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Ranula
Richard H. Wiggins, III, MD, CIIP, FSIIM
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Simple ranula (SR)
                • Diving ranula (DR)
              • Synonyms

                • SR = sublingual gland (SLG) mucocele, SLG mucous retention cyst
                • DR = plunging ranula
              • Definitions

                • SLG or minor salivary gland retention cyst
                  • SR: True cyst confined to sublingual space (SLS)
                  • DR: Extravasation pseudocyst; ruptured SR extending into submandibular space (SMS)
                • Term ranula derives from Latin "rana," meaning "frog"
                  • Sublingual blebs in mouth of frog resemble SR

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Brown RE et al: Diagnostic imaging of benign and malignant neck masses in children-a pictorial review. Quant Imaging Med Surg. 6(5):591-604, 2016
                                              2. Lee JY et al: Plunging ranulas revisited: A CT study with emphasis on a defect of the mylohyoid muscle as the primary route of lesion propagation. Korean J Radiol. 17(2):264-70, 2016
                                              3. Margalit I et al: Point-of-care ultrasound to diagnose a simple ranula. West J Emerg Med. 17(6):827-828, 2016
                                              4. Carlson ER: Diagnosis and management of salivary lesions of the neck. Atlas Oral Maxillofac Surg Clin North Am. 23(1):49-61, 2015
                                              5. Chen CJ et al: Recurrent sublingual ranula or saliva leakage from the submandibular gland? Anatomical consideration of the ductal system of the sublingual gland. J Oral Maxillofac Surg. 73(4):675.e1-7, 2015
                                              6. Fontenot TE et al: Swelling of submandibular region. Plunging ranula. JAMA Otolaryngol Head Neck Surg. 139(10):1073-4, 2013
                                              7. McKinstry S et al: Bilateral plunging ranula: two case reports and a review of the literature. N Z Med J. 126(1385):81-6, 2013
                                              8. Kadom N et al: Neck masses in children: current imaging guidelines and imaging findings. Semin Roentgenol. 47(1):7-20, 2012
                                              9. Harrison JD: Modern management and pathophysiology of ranula: literature review. Head Neck. 32(10):1310-20, 2010
                                              10. Clyburn VL 3rd et al: Ascending and plunging ranula in a pediatric patient. Otolaryngol Head Neck Surg. 140(6):948-9, 2009
                                              11. Lai JB et al: Treatment of ranula using carbon dioxide laser--case series report. Int J Oral Maxillofac Surg. 38(10):1107-11, 2009
                                              12. Patel MR et al: Oral and plunging ranulas: What is the most effective treatment? Laryngoscope. 119(8):1501-9, 2009
                                              13. Zhi K et al: Management of the pediatric plunging ranula: results of 15 years' clinical experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 107(4):499-502, 2009
                                              14. Roh JL et al: Primary treatment of pediatric plunging ranula with nonsurgical sclerotherapy using OK-432 (Picibanil). Int J Pediatr Otorhinolaryngol. 72(9):1405-10, 2008
                                              15. Rosa PA et al: Congenital neck masses. Oral Maxillofac Surg Clin North Am. 20(3):339-52, 2008
                                              16. Haberal I et al: Surgical management of pediatric ranula. Int J Pediatr Otorhinolaryngol. 68(2):161-3, 2004
                                              17. Choi TW et al: Hydrodissection for complete removal of a ranula. Ear Nose Throat J. 82(12):946-7, 951, 2003
                                              18. Fukase S et al: Treatment of ranula wth intracystic injection of the streptococcal preparation OK-432. Ann Otol Rhinol Laryngol. 112(3):214-20, 2003
                                              19. Macdonald AJ et al: Giant ranula of the neck: differentiation from cystic hygroma. AJNR Am J Neuroradiol. 24(4):757-61, 2003
                                              20. Onderoglu L et al: Prenatal diagnosis of ranula at 21 weeks of gestation. Ultrasound Obstet Gynecol. 22(4):399-401, 2003
                                              21. Takagi S et al: Treatment of a plunging ranula with fenestration and continuous pressure. Br J Oral Maxillofac Surg. 41(6):410-3, 2003
                                              22. Woo JS et al: Recurrent plunging ranula treated with OK-432. Eur Arch Otorhinolaryngol. 260(4):226-8, 2003
                                              23. Pandit RT et al: Management of pediatric ranula. Otolaryngol Head Neck Surg. 127(1):115-8, 2002
                                              24. Baurmash HD: Treating oral ranula: another case against blanket removal of the sublingual gland. Br J Oral Maxillofac Surg. 39(3):217-20, 2001
                                              25. Kurabayashi T et al: MRI of ranulas. Neuroradiology. 42(12):917-22, 2000
                                              26. Davison MJ et al: Plunging ranula: clinical observations. Head Neck. 20(1):63-8, 1998
                                              27. Fernandez Moya JM et al: Antenatal diagnosis and management of a ranula. Ultrasound Obstet Gynecol. 11(2):147-8, 1998
                                              28. Ichimura K et al: Surgical management of the plunging ranula: a review of seven cases. J Laryngol Otol. 110(6):554-6, 1996
                                              29. Yoshimura Y et al: A comparison of three methods used for treatment of ranula. J Oral Maxillofac Surg. 53(3):280-2; discussion 283, 1995
                                              30. Coit WE et al: Ranulas and their mimics: CT evaluation. Radiology. 163(1):211-6, 1987
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Abbreviations

                                                            • Simple ranula (SR)
                                                            • Diving ranula (DR)
                                                          • Synonyms

