Transoral approach for plunging ranula--10-year experience.
OBJECTIVE
Plunging ranulas (PRs) are infrequently encountered. The origin of PRs is mostly from the sublingual gland (SLG). Different routes to manage PRs include marsupialization, simple SLG excision, and combined SLG and submandibular gland (SMG) excision either transcervically or transorally. In this study, we demonstrated our experience managing PRs via transoral excision of the SLG with marsupialization.


METHODS
Retrospective study.


METHODS
We retrospectively reviewed 20 patients at Chang Gung Memorial Hospital, Linkou, between January 1999 and April 2009. All patients received preoperative computed tomography or magnetic resonance imaging and were clinically diagnosed with PR. At surgery, the SLG was excised transorally with preservation of Wharton's duct and lingual nerve. The mucus contents of the PRs were drained through the posterior edge of the mylohyoid muscle.


RESULTS
Two patients were found to have final diagnosis of lymphangioma. Eighteen patients were eligible for analysis. The age distribution ranged from 6 to 48 years old. Sexual distribution was equally distributed. The successful rate was 17/18 (94.4%) with a lingual nerve paresthesia rate of 2/18 (11.1%). The paresthesia persisted for 3 and 6 months, respectively. One recurrent patient was salvaged by excision of the SMG and ranula. The other two recurrent patients received excision of the SMG and cyst and had a final diagnosis of lymphangioma.


CONCLUSIONS
Transoral approach with excision of the SLG alone provides a high success rate (94.4%) with minor complications and could be the first choice in managing PRs. The results of this study confirm PRs mostly originate from the SLG.
Huang
Shiang-Fu
SF
Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan.
Liao
Chun-Ta
CT
Chin
Shy-Chyi
SC
Chen
I-How
IH
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D011900:Ranula / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013361:Sublingual Gland / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome