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Plunging ranula is the extravasation of saliva from the sublingual gland caused by trauma or obstruction of the duct, extending through a defect in the mylohyoid muscle into the submandibular gland. The prevalence of plunging ranula is estimated to be about 2.6 per 100,000 cases with mostly unilateral lesions. Bilateral plunging ranula are rare, with only a few cases reported. This case report describes an 11-year-old boy who was diagnosed with bilateral plunging ranula by radiologic examination of ultrasound and CT scan. The patient underwent extirpation surgery with the result of ranula on histopathologic examination. Six-month follow-up after extirpation, the patient was asymptomatic and no sign of recurrence.

Key Clinical Message: A plunging ranula may present initially as an extensive vallecular cyst and correct diagnosis may be reached with the use of ultrasound, fluid aspiration for amylase detection, and MRI imaging. The ranula is a pseudocyst of the sublingual salivary gland and can be divided into two known subtypes. The simple ranula and plunging ranula. While the simple type can be found in the floor of the mouth, the plunging ranula usually pervades the mylohoid muscle and presents as a cervical swelling. The presented case should outline the difficulties in diagnostic and treatment of an uncommon expression of a mucocele above the mylohoid muscle without presenting either a cervical or an intraoral swelling, only extending towards the vallecula. We present a previously unreported clinical manifestation of a ranula of an 18‐year old male, which extends posteriorly, remaining confined in the supramylohyoid muscle space. The cystic lesion protrudes in the oropharynx, and clinically appears as an extensive vallecular cyst. On magnetic resonance imaging the initial suspected diagnosis of a vallecular cyst was changed to the final diagnosis of a plunging ranula. The marsupialization of the cyst sac was performed. Outpatient follow‐up revealed a persisting ostium, indicating a continuous extravasation of the sublingual gland. The present case report describes an unusual clinical presentation of a plunging ranula, remaining above the mylohyoid muscle and protruding into the oropharynx, misdirecting to the first suspected diagnosis of a vallecular cyst. The case highlights the useful contribution of the MRI imaging for differential diagnoses and the need for criteria to indicate further investigations. [ABSTRACT FROM AUTHOR]

Objective(s): Despite advancements in imaging techniques and cytological analysis, plunging ranula remains a challenging surgical, radiologic, and pathologic phenomenon. Of the 18 patients we evaluated at our institution, we highlight three cases that illustrate the high rate of misleading imaging and cytological results when assessing plunging ranula. Methods: Imaging results, biopsy findings, operative techniques, and pathological reports were reviewed from patients who had either a preoperative or postoperative diagnosis of ranula and underwent surgery by a single head and neck surgeon at a tertiary care center. Results: Of the 18 identified patients, computed tomography was correct on preoperative imaging 73% of the time and magnetic resonance imaging was correct on preoperative imaging 71% of the time. Two patients underwent preoperative ultrasound and their ultrasound reports did not accurately diagnose the presence of a ranula. Two patients underwent preoperative fine needle aspiration biopsy due to inconclusive preoperative imaging, in which results suggested either a ranula or epidermal cyst. Both ultimately did not match the final pathology. Three of eighteen patients (17%) underwent an inappropriate initial surgery due to incorrect imaging diagnoses and/or biopsy findings. Conclusion: Despite use of preoperative modalities to distinguish plunging ranula from other cystic floor of mouth lesions, surgeons must be aware that no workup modality is fully precise. The potential for revision surgery must be included in all preoperative discussions for presumed plunging ranula. Level of Evidence: 4 Laryngoscope, 134:2689–2696, 2024 [ABSTRACT FROM AUTHOR]

The article describes the case of a 23-year-old male without previous history of submandibular trauma and surgery, infection, and viral illness with left submandibular painless swelling. Topics discussed include finding on magnetic resonance imaging (MRI), his diagnosis of sublingual gland (SLG) mucocele, and treatments of SMG mucocele.

