Ranulas and Plunging Ranulas Workup

  • Author: Ryan L Van De Graaff, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Feb 24, 2010
 

Imaging Studies

CT scanning

  • Ranulas on CT scanning (as seen in the image below) are described as cystic masses in the submandibular or parapharyngeal space that extend into or abut the sublingual space. On CT scanning, they are noted to be sharply demarcated lesions of low attenuation that conform to their local fascial boundaries. They are generally unilocular in nature. With the exception of a sublingual epidermoid, the appearance of a simple ranula on CT scanning is distinctive. CT scan of ranula. CT scan of ranula.
  • Plunging ranulas are occasionally noted on CT scanning to have a small tail extending into the sublingual space. This finding is almost pathognomonic for plunging ranulas. If this is absent, the presence of a homogeneous cyst in the submandibular or parapharyngeal space that abuts the sublingual space is highly indicative of a plunging ranula.

MRI

  • MRI is the most sensitive imaging study to evaluate the sublingual gland and its pathologic states.
  • On T1-weighted MRI, the gland appears as an area of intermediate signal intensity, lower than adjacent fat but higher than muscle.
  • T2-weighted images help discriminate cysts from surrounding normal structures.

Ultrasonography

Sublingual glands and their pathologic states are difficult to visualize on ultrasonography because of their location.

Next

Diagnostic Procedures

  • Needle aspiration
    • Analysis of fluid from ranulas demonstrates mucus with prominent histiocytes.
    • The biochemistry of this fluid shows high amylase and protein content.
  • Differential diagnosis
    • Lymphadenopathy
    • Cystic hygroma
    • Pleomorphic adenoma
    • Abscess
    • Thyroglossal duct cyst
    • Dermoid or epidermoid cyst
    • Laryngocele
    • Lipoma
    • Hemangioma
    • Cervical thymic cyst
    • Cysts of the parathyroid or thyroid gland
    • Tumor
Previous
Next

Histologic Findings

Most ranulas demonstrate a cyst devoid of epithelial lining, with the wall composed of vascular fibroconnective tissue resembling granulation tissue. Histiocytes predominate the pseudocyst wall. Mucin and foamy macrophages are often observed. Occasionally, partial epithelial linings are observed.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Ryan L Van De Graaff, MD  Consulting Staff, Southwest Idaho Ear, Nose and Throat

Ryan L Van De Graaff, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Kelley, MD  Consulting Staff, Eastern Shore ENT and Allergy Associates and Peninsula Regional Medical Center

Daniel J Kelley, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Laryngological Rhinological and Otological Society, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Peter S Roland, MD  Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Laryngological Rhinological and Otological Society, American Neurotology Society, American Otological Society, North American Skull Base Society, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Alcon labs Honoraria Speaking and teaching; GSK Honoraria Speaking and teaching; Advanced Bionics Honoraria Board membership; Cochlear corp Honoraria Board membership; Med El corp travel grants Consulting

Christopher L Slack, MD  Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position

References

  1. Morton RP, Ahmad Z, Jain P. Plunging ranula: congenital or acquired?. Otolaryngol Head Neck Surg. Jan 2010;142(1):104-7. [Medline].

  2. Garofalo S, Briganti V, Cavallaro S, Pepe E, Prete M, Suteu L. Nickel Gluconate-Mercurius Heel-Potentised Swine Organ Preparations: a new therapeutical approach for the primary treatment of pediatric ranula and intraoral mucocele. Int J Pediatr Otorhinolaryngol. Feb 2007;71(2):247-55. [Medline].

  3. Cochran CS, Zhou CQ, DeFatta RJ, Adelson RT. An innovative method of facilitating ranula excision with methylene blue injection. Ear Nose Throat J. March 2006;85(3):159, 163. [Medline].

  4. Zhao Y, Jia J, Jia Y. Complications Associated with Surgical Management of Ranulas. J Oral Malillofac Surg. 2005;63:51-54. [Medline].

  5. Ali MK, Chiancone G, Knox GW. Squamous cell carcinoma arising in a plunging ranula. J Oral Maxillofac Surg. Mar 1990;48(3):305-8. [Medline].

  6. Baurmash HD. Marsupialization for treatment of oral ranula: a second look at the procedure. J Oral Maxillofac Surg. Dec 1992;50(12):1274-9. [Medline].

  7. Baurmash, HD. A case against sublingual gland removal as primary treatment of ranulas. J Oral Maxillofac Surg. January 2007;65(1):117-21. [Medline].

  8. Coit WE, Harnsberger HR, Osborn AG. Ranulas and their mimics: CT evaluation. Radiology. Apr 1987;163(1):211-6. [Medline].

  9. Danford M, Eveson JW, Flood TR. Papillary cystadenocarcinoma of the sublingual gland presenting as a ranula. Br J Oral Maxillofac Surg. Aug 1992;30(4):270-2. [Medline].

  10. Davison MJ, Morton RP, McIvor NP. Plunging ranula: clinical observations. Head Neck. Jan 1998;20(1):63-8. [Medline].

  11. Fukase S, Ohta N, Inamura K. Treatment of Ranula with Intracystic Injecton of the Streptococcal Preparation OK-432. Ann Otol Rhinol Laryngol. 2003;112(3):214-20. [Medline].

  12. Ichimura K, Ohta Y, Tayama N. Surgical management of the plunging ranula: a review of seven cases. J Laryngol Otol. Jun 1996;110(6):554-6. [Medline].

  13. Ikarashi T, Inamura K, Kimura Y. Cystic lymphangioma and plunging ranula treated by OK-432 therapy: a report of two cases. Acta Otolaryngol Suppl. 1994;511:196-9. [Medline].

  14. Langlois NE, Kolhe P. Plunging ranula: a case report and a literature review. Hum Pathol. Nov 1992;23(11):1306-8. [Medline].

  15. Matt BH, Crockett DM. Plunging ranula in an infant. Otolaryngol Head Neck Surg. Sep 1988;99(3):330-3. [Medline].

  16. McGurk M. Management of the ranula. J Oral Maxillofac Surg. January 2007;65(1):115-6. [Medline].

  17. Mintz S, Barak S, Horowitz I. Carbon dioxide laser excision and vaporization of nonplunging ranulas: a comparison of two treatment protocols. J Oral Maxillofac Surg. Apr 1994;52(4):370-2. [Medline].

  18. Morton RP, Bartley JR. Simple sublingual ranulas: pathogenesis and management. J Otolaryngol. Aug 1995;24(4):253-4. [Medline].

  19. Shimm DS, Berk FK, Tilsner TJ. Low-dose radiation therapy for benign salivary disorders. Am J Clin Oncol. Feb 1992;15(1):76-8. [Medline].

  20. Steelman R, Weisse M, Ramadan H. Congenital ranula. Clin Pediatr (Phila). Mar 1998;37(3):205-6. [Medline].

  21. Sumi M, Izumi M, Yonetsu K. Sublingual gland: MR features of normal and diseased states. AJR Am J Roentgenol. Mar 1999;172(3):717-22. [Medline].

  22. Yoshimura Y, Obara S, Kondoh T. A comparison of three methods used for treatment of ranula. J Oral Maxillofac Surg. Mar 1995;53(3):280-2; discussion 283. [Medline].

  23. Zhao Y, Jia Y, Chen X. Clinical Review of 580 Ranulas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98(3):281-7. [Medline].

 
Previous
Next
 
Ranula. Image courtesy of Sylvan Stool, MD.
Ranula. Image courtesy of Sylvan Stool, MD.
CT scan of ranula.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.