Plunging or Cervical Ranula as a Rare Cause of Respiratory Distress.

The Plunging or cervical ranula is a mucus pseudocyst extension of the sublingual gland that is located below the mylohyoid muscle. In infants, owing to small sublingual and cervical space, clinically large cervical ranulas can lead to a significant impact on swallowing, crying, and even breathing (Carlini et al. in Pediatr Rep 8(4):6576, 2016; Övet et al. in Turk Arch Otorhinolaryngol 53(3):133-135, 2015). In these clinical pictures, we present a case of cervical ranula that grew in a short period leading to respiratory distress. This ranula was aspirated in a PICU setting to relieve respiratory obstruction before definitive surgery in the operation theatre. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04419-4.

Three new species of Forcipomyia (Lepidohelea) (Diptera: Ceratopogonidae) from West Bengal, India.

Three new species of the subgenus Lepidohelea Kieffer, 1917 of the genus Forcipomyia were described from the northern region of West Bengal based on morphological data. Forcipomyia (L.) inflatistyla sp. n. was collected from the Dooars region (Jayanti, near the Core area of Buxa Tiger Reserve), while two new species F. (L.) ranula and F. (L.) sulcoa were procured from Kalimpong in the Eastern Himalaya. Discovery of the three new species raises the total number of species of the genus Forcipomyia to 86 in India. A key to the Indian species of Lepidohelea is also provided.

Outlandish manifestation of swelling in early childhood seen in the patient's floor of the mouth.

Ranula is a cyst-like growth that occurs in the oral cavity beneath the tongue. It consists of saliva from a ruptured salivary gland or duct. Rather than just flowing directly from the glands into the oral cavity, saliva permeates the nearby connective tissues and creates a bubble. A ranula could indeed appear at any time span in a person's life for inexplicable reasons. A trauma such as an oral operation, a facial blow or nibbling the lower lip may possibly start one. The following is a case study of an early childhood boy who reported with a swelling in the floor of the mouth with unknown aetiology from the last 6 months.

Recurrent Plunging Ranula Due to a Sublingual Ectopic Gland: A Rare Clinical Entity.

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.

Epidermoid Cyst in the Submandibular Region Mimicking Plunging Ranula: A Case Report.

Epidermoid cysts rarely present in the submandibular area, constituting approximately less than 7% of all cystic lesions in the head and neck region and less than 0.01% of all oral cavity cysts. Therefore, epidermoid cysts can be easily misdiagnosed, as the differential diagnosis for a submandibular area mass is very broad. Imaging can help define characteristics of the mass; however, a pathologic specimen is usually required for the final diagnosis. Surgical excision is often required and tolerated well by most patients. However, there is a risk of recurrence of the cyst after excision, as well as a rare chance for malignant transformation if not excised, which must be discussed with the patient at the time of diagnosis of epidermoid cyst. We present a 33-year-old Caucasian female with a left submandibular cystic mass measuring 4.7 cm x 2.9 cm, that was originally thought to be a plunging ranula and subsequently diagnosed as an epidermoid cyst. This report is meant to raise awareness of the possibility of a submandibular mass being an epidermoid cyst as well as appropriate workup, treatment, and prognosis of epidermoid cysts in the submandibular region. This report also describes a unique approach to a submandibular epidermoid cyst of which the submandibular gland is divided for access to the cyst for safe and effective excision. To the author's knowledge, this surgical approach has not been described in the literature for a submandibular epidermoid cyst.

Diagnostic Difficulties of Plunging Ranula: A Review of 18 Cases.

OBJECTIVE(S): Despite advancements in imaging techniques and cytological analysis, plunging ranula remains a challenging surgical, radiologic, and pathologic phenomenon. Of the 18 patients we evaluated at our institution, we highlight three cases that illustrate the high rate of misleading imaging and cytological results when assessing plunging ranula. METHODS: Imaging results, biopsy findings, operative techniques, and pathological reports were reviewed from patients who had either a preoperative or postoperative diagnosis of ranula and underwent surgery by a single head and neck surgeon at a tertiary care center. RESULTS: Of the 18 identified patients, computed tomography was correct on preoperative imaging 73% of the time and magnetic resonance imaging was correct on preoperative imaging 71% of the time. Two patients underwent preoperative ultrasound and their ultrasound reports did not accurately diagnose the presence of a ranula. Two patients underwent preoperative fine needle aspiration biopsy due to inconclusive preoperative imaging, in which results suggested either a ranula or epidermal cyst. Both ultimately did not match the final pathology. Three of eighteen patients (17%) underwent an inappropriate initial surgery due to incorrect imaging diagnoses and/or biopsy findings. CONCLUSION: Despite use of preoperative modalities to distinguish plunging ranula from other cystic floor of mouth lesions, surgeons must be aware that no workup modality is fully precise. The potential for revision surgery must be included in all preoperative discussions for presumed plunging ranula. LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.

