title: Are the patients with anatomic variation of the sublingual/Wharton's duct system predisposed to ranula formation?
abstract: OBJECTIVE
  To evaluate ranula development according to anatomic variation of the ductal system of sublingual gland (SLG), especially the presence of Bartholin's duct.
  
  
  METHODS
  The anatomic variation of SLG duct was prospectively investigated and compared between 55 consecutive patients with ranulas treated by SLG excision (group 1) and another 15 consecutive patients undergoing similar surgeries for other conditions (group 2). The ductal structures of SLGs and submandibular glands (SMG) were also compared between the pediatric patients and adult patients with ranulas.
  
  
  RESULTS
  In 32 of 55 patients with ranulas (58.2%) and 1 of 15 patients without ranulas (6.7%), the SLG showed an anatomic variation of the main duct called Bartholin's duct structure (P<0.01). Seventeen of 22 (77.3%) pediatric patients with ranulas had Bartholin's ducts and 15 of 33 (45.5%) adult patients with ranulas had Bartholin's ducts (0.01<P<0.05), but Bartholin's duct which opens near to the orifice of Wharton's duct was not found in this study population. Plunging ranulas that extravasate deep to the mylohyoid were observed in the 6 patients (4 children and 2 adults). There was no recurrence in all cases with ranulas.
  
  
  CONCLUSIONS
  Congenital anatomic variation of the ductal system of the SLG might be a possible cause of ranulas in the patients with simple ranulas, especially in pediatric patients. Surgical resection of the SLG is a better treatment choice for ranulas than other conservative treatments.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, PR China. Electronic address: michaelbozhang@gmail.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hospital of National University of Defense Technology, Changsha, PR China.
authors.forename: Zongfan
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Division of International, Hunan Normal University, Changsha, PR China.
authors.forename: Ricardo M
authors.initials: RM
authors.lastname: Zhang
authors.affiliation: Statistical Solutions, Inc. Exton, PA, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Physical Therapy, Baltimore City Community College, Baltimore, MD, USA.
authors.forename: Feng
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland, Baltimore, MD, USA.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department Family and Preventive Medicine, School of Medicine, University of Utah, UT, USA.
authors.forename: Ke
authors.initials: K
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D063405:Anatomic Variation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D011900:Ranula / Q000209:etiology* / Q000601:surgery; D018987:Salivary Ducts / Q000002:abnormalities*; D012466:Salivary Gland Diseases / Q000150:complications*; D013361:Sublingual Gland / Q000002:abnormalities* / Q000601:surgery; D013363:Submandibular Gland / Q000002:abnormalities*; D055815:Young Adult
keywords: Anatomic variation; Bartholin's duct; Children.; Ranula; Sublingual gland