Plunging ranula with prestyloid parapharyngeal space, masticator space, and parotid gland extension.

Plunging ranula with prestyloid parapharyngeal space, masticator space, and parotid gland extension. INTRODUCTION: Ranulas develop from mucous extravasation secondary to sublingual gland duct obstruction or trauma. Plunging ranula usually dive into the submandibular space. METHODS: This is the first reported case of a plunging ranula with direct extension to the prestyloid parapharyngeal space, masticator space, and parotid gland with avoidance of the submandibular space. RESULTS: The patient presented with a tender parotid mass, of which the differential is broad, including parotitis, parotid malignancy, metastatic malignancy, lymphoma, as well as other infectious etiologies. When an intraoral component is not identified, other differential considerations would be thyroglossal duct cyst, branchial cleft cyst, parathyroid cyst, cervical thymic cyst, dermoid cyst, cystic hygroma, or benign teratoma. CONCLUSION: The case is unique due to ranula extension into multiple spaces. For optimal treatment, the sublingual gland along with its tract and contents needs to completely removed.

Simultaneous bilateral ranula in an edentulous patient. Rare presentation with a brief review of the literature.

A ranula is a large mucocele located in the floor of the mouth. Ranulas is usually a mucous extravasation phenomenon due to injury to sublingual salivary gland. unilateral presentation has been reported in many cases but bilateral presentation and that too in an edentulous patient is quite uncommon. This is a case report of bilateral ranula in an edentulous patient and its management along with a brief review of pertinent literature.

Ránula en niños: presentación de caso clínico / Ranula in children: report of a clinical case

Se presenta una situación clínica de una paciente de sexo femenino, de 12 años de edad, quien concurre al Servicio de Cirugía y Traumatología Bucomaxilofacial del Hospital Zonal General de Agudos General Manuel Belgrano, presentando un aumento de volumen en el piso de boca, renitente, delimitado, de color azulado, indoloro y asintomático (Fig. 1) compatibles con una lesión de la glándula sublingual denominada ránula. Se solicita a la paciente, como estudio por imagen de preferencia, una resonancia magnética con y sin contraste (Fig. 2, Fig. 3). Se procede a su resolución quirúrgica extirpando la lesión conjuntamente con la glándula sublingual, presentando una evolución favorables a corto y largo plazo. Se realiza una búsqueda bibliográfica exponiendo los diferentes tipos de tratamiento posibles, estudios por imágenes de preferencia y posibles complicaciones según tratamiento.

Rapid development of a simple ranula in a child.

OBJECTIVE: A simple ranula is a gradually progressive, benign condition of the salivary gland. The report here describes a very rare case of a simple ranula enlarging in an acute fashion, resulting in airway obstruction. CASE REPORT: A 7-year-old girl presented with swelling in the floor of the mouth, pushing the tongue upward and backward, requiring immediate nasotracheal intubation. Magnetic resonance imaging suggested a simple ranula requiring urgent surgery. The patient was followed up 4 weeks after discharge, at which time she was doing well. CONCLUSION: To the best of the authors' knowledge, this is the first case reported of a simple ranula presenting in an acute fashion, leading to airway compromise in a pediatric patient. The literature is reviewed and features of diagnosis and treatment are presented.

Submandibular gland mucocele associated with a mixed ranula.

Mucoceles of the submandibular gland are extremely rare pathologic occurrences that present an investigative and management dilemma owing to their clinical indistinguishability from plunging ranulas. Of the few that have been documented, these mucous extravasation cysts involved the submandibular gland alone. We describe perhaps the first case of an extensive submandibular gland mucocele occurring in conjunction with a mixed ranula from the ipsilateral sublingual gland, and discuss the various considerations in the management of such lesions.

Acute presentation of a plunging ranula causing respiratory distress: case report.