Management of mucoid cysts of the oral cavity: Cases series and review.

INTRODUCTION: A mucoid cyst is a benign lesion in the oral mucosa resulting from the rupture of a salivary gland duct and the subsequent discharge of mucin into the soft tissues. Mucoceles are more common in children and young adults, and the most common site is the lower inner lips. CASES SERIES PRESENTATION: We describe 3 clinical cases managed in service between 2022 and 2023. Clinical cases are presented in order to detail their clinical history, paraclinical and treatment. DISCUSSION AND CONCLUSION: In general, mucoceles tend to resolve spontaneously, but can sometimes interfere with swallowing or speech. Therefore, in such cases, these lesions must be promptly diagnosed and treated. There are various methods of managing these lesions, each with its own advantages and disadvantages. Surgical technique is preferable when the lesion is persistent, recurrent or symptomatic, and remains the most effective strategy, despite the existence of other, more modern techniques that are better tolerated by patients. But in all cases, follow-up is very important, especially when the mucocele is located in a particular area, such as the ventral side of the tongue, or in a younger population.

Comparison of the distribution of the Bartholin and/or Rivinus salivary ducts assessed with magnetic resonance-sialography in patients with ranula and in healthy subjects.

Background: The distribution and drainage of the sublingual gland ducts have various patterns that might be related to sublingual gland-related diseases, including ranula. This study aimed to elucidate the characteristics of the distribution of Bartholin and/or Rivinus ducts in patients with ranula using magnetic resonance (MR) sialography. Methods: In this retrospective cross-sectional study, the distributions and drainage patterns of sublingual gland ducts on MR sialography were classified in 74 subjects without sublingual gland-related disease as confirmed by both medical history and clinical examination and 15 patients with ranula, respectively. All patients had visited Kyushu Dental University Hospital from July 2015 to June 2022 to undergo MR imaging. Data on the distributions and drainage patterns of the sublingual gland ducts, including the characteristics of the Bartholin and/or Rivinus ducts, were then statistically compared between subjects without sublingual gland-related disease and patients with ranula. The images were assessed by an experienced oral and maxillofacial radiology specialist certified by the Japanese Society for Oral and Maxillofacial Radiology. The distributions (five groups) and drainage patterns (three patterns) of the sublingual gland ducts on MR sialography were classified in reference to previous studies, with some modifications in all subjects without sublingual gland-related disease and patients with ranula. Results: A significant difference in the distribution of the ducts (P<0.001), with a low number of patients exposing an undetected canal or Rivinius duct, was found in the group of patients with ranula (P<0.05). Regarding drainage patterns, no patient with ranula presented a Rivinius duct only. A significant difference in the drainage patterns of the sublingual gland ducts on MR sialography was observed between subjects without sublingual gland-related disease and patients with ranula (P=0.001). Conclusions: The present results suggest that the distribution of the sublingual gland ducts, mainly, the Bartholin duct, may be related to ranula formation. These findings also demonstrate that MR sialography contributes well to preoperative evaluation and is effective for assessing the complex excretory distribution of the sublingual gland ducts.

Characteristic Mean Kurtosis Values in Simple Diffusion Kurtosis Imaging of Dentigerous Cysts.

We evaluated the usefulness of simple diffusion kurtosis (SD) imaging, which was developed to generate diffusion kurtosis images simultaneously with an apparent diffusion coefficient (ADC) map for 27 cystic disease lesions in the head and neck region. The mean kurtosis (MK) and ADC values were calculated for the cystic space. The MK values were dentigerous cyst (DC): 0.74, odontogenic keratocyst (OKC): 0.86, ranula (R): 0.13, and mucous cyst (M): 0, and the ADC values were DC: 1364 × 10-6 mm2/s, OKC: 925 × 10-6 mm2/s, R: 2718 × 10-6 mm2/s, and M: 2686 × 10-6 mm2/s. The MK values of DC and OKC were significantly higher than those of R and M, whereas their ADC values were significantly lower. One reason for the characteristic signal values in diffusion-weighted images of DC may be related to content components such as fibrous tissue and exudate cells. When imaging cystic disease in the head and neck region using SD imaging, the maximum b-value setting at the time of imaging should be limited to approximately 1200 s/mm2 for accurate MK value calculation. This study is the first to show that the MK values of DC are characteristically higher than those of other cysts.

Plunging Ranula Presenting as a Giant Anterior Cervical Cystic Mass: A Case Report and Literature Review.