A ranula is a cystic swelling containing mucous that manifests on the floor of the oral cavity. Typically, it displays as a soft, bluish, and well-defined swelling, enveloped by an epithelial lining. The ranulas are of two types: such as simple ranula and plunging ranula. Ranula is developed due to the accumulation of secretions of sublingual salivary glands above the mylohyoid muscle, whereas plunging ranula results from the collection of mucus along the fascial planes of the neck. Trauma is a common cause of mucous extravasation and accumulation in the surrounding tissues, which results in ranula. Recurrence of ranula, particularly plunging ranula, is very uncommon. This case report describes a recurrent case of plunging ranula in a young adult, which is an extremely rare incidence in clinical practice.

Key Clinical Message A plunging ranula may present initially as an extensive vallecular cyst and correct diagnosis may be reached with the use of ultrasound, fluid aspiration for amylase detection, and MRI imaging. Abstract The ranula is a pseudocyst of the sublingual salivary gland and can be divided into two known subtypes. The simple ranula and plunging ranula. While the simple type can be found in the floor of the mouth, the plunging ranula usually pervades the mylohoid muscle and presents as a cervical swelling. The presented case should outline the difficulties in diagnostic and treatment of an uncommon expression of a mucocele above the mylohoid muscle without presenting either a cervical or an intraoral swelling, only extending towards the vallecula. We present a previously unreported clinical manifestation of a ranula of an 18‐year old male, which extends posteriorly, remaining confined in the supramylohyoid muscle space. The cystic lesion protrudes in the oropharynx, and clinically appears as an extensive vallecular cyst. On magnetic resonance imaging the initial suspected diagnosis of a vallecular cyst was changed to the final diagnosis of a plunging ranula. The marsupialization of the cyst sac was performed. Outpatient follow‐up revealed a persisting ostium, indicating a continuous extravasation of the sublingual gland. The present case report describes an unusual clinical presentation of a plunging ranula, remaining above the mylohyoid muscle and protruding into the oropharynx, misdirecting to the first suspected diagnosis of a vallecular cyst. The case highlights the useful contribution of the MRI imaging for differential diagnoses and the need for criteria to indicate further investigations.

A ranula is a cystic swelling containing mucous that manifests on the floor of the oral cavity. Typically, it displays as a soft, bluish, and well-defined swelling, enveloped by an epithelial lining. The ranulas are of two types: such as simple ranula and plunging ranula. Ranula is developed due to the accumulation of secretions of sublingual salivary glands above the mylohyoid muscle, whereas plunging ranula results from the collection of mucus along the fascial planes of the neck. Trauma is a common cause of mucous extravasation and accumulation in the surrounding tissues, which results in ranula. Recurrence of ranula, particularly plunging ranula, is very uncommon. This case report describes a recurrent case of plunging ranula in a young adult, which is an extremely rare incidence in clinical practice. [ABSTRACT FROM AUTHOR]

Plunging ranula, a subtype of ranula, commonly presents as a submandibular or submental cystic mass without oral counterpart, and its clinical management remains challenging. Herein, the authors report an extremely rare case of 30-year-old female patient with plunging ranula involving the root of the left anterior neck.

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. [ABSTRACT FROM AUTHOR]

Objectives: This study describes a technique of measurement for neck cyst amylase content and reviews the experience of a tertiary referral center for cases of suspected plunging ranula. Methods: A retrospective study was performed at the Manukau Surgical Center in Auckland, New Zealand. Patients with a possible diagnosis of plunging ranula based on clinical presentation and diagnostic aspiration of the cyst contents were included. Demographic data, imaging and laboratory findings were collected, along with findings from surgery and histology. The technique for measuring the amylase of the aspirated cyst contents was also carefully recorded. Results: The 37 cases of confirmed plunging ranula included in this study had a submandibular cystic swelling that was aspirated. Imaging features consistent with a plunging ranula were seen in 89% of the study group. All cases had detectable levels of amylase of ≥3 U/L in the ranula contents. There was large variability (range: 5–560 U/L) in the concentration of amylase, with 70% of the cases demonstrating an amylase concentration below 200 U/L. Aspirates were typically described as viscous (87.5%) and yellow or straw‐colored. Conclusion: The combination of clinical presentation, imaging and the presence of amylase in the cyst contents is diagnostic for plunging ranula. Level of Evidence: 4 Laryngoscope, 133:535–538, 2023 [ABSTRACT FROM AUTHOR]

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.

