Management of Complication after

Marsupialization of the Ranula:

Case Report

- Tichvy Tammama, drg., Sp.BM -

Universitas Jenderal Achmad Yani (Unjani)

 INTRODUCTION

• Ranula: “Rana” -> frog

• Ranula: a mucocele that occurs on the floor of t
he mouth
• It usually appears unilateral and is a bluish lump
like a frog's belly
• 2 types of ranula:
• Simple ranula / oral ranula
• Deep ranula / cervical ranula / plunging ranula

• Problems: swallowing, speech, mastication, airway, secondary

infection.

• Ranula is a rare salivary gland lesion, its prevalence is unknown.

• The number of lesions found is only about 1-10%.

• The ratio of men and women is 1:1,3

• Etiology of ranula:
• Trauma,
• Salivary gland obstruction,
• Salivary gland duct aneurysm

• Management of ranula & recurrence rate:

• Simple IO incision
• Marsupialization (66.67%)
• Excision (57.69%)
• Excision with sublingual gland excision (1.20%)
• Sclerotherapy (OK-432)

• Removing the sublingual salivary gland:

• Trauma to the lingual nerve
• Injury to the submandibular salivary gland duct
• Form a cosmetic disorders as a result of scar tissue on the neck
 CASE REPORT
• Female, 35 y.o
• Complaints:
• a lump at the base of the tongue since 2 mo a
go
• sharp teeth in the area near the lump
• Extra oral: no swelling
• Intra oral:
• a bluish, fluctuating unilateral lump on subling
ual, size: 2.5 x 1.5 x 1 cm
• roots of teeth 45 and 47
• Fluid aspiration: a viscous clear liquid

• Diagnosis: ranula in the right sublingual region

• Patient was offered several treatment options è the patient did

not want surgery, just wanted the lump to be sucked to deflate.
 Initial Treatment
• Incision drainage

local incision on the Dissection: Post drainase

anesthesia most mucus
prominent discharge 10 cc
surface

• Extraction GR 45 + 47
• Oral analgetic
• Explained about the risk of recurrence.
 DefinitiveTreatment
• Two weeks later, the patient complained of the lump
growing back, but not as big as before (1 cm)
• The patient decided to have surgery (marsupialization)
• Asepsis and antiseptic
• Local anesthesia (lingual block + local infiltration)

four sides of the the roof of ranula suturing around

lump were tied was removed (1.5 x the edge of the
with PGA 4-0 to fix 1.5 cm) using roof of the ranula
the lump scalpel no.11 è
mucus fluid 20 cc

• Apply gauze with povidone iodine into the lumen

• Do loose suturing to prevent the gauze from coming out
 Post operative day 1
• The patient complained:
• Pain and difficult to swallow
• lump appearing on the right posterior sublingual and submandibular ar
ea (1 x 0.5 cm)

• The lump was suspected to be due to inflammation or a sutured

mandibular canal
• Treatment: remove some sutures and gauze + oral MP 4 mg
• POD 2: the patient reported reduced swelling and no pain.
 Post operative day 7
• Complained (-)
• Swelling (-), wound healing (+)

• The sutures are allowed to self-absorb as the lumen shrinks to become

the surface of the floor of the mouth
 Discussion

• Ranula is a pseudocyst form due to obstruction of the

major salivary glands

• It’s a phenomenon of duct retention in the sublingual

gland on the floor of the mouth, resulting in bluish
swelling under the tongue

• The size of the ranula can be enlarged, if not treated

immediately, the swelling can interfere with the functi
on of speech, chewing, swallowing, and breathing and
causes the tongue to lift up.
 Management

• Treatment options for ranula:

• Simple drainage incision into the floor of mouth overlying ranu
la
• Marsupialization/windowing è allow the pseudocyst to drain
and communicate into the oral cavity.
• Removal of sublingual cyst (low recurrence, risk damage)
 Complications

• Most commonly reported complications:

• Recurrence (5%)
• Sensory deficit of tongue (4.9%)
• Injury to Wharton’s duct (1.82%)
• Recurrence is usually delayed, as mucus will slowly accumulate.
• Recurrence of ranulas of pediatric patients undergoing marsupialization
: 6.25% (Haberal et.al).
• The recurrence rates of ranulas were not related to swalling patterns or
surgical approach, but intimately related to the methode of surgical pr
ocedures:
• Marsupialization: 66.67%
• Excision of ranula: 57,69%
• Excision of sublingual gland: 1.20%
Injury to submandibular canal:
 Conclusion

• Ranula is a pseudocyst form due to obstruction of the

sublingual salivary glands

• A simple ranula usually treated by marsupialization è

allow the pseudocyst to drain and communicate into the
oral cavity.

• Suturing the window in marsupialization must be done

carefully, because it near canalis of submandibular glan
d è if sutured, it may cause swelling of the
submandibular gland.

• Removing suture may reduce swelling after

marsupalization.