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    Ranula

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    Ryo Raolika
    1) A 19-year-old female presented with a 2x2 cm bluish swelling in the floor of the mouth that was diagnosed as a ranula. 2) The ranula was surgically excised through an intraoral incision. Histopathological examination confirmed the diagnosis. 3) The patient recovered well post-operatively and was disease-free without recurrence during 2 years of follow-up.

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    Ranula

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    Ryo Raolika
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    1) A 19-year-old female presented with a 2x2 cm bluish swelling in the floor of the mouth that was diagnosed as a ranula. 2) The ranula was surgically excised through an intraoral incision. Histopathological examination confirmed the diagnosis. 3) The patient recovered well post-operatively and was disease-free without recurrence during 2 years of follow-up.

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    1) A 19-year-old female presented with a 2x2 cm bluish swelling in the floor of the mouth that was diagnosed as a ranula. 2) The ranula was surgically excised through an intraoral incision. Histopathological examination confirmed the diagnosis. 3) The patient recovered well post-operatively and was disease-free without recurrence during 2 years of follow-up.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    91 views3 pages

    Ranula

    Uploaded by

    Ryo Raolika
    1) A 19-year-old female presented with a 2x2 cm bluish swelling in the floor of the mouth that was diagnosed as a ranula. 2) The ranula was surgically excised through an intraoral incision. Histopathological examination confirmed the diagnosis. 3) The patient recovered well post-operatively and was disease-free without recurrence during 2 years of follow-up.

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    of 3

    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)

    e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 10 Ver. XII (October. 2016), PP 01-03
    www.iosrjournals.org

    Surgical Management of Intraoral Ranula: A Case Report


    Dr Snehal Bansod1, Dr Hitesh Tawari2, Dr.Dev Garg 3, Dr Shaista Quarishi4,
    Ganesh K. Kumeti 5
    1
    Professor, Oral & maxillofacial surgery, MCDRC, Anjora, Durg, Chhattisgarh, India
    2
    Senior Lecturer, Oral & maxillofacial surgery, MCDRC , Anjora, Durg, Chhattisgarh, India
    3
    Senior Lecturer, Oral & maxillofacial surgery, MCDRC, Anjora, Durg, Chhattisgarh, India
    4
    Post Graduate student, Oral Medicine Diagnosis & radiology , MCDRC, Anjora, Durg, Chhattisgarh, India
    5
    Post Graduate student, Oral Medicine Diagnosis & radiology, MCDRC, Anjora, Durg, Chhattisgarh, India

    Abstract: Ranula is a retention cyst of the sublingual gland, which enlarges progressively and extends into the
    surrounding soft tissues. We report a case of oral ranula involving the floor of mouth treated successfully by
    surgical excision following detailed clinical examination, radiological interpretation and histopathological
    diagnosis. The patient was followed up on a regular basis and was disease free.
    Keywords: Ranula, Sublingual gland ,excision.

    I. Introduction
    Ranula is a retention cyst of the sublingual gland, enlarge progressively and extends into the
    surrounding soft tissues. Two variants have been described: A superficial (Oral) ranula and Cervical (Plunging)
    ranula.
    Simple ranulas remain confined to the sublingual space, whereas diving ones extend beyond it .Ranulas
    superior to the mylohyoid muscle appear as a translucent bluish swelling under the tongue, resembling a frog’s
    underside. Primary etiology of these lesions is due to partial obstruction of a sublingual duct.

    II. Case Report


    A 19-old female patient reported to our center with a chief complaint of chronic swelling in the right
    floor of the mouth since 3 months on clinical examination, a bluish well circumscribed swelling measuring 2x2
    cm. Medially, the swelling extended till the midline of the floor of the mouth and the lateral extent was till the
    lingual vestibule. Posteriorly, the swelling limited unilaterally to an imaginary line drawn from the right first
    molar to the other side first molar thus confirming that the swelling did not extend beyond the posterior margin
    of the mylohyoid muscle into deeper spaces. Tongue was displaced towards the left side due to the swelling.
    Careful examination of the right submandibular and sublingual ducts revealed patency.
    Bimanual palpation of the right sublingual gland revealed slight tenderness as compared to the left one.
    There was no history of chronic cheek bite or irritation. No significant extraoral swelling or asymmetry was
    evident.The swelling was soft in consistency and non-tender on palpation. Mucosa over the swelling was normal
    with absence of any ulcerations or sinus discharge. There were no other secondary changes involved like
    paresthesia or cervical lymphadenopathy.

