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(a) Ultrasonogram showing anechoic fluid collection in left submandibular region. (b) Lateral oblique projection of submandibular region with contrast media injected in sublingual space. (c) Coronal T-1 weighed MR image showing hypointense area of fluid collection above and below the mylohyoid muscle. (d) T-2 weighed axial MRI section showing the extensions of the fluid collection.
Source publication
Plunging ranulas, also known as deep, diving, cervical or deep plunging ranula, usually appear in conjunction with oral ranula. Rarely, these ranulas may arise independent of oral swelling. A rare case of plunging ranula without oral swelling is discussed along with review of literature.
Citations
... While preoperative imaging with ultrasound or MRI appears reasonable in the presence of a plunging ranula with a cervical component to differentiate it from other suspected diagnoses such as a lymph node enlargement, an epidermoid cyst, a lateral neck cyst, a herniated thyroglossal cyst, a cystic hygroma, or an external laryngocele, 3,11,16,33,35 the absence of a visible cervical swelling makes differential diagnoses more difficult. However, if a massively extended vallecular cyst is present, further imaging may be useful. ...
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.
... In fewer than 10% of all ranula cases, a retention cyst forms due to congenital obstruction, either from an imperforate salivary duct or an ostial adhesion. [26][27][28] Complications associated with sublingual gland excision include the risk of injury to Wharton's duct (2%), bleeding (1-2%), infection (1-2%), or paresthesia of the lingual nerve (2-12%). 16 In a study conducted by Zhao YF et al., which followed 415 patients, recurrence rates were observed to be 66.6% after marsupialization, 57.69% after ranula excision, and notably lower at 1.2% after sublingual gland excision. ...
Ranula, a salivary gland disorder, manifests as a cystic swelling on the floor of the mouth and can arise from various etiologies such as trauma, obstruction, or inflammation. This article explores the diversity of treatment modalities proposed for ranula, including incision and drainage, marsupialization, and sublingual gland removal. The recurrence of ranula is discussed in relation to treatment types, with reported rates varying significantly. This article discusses a case study of intraoral swelling in a 19-year-old male patient, emphasizing the importance of understanding and managing ranula in clinical practice.
... Among tumoral causes, ranulas are mucoceles (representing about 0.2 cases per 1000 persons) that occur in the floor of the mouth and account for 6% of all oral sialocysts [3][4]. The etiopathogenesis is currently unknown. ...
... The diagnosis of a plunging ranula is usually determined by a combination of history, clinical presentation, and imaging studies [3]. Clinically, it appears as an asymptomatic, continuously enlarging small to medium lesion (4-10 cm) that tends to cause lateral swelling, which can sometimes cross the midline, displacing the tongue, and interfering with oral function. ...
... It usually presents as a non-tender, fluctuant mass that may not be well-defined, freely movable, or associated with the thyroid gland or lymph node chains. Although less common, large ranulas or those located in the caruncula sublingualis may lead to partial obstruction of the Wharton's duct, resulting in submandibular swelling when eating, dysphagia, and airway obstruction [3,13]. ...
Ranula is a benign cystic lesion caused by the escape and collection of salivary mucus. Classically, it is divided into simple ranulas, a cystic mass in the floor of the mouth, and diving/plunging/cervical ranulas, a submandibular mass without apparent intraoral involvement. Although plunging ranula is a well-documented cause of neck swelling, its association with the presence of ectopic sublingual glands is extremely rare, with less than five cases reported.
Other cervical cystic lesions may have the same clinical aspect; therefore, advanced diagnostic techniques like a CT scan or MRI play a critical role in early diagnosis. Different approaches have been used to treat ranulas, including non-invasive, minimally invasive, and surgical techniques.
The purpose of this paper is to highlight a case report of a giant plunging ranula due to an anatomical aberration of the right sublingual gland, along with a significant literature review.
... These can help in identifying the extent and course of the disease. Differentials of cervical ranula may include thyroglossal duct cyst, branchial cleft cyst, cystic hygroma, submandibular sialadenitis, cystic or neoplastic thyroid disease, infectious cervical lymphadenopathy and laryngocele [17]. ...
This case report aims to present an unusual case of a plunging ranula that extended to the superior vertebral body of the T4 vertebrae, we will be elaborating on the patient presentation, investigations, diagnosis, and treatment of the lesion, while also talking about the adversities faced while diagnosing and treating the patient. The rarity of this condition and an atypical presentation makes this a difficult case to diagnose and vigilant treatment is needed to prevent any complications associated with the condition and ensure a successful treatment and recovery.
... 4,5,6 In less than 10% of all ranulas, congenital obstruction, by either an imperforate salivary duct or an ostial adhesion, leads to the formation of a retention cyst. 7 It was suggested that Typically, a ranula is a slow-growing unilateral, very rarely bilateral painless swelling in the floor of the mouth. It can range in size from 4 to 10 cm. ...
... It can range in size from 4 to 10 cm. 7 The frequent age of occurrence is second and third decade and in children younger than 10 years, it has a slight female prediliction. 4,9 They appear as a tense fluctuant dome-shaped vesicle, most of the time with a blue hue. ...