                                                            • SR = sublingual gland (SLG) mucocele, SLG mucous retention cyst
                                                            • DR = plunging ranula
                                                          • Definitions

                                                            • SLG or minor salivary gland retention cyst
                                                              • SR: True cyst confined to sublingual space (SLS)
                                                              • DR: Extravasation pseudocyst; ruptured SR extending into submandibular space (SMS)
                                                            • Term ranula derives from Latin "rana," meaning "frog"
                                                              • Sublingual blebs in mouth of frog resemble SR

                                                          IMAGING

                                                          • General Features

                                                            • CT Findings

                                                              • MR Findings

                                                                • Ultrasonographic Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Brown RE et al: Diagnostic imaging of benign and malignant neck masses in children-a pictorial review. Quant Imaging Med Surg. 6(5):591-604, 2016
                                                                                          2. Lee JY et al: Plunging ranulas revisited: A CT study with emphasis on a defect of the mylohyoid muscle as the primary route of lesion propagation. Korean J Radiol. 17(2):264-70, 2016
                                                                                          3. Margalit I et al: Point-of-care ultrasound to diagnose a simple ranula. West J Emerg Med. 17(6):827-828, 2016
                                                                                          4. Carlson ER: Diagnosis and management of salivary lesions of the neck. Atlas Oral Maxillofac Surg Clin North Am. 23(1):49-61, 2015
                                                                                          5. Chen CJ et al: Recurrent sublingual ranula or saliva leakage from the submandibular gland? Anatomical consideration of the ductal system of the sublingual gland. J Oral Maxillofac Surg. 73(4):675.e1-7, 2015
                                                                                          6. Fontenot TE et al: Swelling of submandibular region. Plunging ranula. JAMA Otolaryngol Head Neck Surg. 139(10):1073-4, 2013
                                                                                          7. McKinstry S et al: Bilateral plunging ranula: two case reports and a review of the literature. N Z Med J. 126(1385):81-6, 2013
                                                                                          8. Kadom N et al: Neck masses in children: current imaging guidelines and imaging findings. Semin Roentgenol. 47(1):7-20, 2012
                                                                                          9. Harrison JD: Modern management and pathophysiology of ranula: literature review. Head Neck. 32(10):1310-20, 2010
                                                                                          10. Clyburn VL 3rd et al: Ascending and plunging ranula in a pediatric patient. Otolaryngol Head Neck Surg. 140(6):948-9, 2009
                                                                                          11. Lai JB et al: Treatment of ranula using carbon dioxide laser--case series report. Int J Oral Maxillofac Surg. 38(10):1107-11, 2009
                                                                                          12. Patel MR et al: Oral and plunging ranulas: What is the most effective treatment? Laryngoscope. 119(8):1501-9, 2009
                                                                                          13. Zhi K et al: Management of the pediatric plunging ranula: results of 15 years' clinical experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 107(4):499-502, 2009
                                                                                          14. Roh JL et al: Primary treatment of pediatric plunging ranula with nonsurgical sclerotherapy using OK-432 (Picibanil). Int J Pediatr Otorhinolaryngol. 72(9):1405-10, 2008
                                                                                          15. Rosa PA et al: Congenital neck masses. Oral Maxillofac Surg Clin North Am. 20(3):339-52, 2008
                                                                                          16. Haberal I et al: Surgical management of pediatric ranula. Int J Pediatr Otorhinolaryngol. 68(2):161-3, 2004
                                                                                          17. Choi TW et al: Hydrodissection for complete removal of a ranula. Ear Nose Throat J. 82(12):946-7, 951, 2003
                                                                                          18. Fukase S et al: Treatment of ranula wth intracystic injection of the streptococcal preparation OK-432. Ann Otol Rhinol Laryngol. 112(3):214-20, 2003
                                                                                          19. Macdonald AJ et al: Giant ranula of the neck: differentiation from cystic hygroma. AJNR Am J Neuroradiol. 24(4):757-61, 2003
                                                                                          20. Onderoglu L et al: Prenatal diagnosis of ranula at 21 weeks of gestation. Ultrasound Obstet Gynecol. 22(4):399-401, 2003
                                                                                          21. Takagi S et al: Treatment of a plunging ranula with fenestration and continuous pressure. Br J Oral Maxillofac Surg. 41(6):410-3, 2003
                                                                                          22. Woo JS et al: Recurrent plunging ranula treated with OK-432. Eur Arch Otorhinolaryngol. 260(4):226-8, 2003
                                                                                          23. Pandit RT et al: Management of pediatric ranula. Otolaryngol Head Neck Surg. 127(1):115-8, 2002
                                                                                          24. Baurmash HD: Treating oral ranula: another case against blanket removal of the sublingual gland. Br J Oral Maxillofac Surg. 39(3):217-20, 2001
                                                                                          25. Kurabayashi T et al: MRI of ranulas. Neuroradiology. 42(12):917-22, 2000
                                                                                          26. Davison MJ et al: Plunging ranula: clinical observations. Head Neck. 20(1):63-8, 1998
                                                                                          27. Fernandez Moya JM et al: Antenatal diagnosis and management of a ranula. Ultrasound Obstet Gynecol. 11(2):147-8, 1998
                                                                                          28. Ichimura K et al: Surgical management of the plunging ranula: a review of seven cases. J Laryngol Otol. 110(6):554-6, 1996
                                                                                          29. Yoshimura Y et al: A comparison of three methods used for treatment of ranula. J Oral Maxillofac Surg. 53(3):280-2; discussion 283, 1995
                                                                                          30. Coit WE et al: Ranulas and their mimics: CT evaluation. Radiology. 163(1):211-6, 1987