandibular gland. Other complications were minor and transient. Review of literature revealed many diverse methods of treating ranula, with varying results. Our series makes a substantial contribution to the number of plunging ranulas reported in the world, and supports the use of transoral sublingual gland excision as first-line treatment of plunging ranula.
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Imaging of the mylohyoid muscle: separation of submandibular and sublingual spaces. AJR Am J Roentgenol 2010; 194:W431-8. [PMID: 20410390 DOI: 10.2214/ajr.09.3516] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This article focuses on the anatomy of the mylohyoid muscle, a crucial landmark in imaging of the oral cavity and upper neck, showing dissected specimens and CT and MR images. CONCLUSION Identification of the relationship of a lesion in the sublingual space to the mylohyoid muscle using MDCT and high-resolution MRI is a key part of the imaging assessment of the oral cavity and upper neck.
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Morton RP, Ahmad Z, Jain P. Plunging Ranula: Congenital or Acquired? Otolaryngol Head Neck Surg 2010; 142:104-7. [DOI: 10.1016/j.otohns.2009.10.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Revised: 09/03/2009] [Accepted: 10/14/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE: To review our clinical experience with plunging ranula and examine the evidence in support of our impression that plunging ranula has a genetic basis. STUDY DESIGN: Case series with chart review. SETTING: Secondary otolaryngology service. SUBJECTS AND METHODS: Review of the medical records of a clinical series of 80 consecutive plunging ranulas in 77 patients was conducted, with recording of clinical and radiological findings, surgical treatment, and outcome. A literature review using MEDLINE and OLD MEDLINE was performed. RESULTS: The majority of plunging ranulas had no intraoral component on clinical examination, although evidence of mucus extravasation from the sublingual gland could be found both radiologically and histologically in all cases. There were four patients with bilateral plunging ranula and one instance of siblings with unilateral plunging ranula. Maoris and Polynesians comprised more than 82 percent of our cases; this was a significant overrepresentation of these ethnic groups ( P < 0.0001). A very strong predominance of cases of Chinese origin was also evident in the literature. CONCLUSION: The clinical findings and the supporting data from the literature, when viewed in light of information relating to the known anatomical anomaly of a dehiscence in the mylohyoid muscle and ectopic sublingual gland lying below the plane of the mylohyoid, appear to support the case for a genetic basis for this unusual clinical entity.
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Affiliation(s)
- Randall P. Morton
- Department of Otolaryngology–Head and Neck Surgery (Drs Morton and Ahmad), Counties-Manukau DHB, Manukau City, New Zealand
| | - Zahoor Ahmad
- Department of Otolaryngology–Head and Neck Surgery (Drs Morton and Ahmad), Counties-Manukau DHB, Manukau City, New Zealand
| | - Prabha Jain
- Department of Radiology (Dr Jain), Counties-Manukau DHB, Manukau City, New Zealand
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15
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Jain P, Jain R, Morton RP, Ahmad Z. Plunging ranulas: high-resolution ultrasound for diagnosis and surgical management. Eur Radiol 2009; 20:1442-9. [PMID: 19943050 DOI: 10.1007/s00330-009-1666-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Revised: 08/30/2009] [Accepted: 09/07/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We see a high incidence of plunging ranulas, particularly in Maori and Polynesian populations. We have investigated the usefulness of ultrasound in the diagnosis and management of plunging ranulas and present our findings. METHODS Thirty-three new cases were examined over 4 years (June 2004 to October 2008). RESULTS High-resolution ultrasound was very successful in determining the extent of the plunging ranula, confirming the cystic nature of the lesion, assessing the status of the mylohyoid muscle (a defect demonstrated in 100% of our cases) and evaluating the sublingual gland for rupture or herniation. Correlation with surgical findings was available for 30 cases. There was excellent ultrasonographic and surgical correlation, particularly with respect to submandibular space cystic collection (29 of 30 cases, 96.7%) and mylohyoid defects (27 of 30 cases, 90%). CONCLUSIONS With the considerations of cost, accessibility and the fact that many of our patients are young (median of 20 years), ultrasound is recommended as the preferred examination for plunging ranula.
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Affiliation(s)
- Prabha Jain
- Department of Radiology, Middlemore Hospital, Counties Manakau, PO Box 93311, Private Bag, Otahuhu, Auckland, New Zealand.
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16
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Ahmed M, Strauss M, Kassaie A, Shotelersuk V, DeGuzman R. Bilateral submandibular gland aplasia with clinico-radiological mass due to prolapsing sublingual salivary tissue through mylohyoid boutonnière: a case report and review. Dentomaxillofac Radiol 2009; 38:121-4. [DOI: 10.1259/dmfr/63254814] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kiesler K, Gugatschka M, Friedrich G. Incidence and clinical relevance of herniation of the mylohyoid muscle with penetration of the sublingual gland. Eur Arch Otorhinolaryngol 2007; 264:1071-4. [PMID: 17479273 DOI: 10.1007/s00405-007-0321-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 04/03/2007] [Indexed: 10/23/2022]
Abstract
Swelling of the submandibular region may cause problems in daily clinical diagnosis and requires further exploration. Ultrasonic examination provides a simple, non-invasive and radiation-free method. The goal of our study was to show the high incidence of herniation of the mylohyoid muscle with penetration of the sublingual glands, in some cases clinically imposing as permanent swelling. Penetration was classified into four grades (Grade 0-III). In course of routine examinations of the neck by ultrasound, the anterior part of the mylohyoid muscle was observed in 124 consecutive patients from our outpatient's clinic, presenting with unclear swelling of the neck, mostly due to lymph nodes. In resting position and during swallowing the degree of penetration of the sublingual gland through the mylohyoid muscle was staged. Almost 60% of patients showed an affection of the mylohyoid muscle at either site of varying degrees. In 40% only a thinning of the muscle could be noticed (grade I), whereas in 21 patients (17%) a significant herniation of the gland during swallowing could be observed (grade II). In two patients (2%) a constant breach of the mylohyoid muscle with permanent herniation of the gland imposing as swelling could be seen (grade III). Occasional or permanent penetration of the sublingual gland through the mylohyoid muscle is not a rare finding and can be found in almost every fifth individual using ultrasound. This may impose clinically as permanent swelling and may be of value in the differential diagnosis of swelling in the submandibular region.
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Affiliation(s)
- K Kiesler
- Ear, Nose and Throat University Hospital, Department of Phoniatrics, Speech and Swallowing, Medical University Graz, Auenbruggerplatz 26-28, 8036 Graz, Austria.
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