OK-432 sclerotherapy of plunging ranula in 21 patients: it can be a substitute for surgery

Abstract

Background and purpose: Although first-choice therapy for the ranula is surgery, this choice presents technical difficulties and frequent recurrences because of insufficient surgery. We evaluated the efficacy of OK-432 sclerosis of the plunging ranula as a substitute for surgery.

Methods: Twenty-one patients with plunging ranula were treated with intralesional injection of OK-432. The liquid content of the ranula was aspirated as much as possible, after which OK-432 solution was injected in the same volumes as that drawn out. Patients were followed on sonography or CT.

Results: Seven (33.3%) patients with plunging ranulas showed total shrinkage and resolution, and 4 (19%) patients showed near-total shrinkage (more than 90% of the volume). Four (19%) patients revealed marked shrinkage (more than 70% of the volume), and 3 (14.3%) patients showed partial shrinkage (less than 70% of the volume). Three (14.3%) patients showed recurrence after total shrinkage 1 month after injection. The overall recurrence rate after each injection was 47% (16 of 34 injections in 21 patients), but the recurrence rate after the last sclerotherapy was only 14%. There were no serious side effects except for fever lasting 2-3 days (12 patients) and swelling (10 patients) for 3-5 days. Mild odynophagia for 1-2 days was also noted in 7 patients, and there was 1 severe case of odynophagia.

Conclusion: OK-432 sclerotherapy of plunging ranula is a safe and potentially curative procedure that may be used as a primary treatment for plunging ranula before considering surgery.

Fig 1.

Case 18. A 29-year-old man with severe left submandibular swelling shows total shrinkage after a single OK-432 injection. A and B, Initial contrast-enhanced CT scan shows a large plunging ranula in the left sublingual (arrows) and submandibular spaces (arrowheads) with extending to the upper neck. C and D, Follow-up postcontrast CT scan obtained 6 months after OK-432 sclerotherapy depicts total shrinkage of the plunging ranula.

Fig 2.

Case 1. A 21-year-old woman with a slow-growing mass in the right sublingual area shows near-total shrinkage after a single OK-432 injection. A, Contrast-enhanced CT scan shows a large cystic lesion (arrows) in the right submandibular space. B, Follow-up CT scan obtained 2 months after OK-432 sclerotherapy shows nearly total shrinkage of the plunging ranula (arrows). C, Follow-up sonogram obtained 43 months after OK-432 sclerotherapy shows 2 small residual cystic lesions (arrows) in the right submandibular space. They represent less than 5% of the original volume of the cyst.

Fig 3.

Case 2. A 24-year-old man with tender swelling in the right submandibular area shows marked shrinkage after 2 OK-432 injections. A, Contrast-enhanced CT scan shows a plunging ranula in the right submandibular space (arrows). B, Contrast-enhanced CT scan obtained 2 months after the first sclerotherapy shows near total shrinkage of the plunging ranula (arrow), but the 3-month follow-up sonogram showed enlargement of the cyst. C, Unenhanced CT scan obtained 3 years after the second injection shows marked shrinkage of the cyst (which was larger than after first injection) (arrow).

Fig 4.

Case 3. A 10-year-old boy with sublingual swelling shows partial shrinkage after 3 OK-432 injections. A and B, The initial contrast-enhanced CT scan shows cystic lesions in the right sublingual space (arrows) and submental space (arrowheads). C and D, Unenhanced CT scan taken 2 months after the first sclerotherapy, depicts disappearance of the cyst in the right sublingual space (arrow), but a cyst remains in the submental space (arrowheads). The ranula in the submental space recurred after its complete shrinkage after the next 2 OK-432 injections.

Fig 5.

Case 13. A 20-year-old man with tender swelling in the left submandibular area. A and B, Initial enhanced CT scan shows multilocular, rim-enhancing cystic lesions in the right sublingual and submandibular space (arrows) with adjacent soft tissue infiltration and swelling (arrowheads). This abscess-like lesion was drained by pigtail catheter for 5 days. OK-432 sclerotherapy was performed 10 days after the pigtail catheter drainage of the plunging ranula. C and D, Follow-up transverse and longitudinal sonograms obtained 11 months after OK-432 sclerotherapy shows complete shrinkage of the cystic lesion in the right sublingual space (arrowheads) and submandibular space (arrows).