Plunging ranula, a subtype of ranula, commonly presents as a submandibular or submental cystic mass without oral counterpart, and its clinical management remains challenging. Herein, the authors report an extremely rare case of 30-year-old female patient with plunging ranula involving the root of the left anterior neck. [ABSTRACT FROM AUTHOR]

Objectives: Plunging ranula is a pseudocyst of saliva extravasated from the sublingual gland (SLG) to the submandibular space. This is treated by transoral excision of the SLG or transcervical cyst excision that might differently affect surgical morbidity and recurrence. This study compared the clinical outcomes of complete vs partial excision of the SLG for plunging ranula. Study Design: A nonrandomized comparative study. Setting: Academic medical center. Methods: This study included 42 patients with plunging ranula who underwent complete or partial excision of the SLG with the evacuation of cystic content. Two surgical methods of complete or partial SLG resection were alternatively allocated to consecutive patients without randomization. The primary outcome was a postoperative recurrence. Secondary outcomes were operation time and complications. Results: Complete and partial excision of the SLG was performed in 22 and 20 patients, respectively, without injury to the Wharton's duct or the lingual nerve. Postoperative complications in 42 patients were minor with temporary events: hematoma, 1 (5%); tongue numbness, 2 (5%); dysgeusia, 4 (9%); and dysphagia, 2 (5%), which did not differ between patients with complete and partial excision of the SLG (P >.1). However, recurrence occurred in only 5 of 20 patients with partial SLG excision but none of 22 patients with complete SLG excision for a median follow-up of 36 months. Conclusions: Complete SLG excision is preferred over partial SLG excision to treat plunging ranula for reducing postsurgical risks of complications and recurrence. [ABSTRACT FROM AUTHOR]

Plunging ranula is the extravasation of saliva from the sublingual gland caused by trauma or obstruction of the duct, extending through a defect in the mylohyoid muscle into the submandibular gland. The prevalence of plunging ranula is estimated to be about 2.6 per 100,000 cases with mostly unilateral lesions. Bilateral plunging ranula are rare, with only a few cases reported. This case report describes an 11-year-old boy who was diagnosed with bilateral plunging ranula by radiologic examination of ultrasound and CT scan. The patient underwent extirpation surgery with the result of ranula on histopathologic examination. Six-month follow-up after extirpation, the patient was asymptomatic and no sign of recurrence., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

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.

Plunging ranulas are rare retention pseudocysts of the major salivary glands, most often of the sublingual gland, and usually occur in individuals from the first to the sixth decade of life with female predominance. Given their similar location and physical and imaging characteristics to thyroglossal cysts, distinguishing the two lesions is often a differential diagnostic dilemma even for the experienced physician. This case report presents a 42-year-old man for whom a preliminary diagnosis of a thyroglossal duct cyst was made based on a physical examination. A neck ultrasound was performed and the lesion was surgically excised. However, pathological analysis revealed a plunging ranula of a salivary gland. A contrast-enhanced computed tomography (CT) of the neck was performed. It showed close proximity of the lesion to the right sublingual salivary gland. Because of this, it was assumed that the gland was associated with the occurrence of his condition, and the patient was offered a complete sialoadenectomy. However, the patient refused this plan of treatment. Approximately seven months later there was a recurrence for which he was operated on again. Despite the warning of a high probability of recurrence, the patient categorically refused sialadenectomy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yankov et al.)

