Intralingual Mucous Extravasation Cyst: An Uncommon Lingual Cyst.

OBJECTIVE: We report a rare case of an intralingual ranula. The differential diagnosis, etiology, diagnostic features, and management are discussed. CASE REPORT: An 18-year-old man presented with a mass that extended along the ventral surface of the tongue and up to the tip. The computed tomography scan clearly defined the extent of a cystic lesion. The pathologic diagnosis of an intralingual ranula was made. CONCLUSION: Lingual cysts have a varied etiology. Diagnosis hinges on histological examination of the cyst wall. Conservative resection and histological examination is the standard of care.

Sublingual gland excision for the surgical management of plunging ranula.

OBJECTIVE: A plunging ranula is a pseudocystic collection of mucin extravasated from the sublingual gland into the floor of mouth and through the mylohyoid muscle into the neck. While the lining of a ranula is non-secreting and resection of the sublingual gland is adequate for simple sublingual mucoceles, many surgeons attempt to address plunging ranulas with extensive transoral and transcervical dissections. We review our experience managing plunging ranulas with intraoral sublingual gland excision and ranula drainage alone. METHODS: This is a case series of patients with plunging ranulas who underwent transoral sublingual gland excision and ranula drainage in the past 10 years at the Massachusetts Eye and Ear. All ranulas were confirmed by radiographic imaging. Data were gathered from the medical record and telephone surveys. RESULTS: Twenty-one patients with 22 distinct ranulas underwent this surgical approach. Average ranula size on imaging was 4.3 cm (SD = 1.3). Thirteen patients with 14 ranulas were followed up for greater than 6 months while the remaining 7 patients were lost to follow-up. Median follow-up for the 13 patients was 30 months (range 6 to 80). One ranula recurred requiring excision of residual sublingual gland (7%). One patient developed a local infection that was treated with antibiotics (7%). No long term complications were reported. CONCLUSION: Simple transoral excision of the sublingual gland with ranula drainage is sufficient for treatment of plunging ranulas. It is essential to obtain a full resection of the gland to prevent relapse. This limited approach has low rates of complications and ranula recurrence.

Recurrent plunging ranula of the neck.

The reported case describes a mismanaged extensive recurrent plunging ranula that occupied a large portion of the neck. The ranula is usually clinically diagnosed. However, absence of visible intra-oral signs may mislead the diagnosis and leads to improper surgical management. Presence of amylase in the aspirated fluids is an important aid in the differential diagnosis. Thereby confirming the salivary origin of the fluids and thus avoiding extensive investigations. The recurrence rate varies according to the procedure performed. Diverse methods of treating ranula have been reported in the literature with variable results. These include marsuplization, excision of the ranula, incision of the ranula and drainage of the contents, excision of the sublingual gland and drainage. The successful procedure to treat plunging ranula depends on complete excision of the affected sublingual gland and drainage of its contents. In this paper, the useful diagnostic investigations and the recommended surgical intervention procedure were described.

Modern management and pathophysiology of ranula: literature review.

BACKGROUND: There is a lack of consensus about the appropriate treatment of ranula. The objective of the present investigation was to produce a scientific basis for treatment. METHODS: A review of the relevant literature is interpreted in the light of improved knowledge about the local anatomy and the pathophysiology of the salivary glands. RESULTS: The oral and plunging ranulas are cystic extravasation mucoceles that arise from the sublingual gland and usually from a torn duct of Rivinus. The sublingual gland is a spontaneous secretor and the salivary flow is resistant to obstruction, which is caused by fibrosis induced by the extravasation. The submandibular gland is not a spontaneous secretor, is less resistant, and does not give rise to ranulas. CONCLUSIONS: Effective treatment is removal of the involved unit of the sublingual gland or inducing sufficient fibrosis to seal the leak through which the mucus extravasates.

Mucocele: a human model for lymphangiogenesis.