OBJECTIVE: A plunging ranula is an uncommon cause of neck swelling which typically presents in a gradually progressive fashion. This report describes a rare case of acute presentation of a plunging ranula. The condition progressed rapidly to respiratory distress, requiring urgent surgery. CASE REPORT: A 14-year-old male student presented with a rapidly enlarging neck swelling associated with a sublingual swelling. Computed tomography suggested the diagnosis of plunging ranula. Several hours after admission, the neck swelling became very tense and the sublingual swelling enlarged dramatically. The tongue was pushed upwards and backwards by the sublingual swelling, causing respiratory embarrassment and requiring urgent surgery. Four months after surgery, there was no evidence of recurrence. CONCLUSION: To the best of the author's knowledge, this is the first case report of a plunging ranula progressing acutely and rapidly to cause respiratory compromise. The literature is reviewed and pertinent features concerning the diagnosis and management of plunging ranula are presented.

Ranulas: possible signs for HIV/AIDS? 1 year Ugandan descriptive study.

INTRODUCTION: Certain oral manifestations signal progression of HIV disease among HAART naïve patients or an increase in the plasma HIV-1 RNA levels for those on treatment. Ranulas may be one of those manifestations. Therefore, this study describes the clinical features of patients who presented with ranulas including their demographics, HIV sero-status and the CD4 CD8 cell counts for those who were HIV positive. METHODS: A prospective study on ranulas was undertaken at Mulago national referral hospital and St Mary's hospital Lacor covering the period December 2008 to November 2009. RESULTS: Fifty-seven cases participated in the study: 38.6% male and 61.4% female. Out of the study group, 73.7% were HIV positive. This was statistically significant (Chi = 12.789, df = 1, p = 0.001). In relation, to CD4 cell count, 23.8% had <200 cells/mm(3), 35.7% between 200-500 cells/mm(3) and 40.5% more than 500 cells/mm(3). The CD4-to-CD8 ratio ranged from 0.02-0.98 with an average of 0.31 ± 0.23, median and mode of 0.27 and 0.32, respectively. CONCLUSIONS: It is felt that ranulas may be one of the oral manifestations of worsening immunity in HIV/AIDS disease. Therefore, more research is needed to establish if it should be included among known oral manifestations of the disease.

Quantification of HIV-1 viral load in the fluid of ranulas in HIV-positive patients.

OBJECTIVE: This study aimed to detect and quantify the HIV-1 viral load in ranula fluid of HIV-positive patients. STUDY DESIGN: Fourteen HIV-positive patients (13 not on highly active antiretroviral therapy) presenting with ranulas were prospectively evaluated. The viral load in the ranula fluid was quantified, and the results were correlated with CD4(+) cell count and viral load in the patient's blood. The NucliSens EasyQ system (NucliSens Easymag; bioMérieux), which is based on nucleic acid sequence-based amplification and real-time detection using molecular beacons, was used to quantitate viral RNA in the fluid. RESULTS: Concentrations of HIV-1 RNA ranged from 25 to 1,600,000 copies/mL in the fluid. However, no significant statistical correlation could be established with either CD4(+) cell count or viral load in patients' blood. CONCLUSIONS: Various concentrations of HIV-1 RNA were found in ranula fluid, which appears to serve as a viral reservoir in HIV-infected patients.

Comparative study of the effect of antiretroviral therapy on benign lymphoepithelial cyst of parotid glands and ranulas in HIV-positive patients.

OBJECTIVE: This study's aim was to assess the effect of highly active antiretroviral drugs (HAART) on benign lymphoepithelial cysts (BLEC) of the parotid and ranulas. STUDY DESIGN: The records of 10 HIV-positive patients who presented with BLEC were reviewed, and 14 HIV-positive patients who presented with ranulas were prospectively enrolled. Patients in both groups received the same combination of HAART and were clinically evaluated for the first 3 months. Patients with ranulas were followed for an additional 3 months. A clinical reduction in the size of the lesions was considered to be a positive outcome. RESULTS: All parotid glands with BLEC resolved within 3 months. No positive results were observed in ranulas during the first 3 months. However, some of the ranulas displayed a positive result after the initial 3 months of HAART. CONCLUSIONS: In contrast to BLEC, ranulas in HIV-positive patients seem to present a mixed and delayed response to HAART.

Oral mucoceles and ranulas may be part of initial manifestations of HIV infection.

