Ranula

A ranula is a special type of mucous retention cyst most commonly caused by partial obstruction of the excretory duct of the sublingual gland. Rarely, it may originate from the cervical sinus or from branchial cleft remnants. The classic or simple ranula is a true cyst lined with cuboidal, columnar or squamous epithelium and filled with mucoid material similar to that found in mu-coceles. It produces a mass in the floor of the mouth to one side of the midline. Dissection of the mucus into the fascial planes of the neck results in a pseudocyst called plunging ranula. Simple ranulas are distinguished from mucoceles by their location and by the presence of an epithelial lining [11].

The plunging ranula may mimic other cystic or glandular swellings, such as dermoid and epidermoid cysts, TDC or cystic hygroma. Quick and Lowell [90] have pointed out that no specific clinical diagnostic tests are available to distinguish these lesions. Consequently, a definitive diagnosis is dependent on postoperative histopathologic evaluation of the surgical specimen.

The management of these lesions requires removal of the sublingual gland and excision of the ranula. The recurrence rate after this procedure is 0%. Excision of only the ranula was followed by a 25% recurrence rate, whereas marsupialisation results in a 36% recurrence rate [129].

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