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Introduction Ranulas are divided into oral (OR) and plunging (PR) and comprise the most common pathology of the sublingual gland. This study presents a case series of patients operated due to OR and PR within different type of modalities in a 1-year period. Objective The aim of this study is to determine the optimal surgical treatment of ranulas based on our results as well as in the literature review. Methods The medical charts of 7 patients with sublingual gland ranulas treated in 2020 were reviewed. Results The median age of the patients was 19. Three patients with OR were treated by marsupialization, micromarsupialization, and sublingual gland excision. Four patients with PR were operated via cervical approach in three cases and intraoral approach in one case. No recurrence was observed in 14 months of follow-up, on average. Conclusion Micromarsupialization should be consider as the primary treatment for OR. In case of recurrent OR and primary or recurrent PR, the best results might be obtained by radical excision of the sublingual gland, which can be performed without resection of the ranula sac with the intraoral approach.

Background and Objectives For plunging ranula, excision of the sublingual gland has been the major treatment option, with sclerotherapy being widely used as minimal invasive treatment. We compared the outcomes of these two methods as an initial treatment for ranula and investigated the outcomes of salvage procedure in recurred patients.Subjects and Method Patients were classified into the excision group (n=35) and the sclerotherapy group (n=39) according to the type of their initial treatment. The outcomes of the initial and salvage treatment were determined as recurrence or non-recurrence at 3 months after treatment, and statistically compared between the excision and the sclerotherapy groups.Results Recurrence in the sclerothearpy group (n=20, 51.3%) showed a significantly higher rate (p

Introduction: Neck masses are frequently encountered in clinical practice and differential diagnoses of a patient presenting with a neck mass is wide. Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) is an imaging technique based on molecular diffusion. It is a very helpful complementary technique in distinguishing neoplastic from non neoplastic tissue and has numerous applications in the evaluation of head and neck masses especially in head and neck lymphadenopathy. Aim: To evaluate the accuracy of Apparent Diffusion Coefficient (ADC) in differentiating benign and malignant neck masses. Materials and Methods: A single-centre cross-sectional study comprising of 50 patients of all age groups with clinical suspicion of neck swelling was conducted in Department of Radiodiagnosis at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India from March 2018 to February 2020. All patients included were subjected to general physical and detailed local examination. MRI was carried out on 1.5 Tesla Unit On Philips Intera Achieva using Sense Body Coil with b factor of 0 and 1000 s/mm² and ADC maps were generated and the results were compared with histopathological results and/or follow-up. Statistical assessment was carried out using Statistical Package for the Social Sciences (SPSS) version 24.0. Qualitative data were compared using the Chi-square test. Results: The most common cause of neck mass was lymph nodal masses (18%) with highest numbers of patients in age group 40-60 years (34%). When a cut-off ADC value of 1.1×10-3 s/ mm² was used, sensitivity of 95.23% and specificity of 89.65% were obtained for characterisation of malignant lesions which was statistically significant. There was a strong agreement (k value=0.838) in diagnosing the nature of lesion using ADC value on MRI with histopathological findings. Conclusion: Diffusion Weighted Imaging (DWI) and ADC values are new promising aspect of MRI and can help in differentiating the nature of the neck lesions. DWI can readily differentiate between benign and malignant lesions of neck with good efficacy and reproducibility.

There are 2 types of ranulas: oral ranulas and plunging (cervical) ranulas. The management of the cervical ranula involves surgical excision of the oral portion of the ranula along with the associated sublingual salivary gland. The sublingual gland is easily removed from an intraoral approach. Significant anatomic structures associated with the removal of the sublingual gland are the submandibular duct, lingual nerve, and sublingual artery. Knowledge of the anatomy makes the surgery easier and without complications.

Ranula is a rare benign cystic lesion in the floor of the mouth, which can herniate through the mylohyoid muscle and become a plunging ranula. Treatment for ranulas is currently surgical excision of the sublingual gland. Sclerotherapy with OK-432 is a well-established treatment of lymphatic malformations, but not yet thoroughly evaluated on ranulas. Objectives: To evaluate sclerotherapy of ranulas with OK-432 in a randomized double-blinded trial.20 patients with plunging or intraoral ranula were randomized to two double-blinded injections with OK-432 or saline. Effect on the ranula and evaluation of symptoms and QOL were investigated.Treatment response differed significantly between OK-432 and placebo,This study suggests that sclerotherapy with OK-432 in ranula is a very effective treatment for intraoral ranulas, but possibly less useful in plunging ranulas.This is a limited study, but we believe that sclerotherapy with OK-432 should be recommended as primary treatment at least for intraoral ranulas.

