Ranula: Current Concept of Pathophysiologic Basis and Surgical Management Options.

BACKGROUND: There is no consensus opinion on a definitive surgical management option for ranulas to curtail recurrence, largely from the existing gap in knowledge on the pathophysiologic basis. AIM: To highlight the current scientific basis of ranula development that informed the preferred surgical approach. DESIGN: Retrospective cohort study. SETTING: Public Tertiary Academic Health Institution. METHOD: A 7-year 7-month study of ranulas surgically managed at our tertiary health institution was undertaken-June 1, 2008-December 31, 2015-from case files retrieved utilising the ICD-10 version 10 standard codes. RESULTS: Twelve cases, representing 0.4 and 1.2% of all institutional and ENT operations, respectively, were managed for ranulas with a M:F = 1:1. The ages ranged from 5/12 to 39 years, mean = 18.5 years, and the disease was prevalent in the third decade of life. Main presentation in the under-fives was related to airway and feeding compromise, while in adults, cosmetic facial appearance. Ranulas in adults were plunging (n = 8, 58.3%), left-sided save one with M:F = 2:1. All were unilateral with R:L = 1:2. Treatment included aspiration (n = 2, 16.7%) with 100% recurrence, intra-/extraoral excision of ranula only (n = 4, 33.3%) with recurrence rate of 50% (n = 2, 16.7%), while marsupialisation in children (n = 1, 8.3%) had no recurrence. Similarly, transcervical approach (n = 5, 41.7%) with excision of both the ranula/sublingual salivary gland recorded zero recurrence. Recurrence was the main complication (n = 4, 33.3%). CONCLUSION: With the current knowledge on the pathophysiologic basis, extirpation of both the sublingual salivary gland and the ranula by a specialist surgeon is key for a successful outcome.

Treatment of a ranula using an Er,Cr:YSGG laser.

A ranula is an extravasational cyst arising from the sublingual gland. The "cyst" cavity does not have an epithelial lining, and because of this is notoriously difficult to eliminate. Usual treatment requires complete excision of the sublingual gland, exteriorizing the gland through establishment of a secondary ductal structure by placement of a long-term indwelling catheter, or packing, all requiring patient compliance. Unroofing alone is often followed by recurrence via resealing or closure with formation of a new roof. The accompanying scarring and damage to additional ducts may also result in recurrence. Combining unroofing with a technique that would prevent resealing of the remaining portion, scarify the base of the ranula to eliminate residual glandular acini, and be more comfortable and non-interfering with the daily activity of the patient, is an acceptable object of treatment of a ranula. The use of a water-based laser system to accomplish these goals appears to be a desirable and simple method.

Tratamento cirúrgico da rânula / Surgical treatment of ranula

Introdução: Rânulas são lesões císticas no soalho da boca. Elas surgem por extravasamento de muco após trauma local ou por obstrução dos ductos. O objetivo deste estudo é relatar nossa experiência com o tratamento cirúrgico das rânulas. Pacientes e método: Vinte pacientes foram submetidos à excisão cirúrgica da rânula e estudados retrospectivamente por meio de revisão de prontuário. Resultados: A idade variou de 13 a 38 anos. Catorze eram do gênero feminino e seis do masculino. Três pacientes relataram crescimento do cisto após algum trauma. As lesões foram notadas de 3 semanas a 10 anos. O tamanho variou de 0,5 a 8 cm. Houve dois casos de rânula supra-hióidea. Excisão completa do cisto foi realizada em 18 pacientes, 2 pacientes foram submetidos a marsupialização e a glândula sublingual foi removida em 3 casos. Todos os casos de ressecção total foram efetuados por via intra-oral. O seguimento dos pacientes variou de 6 a 24 meses e os índices de recidiva foram analisados. Dois pacientes (10%) apresentaram recidiva após a ressecção. Rompimento da lesão ocorreu durante da dissecação cirúrgica em 4 casos (20%). O rompimento ocorreu em ambos os casos que apresentaram recorrência. Catorze casos eram cistos verdadeiros com camada epitelial, enquanto que 6 eram pseudocistos. Três pacientes portadores de lesões pequenas foram operados sob anestesia local. O desconforto pós-operatório foi mínimo. Conclusão: Dois pacientes (10%) apresentaram recidiva após excisão total. Rompimento ocorreu em ambos os casos durante a cirurgia. Catorze casos eram cistos verdadeiros com camada epitelial e 6 eram pseudocistos.