Ranula

A Brief description on Ranula

1. Mucocele Mucus is the exclusive secretory product of the accessory minor salivary glands and the most prominent product of the sublingual gland. The mechanism for mucus cavity development is extravasation or retention

2. Mucoceles , exclusive of the irritation fibroma, are most common of the benign soft tissue masses in the oral cavity. Muco : mucus , coele : cavity . When in the oral floor, they are called ranula .

3. Extravasation is the leakage of fluid from the ducts or acini into the surrounding tissue. Extra : outside, vasa : vessel Retention: narrowed ductal opening that cannot adequately accommodate the exit of saliva produced, leading to ductal dilation and surface swelling. Less common phenomenon

4. Consist of a circumscribed cavity in the connective tissue and submucosa producing an obvious elevation in the mucosa

5. The majority of the mucoceles result from an extravasation of fluid into the surrounding tissue after traumatic break in the continuity of their ducts. Lacks a true epithelial lining.

6. Ranula Is a term used for mucoceles that occur in the floor of the mouth. The name is derived form the word rana , because the swelling may resemble the translucent underbelly of the frog.

7. CONGENITAL ACQUIRED MAY BE FOUND IN NEWBORN INFANTS

8. ETIOLOGY Obstruction of one of the salivary glands. Essentially a Retention cyst. Spontaneous or results from surgery to the floor of mouth,especially sub- mandibukar duct relocation.

9. An Extravasation cyst arising from gland of NUHN or BLANDIN Occasionally submandibular gland Initially there is a blockage of duct causes retention cyst and with increased pressure there is rupture of acini leading to extravasation cyst.

10. Smooth cystic swelling under the tongue usually to one side. Presents as a blue dome shaped swelling in the floor of mouth (FOM ) or transparent with overlying blood vessels. They tend to be larger than mucoceles & can fill the FOM & elevate tongue.

11. Located lateral to the midline, helping to distinguish it from a midline dermoid cyst . If larger,may affect both breathing and swallowing.

12. Plunging or Cervical Ranula Occurs when spilled mucin dissects through the mylohyoid muscle and produces swelling in the neck. Extravasation of mucus occurs behind the confines of the floor of the mouth through the mylohyoid muscle into the upper neck or sub mental region Soft,Cross Fluctuant,Non tender,Dumb bell shaped swelling in sub mandibular region. Bi-Digitally palpable.

13. Concomitant FOM swelling may or may not be visible. Difficult to distinguish clinically from cystic hygroma Can be readily picked up by MRI Hygroma has simple epithelial lining,ranula contained by loose connective tissues.

14. Treatment of Mucoceles in Lip or Buccal mucosa Excision with strict removal of any projecting peripheral salivary glands Avoid injury to other glands during primary wound closure

15. Treatment Simple aspiration or drainage results in high recurrence. Both simple and plunging ranula needs excision of cyst wall and sublingual gland. Great care to preserve lingual nerve Sometimes ranula presenting in neck may need cervical incision