Mucoceles originating in submandibular gland (SMG) which are extravasation type are extremely rare. Because the extraoral approach with potential risks of facial nerve injury and scar formation is commonly performed, we report endoscopically-assisted intraoral removal of submandibular gland mucocele as minimally invasive surgery. A 28-year-old female was referred to our department with an eight-week history of left submandibular painless swelling. Radiological diagnosis was not plunging ranula but SMG mucocele. The patient underwent endoscopically-assisted intraoral removal of SMG under general anesthesia as minimally invasive surgery. A mucosal incision on the left oral floor was made. After soft tissues surrounding the SMG were dissected bluntly, the mucocele and SMG were exposed more prominently by digital pressure applied beneath the lower border of the mandible by an assistant. The SMG was gripped with forceps after aspiration of mucocele, and pulled up through the incision by gland dissection. Because the facial artery penetrated the SMG, the facial artery was ligated and cut. The SMG with mucocele was removed completely in intraoral approach. Although there was no continuity with SMG and sublingual gland (SLG), the SLG was also removed preventively. The pathological diagnosis was SMG mucocele. Although lingual nerve paresthesia occurred postoperatively, the paresthesia was recovered completely 3 weeks after surgery. There was no recurrence 2.5 years after surgery. Because intraoral removal of SMG can be performed without cervical scar and facial nerve injury, this intraoral approach with endoscopic assistance can be an alternative to transcervical approach.

Plunging ranulas are recognized as soft cystic swellings in the submandibular gland area of the upper cervical region. Here, we report the case of a patient who had a large plunging ranula that extended to the inferior lingular segment of the left lung. A surgical excision of the sublingual gland was performed, and a drainage tube inserted in the neck. After two years of follow-up, there was no evidence of recurrence of the ranula. Although there are several methods of treating plunging ranulas, we demonstrate here that sublingual gland excision is an appropriate treatment modality for cases of large plunging ranula.

Background: Ranula may grow into a considerable size as to cause obstructive symptoms, especially in infants when neglected. The aim is to describe the clinical presentation, treatment, and outcome of ranulas. Methods: This is a retrospective study of patients with ranulas that presented during the periods of January 2000 to December 2019 in the Department of Otorhinolaryngology, Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Northwest, Nigeria. Results: A total of 29 patients were seen during the review period: twelve (41.4%) males and 17 (58.6%) females. Age ranged from 3 days to 48 years (median 3 years). Most of the patients 19 (65.5%) were below the age of 10 years. Twenty-one (72.4%) patients had simple oral ranulas: 8 (38.1.6%) patients were congenital ranulas characterized by tongue protrusion and dysphagia. Plunging ranulas were seen in 8 (27.5%) patients, and 2 (25%) of these patients were HIV infected. Simple marsupialization was done for 10 (34.5%) patients, and one of these patients had an elective tracheostomy for difficult intubation. Sublingual gland excision and with the evacuation of the cyst were done for 16 (55.2%) patients. One of the patients with plunging ranula opted for conservative management. Only 12 (41.4%) patients came for follow up: a patient had recurrence 2 years after excision of plunging ranula. Conclusion: Ranula, when neglected can cause obstructive symptoms presenting as tongue protrusion in children. Inadequate follow up was seen in the majority of the patients. Adequate follow up to determine the recurrence, especially those who had marsupialization, is most desirable.

