Ranula

Ranula

• 1.
  Mucocele  Mucus isthe 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, exclusiveof 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 theleakage 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 ofa circumscribed cavity in the connective tissue and submucosa producing an obvious elevation in the mucosa
• 5.
   The majorityof 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 aterm 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 ofone 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 Extravasationcyst 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 cysticswelling 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 lateralto the midline, helping to distinguish it from a midline dermoid cyst.  If larger,may affect both breathing and swallowing.
• 13.
  Plunging or CervicalRanula  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.
• 14.
   Concomitant FOMswelling 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.
• 15.
  Treatment of Mucoceles inLip or Buccal mucosa  Excision with strict removal of any projecting peripheral salivary glands  Avoid injury to other glands during primary wound closure
• 16.
  Treatment o Simple aspirationor drainage results in high recurrence. o Both simple and plunging ranula needs excision of cyst wall and sublingual gland. o Great care to preserve lingual nerve o Sometimes ranula presenting in neck may need cervical incision