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

OBJECTIVE: To study the clinical features and treatments of congenital submandibular duct dilatation. METHODS: Seven children with congenital submandibular duct dilatation from January 2008 to March 2018 were included in this study, whose average age was 5 months and 22 days. The clinical manifestations are unilateral swelling of the mouth floor. All seven children underwent sublingual gland resection, submandibular gland dilatation catheter resection, and catheter reroute under general anesthesia. Intraoperatively, the orifice of the submandibular gland was constricted and part of the catheter was dilated. RESULTS: All seven patients had good healing without swelling or cyst formation. CONCLUSIONS Congenital submandibular duct dilatation occurs at a young age. Early diagnosis and treatment can help prevent further expansion of the catheter and avoid gland atrophy, feeding difficulty, and breathing obstruction. Simultaneous excision of the sublingual gland can avoid the formation of postoperative sublingual cyst.
Child ; Dilatation ; Humans ; Infant ; Ranula ; Salivary Ducts ; Sublingual Gland ; Submandibular Gland

Humans ; Male ; Middle Aged ; Paranasal Sinuses ; diagnostic imaging ; Sublingual Gland Neoplasms ; diagnosis

Ranula is a mucocele caused by extravasation of the sublingual gland on the floor of the mouth. The most common presentation is a cystic mass in the floor of the mouth. A portion of the sublingual gland could herniate through the mylohyoid muscle, and its extravasated mucin can spread along this hiatus into submandibular and submental spaces and cause cervical swelling. This phenomenon is called plunging ranula. A variety of treatments for ranula has been suggested and include aspiration of cystic fluid, sclerotherapy, marsupialization, incision and drainage, ranula excision only, and excision of the sublingual gland with or without ranula. Those various treatments have shown diverse results. Most surgeons agree that removal of the sublingual gland is necessary in oral and plunging ranula. Four patients with ranula were investigated retrospectively, and treatment methods based on literature review were attempted.
Drainage ; Humans ; Mouth ; Mucins ; Mucocele ; Ranula ; Retrospective Studies ; Sclerotherapy ; Sublingual Gland ; Surgeons

PURPOSE: To evaluate the usefulness of shear wave elastography in the diagnosis of oral and maxillofacial diseases. MATERIALS AND METHODS: Ten patients with oral and maxillofacial diseases and 28 volunteers drawn from our student doctors were examined by shear wave elastography with a 14-MHz linear transducer using an Aplio 300 apparatus (Canon Medical Systems, Otawara, Japan). A statistical analysis of the shear elastic modulus (kPa) of healthy tissue (the sublingual gland, submandibular gland, anterior belly of the digastric muscle, and geniohyoid muscle) in the 28 volunteers was performed using 1-way repeated measures analysis of variance with the Tukey honest significant difference test. The maximum shear elastic modulus (kPa) of 8 patients with squamous cell carcinoma (SCC) and 2 patients with benign lesions was evaluated with the Mann-Whitney U test. The analysis used a 5% significance level. RESULTS: The mean shear elastic modulus of the sublingual gland (9.4±3.7 kPa) was lower than that of the geniohyoid muscle (19.2±9.2 kPa, P=.000) and the anterior belly of the digastric muscle (15.3±6.1 kPa, P=.004). The maximum shear elastic modulus of the SCCs (109.6±14.4 kPa) was higher than that of the benign lesions (46.4±26.8 kPa, P=.044). CONCLUSION: Our results demonstrated the usefulness of shear wave elastography in the diagnosis of oral and maxillofacial diseases. Shear wave elastography has the potential to be an effective technique for the objective and quantitative diagnosis of oral and maxillofacial diseases.
Carcinoma, Squamous Cell ; Diagnosis ; Elastic Modulus ; Elasticity Imaging Techniques ; Humans ; Neck ; Sublingual Gland ; Submandibular Gland ; Transducers ; Ultrasonography ; Volunteers

Although hyaluronic acid (HA) has been developed as a nanoparticle (NP; 320–400 nm) for a drug delivery system, the tissue targeting efficacy and the pharmacokinetics of HA-NPs are not yet fully understood. After a dose of 5 mg/kg of cyanine 5.5-labeled HA-NPs or HA-polymers was intravenously administrated into mice, the fluorescence was measured from 0.5 h to 28 days. The HA-NPs fluorescence was generally stronger than that of HA-polymers, which was maintained at a high level over 7 days in vivo, after which it gradually decreased. Upon ex vivo imaging, liver, spleen, kidney, lung, testis and sublingual gland fluorescences were much higher than that of other organs. The fluorescence of HA-NPs in the liver, spleen and kidney was highest at 30 min, where it was generally maintained until 4 h, while it drastically decreased at 1 day. However, the fluorescence in the liver and spleen increased sharply at 7 days relative to 3 days, then decreased drastically at 14 days. Conversely, the fluorescence of HA-polymers in the lymph node was higher than that of HA-NPs. The results presented herein may have important clinical implications regarding the safety of as self-assembled HA-NPs, which can be widely used in biomedical applications.
Animals ; Drug Delivery Systems ; Fluorescence ; Hyaluronic Acid ; Kidney ; Liver ; Lung ; Lymph Nodes ; Mice ; Nanoparticles ; Pharmacokinetics ; Spleen ; Sublingual Gland ; Testis ; Tissue Distribution ; Toxicokinetics