Ranula is defined as a swelling on the floor of the mouth, and its etiology is unclear. Aspects of etiopathogenesis, origin, and management remain debatable. The rationale of our study was to eliminate the discrepancies pertaining to the etiopathogenesis and management of ranula. Our objective was to determine the etiopathogenesis of ranula by systematically reviewing the available literature and to establish the best treatment protocol for ranula (intraoral and plunging). Case series, case reports, and observational and longitudinal studies referring to the etiology, pathogenesis, and management of ranula were included, and the previously published review articles were excluded from our study. We performed an electronic search from the year of inception of the database to December 2019. PubMed, Science direct, and Google Scholar databases were explored without restrictions of language or publication date. The search algorithm was Ranula {Mesh Major topic} and {Etiopathogenesis}, Ranula {Mesh Major topic} and {Management}. A total of 64 full-text articles were assessed. We concluded that the presence of the Bartholin duct might be a possible cause of intraoral ranula development, indicating that it originates from greater sublingual gland. Intraoral and plunging ranula are traumatic extravasation pseudocysts. Congenital ranula are histopathologically classified retention cysts lined with stratified squamous epithelium. The mylohyoid muscle exhibits dehiscence, which is commonly present in the anterior two-third part from which a part of the sublingual gland can be herniated or mucus can extravasate, leading to the formation of plunging ranula. Transoral excision with complete excision of ipsilateral sublingual gland remains the gold standard treatment of intraoral ranula and gold standard surgical treatment for plunging ranula. For mixed ranula, the treatment includes transoral excision of the sublingual gland along with the drainage of cyst. [ABSTRACT FROM AUTHOR]

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]

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. [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]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

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.

Plunging ranula (PR) is a cystic mass presenting on the lateral side of the neck with or without a history of the usual presentation of an intraoral lesion. “PR” is recognized as an uncommon lesion that has been found predominantly in the third decade of life mostly in males. However, the exact prevalence of “PR” is not yet known. We report a rare case of an extensive PR that reached the parapharyngeal space in a 17-year-old Saudi female. The diagnosis was made when she presented to the ENT clinic with swellings in the right submandibular and right floor of the mouth. The diagnosis of “PR” with the absence of an oral lesion is very challenging and requires a detailed history, clinical examination, and radiological imaging. Different modalities of treatment have been discussed. However, the excision of ranula and the sublingual gland is the most effective way of 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. [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]

Congenital ranula is rare. We report a large, symptomatic, congenital plunging ranula associated with a salivary gland cyst in the neck. To the best of our knowledge, this is the first such reported case. Even though both the cysts had their origin from the sublingual gland, only the cervical cyst had a capsular covering. Herniation of a part of the immature sublingual gland anlage through a congenital mylohyoid defect, its separation, and subsequent maturation could explain this occurrence.

Epidermoid inclusion cysts are rare in the oral cavity, accounting for less than 0.01% of cysts found there. These cysts are defined as epidermoid if they contain only epithelial lining, dermoid if skin appendages, and teratoid if they contain other tissues such as muscle, cartilage, and bone. This case report describes a case of a plunging ranula that was later diagnosed as an epidermoid inclusion cyst. The patient is a 22-year-old male who presented with swelling in the floor of the mouth and difficulty eating solid foods for the past 4 months. Upon examination, a shiny, pink-colored mass measuring 1 cm × 5 cm was observed, which displaced the tongue upward and backward. MRI scan of the brain, face, and neck revealed a well-defined, non-enhancing cystic mass measuring 6.6 cm × 4.5 cm that extended beyond the sublingual area. Histopathological examination after surgical removal of the cyst revealed that the cyst wall was lined with stratified squamous keratinized epithelium with a retained granular layer, and the cavity was filled with lamellated keratin flakes. The patient recovered well after surgery; no recurrence was observed at the 6-month follow-up., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Few cases of plunging ranulas (PRs) occur during childhood and the lesions are frequently misdiagnosed. Here, a PR in a child is reported along with a literature review. A seven-year-old female complaining of swelling in the midline neck, left-submandibular region, was evaluated. No oral cavity or major salivary glands abnormalities were detected. On palpation, a soft, painless, and fluid-containing mass was observed. The suspicion PR was performed by ultrasound. The diagnosis was confirmed with a histopathological examination. The lesion was removed with a cervical approach, without recurrence. PR is an uncommon condition in children under 10 years of age. Differential diagnosis depends on clinical examination and ultrasonography. A computed tomography-scan and magnetic resonance imaging can be performed if the diagnosis remains uncertain. In pediatrics, the key to success of the treatment may rely on the radical excision of the cyst and sublingual gland, via an intraoral or submandibular approach.

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]

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, 126:2739-2743, 2016. [ABSTRACT FROM AUTHOR]