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

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

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

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*

Schwannoma is a relatively slow-growing, encapsulated benign tumor that is derived from the Schwann cell of the nerve sheath. We report here on a case of schwannoma of the mouth floor with a review of the literature. A 67-year-old woman presented with a right mouth floor mass, which was first detected 5 years ago. The preoperative diagnosis was ranula on the basis of the physical findings and the computerized tomographic findings. However, the mass was found to be a true neoplastic lesion rather than a cystic lesion in the course of surgical dissection. The permanent pathologic report of the mass was schwannoma. Postoperatively, although the patient had no problem with taste, the pain-sense, speech and swallowing, she had mild deviation of the tongue towards the same side of the mass, which means that the function of the hypoglossal nerve was somewhat impaired. Her tongue deviation was spontaneously resolved within 6 weeks postoperatively.
Aged ; Deglutition ; Female ; Humans ; Hypoglossal Nerve ; Lingual Nerve ; Mouth ; Mouth Floor ; Neurilemmoma ; Ranula ; Tongue

Plunging ranula is rare and manifests as the submandibular or submental cystic mass, without intra-oral abnormality. It usually causes misdiagnosis and malpractice. This article reported a case of plunging ranula that appeared as a massive mass located behind the left ear. A 6-year-old child presented with recurrent left retroauricular swelling over six months without obvious inducement. The mass showed repeatedly swelling and persistent skin ulcers. Physical examinations described a fluctuant, nontender mass behind the left ear whose size was about 5 cm×5 cm×3 cm. The skin upon the surface of the mass was thin and red, and overflowed yellow slimelike contents. Computed tomography (CT) showed an extensive cystic lesion in the left neck. After local incision and drainage the mass was shrink. With the primary clinical diagnosis of branchial cyst, the patient underwent mass resection through postauricular incision. During the operation, the fistula was traced to the area around the sublingual gland, and the postoperative pathology report demonstrated cystic spaces occurring in soft tissue without lymphoid tissue. One month postoperatively, the patient presented the "egg-white", wire-drawing transparent viscous fluid outflowing from the left external auditory canal, indicating that the fluid in the external auditory canal originated from the sublingual gland and the disease was the plunging ranula presenting as a giant left retroauricular mass. We readmitted the patient to the hospital and the ipsilateral sublingual gland was completely removed in the mouth under general anesthesia. No clinical evidence of recurrence was found at the end of 9 months follow-up. So far, there is no literature reporting plunging ranula behind ear. This case report describes the clinical manifestation, diagnosis, and differential diagnosis and treatment of a case of plunging ranula, and reveals that, other than the submandibular or submental, plunging ranula also could be found in retroauricular region. The plunging ranula is difficult to fully confirm through a clinical character, and usually easy to be misdiagnosed as other tumors, like lymphatic malformation, venous malformations, etc. Radiographic examination and/or puncture fluid observation are required for identification. "Egg-white", wire-drawing mucous secretion is the most important characteristic in clinical diagnosis of sublingual gland cyst. However, if sublingual gland resection, i.e. removal of the source of cyst fluid is performed, a good prognosis can be achieved.
Child ; Humans ; Neoplasm Recurrence, Local ; Ranula ; Salivary Gland Diseases ; Sublingual Gland ; Tomography, X-Ray Computed

Surgical excision has traditionally been the treatment of choice for benign non-thyroid cystic neck masses, including lymphatic malformation, ranula, branchial cleft cyst, thyroglossal duct cyst, and parathyroid cyst. However, there is a tendency toward recurrence after surgery, and surgery may be accompanied by complications, including nerve injuries, vascular injuries, and scar formation. Ultrasound-guided sclerotherapy using various agents has been challenged and successfully applied as an alternative treatment for benign non-thyroid cystic neck masses. This report reviews the available sclerosing agents and describes the applications of sclerotherapy to the treatment of benign cystic masses in the neck.
Branchioma ; Cicatrix ; Neck* ; Picibanil ; Ranula ; Recurrence ; Sclerosing Solutions ; Sclerotherapy* ; Thyroglossal Cyst ; Ultrasonography ; Vascular System Injuries

Surgery has been the classic treatment of choice for benign cystic diseases, including lymphatic malformation, ranula, branchial cleft cyst, thyroglossal duct cyst, thyroid cyst, parathyroid cyst, and lymphocele. However, surgery is associated with a tendency toward recurrence and may be accompanied by various complications, such as nerve injuries, vascular injuries, and scar formation. Therefore, sclerotherapy using various agents has been applied successfully to treatment of benign cystic diseases in the neck. This editorial reviews the use of various sclerotic agents and application of sclerotherapy to benign cystic diseases in the neck.
Branchioma ; Cicatrix ; Lymphocele ; Neck ; Ranula ; Recurrence ; Sclerotherapy ; Thyroglossal Cyst ; Thyroid Gland ; Vascular System Injuries