Background: Ultrasound-guided-fine-needle aspiration drainage (US-FNAD) and US-percutaneous ethanol injection (US-PEI) have been widely used in the management of benign neck cysts. However, the long-term results of US-FNAD and US-PEI are not well elucidated. Methods: We retrospectively collated patients under neck US examinations from March 2007 to December 2017 and investigated the recurrence after US-FNAD and US-PEI. Univariate and multivariate Cox regression analyses were used to assess significant risk factors for recurrence after US-FNAD. Results: A total of 1075 patients were recruited, and their age was 50 ± 15 (mean ± standard deviation) years. A total of 862 patients had thyroid cysts, 118 patients had thyroglossal duct cysts (TGDC), twenty patients had branchial cleft cysts, 64 patients had parotid sialocysts, and 11 patients had plunging ranulas. Majority of the patients (97%, 1037/1075) reported significant symptom improvement immediately. However, 38% of the patients had recurrence with a median 3-year follow-up period. In a multivariate Cox regression analysis with adjustment for age and gender, plunging ranula (hazard ratio [HR]: 2.44, 95% confidence interval [CI]: 1.19–4.99) and lateral dimension size ≥ 0.8 cm (HR: 1.32, 95% CI: 1.04–1.67) after US-FNAD were independent risk factors for recurrence. There were 15 male and 19 female patients who received US-PEI therapy after repeated US-FNAD, of whom 23 patients had thyroid cysts, 6 had plunging ranulas, 4 had TGDC, and one had a branchial cleft cyst. The overall success rate was 94% (32/34), with a median follow-up period of 1.6 years. Two recurrent symptomatic patients had plunging ranulas. Some patients stated mild pain (21%, 7/34) and swelling sensation (26%, 9/34) after the injection. No major complications, such as vocal fold paresis or airway compression, were found. Conclusion: US-FNAD is an effective tool in the management of benign neck cysts with a 38% recurrence rate. Plunging ranulas have the highest rate of recurrence after FNAD. US-PEI is effective for most recurrent neck cysts after repeated US-FNAD.

Juvenile primary Sjögren’s syndrome (pSS) is rare. Although recurrent parotitis is reported to be the most common symptom of juvenile pSS, the clinical symptoms and features of the syndrome are not well understood and are poorly defined. Here we report a rare case of juvenile pSS in a patient with plunging ranula. The patient had no symptoms other than swelling of the oral floor and had no symptoms of parotitis. Magnetic resonance imaging (MRI) revealed the diagnosis of plunging ranula. In addition, the findings of the bilateral parotid glands on MRI and subsequent ultrasonography (US) strongly suggested SS. On the basis of these imaging findings and laboratory data, a pediatric rheumatologist confirmed the diagnosis of juvenile pSS. The ranula may be one clinical sign of SS. However, this association remains generally unknown. Hypothesizing that SS might cause ranula development, we retrospectively investigated cases of patients with ranula who underwent MRI at our hospital. We found that many of these patients (> 20%) had characteristic findings strongly suggestive of SS. This result suggests that SS-induced changes in the sublingual glands are one cause of ranula formation. We think that ranula is a sign of early-stage SS. Therefore, patients with ranulae, whether adults or children, should undergo careful assessment of not only the sublingual glands but also the parotid and submandibular glands with MRI and/or US to investigate possible SS. This assessment may lead to early detection of SS.

Epidermoid cysts are abnormal structures originating from abnormal ectoderm and are benign and slow growing. These are found anywhere in the body. They arise during embryonic fusion due to entrapment of epithelial remnants and sometimes due to faulty implantation of the epithelium. The cysts can be epidermoid (squamous epithelium), true dermoid (skin apppendages), and teratoid (all germ layers). They are usually diagnosed by fine-needle cytological aspiration and require imaging to plan line of treatment. Diagnostic dilemma is always an issue as cystic lesions are commonly found in the head-and-neck region. Here, we present a case of large epidermoid cyst involving sublingual and submandibular region.

