title: Ranula: Current Concept of Pathophysiologic Basis and Surgical Management Options.
abstract: There is no consensus opinion on a definitive surgical management option for ranulas to curtail recurrence, largely from the existing gap in knowledge on the pathophysiologic basis.
  
  
  
  To highlight the current scientific basis of ranula development that informed the preferred surgical approach.
  
  
  
  Retrospective cohort study.
  
  
  
  Public Tertiary Academic Health Institution.
  
  
  
  A 7-year 7-month study of ranulas surgically managed at our tertiary health institution was undertaken-June 1, 2008-December 31, 2015-from case files retrieved utilising the ICD-10 version 10 standard codes.
  
  
  
  Twelve cases, representing 0.4 and 1.2% of all institutional and ENT operations, respectively, were managed for ranulas with a M:F = 1:1. The ages ranged from 5/12 to 39 years, mean = 18.5 years, and the disease was prevalent in the third decade of life. Main presentation in the under-fives was related to airway and feeding compromise, while in adults, cosmetic facial appearance. Ranulas in adults were plunging (n = 8, 58.3%), left-sided save one with M:F = 2:1. All were unilateral with R:L = 1:2. Treatment included aspiration (n = 2, 16.7%) with 100% recurrence, intra-/extraoral excision of ranula only (n = 4, 33.3%) with recurrence rate of 50% (n = 2, 16.7%), while marsupialisation in children (n = 1, 8.3%) had no recurrence. Similarly, transcervical approach (n = 5, 41.7%) with excision of both the ranula/sublingual salivary gland recorded zero recurrence. Recurrence was the main complication (n = 4, 33.3%).
  
  
  
  With the current knowledge on the pathophysiologic basis, extirpation of both the sublingual salivary gland and the ranula by a specialist surgeon is key for a successful outcome.
authors.affiliation: Oto-Rhinolaryngology, University of Jos, Jos, Nigeria. dankokong@yahoo.com.|ORL-Head and Neck Surgery, Jos University Teaching Hospital, Jos, Nigeria. dankokong@yahoo.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kokong
authors.affiliation: Department of ORL-Head and Neck Surgery, Jos University Teaching Hospital, PMB 2076, Jos, Plateau, Nigeria.
authors.forename: Augustine
authors.initials: A
authors.lastname: Iduh
authors.affiliation: Department of ORL-Head and Neck Surgery, Jos University Teaching Hospital, PMB 2076, Jos, Plateau, Nigeria.
authors.forename: Ikechukwu
authors.initials: I
authors.lastname: Chukwu
authors.affiliation: Jos University Teaching Hospital, PMB 2076, Jos, Nigeria.
authors.forename: Joyce
authors.initials: J
authors.lastname: Mugu
authors.affiliation: Department of Anaesthesia, College of Medicine, University of Jos & Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Samuel
authors.initials: S
authors.lastname: Nuhu
authors.affiliation: Department of General Surgery, College of Medicine, University of Jos & Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Sule
authors.initials: S
authors.lastname: Augustine
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011900:Ranula / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012466:Salivary Gland Diseases / Q000601:surgery; D055502:Secondary Prevention; D013361:Sublingual Gland / Q000601:surgery; D055815:Young Adult