Plunging ranula, a subtype of ranula, commonly presents as a submandibular or submental cystic mass without oral counterpart, and its clinical management remains challenging. Herein, the authors report an extremely rare case of 30-year-old female patient with plunging ranula involving the root of the left anterior neck.

Three Signs to Help Detect Sjögren's Syndrome: Incidental Findings on Magnetic Resonance Imaging and Computed Tomography.

This study aimed to retrospectively investigate the prevalence of Sjögren's syndrome (SS) among patients with ranulas, parotid cysts, or parotid calcifications; identify the characteristic magnetic resonance imaging (MRI) or computed tomography (CT) findings of the lesions associated with SS; and compare the SS disease stages among SS patients with the three lesion types. A total of 228 patients with the lesions were classified into SS, possible SS, and non-SS groups. The prevalence of SS among patients with ranulas, parotid cysts, or parotid calcifications was 16%, 24%, and 40%, and the rates of either SS or possible SS were 25%, 41%, and 64%, respectively. SS was associated with (i) ranulas: ≤17 mm; (ii) parotid cysts: bilateral and multiple; and (iii) parotid calcifications: in females, bilateral, multiple, parenchymal, and no coexisting calcifications in other tissues. SS patients with ranulas were significantly younger and had lower submandibular gland stage scores on MRI/CT than those with other lesions. Additionally, in 58% and 15% of SS patients with ranulas and parotid calcifications, respectively, detection of the lesions led to the diagnosis of primary SS. Therefore, recognizing the prevalence of SS among patients with these lesions and the findings associated with SS can help detect undiagnosed SS.

Diagnosis and Surgical correction of salivary affections in buffaloes (Bubalus bubalis); a retrospective study.

AIM: This study aimed to describe the diagnosis and treatment of various surgical salivary affections in buffaloes. MATERIALS AND METHODS: This study included 135 buffaloes examined at Dakahlia Governorate between 2011 and 2022 suffering from various surgical salivary affections. The recorded surgical affections had salivary fistula (n = 44), ectasia of Stenson's duct (n = 11), ranula/mucocele (n = 46), and cervical sialocele (n = 34). The buffaloes were sedated using an intramuscular injection of xylazine (0.05 mg/kg) and local infiltration analgesia of lidocaine for specific surgical interventions. RESULTS: The salivary duct fistula cases were surgically corrected using a retrograde infusion of povidone-iodine into the duct and its double ligation with Prolene following fistulectomy. Intraoral marsupialization was done in buffaloes suffering from ectasia of the parotid duct. The mucocele /ranula was surgically incised with daily flushing with povidone-iodine. The cervical sialocele was treated by giving an elliptical excision on the sialocele, and sialoadenectomy of the mandibular salivary gland was performed to facilitate dynamic fluid/saliva drainage. A 92.5% of diseased buffaloes showed an uneventful recovery without any postoperative complications after the first treatment, whereas 7.5% of animals tended to recur. The most common and almost equally distributed salivary affections recorded in adult buffaloes were parotid duct fistula, mucocele, and cervical sialocele. The Stenson's duct ectasia was commonly registered in calves, being congenital. CONCLUSION: Ranula was the most common salivary affection encountered in adult buffaloes, closely followed by parotid duct fistulae and cervical sialoceles. Stenson's duct ectasia was the least encountered salivary affection in calves and was congenital. All salivary affections were corrected easily and safely, with satisfactory outcomes.

A Unique Case of Plunging Dermoid Cyst in an Elderly Male: A Case Report.

Dermoid cysts are the least commonly occurring developmental cysts in the oral and maxillofacial region. They may be congenital or acquired and are seen as asymptomatic swellings that are slow and progressive. It is very difficult to differentiate plunging ranulas from plunging dermoid cysts as both of them have very similar clinical features. However, since both entities have different treatment strategies, it is important to differentiate one from the other. A 57-year-old male patient reported to the Department of Oral Medicine and Radiology with a large swelling in the submental region. To the best of our knowledge, the present case report is the first one showing such an extensive lesion of plunging dermoid cyst mimicking plunging ranula in an elderly male patient. The report mainly focuses on the diagnostic challenges faced to reach the final diagnosis.

Concurrent Perioperative Diagnosis of HIV in a Patient With Plunging Ranula: A Case Report.