OBJECTIVES We present a series of bilateral plunging ranula patients to examine the etiology, diagnosis, treatment, and prognosis of this condition. METHODS A retrospective chart review was performed on all cases of plunging ranula treated at the Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, New Zealand, between 2001 and 2019. RESULTS There were 17 patients with bilateral plunging ranulas from a total of 187 plunging ranula patients. Eight patients were of Pacific Island descent; six were Maori; and three were Asian. There were no European patients with bilateral plunging ranulas. There were three types of bilateral plunging ranula patients: 1) Metachronous plunging ranulas-Five patients presented with a unilateral plunging ranula with no evidence of a contralateral plunging ranula on initial imaging. Despite negative contralateral imaging findings, these patients developed a clinically evident contralateral plunging ranula 21 to 61 months later. 2) Synchronous plunging ranulas detected on imaging-Eight patients presented with a clinically evident unilateral plunging ranula but also had a contralateral plunging ranula detected on imaging. 3) Clinically evident synchronous plunging ranulas-Four patients presented with bilateral clinically evident plunging ranulas, which were also evident on imaging. Twelve patients underwent bilateral transoral sublingual gland excision and plunging ranula evacuation. CONCLUSION All patients with a unilateral plunging ranula should be advised of the potential for developing contralateral disease, and this should be emphasized in patients of Pacific Island, Maori, and Asian descent. LEVEL OF EVIDENCE 4 Laryngoscope, 131:73-77, 2021.

Ranula is a mucocele caused by extravasation of the sublingual gland on the floor of the mouth. The most common presentation is a cystic mass in the floor of the mouth. A portion of the sublingual gland could herniate through the mylohyoid muscle, and its extravasated mucin can spread along this hiatus into submandibular and submental spaces and cause cervical swelling. This phenomenon is called plunging ranula. A variety of treatments for ranula has been suggested and include aspiration of cystic fluid, sclerotherapy, marsupialization, incision and drainage, ranula excision only, and excision of the sublingual gland with or without ranula. Those various treatments have shown diverse results. Most surgeons agree that removal of the sublingual gland is necessary in oral and plunging ranula. Four patients with ranula were investigated retrospectively, and treatment methods based on literature review were attempted.

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We report the case of a 6-year-old patient with suspected recurrence of a plunging ranula in clinical and ultrasonographic examination. Surgical resection of the left submandibular and sublingual glands had already been performed. Since persistent glandular tissue could not be excluded with certainty via MRI, we expanded diagnostics by performing a PET/MRI using a head and neck imaging protocol and the radiotracer 18F-PSMA-1007, which is physiologically expressed by salivary gland tissue. The 18F-PSMA-PET/MRI provided evidence of a cystically transformed, diminishing seroma in the left retro-/submandibular region. No 18F-PSMA expressing glandular tissue could be detected in the area of resection, excluding a relapse of a plunging ranula. As a consequence, we opted for a conservative treatment without further surgical intervention. We conclude that a simultaneous 18F-PSMA-PET/MRI is a comprehensive imaging modality, which can help to rule out persistent salivary tissue and recurring plunging ranula. It is a useful tool to facilitate the decision making of surgical interventions.

Ranulas are mucoceles that occur as a result of saliva's leakage from a sublingual gland, due to obstruction or trauma of its duct. Ranulas can either be confined to the floor of the mouth or invade submandibular and submental spaces. In this case, they are called plunging ranulas which are rarely found in children. The aim of this study is to report a case treated by our group and discuss its management.

Neck masses in children are a common clinical concern but there is a paucity of published information about them. We organised this retrospective study to analyse their prevalence and treatment in Northwest China. The records of 207 children who presented with neck masses between 2008 and 2017 were retrieved from the Department of Oral and Maxillofacial Surgery, Lanzhou University Second Hospital, and age, sex, clinical presentation, preoperative investigation, surgical procedure, histopathological diagnosis, and complications were recorded. Their mean (range) age was 10 years (6 months to 21 years), and the male:female ratio was 1.23:1. In total 128 patients (62%) had congenital lesions, 35 (17%) had inflammatory lesions, and 44 (21%) had neoplastic lesions. The most common mass was a thyroglossal cyst (31%), followed by plunging ranula (17%) and lymphangioma (16%). Temporary injury to the facial nerve and wound infection were the major complications of surgical treatment. The types of neck masses in Northwest China differ from those previously reported, which may be attributed to genetic alterations in people of this race. The present report adds to the knowledge of diagnosis and treatment of neck masses in children in Northwest China, and brings out the demographic differences between races.