The mechanism of lymphangiogenesis is poorly understood, and controversy exists whether it is part of the inflammatory response to tissue injury. Utilizing markers specific to lymphatics, we aimed to study if lymphangiogenesis plays a role in the tissue response of mucoceles. Twenty-three extravasated mucoceles were selected. They were grouped by using widely accepted histologic criteria of wound healing into early-, intermediate-, and late-phase lesions. To identify lymphatic vessels we used lymphatic endothelium-specific antibodies (VEGFR3, Prospero-related homeobox gene-1 [Prox-1], and D2-40). To assess the proportion of lymphatic channels to all lesional vessels we used the panendothelial marker CD31. The presence, distribution, and proportion of lymphatic channels were assessed and compared among the groups. To investigate the involvement of lymphangiogenic signals, the expression of VEGFC was determined. To assess for proliferative activity of lymphatic endothelial cells we utilized Ki-67 antibody. Early-phase lesions (n = 6) were characterized by the presence of centrally located mucicarmine-positive material (mucin pools) with numerous inflammatory cells dominated by mucin-laden CD163-positive macrophages. Only scattered peripheral thin-walled large and small vessels were seen in the stroma surrounding the central mucin pool. Less than half of these vessels were of lymphatic nature as determined by Prox-1, VEGFR3, and D2-40 positivity. The histology of the intermediate-phase lesions (n = 6) was dominated by numerous lymphatics of varying size, not seen in the early phase. The histology of late-phase lesions (n = 11) resembled a "pseudo-cyst," with dense granulation tissue containing rare macrophages and rare lymphatic vessels. Although VEGFC was present in all phases, the highest expression was in the early phase. Low-grade proliferative lymphatic endothelium was noted in the intermediate lesions with a Ki-67 index of 4%. Early lymphangiogenesis and late lymphatic vessel regression were observed during mucocele evolution. The abundant newly formed ectatic lymphatic vessels seen in the intermediate phase may play a role in the clearance of extravasated material (mucin, edema, and lymph fluid) and in the initiation of the young fibroblast-rich granulation tissue. Mucocele appears to be an excellent human model for studying the factors that play a role in new lymphangiogenesis and regression.

Rânula: revisão da literatura e relato de caso clínico / Ranula: literature review and clinical case report

Os autores, através deste artigo, fazem uma revisão da literatura sobre uma lesão que acomete o assoalho bucal, a rânula. Mostram também os aspectos clínicos, a etiologia, o diagnóstico diferencial, as formas de tratamento, e apresentam um relato de caso de rânula em assoalho de boca tratada por meio de cirurgia (marsupialização).

The authors through this article report a literature review on the buccal floor, the ranula. Showing clinical aspects, etiology, differential diagnostic, ways of treatment and a case related of a ranula in buccal floor treated through surgery (marsupialization).

Acinic cell carcinoma found by recurrence of a mucous cyst in the sublingual gland.

This case report describes an acinic cell carcinoma found by a recurrence of a ranula in the sublingual gland. A 42-year-old male was admitted to the hospital of the Tokyo Dental College with a swelling in his right oral floor but without pain. The lesion was treated by windowing the same day under the diagnosis of a ranula, but the swelling appeared again at the same area eight months after the first operation. A resection was performed, and the specimen was sent to the clinical laboratory for pathological diagnosis. Proliferating serous cells were seen in part of the wall of an exudative mucous cyst. PAS staining was partially positive, and immunohistochemical staining for S-100 protein, lactoferrin, and amylase were also positive in cytoplasmic granules. This report concludes that the pathological diagnosis is beneficial in clarifying the reasons for the recurrence of a benign lesion.

Simple sublingual ranulas: pathogenesis and management.

Simple ranulas in the floor of the mouth usually reflect a mucus escape reaction that develops after disruption of sublingual gland elements. As such, they comprise an accumulation of mucus within connective tissue and lack an epithelial lining. Simple ranulas should be distinguished from cervical, or plunging, ranulas. Recommended treatments for simple ranulas usually involve excision of the ipsilateral sublingual gland, "marsupialization," or simple excision of the cyst. Alternatively, the ranula can be treated with the placement of a silk suture or seton into the dome of the cyst. Four cases using this technique are reported.