Dermoid cysts are anatomic embryonic abnormalities that are rarely seen in the oral cavity. Histologically, they are further classified as epidermoid, dermoid or teratoid. We report a case in which an 18-year-old girl who developed an epidermoid cyst presenting as a large sublingual swelling occupying the entire floor of the mouth causing snoring and speech difficulty. We emphasized on the clinical steps in achieving an accurate diagnosis, possible differential diagnosis, necessary imaging techniques and management of epidermoid cyst.
Epidermal Cyst ; Ranula ; Mouth Floor ; Dermoid Cyst

OBJECTIVES: This study evaluated the clinical results of partial sublingual glandectomy accompanying the excision of ranula as new treatment modality. MATERIALS AND METHODS: A total of 43 patients who were treated between 1999 and 2007 for oral or plunging ranula were reviewed. All patients were treated surgically by various methods with a total of 55 different procedures performed. Ten cases of partial sublingual glandectomy with excision of the ranula were conducted. All excised specimens were examined. We compared the clinical outcomes resulting from each treatment method. RESULTS: The recurrence rates for marsupialization, excision of ranula, marsupialization with gauze packing, total excision of sublingual gland and ranula, and partial sublingual glandectomy with excision of ranula were 50%, 25%, 25%, 0% and 10%, respectively. Of the 10 patients treated by partial sublingual glandectomy with ranula excision, only one experienced recurrence (10%), i.e., plunging ranula. None of the ranulas contained an epithelial lining, and the excised portion of the feeding sublingual glands showed degenerative changes. CONCLUSION: In removal of ranulas, we found that excision of the attached sublingual gland, which removed the feeding portion and degenerative acinar cells, yielded good outcomes. Thus, as a new conservative method for treatment, we recommend partial sublingual glandectomy to accompany excision of the ranula.
Acinar Cells ; Humans ; Ranula ; Recurrence ; Sublingual Gland ; Treatment Outcome

Humans ; Infant, Newborn ; Male ; Ranula ; Retropharyngeal Abscess ; etiology ; Thyroglossal Cyst

An oral foregut cyst is a rare congenital choristoma lined by the respiratory and/or gastrointestinal epithelium. The exact etiology has not been fully identified, but it is thought to arise from misplaced primitive foregut. This lesion develops asymptomatically but sometimes causes difficulty in swallowing and pronunciation depending on its size. Thus, the first choice of treatment is surgical excision. Surgeons associated with head and neck pathology should include the oral foregut cyst in the differential diagnosis for ranula, dermoid cyst, thyroglossal duct cyst and lymphangioma in cases of pediatric head and neck lesions.
Choristoma ; Deglutition ; Dermoid Cyst ; Diagnosis, Differential ; Epithelium ; Head ; Lymphangioma ; Neck ; Pathology ; Ranula ; Thyroglossal Cyst ; Tongue*

PURPOSE: The purpose of this study is to analyze the CT features of the cystic masses in the neck and to review differential diagnosis. MATERIALS AND METHODS: We retrospectively reviewed and analyzed the CT findings of 22 histopathologically proved, cystic neck masses in regard to the location in fascial plane and relationship with adjacent organ. RESULTS: Of 22 cases, ten congenital cysts two ranulas, seven inflammatory lesions, and three solid tumors were includded. Ten congenital cystic masses were located in typical locations as branchial cleft cyst(5) in mandibular angle, thyroglossal duct cyst(3) in visceral space embeded within the strap muscles, cystic hygroma(1) and cavernous hemangioma(1) in posterior cervical space with insinuating appearance. Two cases of ranula included one simple ranula localized in sublingual space and a plunging ranula extending to adjacent submandibular space. Seven cases of inflammatory lesions were characterized by multispatial locations and good contrast-enhancement of walls and adjacent tissue. Solid masses of low density mimicking cyst were two pleomorphic adenomas of submandibular gland and one neurilemmoma. CONCLUSION: It is considered that thorough analysis of the CT findings with attention to typical location, CT appearance, and the relationship with the adjacent structures usually leads to the correct diagnosis.
Adenoma, Pleomorphic ; Branchial Region ; Diagnosis ; Diagnosis, Differential* ; Muscles ; Neck* ; Neurilemmoma ; Ranula ; Retrospective Studies ; Submandibular Gland

PURPOSE: To evaluate the efficacy of OK-432 solution for sclerotheraphy of cystic lesions of the head and neck. MATERIALS AND METHODS: Nineteen cystic lesions comprising ten plunging ranulas, three simple ranulas, three cystic lymphangiomas, one first branchial cleft cyst and two unknown supraclavicular cysts considered to be lymphangiomas were treated by sucking out as much liquid content as possible and then injecting the same volume of OK-432 solution under ultrasound guidance. Patients were followed up clinically and radiologically. RESULTS: Follow-up sonography or CT performed after a mean interval of nine months showed total or near-total shrinkage of four plunging ranulas. However, six such lesions recurred in spite of more than one (mean, two) sclerotherapy sessions. In cases involving two simple ranulas at the floor of the mouth, failure resulted from extracystic leakage of OK-432 solution via the puncture site. Two unilocular cystic lymphangiomas completely regressed during the follow-up period (mean, seven months), but the multilocular type showed a 65% volume reduction after 12 months. A first branchial cleft cyst was markedly reduced in size, with only a small cystic portion remaining after eight months, follow-up. Two supraclavicular cysts with straw-color fluid did not respond to sclerotherapy. CONCLUSION: OK-432 sclerotherapy of macrocystic lymphangiomas is an effective and promising alternative to surgery. For other cysts, however, including plunging ranula, efficacy varied, and 64% of such lesions recurred.
Branchioma ; Follow-Up Studies ; Head* ; Humans ; Lymphangioma ; Lymphangioma, Cystic ; Mouth ; Neck* ; Picibanil* ; Punctures ; Ranula ; Sclerotherapy* ; Ultrasonography