BACKGROUND AND OBJECTIVES: Ranulas, pseudo cysts found on the floor of mouth, develop from the retention or extravasation of saliva from the sublingual gland. The main treatment of ranula is surgical excision but the extent of surgery is controversial. The aim of this study was to evaluate the significance of sublingual gland excision in the surgical treatment of ranula. SUBJECTS AND METHOD: We retrospectively reviewed 112 patients with ranula who had undergone surgical excision from January 2004 to April 2016. Those who underwent any previous treatment such as sclerotherapy, marsupialization, or excision of cyst were excluded in the study. Surgical outcomes including complications and recurrence were compared between the group that went through simple cyst excision and the group that went through cyst and sublingual gland excision. RESULTS: Of 112 patients, 94 were simple ranula and 18 were plunging ranula. Thirty-seven (33%) were male and 75 (67%) were female. Of the 94 simple ranula patients, 23 underwent excision of cyst only; the remaining 71 patients and all other patients with plunging ranula underwent excision of cyst and sublingual gland together. The recurrence rate was significantly lower for the cyst and sublingual gland excision group than for the simple cyst excision group (2.2% vs. 17.4%, p=0.004). The complication rate did not differ between the two groups (4.3% vs. 1.1%, p=0.298). CONCLUSION: The excision of sublingual glands as well as cysts is an important option to reduce recurrence in the surgical treatment of ranula.
Female ; Humans ; Male ; Methods ; Mouth Floor ; Ranula* ; Recurrence ; Retrospective Studies ; Saliva ; Sclerotherapy ; Sublingual Gland*

Mammals have 3 pairs of major salivary glands i.e., the parotid, submandibular, and sublingual glands. Saliva secretion of these glands is modulated by taste perception. Salivary glands are composed mainly of acinar and ductal cells. Primary saliva is secreted by acinar cells and modified during ductal flow. Recently, of the murine 35 bitter taste receptors, Tas2r108 was expressed at highest levels in the submandibular gland by qPCR. Further, Tas2r108-transfected cells respond to a range of bitter compounds, such as denatonium, quinine, colchicine, diphenidol, caffeine and dapson. The objective of the present study was to characterize the expression of Tas2r108 mRNA in acinar and/or ductal cells of the submandibular gland using in situ hybridization (ISH). Male 42-60 days old DBA2 mice were used in the study. Messenger RNAs were extracted from the submandibular gland for generating digoxigenin (DIG) labeled-cRNA probes. These probes were transcribed in anti-sense and sense orientation using T7 RNA polymerase. Dot blot hybridization was performed using DIG labeled-cRNA probes, in order to estimate integrity and optimal diluting concentration of these probes. Subsequently, ISH was performed on murine submandibular gland to detect Tas2r108 mRNA. Dot blot hybridization data demonstrated that Tas2r108 DIG labeled-cRNA anti-sense probes specifically detected Tas2r108 cDNA. ISH results showed that the anti-sense probes labeled acinar and ductal cells in the submandibular gland, whereas no staining was visible in sense controls. Interestingly, the Tas2r108 expression levels were higher in acinar than ductal cells. These results suggested that Tas2r108 might be more associated with primary saliva secretion than with ductal modification of saliva composition.
Acinar Cells ; Animals ; Antisense Elements (Genetics) ; Caffeine ; Colchicine ; Digoxigenin ; DNA, Complementary ; DNA-Directed RNA Polymerases ; Humans ; In Situ Hybridization* ; Male ; Mammals ; Mice ; Quinine ; RNA, Messenger ; Saliva ; Salivary Glands ; Sublingual Gland ; Submandibular Gland* ; Taste Perception

Neurilemmomas are well-encapsulated, benign, slow-growing tumors originating from Schwann cells of the nerve sheath surrounding cranial, peripheral, or autonomic nerves. Intraoral neurilemmomas are relatively rare and have a wide variety of morphologic and radiologic features. This makes differential diagnosis difficult, and only histopathological features can lead to a definitive neurilemmoma diagnosis. In this report, we present the case of a 30-year-old woman whose chief complaint was a solitary, nodular mass on the right floor of the mouth. After computed tomography and magnetic resonance imaging, we performed an incisional biopsy that showed the typical characteristics of a neurilemmoma. The mass was removed completely through an intraoral surgical approach. Despite losing a portion of the lingual nerve, the patient did not complain of any specific discomfort. Wound healing was uneventful and there were no signs or symptoms of recurrence.
Adult ; Autonomic Pathways ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Lingual Nerve ; Magnetic Resonance Imaging ; Mouth* ; Neurilemmoma* ; Recurrence ; Schwann Cells ; Sublingual Gland ; Wound Healing

Adenoid cystic carcinoma (ACC) of the sublingual gland is an extremely rare neoplasm. The clinicopathological characteristics of ACC are slow-growing swelling with or without ulceration, perineural spread, local recurrence, and distant metastasis. This report describes a 58-year-old male who had a slowly growing swelling without ulceration on the right side of the mouth floor that had been present for 1 month. In a radiological examination, the mass showed multilocular cystic features and no bony or tongue muscle invasion. No enlarged cervical lymph nodes were detected. Excisional biopsy and histological analysis showed that the lesion was ACC. In addition to reporting a rare case of ACC, this report also discusses the differential diagnosis and treatment of ACC with a review of the relevant literature.
Adenoids* ; Biopsy ; Carcinoma, Adenoid Cystic* ; Diagnosis, Differential ; Humans ; Lymph Nodes ; Male ; Middle Aged ; Mouth Floor ; Neoplasm Metastasis ; Recurrence ; Salivary Glands ; Sublingual Gland* ; Tongue ; Ulcer