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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. [ABSTRACT FROM AUTHOR]

Mucoceles usually originate from minor salivary glands. They rarely develop from the submandibular gland, and the location of all previously reported submandibular gland mucoceles is extra‐glandular. To the best of our knowledge, no reports have described a localized mucocele occurring within the submandibular gland. We herein present an extremely rare case of a localized mucocele including a sialolith that occurred in the submandibular gland. Extirpation of the submandibular gland including both the mucocele and sialolith was performed, and no postoperative complications occurred during the 2‐year follow‐up. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Treatment for ranula is classified into three categories depending on how the leaking saliva is managed: removal of the leaking site by intraoral or transcervical resection of the sublingual gland; formation of a drainage tract through the wall of the pseudocyst by micromarsupialisation or marsupialisation; or sealing of the site of the leak by inducing fibrosis with a sclerosing agent. Resection of the sublingual gland is probably the option most likely to be curative for both oral and plunging ranula considering their pathophysiology. Although alternative treatments have been introduced to avoid the invasiveness of resection of the gland, their outcomes have been inconsistent. The objective of this study therefore was to help decision-making by providing more integrated rates of cure, consistency of treatment, and morbidity, depending on types of treatment used in previous series of cases. We used proportion meta-analysis of 39 such published series, and the most curative treatment for oral ranula was intraoral resection of the sublingual gland. Micromarsupialisation and its modification showed cure rates comparable with those of resection of the gland, but these were moderately inconsistent. In the treatment of plunging ranula, there was no significant difference in cure rate between the intraoral and transcervical approaches, although they both showed higher cure rates than injection of OK-432. Comparisons of morbidity were available for patients who had developed nerve dysfunction and haematoma after the intraoral and transcervical approaches and there was no significant difference between the two, though the morbidity was higher after the transcervical than that after the intraoral approach. In conclusion, intraoral resection of the sublingual gland is sufficient treatment with a tendency to have fewer complications than that in the transcervical approach. [ABSTRACT FROM AUTHOR]

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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. [ABSTRACT FROM AUTHOR]

Plunging ranula is a mucous retention cyst found on the floor of mouth which arises from the submandibular and sublingual salivary glands extending to lateral aspect of neck, which may often cause potential airway obstruction leading to difficulty in airway management. A forty year old female patient was admitted to our hospital with large, painless swelling in the floor of mouth extending to the lateral part of body of mandible and neck. This intraoral swelling distorted the normal airway anatomy thus making airway management difficult as the patient was planned for excision of swelling under general anaesthesia. So we present a case of successful management of a difficult airway by using awake fibre optic intubation in a patient posted for excision of a large plunging ranula under general anaesthesia. [ABSTRACT FROM AUTHOR]

Abstract: Plunging ranulas arise when a simple ranula extends beyond the floor of the mouth into the neck. Diagnosis is difficult even with modern imaging techniques as they mimic other neck lesions, and traditional treatment involves enucleation of the cyst from the neck. Despite this invasive surgery they tend to recur. We describe a less invasive approach to treatment and review the diagnostic pitfalls. From 2002 to 2011, eight patients presented with a plunging ranula. They were split into two groups: those for whom an incorrect diagnosis was made and those where a less invasive treatment approach was employed. Three patients were misdiagnosed with cervical lymphangioma and had inappropriately invasive surgery. Five patients with established plunging ranulas were treated using an intraoral approach alone, eliminating the need for a cervical incision. Misdiagnosis of a plunging ranula leads to extensive and unnecessary surgery. We propose an algorithm to simplify investigation that employs a low threshold for fine-needle aspiration cytology. The cases presented indicate that these lesions can be managed by a less invasive procedure than currently practised. [Copyright &y& Elsevier]

Sclerotherapy with OK-432 injection has been recommended as the treatment of choice for plunging ranula because of its safety and minimal complications. However, the recurrence rate after sclerotherapy with OK-432 is variable and has been reported as 0–50%, and some reports have preferred surgical treatment despite the greater risk of potential complications. This article presents three cases of plunging ranula treated with ultrasound-guided injection of OK-432, resulting in successful regressions without major complications or recurrences. Ultrasound-guided intervention might increase the success ratio for sclerotherapy, despite the low number of patients for which it was effective in this study. [ABSTRACT FROM AUTHOR]

Summary: A plunging or cervical ranula is a mucous extravasation pseudocyst which arises from the sublingual gland and crosses the mylohyoid line into the neck. The definitive surgical treatment for plunging ranula is transoral excision of the ipsilateral sublingual gland. Plunging ranula is a rare entity in the pediatric population. To our knowledge, there are no reported cases of pediatric plunging ranula extending to the skull base. We present a rare case of a pediatric plunging ranula with extension to the parapharyngeal space and skull base as well as a review of the literature. [Copyright &y& Elsevier]

Abstract: An extremely rare case with asynchronous triple presentations of the salivary extravasation cyst was presented. A 5-year-old girl, who had a history of the Sistrunk surgery, presented with bilateral plunging ranulas first, and they were treated through an excision of the sublingual gland with an evacuation of the cyst via cervical and intraoral approach, respectively. Another cyst occurred later at the base of the tongue, and was excised through a laryngoscope. Histopathological examinations revealed all with no epithelial linings. The past surgery for thyroglossal duct cyst and/or its possible remnant may be associated with occurrence of these midline mucous cysts. [Copyright &y& Elsevier]

Abstract: Ranulas are rare cystic lesions resulting from damage or rupture of one or more of the ducts of the sublingual gland, that lead to mucus extravasation or dilatation of the gland''s duct. Extravasation cysts are more common than retention cysts. We present a case of a 45-year-old male with a squamous cell carcinoma of the ventral surface of the tongue that was treated with excision of the oral lesion and bilateral supraomohyoid neck dissection without supplementary radiotherapy. A left myocutaneous platysma flap was raised for defect closure. Ten months postoperatively he presented complaining of swelling of the right submandibular region. The diagnosis, based on his medical anamnesis and the CT imaging, was a sublingual-plunging ranula. It is postulated that the ranula resulted from damage to the ducts of the sublingual gland during selective neck dissection. One year postoperatively there are no signs of recurrence either of the ranula or of the cancer. We suggest that sublingual gland excision and intraoral cyst marsupialization is a logical treatment for sublingual-plunging ranulas. [Copyright &y& Elsevier]

Ranulas are mucoceles that develop as a result of mucous extravasation from the sublingual gland and typically present in the floor of mouth. The treatment of ranulas are various, mainly including surgical and nonsurgical methods. The preferred treatment of oral and plunging ranulas is still uncertain. According to the complications associated with surgical therapy, nonsurgical sclerotherapy has been advocated by clinicians for its advantages of less injury, no scar, less suffering, etc. Recently, it was reported that OK-432 was a relatively effective sclerosing agent for both lymphatic malformations and ranulas, although it has a high rate of recurrence after treating ranulas. Pingyangmycin is another reported conventional sclerosing agent for lymphatic malformations. Herein, we hypothesize that intracystic injection of pingyangmycin may be an optimal method for the treatment of ranulas. [ABSTRACT FROM AUTHOR]