It is well documented and generally accepted that enlargement of parotid salivary glands, as part of HIV-related salivary gland diseases (HIV-SGD), may be the initial symptoms/manifestations of the HIV infection. Oral mucoceles and ranulas are also frequently described as oral manifestations, in association with HIV infection. However, little is known about these latter lesions as being the initial symptoms indicative of an HIV infection. This prospective study has investigated the possibility that oral mucoceles in general, and ranulas in particular, could be the initial symptoms of an underlying and undiagnosed HIV infection. A total of 50 patients including cases of oral mucoceles and ranulas were consulted in a tertiary referral hospital set up. Nineteen (63%) out of 30 HIV-positive patients presenting with oral mucoceles/ranulas, did not know their HIV status at the first consultation. Oral mucoceles/ranulas were for these patients, the only motives for visiting the health facility, and they were also the only clinical identifiable features (symptoms). Oral mucoceles and ranulas should, in the context of HIV-salivary gland diseases, be considered as initial symptoms and early manifestations of HIV infection. Routine HIV testing in all patients with oral mucoceles and ranulas is, according to this study, justified and should be recommended.

Plunging ranula in young HIV patient.

The case of a 15-year-old African-American male with congenital HIV on highly active antiretroviral therapy (HAART) therapy with a plunging ranula who was treated with surgical removal of the offending sublingual gland and suffered no complications. This case may serve as an example that young HIV patients with this pathologic condition should be expected to have a similar course as a non-HIV patient.

Lingual tumors in infants: a case report and review of the literature.

Tumors of the tongue and the base of mouth are seen rarely in children. The incidence of the ones that are large enough to fill the oral cavity is especially low. If not recognized and treated, tongue tumors may obstruct the upper aero-digestive tract and be fatal. A case of a huge lingual cystic tumor mimicking ranula, and obstructing the upper aero-digestive tract, which was diagnosed antenatal and treated during and after the delivery, is presented together with a review of the literature.

Plunging ranula as a complication of intraoral removal of a submandibular sialolith.

Mucous cysts in the submandibular region--so-called 'plunging' ranula--are relatively uncommon. We report a case of a plunging ranula that complicated excision of an intraductal sialolith of the submandibular gland.

Sarcoid ranula. Its association with wide-spread sarcoidosis.

The presence of noncaseating granulomas in salivary tissue is a specific feature of sarcoidosis. We document the case of a healthy woman who presented with a sarcoid ranula of the sublingual salivary gland without any other manifestations of the disease. This sarcoid ranula subsequently progressed to symptomatic widespread sarcoidosis in a span of 7 months. An asymptomatic sarcoid ranula may thus possibly represent a precursor to widespread sarcoidosis.

Submandibular cystic hygroma resembling a plunging ranula in a neonate. Review and report of a case.

Cystic hygromas are large lymphangiomas that are most often found in the posterior triangle of the neck and the axilla in children. They are most frequently found before age 2 and may be massive. After upper respiratory infection, they may become infected and enlarged, causing dysphagia and toxemia. The diagnosis can usually be made by history and physical examination and confirmed by biopsy. Treatment is by surgical excision of small lesions and staged debulking excisions in more severe cases. A patient with a cystic hygroma having many clinical characteristics of a plunging ranula is presented. The cyst fluid was aspirated and analyzed for its amylase, sodium, potassium, chloride, urea nitrogen, glucose, and total protein content. The characteristics of the fluid were also compared with those of lymph and saliva. This report demonstrates the difficulty in determining the diagnosis of a tumor that has the clinical features of a cystic hygroma, as well as a plunging ranula. The necessity of a proper presurgical diagnosis is essential since the form of therapy for each is different and conflicting. A method that distinguishes between the cervical cystic hygroma and a plunging ranula by means of aspirated fluid is discussed.

Squamous cell carcinoma arising in a plunging ranula.

A case report of a 36-year-old man with a plunging ranula of 15 years' duration, in which squamous cell carcinoma arose from the cyst wall, is presented. Pathogenesis and treatment of ranulas is briefly discussed.

Ranula and sarcoid granuloma of a sublingual gland.

A case is reported in which the treatment of the ranula consisted of dissection of the cystic wall along with excision of the sublingual gland of origin. The histological picture of the gland was consistent with sarcoidosis. Thereafter, all other examinations were negative for sarcoidosis. However, there remains the possibility that the lesion may be the precursor of widespread sarcoidosis which might occur in the future.