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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

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: 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.

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.

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.

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

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.

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.

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.

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.

The optimal treatment of plunging ranula does not necessarily involve excision of the ranula.

This is a case report of a female 1-year-old patient who complained of an increase in the volume of the tongue perceived by her mother since her first month of life, which hinted swallowing, episodes of suffocation, and injury to the onset of articulated language. Orascopy showed an increase in the bilateral sublingual volume, with softened consistency on palpation. Diagnostic and therapeutic drainage of the lesion was performed, with posterior analysis of the mucoserous aspect fluid, suggesting a benign tumor in the floor of the mouth. The patient had recurrence of the lesion after a few months. Proceeding with the diagnostic investigation, submentonian ultrasonography was performed, evidencing a cystic image with echoes, located in the topography of the sublingual glands, measuring 4.7 x 3.3 centimeters, suggestive of a plunging ranula. The patient was submitted to the surgical procedure for excision of the lesion that occurred without intercurrences.

Ranula is a bluish translucent cystic lesion in the floor of mouth. It can be true cyst occurring due to obstruction of the sublingual gland or a minor salivary gland or a pseudocyst as a result of ductal injury leading to extravasation and accumulation of saliva in surrounding tissues. Two variants of ranula are described in the literature: simple oral ranula and deep diving or plunging ranula. We report a case of plunging ranula with both oral and cervical components which is treated successfully by surgical excision. This case report involves an unusually large ranula involving floor of mouth with cervical extension, more towards left side, in a 26 years old male. It is successfully removed in- toto by transcervical approach. The patient was followed up on a regular basis and was disease free.

Purpose The aim of this study was to illustrate and confirm that the complete intraoral excision of the sublingual gland alone, is anatomically the most rational approach, for the management of plunging ranula. Material and methods We retrospectively reviewed clinical charts of diagnosed HIV-infected patients presenting with plunging ranula. The intraoral approach was used for the complete excision of the sublingual gland with evacuation of the pseudocystic content only. Neither extra oral approach, nor ranula dissection / drainage was performed. The surgical procedure was performed using local anesthesia. Pre- and postoperative MRI-scan investigations were recorded. Histological reports were documented to confirm the diagnosis of oral mucocele. Patients were clinically monitored. Results We identified 90 adults presenting with oral mucocele, type ranula. Seventy (77%) of them were diagnosed with HIV infection. Plunging ranula was recorded in 35 (50%) patients from the latter group. The study enrolled 11 operated patients whose files contained useable data, including an acceptable follow-up period. The postoperative follow-up period ranged from three to 15 months. The clinical and postoperative MRI-scans of operated patients demonstrated satisfactory results. There were neither postoperative complications nor recurrence of ranula reported. Conclusion The location of the sublingual gland in the floor of the mouth coupled with the physio-pathogenesis of the plunging ranula, makes the transoral complete excision of the offending gland, with the intraoral evacuation of the pseudocyst, anatomically the most rational approach for plunging ranula management. There is no need for cervical approach, ranula dissection and/or postoperative placement of drainage.

Plunging ranula (PR) is a mucus extravasation pseudocyst arising from the sublingual glands that forms following mucus escape that herniates through the mylohyoid muscle along the fascial planes into the cervical, submandibular, or submental space. They are rare in children, and surgical management is the most common performed therapy. We report a case of an 11-year-old female patient who sought dental treatment after a 3-year history of swelling in the right sublingual gland and the floor of the mouth, which was asymptomatic. The patient's medical history was unremarkable. Computed tomography image showed a well-defined ovoid lesion with hypoattenuation in the right sublingual gland measuring 4.5 × 4 cm. The initial diagnosis was PR, which was later confirmed by anatomopathologic analysis. Surgical excision of the right sublingual gland was performed intraorally under general anesthesia, followed by floor of the mouth marsupialization. The patient is currently being followed-up with no signs of local recurrence.

