21/53. Low-dose radiation therapy for benign salivary disorders. Two patients, one with a persistent salivary fistula after surgery for a skin tumor overlying the parotid region, and the other with a ranula recurrent after surgery, were treated with low-dose irradiation. Both problems resolved after a total dose of less than 30 Gy, and neither patient experienced xerostomia. In selected patients, low-dose radiation therapy offers a solution to persistent salivary flow refractory to surgical management. ( info) |
| This case report describes an acinic cell carcinoma found by a recurrence of a ranula in the sublingual gland. A 42-year-old male was admitted to the hospital of the tokyo Dental College with a swelling in his right oral floor but without pain. The lesion was treated by windowing the same day under the diagnosis of a ranula, but the swelling appeared again at the same area eight months after the first operation. A resection was performed, and the specimen was sent to the clinical laboratory for pathological diagnosis. Proliferating serous cells were seen in part of the wall of an exudative mucous cyst. PAS staining was partially positive, and immunohistochemical staining for S-100 protein, lactoferrin, and amylase were also positive in cytoplasmic granules. This report concludes that the pathological diagnosis is beneficial in clarifying the reasons for the recurrence of a benign lesion. ( info) |
23/53. Pediatric intraoral ranulas: an analysis of nine cases. An intraoral ranula is a retention cyst arises from the sublingual gland on the floor of the mouth as a result of ductal obstruction and fluid retention. Many techniques for management of ranulas have been described in the literature. The purpose of this study was to analyze our surgically treated pediatric patients with intraoral ranulas and to discuss the results in the light of the literature. Nine pediatric patients (six females and three males) with intraoral ranulas surgically treated were analyzed retrospectively regarding their treatment methods and results. The surgical specimens were also re-examined histologically. Seven cases of superficial, protruded and smaller than 2 cm ranulas were treated with marsupialization (unroofing). Two cases who were previously operated and then recurred had bigger than 2 cm ranulas. In these two cases, marsupialization of the ranula plus removal of the sublingual gland was performed. The most common complication was intraoperative cyst rupture of the ranula, which was noted in four cases. A recurrence was observed in only one case in the 16th months of follow up period. Our findings show that marsupialization is a suitable and effective method for pediatric intraoral ranulas, whereas in recurrent cases marsupialization of the ranula combined with total excision of sublingual gland may be preferred. ( info) |
24/53. Thoracic ranula: an extremely rare case. We present the first case of a thoracic ranula which originated from the left submandibular area extending into the subcutaneous tissue planes of the anterior chest wall. The patient had a history of surgery for a previous benign left salivary gland cyst, and presented with an enlarging mass in the anterior chest wall. This was a recurrence of a ranula, with an extension into the anterior thoracic wall. The thoracic ranula was excised, together with ipsilateral sublingual and submandibular glands, via a transcervical approach. No recurrence was detected over a 3-year post-operative follow up. ( info) |
25/53. Sublingual ranula: report of a submandibular clinical case. ranula is a raised mucocele on the oral floor. When the mucocele extends and passes the sublingual space and invades the submandibular space it may be called ''plunging ranula''. Its etiology is not completely known. Our clinical case is a clear example: a 10-year old formation, not painful, developed during several years and originally of small dimension located in the sublingual region. The purpose of this study is to underline that the surgical treatment of choice, in these clinical situations, is the drainage of the cavity and marsupialization rather than a radical removal. ( info) |
26/53. An unusual case of floor of mouth swelling: case report, differential diagnosis and a review of the literature. The oral cavity is an uncommon site for a true lipoma. A distinct histological variant is the spindle cell lipoma. This is a rare oral lesion. A case of an intra-oral spindle cell lipoma in a 55-year-old female is reported, a differential diagnosis is presented and the histopathology is discussed. CLINICAL RELEVANCE: An oral swelling is a common presenting complaint and requires further investigation. ( info) |
27/53. Treatment of a ranula using an Er,Cr:YSGG laser. A ranula is an extravasational cyst arising from the sublingual gland. The "cyst" cavity does not have an epithelial lining, and because of this is notoriously difficult to eliminate. Usual treatment requires complete excision of the sublingual gland, exteriorizing the gland through establishment of a secondary ductal structure by placement of a long-term indwelling catheter, or packing, all requiring patient compliance. Unroofing alone is often followed by recurrence via resealing or closure with formation of a new roof. The accompanying scarring and damage to additional ducts may also result in recurrence. Combining unroofing with a technique that would prevent resealing of the remaining portion, scarify the base of the ranula to eliminate residual glandular acini, and be more comfortable and non-interfering with the daily activity of the patient, is an acceptable object of treatment of a ranula. The use of a water-based laser system to accomplish these goals appears to be a desirable and simple method. ( info) |
28/53. Salivary gland cysts of the oral cavity: clinical observation and surgical management. Mucoceles are common cystic lesions of the oral mucosa. Extravasation mucoceles are mainly found in the lower lip of young patients, whereas retention mucoceles are usually located in the cheek or palate of older patients. The disparate site and age incidences of extravasation and retention mucoceles suggest that these two types are not related and have different pathogenesis. Treatment modalities for mucoceles are reviewed, with special attention to the cryosurgical technique for the treatment of oral ranulas. ( info) |
29/53. Plunging ranula following bilateral submandibular duct transposition. Submandibular duct transposition is now a standard surgical procedure for the treatment of severe drooling. However, this is our first experience of a plunging ranula arising as a complication of the technique. In the surgical management of this complication, the single most important step is excision of the sublingual gland to prevent recurrence. ( info) |
30/53. Submandibular cystic hygroma resembling a plunging ranula in a neonate. review and report of a case. Cystic hygromas are large lymphangiomas that are most often found in the posterior triangle of the neck and the axilla in children. They are most frequently found before age 2 and may be massive. After upper respiratory infection, they may become infected and enlarged, causing dysphagia and toxemia. The diagnosis can usually be made by history and physical examination and confirmed by biopsy. Treatment is by surgical excision of small lesions and staged debulking excisions in more severe cases. A patient with a cystic hygroma having many clinical characteristics of a plunging ranula is presented. The cyst fluid was aspirated and analyzed for its amylase, sodium, potassium, chloride, urea nitrogen, glucose, and total protein content. The characteristics of the fluid were also compared with those of lymph and saliva. This report demonstrates the difficulty in determining the diagnosis of a tumor that has the clinical features of a cystic hygroma, as well as a plunging ranula. The necessity of a proper presurgical diagnosis is essential since the form of therapy for each is different and conflicting. A method that distinguishes between the cervical cystic hygroma and a plunging ranula by means of aspirated fluid is discussed. ( info) |