... 9 Intraoral ranulas were seen in 45% of the cases; 34% of the cases were said to be associated with plunging ranulas and 21% of plunging ranulas occur without oral swelling. 7 There are few mechanisms to explain the formation of plunging ranula, the sublingual gland may project through the mylohyoid, or an ectopic sublingual gland may exist on the cervical side of mylohyoid, this explains most plunging ranulas that exist without an oral component. Secondly, a dehiscence or hiatus in the mylohyoid muscle may occur, this defect is observed along the lateral aspect of the anterior two-thirds of the muscle, through this defect, the mucin from the sublingual gland may penetrate to the submandibular space. ...
terms of the creative common's attribution license (http://creativecommons.org/licenses/by/4.0). Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Abstract Plunging ranula which is also known as diving or cervical ranula usually occurs along with oral ranula. They commonly arise from the sublingual gland. Ranula is a nonepithelial-lined salivary gland cyst that is formed due to escape of mucus from sublingual gland and its successive herniation via the mylohyoid muscle into submandibular space and beyond. Here we present a case of unilateral plunging ranula in a 5-year-old child in which ultrasonography was used as a diagnostic tool and managed by a less invasive procedure without complication and recurrence.
... Magnetic resonance imaging (MRI) is the gold standard for further differential diagnosis of the ranula. The T2-weighted images demonstrate a characteristic heterogeneously increased signal within the lesion (16). However, if the ranula has a high protein concentration, the signal intensities may be high for all of the imaging sequences (16). ...
... The T2-weighted images demonstrate a characteristic heterogeneously increased signal within the lesion (16). However, if the ranula has a high protein concentration, the signal intensities may be high for all of the imaging sequences (16). In such cases, a differential diagnosis of lipomas is difficult (17). ...
A 75-year-old male patient visited Gangneung-Wonju National University Dental Hospital (Gangneung, South Korea) with a 35-mm fluctuant lesion on the floor of the mouth. It was a dome-shaped exophytic lesion with its top on Wharton's duct orifice area. The encapsulated lesion was excised cautiously and the final diagnosis was non-infiltrating angiolipoma. To the best of our knowledge, this is the first report of an intraoral approach for the treatment of a non-infiltrating angiolipoma on the floor of the mouth in an elderly patient. Differentiating it from a ranula is essential for the surgical approach and, as there is a higher transition to infiltrating angiolipoma, definite treatment should be considered in elderly patients.
... Ranulas are cystic lesions in the floor of the mouth developed due to obstruction to the outflow of saliva in the sublingual gland [1]. They have derived their nomenclature from the Latin word "Rana" meaning frog, due to their peculiar translucent bluish color resembling the belly of a frog [2]. Due to an obstruction to the outflow of saliva in the sublingual gland, there is proximal dilatation of the sublingual gland duct, followed eventually by its rupture, leading to extravasation of the saliva into surrounding soft tissues. ...
... Simple ranulas are cystic lesions confined to the floor of the mouth with no extension into the submandibular space. On the other hand, ranulas that extend or plunge beyond the mylohyoid muscle to enter the adjacent spaces like submandibular or parapharyngeal space are known as 'plunging ranulas' [2]. In some cases, dehiscence or break in the mylohyoid muscle itself paves way for the extension of cysts into the submandibular region [1]. ...
... In some cases, dehiscence or break in the mylohyoid muscle itself paves way for the extension of cysts into the submandibular region [1]. With a prevalence of 0.2 cases per 1000 individuals, ranulas make up for six percent of all oral cystic lesions [2]. However, congenital ranulas are very rare with a prevalence of 0.79%. ...
Ranulas are cystic lesions located in the floor of the mouth. These are "pseudocysts" and are developed due to an obstruction in the sublingual gland. Congenital variants of plunging ranulas are very rare. Here, we report a case of an eight-year-old male child presenting with congenital swelling with an intraoral component as well as extension to the submandibular gland region. The swelling was painless and gradually growing in size.
... Ranulas should be treated conservatively, according to Baurmash et al., with marsupialization and guaze packing. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Excision of the ranula was performed in the first case, and marsupialization with excision of the sublingual salivary gland was performed in the second case, without any relapse. ...
The mucocele, the oral ranula, and the cervical, or plunging, ranula are all clinical terminology for a pseudocyst with mucus leakage into the soft tissues surrounding it. These lesions are caused by mucin spilling into the surrounding soft tissues as a result of trauma or congestion to the salivary gland excretory duct. The emergence of mucoceles and ranulas is dependent on the interruption of saliva flow from the salivary glands' secretory mechanism. Two patients with a specific diagnostic were treated and are shown in this article.
... Lastly, a duct from the SL gland may unite with the SM gland or its duct, forming ranulas continuous with the SM gland. (9) Plunging ranulas most commonly occupy the SM triangle and connect with the SL gland by crossing over the posterior edge of mylohyoid muscle. Coit et al, (10) reached a conclusion that diagnosing a plunging ranula was greatly suggested by the 'tail sign', a small extension into the SL space with the majority of the cyst seen in the SM space. ...
Background: The floor of the mouth (FOM) is located below the tongue in the oral cavity. Many diseases can occur in the FOM that are unique to this anatomical location. Clinical examination of the mucosal surface of the FOM is easy without imaging, because the superficial pathologies can be assessed by the bare eye. However, if the disease has a deep extension into the FOM or spreads beyond its boundaries, imaging may then be necessary. Different imaging modalities can be helpful in examining the FOM
... The long duration of the cyst before presentation in our case might be due to the series of drainages both by self-trauma and practitioners. This is similar to the case report by Gupta and Karjodkar in which there was a surgical intervention by a family physician, six months before presentation [10]. ...