A mucocoele or extravasation of mucus is common in minor salivary glands, but unusual in major ones. Those from the submandibular gland are a diagnostic challenge and conventional management includes excision of the associated gland. We describe a 27-year-old man with a mucocoele of the submandibular gland that presented as a lateral cervical swelling and looked like a plunging ranula. The cystic lesion was completely excised and, to our knowledge, this is the first published case in which the submandibular gland was saved with no recurrence up to two years postoperatively.

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.

Objective A plunging ranula is a pseudocystic collection of mucin extravasated from the sublingual gland into the floor of mouth and through the mylohyoid muscle into the neck. While the lining of a ranula is non-secreting and resection of the sublingual gland is adequate for simple sublingual mucoceles, many surgeons attempt to address plunging ranulas with extensive transoral and transcervical dissections. We review our experience managing plunging ranulas with intraoral sublingual gland excision and ranula drainage alone. Methods This is a case series of patients with plunging ranulas who underwent transoral sublingual gland excision and ranula drainage in the past 10 years at the Massachusetts Eye and Ear. All ranulas were confirmed by radiographic imaging. Data were gathered from the medical record and telephone surveys. Results Twenty-one patients with 22 distinct ranulas underwent this surgical approach. Average ranula size on imaging was 4.3 cm (SD = 1.3). Thirteen patients with 14 ranulas were followed up for greater than 6 months while the remaining 7 patients were lost to follow-up. Median follow-up for the 13 patients was 30 months (range 6 to 80). One ranula recurred requiring excision of residual sublingual gland (7%). One patient developed a local infection that was treated with antibiotics (7%). No long term complications were reported. Conclusion Simple transoral excision of the sublingual gland with ranula drainage is sufficient for treatment of plunging ranulas. It is essential to obtain a full resection of the gland to prevent relapse. This limited approach has low rates of complications and ranula recurrence.

Objective:To highlight the value of sialendoscopy during transoral resection of the sublingual gland for a plunging ranula to prevent iatrogenic injury to the submandibular duct.Method and results:The clinical course of a 20-year-old male with a plunging ranula was analysed. The patient underwent transoral resection of the affected sublingual gland and pseudocyst. Sialendoscopy was used to confirm patency of the submandibular duct with placement of a Marchal dilator to aid in preservation of the duct during sublingual gland dissection. The sublingual gland was successfully removed, with no injury to the submandibular duct or lingual nerve. During follow up, the patient had slight numbness to the tip of the tongue, which resolved after 2–3 days. Post-operative examination showed the submandibular duct to be intact and there was no swelling of the submandibular area.Conclusion:Sialendoscopy-assisted transoral sublingual gland resection for a plunging ranula is a safe and effective technique. Sialendoscopy aids in skeletonisation and preservation of the submandibular duct.

Purpose of review Ranula is extravasation mucocele arising from the sublingual gland, influencing the swallowing or eating; this review focuses on the most recent literature pertaining to pediatric ranulas and aims to comprehensively describe the methods of diagnosis and management approaches. Recent findings Ranulas consist of intraoral ranula and plunging ranula, which are frequently misdiagnosed, so it is vital for the differential diagnosis of pediatric ranulas to depend on the clinical examination, imaging and fine-needle aspiration cytology. Pediatric patients should first be observed for 6 months before other treatments. OK-432 could activate inflammatory reaction to induce shrinkage of pediatric ranulas. Marsupialization, incision with drainage and ranula excision alone, are associated with a high rate of recurrence, even marsupialization with packing and modified micromarsupialization should be prudently applied for primary treatment of intraoral ranula. Laser excision is considered an alternative treatment for intraoral ranula of pediatric patients because of low recurrence rates and surgical complications. Recently, sublingual gland with or without ranula excision is a reasonable and suitable choice for radical treatment in pediatric patients. Summary The principal goal of pediatric ranula management is radical sublingual gland excision, sealing the mucus extravasates and lowest complications.

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.