    Fig(1) showsPreoperative swelling Fig(2) shows well defind Lesion

    DOI: 10.9790/0853-1510120103 www.iosrjournals.org 1 | Page


    Surgical Management Of Intraoral Ranula: A Case Report

    Radiographic examination was not significant with absence of any calcifications. For detailed study
    T1, T2 weighted Magnetic resonance imaging was advised, which revealed right side lesion involving
    sublingual space inferolaterally restricted by mylohyoid muscle and medially by genioglossus muscle. On post
    contrast scan smooth peripheral enhancement is seen. Mass Measures 34(AP) x 24(CC) x 9.8(TR)mm in size.
    Aspiration was performed under topical anesthesia and collection of thick mucus like aspirated, which was
    subjected to cytological examination. Initial diagnosis of ranula was made on the basis of clinical appearance,
    cytological examination and MRI report. Based on the clinical, histological findings, treatment was planned
    excision of the lesion.

    Figure(3) shows MRI of lesion

    The lesion was approached intraorally through a mucosal incision placed over the lesion, Careful
    dissection in the submucosal plane revealed a well encapsulated soft swelling which was fragile but could be
    separated from the surrounding connective tissue and muscle plane then surgical excision was done. Complete
    haemostasis was achieved and primary closure performed. The excised specimen was sent for histopathological
    examination which confirmed the diagnosis of ranula.

    Figure (4) shows excised tissue specimen

    Histological examination shows mucous laden macrophages along with damaged and dilated minor
    salivary gland ducts in the connective tissue. Few normal mucous acini and chronic inflammatory cells are also
    seen. There were no specific complaints postoperatively. The patient was disease free without any recurrence
    during the follow-up period(2 years).

    Figure (5) shows suturing of defect


    DOI: 10.9790/0853-1510120103 www.iosrjournals.org 2 | Page
    Surgical Management Of Intraoral Ranula: A Case Report

    III. Discussion
    A ranula is a mucus filled cavity, a mucocele, in the floor of the mouth in relation to the sublingual
    gland”. The name “ranula” is derived from the Latin word “rana” meaning “frog”. These represent for 6% of all
    oral sialocysts. Although there is no specific sex predilection for ranula in the floor of the mouth which develops
    from extravasation of mucus after trauma to the sublingual gland or obstruction of the duct.
    MRI study is most sensitive investigation to evaluate the sublingual gland and other structure. On
    MRI, the ranula’s characteristic appearance is usually dominated by its high water content
    Thus, it has a low T1-weighted, an intermediate proton density, and high T2-weighted signal intensity.
    This appearance, especially in a plunging ranula, may be similar to that of a lymphangioma, a lateral
    thyroglossal duct cyst, and possibly an inflamed lymph node.
    However, if the protein concentration of the ranula’s contents is high, the signal intensities can vary,
    often being high on all imaging sequences. In such cases, the MRI differential diagnosis includes entities such as
    dermoids, epidermoids, and lipomas. Surgical management of ranula include incision and drainage, Enucleation
    of ranula, marsupialization and marsupialization with packing or complete excision of sublingual gland,
    cryosurgery, fenestration and continuous pressure.
    The recurrence rate with the various treatments was 100% in cases of incision and drainage, 61% in
    cases of simple marsupialization, and 0% in the case of Enucleation of the ranula with or without sublingual
    gland excision Surgical excision is best treatment for ranula.CO2 laser as a treatment modality has been used in
    few cases to vaporize ranulas.

    Conflict of Interest:- There is no conflict of interest in this case report.

    References
    [1]. Antonio Nanci. Ten Cate's Oral Histology: Development, Structure, and Function. Mosby 2005. Missouri; chap 11: 299-328.
    [2]. Standring, S.; Berkovitz, B. K. B.; Hackney, C. M.; Ruskell, I. G. L. Gray's Anatomy. The Anatomical Basis of clinical practice.
    39th Churchill & Livingtone. Chapter 8; 1290-1298
    [3]. Y.Y.P. Lee, K.T. Wong, A.D. King, A.T. Ahuja. Imaging of salivary gland tumours. European journal of radiology. Volume 66,
    Issue 3, Pages 419-436 (June 2008)
    [4]. Arbab AS, Koizumi K, Toyama K, et al. Various imaging modalities for the detection of salivary gland lesions: the advantages of
    201Tl SPET [in process citation]. Nucl Med Commun 2000;21:277–284
    [5]. Travis L, Hecht D. Acute and chronic inflammatory diseases of the salivary glands: diagnosis and management. Otolaryngol Clin
    North Am 1977;10:329–338

    DOI: 10.9790/0853-1510120103 www.iosrjournals.org 3 | Page

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