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, 134:2689-2696, 2024.

Ránula cervical gigante: a propósito de un caso / Huge plunging ranula: about a case

La ránula es una lesión pseudoquística causada por la retención de contenido salival de la glándula sublingual en el tejido conjuntivo subyacente, siendo la patología más frecuente de esta glándula. Su localización es a nivel del suelo de la boca, pudiendo en ocasiones extenderse a través del músculo milohioideo hacia la región submaxilar o cervical (ránula plunging o cervical), presentándose clínicamente como una tumoración laterocervical de crecimiento lento. El apoyo de imágenes mediante ecografía, tomografía computarizada, o RM (resonancia magnética) es fundamental para un correcto diagnóstico. Respecto al tratamiento, el procedimiento más aceptado y con menos tasas de recurrencia es la escisión de la ránula cervical por abordaje laterocervical, asociada a la extirpación de la glándula sublingual implicada vía transoral. Aquí presentamos el caso clínico de un varón de 25 años quien presenta una masa laterocervical derecha de seis meses de evolución de crecimiento progresivo e indoloro. La ecografía y RM confirman una ránula cervical gigante de 62x45x101 mm, que se localiza en espacio submandibular derecho, alcanzando el espacio parafaríngeo en su vertiente más craneal. Debido a las características de la lesión y su anatomía se decide tratamiento quirúrgico.

The ranula is a pseudocystic lesion caused by the retention of salivary content of the sublingual gland in the underlying connective tissue, being the most frequent pathology of this gland. Its location is at the level of the floor of the mouth and can sometimes extend through the mylohyoid muscle towards the submaxillary or cervical region (plunging or cervical ranula), clinically presenting as a slow-growing laterocervical tumor. The support of images by ultrasound, computed tTomography or MRI (magnetic resonance imaging) is essential for a correct diagnosis. Regarding treatment, the most accepted procedure, and with the lowest recurrence rates is excision of the cervical ranula by the laterocervical approach, associated with the transoral removal of the involved sublingual gland. Here, we present the clinical case of a 25-year-old man who presented a six-month-old right laterocervical mass of progressive and painless growth. Ultrasound and MRI confirmed a giant cervical ranula measuring approximately 62x45x101 mm, located in the right submandibular space, reaching the parapharyngeal space in its most cranial aspect. Due to the characteristics of the injury and its anatomy, surgical treatment was decided.

Tratamiento de la ránula sublingual: revisión de la literatura. A propósito de un caso / Relationship between treatment of sublingual ranula: literature review. A case report

El objetivo de este trabajo es conocer las principales técnicas para el tratamiento de la ránula sublingual, llevando a cabo una revisión de la literatura existente a propósito de un caso clínico. Con respecto al caso clínico se trata de una paciente mujer de 20 años que acude a consulta por aumento de tamaño del suelo de la boca de unos 3x5 cm. Al realizar la resonancia magnética, se observa una lesión quística en la región sublingual derecha. Se planifica cirugía de escisión radical, extirpando la glándula sublingual derecha y la lesión. Se pauta como tratamiento antibiótico amoxicilina-ác. clavulánico 875/125 mg y antiinflamatorio metilprednisolona 40 mg y dexketoprofeno 50 mg. Como conclusión la técnica más utilizada, hoy en día, es la cirugía radical, seguida de la micromarsupialización y técnicas modernas mínimamente invasivas

The objective of this study is to know the main techniques for the treatment of the sublingual ranula, through a literature review about a clinical case. With regard to the clinical case, this is a 20 year old female patient present at medical clinic for an increase size of the floor of the mouth of about 3x5cm. When performing a magnetic resonance, observe a cystic lesion in the right sublingual region. Radical excision surgery planned, removing the right sublingual gland and the lesion. It is prescribed as antibiotic treatment amoxicillin-clavulanic acid 875/125 mg and anti-inflammatory methylprednisolone 40 mg and dexketoprofene 50 mg. In conclusion, the most used technique, nowadays, is the radical surgery, followed by the micromarsupialisation and minimally invasive modern technique

Ránula: diagnóstico prenatal / Ranula: prenatal diagnosis

Patogenia, características clínicas, clasificación, diagnóstico pre y postnatal, y diagnósticos diferenciales de esta formación.(AU)