BACKGROUND AND OBJECTIVES : Although surgery is the first choice of therapy for ranula, sometimes complete excision is very difficult. Therefore, nonsurgical therapies with less associated morbidity have been required for the treatment of ranula. This study examined the effectiveness of intracystic injection of OK-432 for treatment of ranula. SUBJECTS AND METHOD : Total 32 patients with ranula (24, intraoral type ; 8, plunging type) were treated with OK-432 sclerotherapy. Aspirated mucus of ranula was replaced with an equal volume of OK-432 solution of 0.01 mg/mL. The size of ranula was compared before and after sclerotherapy. RESULTS : Twenty five of 32 patients (78%) showed a complete response after sclerotherapy : higher in plunging ranula (88%) than in intraoral ranula (75%). Rupture of ranula developed in 8 of 25 patients (32%) with intraoral ranula within a few days after injection. Recurrence occurred in 3 patients during follow-up period of median 12 months (range 9-22 months) after last injection. There were no major side effects, scarring, or increased morbidity to surgery of the OK-432 injected lesions. CONCLUSION : The intracystic injection of OK-432 is highly effective as a primary treatment modality of ranula.
Cicatrix ; Follow-Up Studies ; Humans ; Mucus ; Picibanil* ; Ranula* ; Recurrence ; Rupture ; Sclerotherapy*

BACKGROUND AND OBJECTIVES: Although sclerotherapy has been recently applied for plunging ranula, surgical approaches such as marsupialization have been the primary mode of treatment. Marsupialization may be done through simple excision via transcervical approach or via combined approach, intraorally and trabscervically. This study examined the effectiveness of intraoral excision for the treatment of plunging ranula. SUBJECTS AND METHOD: This prospective clinical study was comprised of 15 patients who were treated for plunging ranula through intraoral excision of the raluna and sublingual gland. RESULTS: All of the 15 patients showed a complete removal of sublingual gland. The cystic wall of ranula could be dissected for only three patients (20%) and for twelve patients (80%), it could not be dissected intraorally. Rupture of ranula developed in all patients (100%) during intraoral dissection. Recurrence did not occurr at all during a median follow-up period of 14 months (range, 7-35 month) after the intraoral excision. There were no side effects and external scarring. CONCLUSION: The intraoral approach for removal of the plunging ranula is highly effective as a primary treatment modality of plunging ranula.
Follow-Up Studies ; Humans ; Prospective Studies ; Ranula ; Recurrence ; Rupture ; Sclerotherapy ; Sublingual Gland

BACKGROUND AND OBJECTIVES: Although surgical excision has been considered to be the treatment of choice by most of the surgeons, sclerotherapy of ranula has gained popularity during recent years. A prospective clinical trial was conducted to evaluate the efficacy of Picibanil(R) sclerotherapies for treating ranula children. SUBJECTS AND METHOD: Three patients were enrolled in the study conducted during 2002. All patients were not hospitalized. Picibanil(R) was injected into the lesion. One girl and two boys with ages ranging from 8 to 12 years were treated. RESULTS: Disappearance or marked reduction of the lesion and no recurrence of the ranula were observed in all children. Following each injection, local pain at the injection site was observed in 2 children and transient fever was observed in one child, but such problems resolved within a few days and no serious complication was developed. CONCLUSION: Our experience gives a suggestion that intralesional injection therapy using Picibanil(R) for intraoral ranula is relatively safe and can be used as a substitute for surgery in the treatment of ranula.
Child* ; Female ; Fever ; Humans ; Injections, Intralesional ; Picibanil ; Prospective Studies ; Ranula* ; Recurrence ; Sclerotherapy

BACKGROUND AND OBJECTIVES: In most cases of benign neck cysts, surgical excision has been considered the definite treatment. However, it is difficult to excise cysts completely in some cases. In view of this, non-surgical treatment for these lesions has been attempted with sclerosing agents. Some authors presented case reports on using OK-432 or 99% Alcohol sclerotherapy. In this study, we compared OK-432 and 99% Alcohol sclerotherapy with regards to effectiveness and complications associated in treating benign neck cyst. SUBJECTS AND METHOD: We retrospectively reviewed 29 patients who had undergone sclerotherapy with OK-432 or 99% Alcohol for benign neck cyst, such as ranula, lymphangioma, thyroglossal duct cyst and branchial cleft cyst. Information was gathered with respect to age, sex, number of injections, post-sclerotherapy side effects and outcome of treatments. RESULT: In the OK-432 sclerotherapy, 16 patients (69.6%) showed complete response, and 5 patients (20.7%) showed intermediate response. No response was seen in 2 patients (9.7%). In the 99% Alcohol sclerotherapy, 5 patients (83.3%) showed complete response, and 1 patient (16.7%) showed intermediate response. The side effects observed from intracystic injection therapy with OK-432 and 99% Alcohol were fever (55.2%) and localized pain (44.8%). In the OK-432 sclerotherapy, 18 patients (78.3%) had complications, In the 99% Alcohol, 3 patients (50%) had complications. However, these complications spontaneously disappeared after several days in all the cases. CONCLUSION: The results showed that OK-432 and 99% Alcohol injection is an effective and safe treatment for benign neck cyst. The effectiveness of OK-432 and 99% Alcohol injection is very similar.
Branchioma ; Fever ; Humans ; Lymphangioma ; Neck* ; Picibanil* ; Ranula ; Retrospective Studies ; Sclerosing Solutions ; Sclerotherapy* ; Thyroglossal Cyst