Plunging ranula of the submandibular area

Abstract

The term "ranula" is used to describe a diffuse swelling in the floor of the mouth caused by either a mucous extravasation or, less commonly, a mucous retention cyst derived from the major sublingual or submandibular salivary glands. The most common presentation of ranula is a painless, slow-growing, soft, and movable mass located in the floor of the mouth. Ranula may be simple or plunging. Simple ranula often present as masses in the floor of the mouth, limited to the mucous membranes. Diving ranulas extend through the facial plans, usually posterior to the mylohyoid muscle into the neck, and present as cervical masses. Thyroglossal duct cyst, branchial cleft cyst, cystic hygroma, submandibular sialadenitis, intramuscular hemangioma, cystic or neoplastic thyroid disease might be included in differential diagnosis. A variety of surgical procedures have been quoted in the literature ranging from marsupialization, excision of the ranula, sclerotherapy, and excision of the sublingual gland. The recurrence rate varies according to the procedure performed.

Keywords: Marsupialization; mouth floor; ranula; submandibular gland.

Figure 1

A diffuse, soft, fluctuant swelling presents in the left submandibular region, which was extended to the neck

Figure 2

A small, smooth surface, and movable mass in the floor of the mouth, to one side of the lingual frenum

Figure 3

The tooth number 47 had caries, but there was no lesion in the left side of radiography

Figure 4

CT showed a well-defined cystic mass lesion in the submandibular space without peripheral enhancement

Figure 5

Sonographic examination, revealed space occupying mass with 62×25 mm, which was cyst like with capsule

Figure 6

Histopatological findings show the inflammation includes numerous foamy histiocytes (arrow)