Introduction Ranula is a pseudocyst in the floor of the mouth originating from the sublingual salivary gland.A variety of surgical procedures have been quoted in the literature. But the main concern is high rate of recurrence. Aim of the present study is to describe a definitive technique for managing ranula and compare the result with review of literature. Materials and Methods A prospective study was done in the department of ENT in a tertiary care hospital of West Bengal from 1st April, 2014 to 31st March, 2019. Patients presenting with ranula irrespective of age and sex; size of the mass; whether primary or recurrent case were included in the study. Patients presenting with congenital and plunging ranula were excluded. Patients were treated with total excision of ranula along with sublingual salivary gland. Patients were followed up regularly for at least one year post-operatively. Results We treated thirteen primary and four recurrent cases of ranula. Among them eight were male and nine were female. Patients were from seven to thirty three years of age with most being in the second decade of life. There was no injury to lingual nerve or submandibular duct in any patient. We did not observe any recurrence till date. Conclusion Successful management of a ranula includes identification of the extent of the cyst and removal of the cyst along with the sublingual salivary gland. When done meticulously, this technique gives 100% success without any complication.

Histopathologically adult extracardiac rhabdomyoma is a benign tumour of mature striated muscle. It is a slow- growing tumour with predilection to occur in head and neck region. They appear mainly as a solitary lesion, and about 15% of them can be multicentric. A 56-year-old man presented to us with the floor of mouth swelling persisted for one year and the right neck swelling for three years mimicking a plunging ranula. Radiological imaging revealed enhancing mass at the floor of mouth and submandibular region. The mass represented a nonvascular benign tumour. Subsequently, the patient underwent excision of the mass via transcervical and transoral method. Histopathological examination revealed adult type of extracardiac rhabdomyoma. Adult type of extracardiac rhabdomyoma should be considered in the differential diagnosis for the head and neck masses. A complete excision will reduce the risk of recurrence.

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.

The incidence ranging of the dermoid and epidermoid cysts on the head and neck, from 1.6 to 7.0%, and they represent less than 0.01% of all oral cavity cysts. Histologically, they can be further classified as epidermoid, dermoid or teratoid. We analyzed two rare cases of large epidermoid cysts of the floor of the mouth, with sublingual as well as submental component resembling plunging ranula. Two female patients (age 15 and 16 y. o.), who’s had sublingual and submental swellings of oral floor with breathing and swallowing difficulties. The suspected clinical diagnosis of the sublingual dermoid or epidermoid cysts were supported by the radiological finding after performing ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI). On the radiological investigation the differentiation between epidermoid cysts, ranulas, cystic tumours, mucous extravasation phenomena and hygromas sometimes indistinguishable, leading in the determination of internal component differentiation and has pathognomonic signs to differentiate. The lesions were surgically excised using an intraoral approach. Microscopic examinations revealed a dermoid cyst of the epidermoid type. Keywords: Sublingual Epidermoid Cyst, Plunging Ranula, Ultrasonography, Computed Tomography, Magnetic Resonance Imaging

Plunging ranulas are most often treated surgically; various surgical approaches may be necessary depending on the unique characteristics of each case. Here, we present the case of a plunging ranula noted on imaging to have a cordlike tether, which was revealed intraoperatively to be the lingual nerve. This case illustrates the importance of preoperative imaging for surgical planning, and when a transcervical approach may be the best choice for plunging ranulas.

BACKGROUND Plunging ranulas are rare mucous extravasation pseudocysts that arise in the floor of the mouth and pass into the submandibular space of the neck. The aim of this study was to investigate the diagnosis, surgical management and outcomes of patients with a plunging ranula at our institution in South East Queensland over a 10-year period. METHODS A retrospective analysis of adult patients diagnosed with and treated for plunging ranula between 2006 and 2016 at Logan Hospital was conducted. Patient demographics, preoperative investigations, surgical management and post-operative outcomes were collected from medical records. RESULTS A total of 18 adult patients were treated for plunging ranula. Of the 18 cases, 17 were treated via transoral excision of the sublingual gland. The mean age at presentation was 28.8 years with a 3:1 female to male predominance. Fifty-six percent of patients were of Polynesian descent. The success rate was 94% with only one patient experiencing recurrence and requiring re-excision of remnant sublingual gland tissue. Three patients (17%) developed complications related to post-operative bleeding. There was a slight predominance for right-sided disease (56%) compared with left and one case of bilateral plunging ranulas in this series. CONCLUSION This study demonstrates that excision of the sublingual gland is an effective and safe treatment for plunging ranula. The majority of plunging ranulas occur in patients aged