Introduction The aim of this study was to analyze the clinical features and treatment outcomes in order to determine the optimal management of ranulas in our Oral and Maxillofacial Surgery department with long-term results. Patients and methods A retrospective study was performed to evaluate patients with a final diagnosis of a simple or plunging ranula at Lille Teaching Hospital from May 2000 to January 2017. Clinical data on ranulas that were reviewed included gender, age, symptoms, location of the lesion, surgical procedures, complications, recurrence and follow-up. Results The 26 patients included in the study comprised 18 males and 8 females, ranging from 3-months to 38 years of age. A total of 27 ranulas were managed: 25 oral ranula and 2 plunging ranulas. Twelve patients had undergone marsupialization (44.4%), 7 patients had complete excisions of the ranula (25.9%) or partial excisions combined with marsupialization (14.8%) and 4 patients (14.8%) had undergone excision of the sublingual gland (SLG). Seven ranulas recurred (25.9%). Not a single case recurred following the excision of the SLG. Treatments that included marsupialization were associated with the lowest recurrence rate (16.7%) after SLG excision, followed by combined marsupialization and ranula excision (25%) and by ranula excision alone (57%). There were no major complications. Discussion Long-term outcomes confirm the different surgical procedures available in the outpatient clinic for the management of ranulas based on our surgical experience. Transoral resection of the SLG should be the optimal treatment, producing the lowest recurrence rate.

Ancient schwannomas are benign, slow-growing tumours derived from the neural sheath. They are characterized by degenerative changes which are not seen in the common schwannoma. An unusual case of ancient schwannoma of the sublingual space is reported to highlight the diagnostic challenge that this tumour presents. A 49-year-old male patient presented with an 8-month history of a right-sided neck swelling, palpable in the anterior part of the submandibular triangle. Pre-operative imaging showed a non-enhancing mass in the sublingual space spilling into the submandibular triangle, consistent with a plunging ranula. Fine needle aspiration cytology was inconclusive. However, histopathology of the lesion confirmed the diagnosis of an ancient schwannoma, which is seldom found in the sublingual space.

Branchial anomalies may be diagnosed at any age but present most commonly in infancy and childhood as a cutaneous sinus, a cyst or an abscess. The differential diagnosis of a cystic lateral neck mass includes thymic, parathyroid and thyroid cysts, cystic metastases (papillary thyroid carcinoma, oropharyngeal squamous cell carcinoma, skin cancer), tuberculous cold abscess, lymphatic malformation, plunging ranula, and laryngocoele. The existence of branchiogenic carcinoma is controversial. Cystic metastases to cervical lymph nodes originating from oropharyngeal squamous cell carcinoma occur far more commonly and should be suspected particularly in adult patients presenting with cystic masses in Levels 2 or 3 of the neck.

Objectives/Hypothesis To describe clinical characteristics of oral mucoceles/ranulas, with a focus on human immunodeficiency virus (HIV)-related salivary gland diseases. Study Design A descriptive and clinical study, with review of patient data. Material and Methods We reviewed 113 referred cases of oral mucocele. The following anatomical sites were identified: lip, tongue, and floor of the mouth (simple ranulas), as well as plunging ranulas. The age and gender data of the patients with oral mucoceles were recorded. The HIV status of the patients and other information were reviewed. Results There were 30 (26.5%) males and 83 (73.5%) females. Most patients were below 30 years of age, with the peak frequency in the first and second decade. Ranula (simple and plunging) represented 84.1% of the mucocele locations. Mucocele on the lips represented 10.6%. Seventy-two (63.7%) patients were HIV positive; and 97.2% of them had ranulas. Thirty-eight (33.6%) patients presented with plunging ranulas; and 92.1% of them were HIV positive, compared with two patients presenting with plunging ranulas in the HIV-negative group. These results strongly suggest that an HIV-positive patient is statistically (P < 0.001) more at risk of presenting with not only a simple, but also a plunging ranula type. Conclusion This study presents a different clinical picture of oral mucoceles/ranulas, as observed in HIV-positive patients. Additionally, it suggests a possible clinical link between the two pathologies. The authors strongly support the suggestion that oral mucocele/ranula is an HIV-related salivary gland disease. Level of Evidence 4. Laryngoscope, 125:1130–1136, 2015