Ranula

A ranula is a mucus extravasation cyst

involving a sublingual gland and is a type
of mucocele found on the floor of the
mouth. Ranulae present as a swelling of
connective tissue consisting of collected
mucin from a ruptured salivary gland
caused by local trauma. If small and
asymptomatic further treatment may not
be needed, otherwise minor oral surgery
may be indicated.
 Ranula

Specialty Oral and maxillofacial

surgery

Signs and symptoms

Ranula in a female

A ranula usually presents as a translucent,

blue, dome-shaped, fluctuant swelling in
the tissues of the floor of the mouth. If the
lesion is deeper, then there is a greater
thickness of tissue separating from the
oral cavity and the blue translucent
appearance may not be a feature. A ranula
can develop into a large lesion many
centimeters in diameter, with resultant
elevation of the tongue and possibly
interfering with swallowing (dysphagia).
The swelling is not fixed, may not show
blanching, and is non-painful unless it
becomes secondarily infected. The usual
location is lateral to the midline, which
may be used to help distinguish it from a
midline dermoid cyst.[1] A cervical ranula
presents as a swelling in the neck, with or
without a swelling in the mouth. In
common with other mucoceles, ranulae
may rupture and then cause recurrent
swelling. Ranulae may be asymptomatic,
although they can fluctuate rapidly in size,
shrinking and swelling, making them
difficult to detect.

Complications …

Infection
Repeated trauma
 Bursting and reformation
Dysphagia (in the case of a large ranula)

Causes
Minor trauma to the floor of the mouth is
thought to damage the delicate ducts that
drain saliva from the sublingual gland into
the oral cavity.[2] The lesion is a mucous
extravasation cyst (mucocele) of the floor
of mouth, although a ranula is often larger
than other mucoceles (mainly because the
overlying mucosa is thicker).[3] They can
grow so large that they fill the mouth. The
most usual source of the mucin spillage is
the sublingual salivary gland, but ranulae
may also arise from the submandibular
duct or the minor salivary glands in the
floor of the mouth. A cervical ranula
occurs when the spilled mucin dissects its
way through the mylohyoid muscle,[1]
which separates the sublingual space
from the submandibular space, and
creates a swelling in the neck. It may
occur following rupture of a simple
ranula.[4] Rarely, ranulae may extend
backwards into the parapharyngeal
space.[4]

Mechanism
The fluid within a ranula has the viscous,
jellylike consistency of egg white.
Diagnosis

Ranula, micrograph. H&E stain.

The histologic appearance is similar to

mucoceles from other locations. The
spilled mucin causes a granulation tissue
to form, which usually contains foamy
histiocytes.[1] Ultrasound and magnetic
resonance imaging may be useful to
image the lesion.[4] A small squamous cell
carcinoma obstructing the Wharton duct
may require clinical examination to be
distinguished from a ranula.[5]

Criteria …

Mostly seen in young children and

adolescents, both sexes are equally
affected. Swelling in floor of mouth,
which may be painful. Mostly unilateral,
on one side of frenulum.
Shape is spherical
Size varies from 1 – 5 cm in diameter
Color is pale blue with characteristics
semi transparent appearance.
 Surface is smooth and mucous
membrane is mobile over the swelling.
Tenderness is absent
Fluctuation test is positive
Transillumination test is positive
Cervical lymph nodes are not enlarged.
May or may not have prolongation in the
neck.

Classification …

A ranula is a type of mucocele, and

therefore could be classified as a disorder
of the salivary glands. Usually a ranula is
confined to the floor of the mouth (termed
a "simple ranula").[6] An unusual variant is
the cervical ranula (also called a plunging
or diving ranula), where the swelling is in
the neck rather than the floor of the
mouth.[1] The term ranula is also
sometimes used to refer to other similar
swellings of the floor of mouth such as
true salivary duct cysts, dermoid cysts and
cystic hygromas.[1] The Latin word rana
means "frog" (ranula = "little frog").

Treatment
Treatment of ranulae usually involves
removal of the sublingual gland. Surgery
may not be required if the ranula is small
and asymptomatic.[2] Marsupialization
may sometimes be used, where the intra-
oral lesion is opened to the oral cavity with
the aim of allowing the sublingual gland to
re-establish connection with the oral
cavity.

Epidemiology
The lesion is usually present in children.[2]
Ranulae are the most common pathologic
lesion associated with the sublingual
glands.[3]

Other animals
 Ranula in a dog

excision of both mandibular and major

sublingual glands in a dog

References
Kahn, Michael A. Basic Oral and
Maxillofacial Pathology. Volume 1.
2001.
1. Bouquot, Brad W. Neville, Douglas D.
Damm, Carl M. Allen, Jerry E. (2002). Oral &
maxillofacial pathology (2. ed.).
Philadelphia: W.B. Saunders. pp. 391–392.
ISBN 978-0721690032.
2. Newlands, edited by Cyrus Kerawala, Carrie
(2010). Oral and maxillofacial surgery.
Oxford: Oxford University Press. p. 199.
ISBN 9780199204830.
3. Hupp JR, Ellis E, Tucker MR (2008).
Contemporary oral and maxillofacial
surgery (5th ed.). St. Louis, Mo.: Mosby
Elsevier. pp. 410 –411.
ISBN 9780323049030.
 4. La'Porte, S. J.; Juttla, J. K.; Lingam, R. K. (14
September 2011). "Imaging the Floor of the
Mouth and the Sublingual Space" .
Radiographics. 31 (5): 1215–1230.
doi:10.1148/rg.315105062 .
PMID 21918039 .
5. Boulos MI, Cheng A (2006-02-01). "Case 1:
What is that in your mouth?" . Paediatrics &
Child Health. 11 (2): 107–8.
PMC 2435329 . PMID 19030265 .
. Shaw, JHF. "Salivary Gland Surgery" .
unsupplied. Retrieved 8 February 2013.

External links
Classification ICD-10: K11.6 • D

ICD-9-CM: 527.6 •

MeSH: D011900 •

DiseasesDB: 31432

External resources MedlinePlus:

001639 •

eMedicine: derm/648

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