Objective The aim of this article was to conduct a 25-year retrospective study within an oral surgery department, on the incidence of the ranula in children and its ideal treatment, associated with a literature review on the plunging ranula in pediatrics. Methods A retrospective review of the medical records of pediatric patients (0–12 years) from 1995 to 2020 was performed in an oral surgery department in Maringa/Brazil. The examined data included age of the patients, sex, clinical signs, time of evolution and follow-up, complementary exams, type of ranula, diagnostic hypothesis, surgical procedures and accesses, complications and recurrence. In addition, a literature review was carried out on the plunging ranula in children, using the MEDLINE database, from 1995 to 2020, with the search terms: “PLUNGING RANULA” OR “CERVICAL RANULA. A PICOS was established and PRISMA standards were followed. Results In the retrospective study, of the 11 patients found, 10 were with simple ranulas and only 1 with plunging ranula. All patients were approached by intraoral access, and conservative treatments had higher recurrence rates. The case of plunging ranula was treated by intraoral resection of the sublingual gland and saliva drainage, and obtained good results with 15 years of follow-up. In the literature review, 372 articles were found, which 10 were qualitatively selected after inclusion and exclusion criteria. Excision of the sublingual gland was the most prevalent procedure, and intraoral and extraoral accesses had the same incidence, despite the fact that the last one had higher percentages of complications. Conclusion The treatment of ranulas is variable; however, it is proven that conservative methods have higher rates of recurrence. As for the plunging ranula, resection of the sublingual gland through intraoral access, associated with mucus leakage, is considered a safe and effective treatment.

Key Clinical Message Plunging ranulas are rare; report of this condition is particularly limited in our environment. We present case series in children; with all cases having both oral and cervical components. It is important to note this type of presentation of plunging ranula and their appropriate management.

Dermoid cyst of the floor of the mouth is a rare condition. It usually present as a non-tender, slow growing swelling at the sublingual region. The clinical presentation may be similar to several other conditions. We report a case of an adolescent female who present at our institution with a sublingual swelling which was initially diagnosed as a plunging ranula. The lesion was excised together with the sublingual gland and then diagnosed histologically as a dermoid cyst. Post-operative healing was uneventful. This report will also review the current literature on the clinical, radiological and histological aspect of the dermoid cyst to give the reader a greater understanding of this rare condition.

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.

A ranula is a salivary gland cyst that typically presents as a localized superficial swelling on the floor of the mouth. A plunging ranula may develop when extravasation of mucus extends through or around the mylohyoid muscle and deeper into the neck, and can present as a neck lump with or without swelling on the oral floor. Here, we report a case of repeated local recurrence of a plunging ranula that expanded into the infratemporal fossa and was successfully treated by an intraoral surgical treatment. An 11-year-old otherwise healthy Japanese girl presented with extravasation and swelling in the left submandibular region, decreased flow of saliva from the sublingual and submandibular glands, and a 3 × 2 cm fluctuant swelling on the oral floor. Magnetic resonance imaging showed a large plunging ranula expanding to the infratemporal fossa. Surgical fenestration of the cyst wall and extirpation of the sublingual gland was performed using an intraoral approach. A Penrose drain was placed in the oral floor after fenestration of the cyst wall. The lesion was found to have expanded from the submandibular space to the infratemporal fossa through the parapharyngeal space. Drainage was effective, and the postoperative course was uneventful and without recurrence after 1.5 years of follow-up.

Background/Aims: Plunging ranulas are oral mucoceles that often cannot be visualized directly and thus can be challenging to diagnose and differentiate from other neck lesions. Surgery is the preferred treatment option, but the optimal approach requires careful consideration. Methods: We report the case of a plunging ranula presenting as an isolated neck mass in a 33-year-old patient. This patient was treated with a novel transoral robotic surgery (TORS)-assisted approach aided by sialendoscopy. Results: TORS allowed for exceptional visualization and access to the plunging ranula and sublingual gland while avoiding critical neurovascular structures. The patient healed well without recurrence or complications. Conclusion: The TORS approach with sialendoscopy for plunging ranulas described in this case report shows promise and should be considered for certain clinical presentations. Additional studies evaluating the effectiveness of TORS for plunging ranulas may be indicated.