Oral manifestations may be the earliest indicators of HIV infection as it has strong association with oral candidiasis, hairy leukoplakia, linear gingival erythema, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis, Kaposi sarcoma, and lymphoma. Other conditions such as diffuse infiltrative lymphocytosis syndrome, benign lymphoepithelial cyst, and salivary gland neoplasm have also been reported in HIV patients. Ranulas are caused by salivary leakage from the sublingual gland as a result of ductal obstruction or trauma. At the present time, there is no clear evidence of a link between plunging ranula and HIV. The authors described a case of plunging ranula of the right floor of the mouth with a concurrent perioperative diagnosis of HIV. Surgical excision of ranula and associated salivary glands via submandibular and intraoral approach was successfully done with no recurrence over a period of one year. This case also highlights the importance of taking a thorough clinical history from patients and always practicing universal precautions, especially during surgical interventions.

An Unusual Case of Sublingual Epidermoid Cyst Mimicking Plunging Ranula.

Epidermoid cyst in the oral cavity is uncommon. It is even more rare to see an epidermoid cyst in the sublingual region. We report the case of a 30-year-old male presenting with a swelling in the floor of the mouth extending into the submental and submandibular regions. The midline swelling was painless, soft, and dome-shaped. CT scan contrast revealed the site and extent of swelling. The complete surgical excision of the lesion was performed via a transcervical approach. Histopathology revealed cystic fibrocollagenous tissue covered by squamous epithelium containing some keratin flakes.

A Giant Epidermoid Cyst in the Floor of Mouth Mimicking Ranula.

Dermoid cysts are benign ectodermal-derived epithelial cysts rarely found on the floor of the neck. They may be congenital or acquired. They comprise three histological variants according to their contents and include dermoid, epidermoid, and teratoma. Epidermoid cysts are lined by epithelium but do not contain skin appendages like hair follicles and sebaceous glands, as seen in dermoid cysts. Teratoma on the other hand contain mesodermal element. They reveal either a supra-myelohyiod or infra-myelohyiod floor-of-mouth location and can be clinically confused with various close differentials including infections, tumours, mucous extravasation phenomena, and embryonic abnormalities. A 28-year-old female presented with a complaint of painless large swelling beneath the chin. Computed tomography (CT) scan with contrast revealed a right para-median thick-walled cystic lesion located in the sublingual space. A plunging ranula was suspected on radiological assessment. Aspiration cytology revealed keratin-containing fluid and pointed towards a tentative diagnosis of dermoid/epidermoid cystic lesion. The mass lesion was explored via a transcutaneous neck approach. The final histopathological evaluation of the excised cystic lesion eventually confirmed a diagnosis of epidermoid cyst. Consider epidermoid cyst as a possible differential for any floor-of-mouth swelling. They can be clinically and radiologically confused with close differential including ranula, dentoalveolar cyst and lipoma. Aspiration cytology examination is sometimes helpful in equivocal cases. Cyst excision with histological examination allows for a confirmatory diagnosis and is possibly the only means of distinguishing between specific histological variants of dermoids.

Sublingual Epidermoid Cyst: Diagnosis, Surgical Treatment, and Follow-Up in a 22-Year-Old Male-A Case Report.

Epidermoid inclusion cysts are rare in the oral cavity, accounting for less than 0.01% of cysts found there. These cysts are defined as epidermoid if they contain only epithelial lining, dermoid if skin appendages, and teratoid if they contain other tissues such as muscle, cartilage, and bone. This case report describes a case of a plunging ranula that was later diagnosed as an epidermoid inclusion cyst. The patient is a 22-year-old male who presented with swelling in the floor of the mouth and difficulty eating solid foods for the past 4 months. Upon examination, a shiny, pink-colored mass measuring 1 cm × 5 cm was observed, which displaced the tongue upward and backward. MRI scan of the brain, face, and neck revealed a well-defined, non-enhancing cystic mass measuring 6.6 cm × 4.5 cm that extended beyond the sublingual area. Histopathological examination after surgical removal of the cyst revealed that the cyst wall was lined with stratified squamous keratinized epithelium with a retained granular layer, and the cavity was filled with lamellated keratin flakes. The patient recovered well after surgery; no recurrence was observed at the 6-month follow-up.

Ranula Formation After Lingual Frenectomy in a Newborn.

Ankyloglossia is a developmental anomaly characterized by a shortened lingual frenulum, which can range from cases with no clinical relevance to severe cases, where frenectomy may be indicated. In newborns, this indication has increased exponentially. The purpose of this report is to discuss obstruction of the sublingual caruncle, with a recurrent ranula, as a post-surgical complication of laser lingual frenectomy performed in a newborn. The treatment provided is also discussed (marsupialization and removal of the affected sublingual glands). Lingual frenectomy should be performed with great care, especially in newborns, because the sublingual caruncles can be affected and complications can occur.

Intraoral approach for the treatment of non­infiltrating angiolipoma of the floor of the mouth in an elderly patient: A case report with review of the literature.

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.