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*

BACKGROUND AND OBJECTIVES: A plunging ranula represents a mucus escape reaction occurring because of the disruption of the sublingual salivary gland. It is common condition found in young adults, although the reported age range is 2-61 years. There is said to be a slightly female preponderance of about 1.3:1 (F:M). Surgical incision has been considered the definite treatment, but sometimes complete excision is very difficult. Non-surgical treatment of these lesions has been attempted, but the results have not been satisfactory. In this study, we present our experiences with picibanil (OK-432) sclerotherapy for a plunging ranula. SUBJECTS AND METHOD: We retrospectively reviewed 12 patients who have undergone sclerotherapy with picibanil for plunging ranula. Information was collected on age, sex, number of injection, post-sclerotherapy side effects and outcome of treatment. RESULTS: Six patients (50%) showed a complete response, and 4 patients (33%) showed intermediate response. No response was seen in 2 patients (16%). Fever (41.7%) and pain (33.3%) were observed as side effects of intracystic OK-432 injection therapy. However, fever and pain disappeared after several days in all cases. CONCLUSION: The results show that OK-432 injection is an effective and safe treatment for plunging ranulas.
Escape Reaction ; Female ; Fever ; Humans ; Mucus ; Picibanil* ; Ranula* ; Retrospective Studies ; Salivary Glands ; Sclerotherapy* ; Young Adult

Acinic cell carcinoma (ACC) is a low-grade malignancy of salivary gland that constitutes approximately 17% of primary salivary gland malignancies. ACC predominantly occurs in the parotid gland. The higher incidence in the parotid gland seems to be related with the serous acinar cells of the glands, while the sublingual gland is a mixed gland, predominantly mucinous. Therefore, ACCs which originated in the sublingual gland are very rare and till now only 8 cases have been reported in the literature. Recently, we experienced a case of ACC which was found incidentally in the surgical specimen of a ranula arising in the sublingual gland. The finding of this case suggests that the early pathological diagnosis is needed to clarify the reasons for the recurrence of a ranula.
Acinar Cells* ; Carcinoma, Acinar Cell* ; Diagnosis ; Incidence ; Mucins ; Parotid Gland ; Ranula* ; Recurrence ; Salivary Glands ; Sublingual Gland*

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