Plunging ranulas are pseudocysts in which mucous have extravasated either around or through the mylohyoid muscle to escape the confines of sublingual space to involve the submandibular and inferior aspect of parapharyngeal spaces. We describe a rare case of extensive bilateral plunging ranula in which involvement of multiple tissue spaces was well illustrated by magnetic resonance imaging. Clinical and histologic features and pathogenesis have been concisely discussed. The ranulas mostly occur unilaterally and to the best of our knowledge, the development of two discrete ranulas/bilateral presentations in the same patient is especially rare and very few cases have been reported until now. Although the cause of extravasations remains unclear, this case report is significant because of its characteristic possible habit-related etiology. How to cite this article Bishen KA, Singh A, Limaye M, Mishra K. Bilateral Plunging Ranula due to Habitual Etiology. J Oral Health Comm Dent 2017;11(1):19-22.

Objectives Plunging (or diving) ranulas are extravasation pseudocysts arising from the sublingual gland that present as soft submandibular swelling. The "tail sign" has been widely reported as pathognomonic for their diagnosis. It is described as a smooth tapering comet-shaped unilocular fluid mass with its "tail" in the collapsed sublingual space (SLS) and its "head" in the posterior submandibular space. This sign is based on the premise that extravasated saliva from the sublingual gland in the SLS escapes and plunges, over the posterior edge of the mylohyoid muscle into the submandibular space. Therefore, some fluid must be present in the posterior SLS in almost all patients with plunging ranulas. This study aimed to determine the frequency of fluid seen with ultrasound (US) in the posterior SLS to corroborate the tail sign. Methods A total of 126 consecutive cases of surgically proven plunging ranulas were investigated with US over 13 years. The findings were reviewed retrospectively for the prevalence of fluid in the posterior SLS. Results Thirteen patients (10.3%) showed SLS fluid on US images. Most showed fluid extension through a mylohyoid dehiscence. Only 2 patients (1.6%) showed fluid within the posterior SLS, and 1 patient alone in this entire study showed all of the components of the classically described tail sign. Conclusions This largest ever radiologic study showed low prevalence of the tail sign in 2 of 126 patients. A mylohyoid dehiscence was the more common route for extravasation. Absence of the tail sign does not exclude the diagnosis of a plunging ranula.

[No abstract available]

Ranula is an oral floor cyst, originating from the extravasation of salivary mucus from the sublingual gland due to obstruction of the gland ducts. This report presents the case of an extensive congenital plunging ranula in a 19-day-old male newborn. The infant presented easy fatigue, with delay in the time of the feedings during breastfeeding due to volumetric enlargement in mouth floor and ventral tongue regions since birth. The therapeutic proposal was marsupialization of the lesion. However, during surgery, due to the ranula’s location and the possibility of relapse, the enucleation of the lesion was performed. Infant was kept intubated in the neonatal ICU for three days and was under nasogastric fed for seven days. Excision of the ranula and maintenance of intubation was done until the reduction of post-operative oedema prevented intercurrences in the post-operative period and allowed a good clinical evolution of the child who recovered his respiratory and digestive function.

Simple ranula is a cystic swelling confined to the floor of mouth while plunging ranula presents with extension to the neck. Congenital ranula presenting with symptoms of feeding difficulties is a very rare occurrence. There is paucity of literature regarding the management of large congenital ranula. Varied treatment options are described for the management of ranula with variable recurrence rate. In paediatric and adult patients, ranula is considered as a type of extravasation cyst and removal of sublingual gland is advocated to remove the sources of extravasation. Congenital ranula is usually a variant of retention cyst and should be treated with marsupialisation or simple excision of cyst while cyst excision with sublingual sialadenectomy should be reserved for recurrent cases.

Rânula é definida como um pseudocisto originada do extravasamento de líquido mucinoide da glândula sublingual, frequentemente associado a trauma ou obstrução do ducto da glândula. Clinicamente, caracterizada por uma coloração azulada, translúcida localizada no assoalho bucal e pode ser classificada como rânula intraoral ou mergulhante. O diagnóstico inclui exame clínico detalhado e exames de imagens combinados com achados histopatológicos. Abordagens terapêuticas podem ser aplicados para tratamento esta lesão, como marsupialização, exérese da rânula associada ou não a glândula sublingual e exérese da rânula juntamente a glândula sublingual e submandibular. O objetivo deste artigo foi relatar um caso de rânula mergulhante, tratada por exérese seguida de marsupialização da lesão cística, após um ano de acompanhamento com recidiva. Concluímos que um tratamento menos invasivo pode não apresentar a melhor estratégia para o tratamento de rânula mergulhante, devido as maiores chances de recidiva.

Objectives/Hypothesis Estimate the incidence rate and provide basic descriptive epidemiologic characteristics of plunging ranulas in a multi-ethnic population. Study Design Case series with chart review. Methods The study group comprised all Counties Manukau Health (CMH, Manukau City, Auckland, New Zealand) patients presenting to the CMH Department of Otolaryngology with a diagnosis of plunging ranula from January 2001 to December 2013, as recorded in the departmental case register. Non-CMH domicile patients were excluded. South Auckland comprised the base population, as serviced by CMH. The 2006 New Zealand census data was used for population demographics. Results A total of 134 cases of plunging ranula were identified. The overall annual crude incidence rate was 2.4 per 100,000 person-years. The gender specific incidence rate for males was 3.2 per 100,000 (95% confidence interval [CI]: 2.5. 3.9) and for females was 2.0 per 100,000 (95% CI: 1.5, 2.6). The overall age-adjusted annual incidence rate was 2.6 per 100,000 (95% CI: 2.1, 3.0). The age-adjusted incidence was highest among Maori (6.7 per 100,000, 95% CI 4.9, 8.4), followed by Pacific Island (4.4 per 100,000, 95% CI 3.2, 5.6), Asian (0.7 per 100,000, 95% CI 0.2, 1.2), and European population (0.6 per 100,000, 95% CI 0.3, 0.8). Conclusion We have quantified for the first time the age-specific and age-adjusted incidence rates for plunging ranula by gender and ethnicity. The results show a likely underlying genetic predisposition for this condition, possibly with a superimposed environmental acquired factor relating to external, minor blunt trauma to the neck. Level of Evidence 4. Laryngoscope, 2016

Among all the epidermoid cysts originating throughout the body, 7% occurs in the head and neck region, with 1.6% intra-orally. Intra-orally, it is mainly located in the submandibular, sublingual and submental region as a benign, painless lesion. This leads to symptoms such as dysphagia, dyspnoea and have a malignant transformation potential as well. Treatment of choice is surgical excision. This is a case report of epidermoid cyst diagnosed clinically as plunging ranula.

Objective: Epidermoid cyst is a cystic malformation which is most common in second and third decades, quite rare in oral cavity, which can be congenital or acquired and does not include skin tags. In this case report, we defi ned a giant epidermoid cyst which is located in mouth fl oor involving oral and submental regions, mimicking “plunging ranula” and discussed its surgical treatment.

Evidence supporting any one treatment for plunging ranula is limited. Standard treatment-complete excision of the sublingual gland and ranula-is invasive and morbid given the close operative proximity to the submandibular duct and lingual nerve. OK-432 (Picibanil; Chugai Pharmaceutical Co., Tokyo, Japan) sclerotherapy has been studied as a less invasive treatment but is inaccessible in the United States. This report illustrates the successful management of a plunging ranula using ultrasound-guided percutaneous ethanol injection. Within 2 months of the procedure, the patient had complete resolution of the plunging ranula, with no associated side effects. We propose that ultrasound-guided percutaneous ethanol injection be considered for the management of plunging ranula. Laryngoscope, 127:2239-2241, 2017.

A ranula is a lesion that arises from mucin spillage from the sublingual or submandibular gland ducts, beneath the mucosa of the oral floor. A plunging or cervical ranula dissects the mylohyoid muscle and appears as a submandibular swelling. Rarely, a plunging ranula is encountered without its oral counterpart. Here, we report a rare case of a plunging ranula that occurred without its oral counterpart in a 11-year-old male patient. We have also discussed the pathogenesis and treatment options for the ranula.