Ranula: Causes, Symptoms, and Treatment

Ranula is a type of mucous cyst that occurs in the floor of the mouth. It is essential to understand the causes, symptoms, and treatment options to effectively manage this condition.

Ranula is a mucous extravasation cyst that forms in the floor of the mouth. The term "ranula" is derived from the Latin word "rana," meaning frog, as the swelling resembles a frog’s underbelly.

Ranulas are typically caused by the rupture of a salivary gland duct, leading to the accumulation of saliva in the surrounding tissues.

---

Types of Ranula

Ranulas are classified into two main types:

Understanding the type of ranula is crucial for determining the appropriate treatment approach.

Causes of Ranula

Salivary Gland Trauma

The most common cause of ranula is trauma to the salivary glands. This trauma can result from accidental biting, dental procedures, or even certain medical conditions that affect the salivary glands.

Obstruction of Salivary Ducts

Obstruction of the salivary ducts, often due to sialoliths (salivary stones) or strictures, can lead to the formation of a ranula. The obstruction prevents the normal flow of saliva, causing it to accumulate and form a cyst.

Inflammatory Conditions

Inflammatory conditions such as sialadenitis can also contribute to the development of ranula. Inflammation can lead to the rupture or obstruction of the salivary ducts, resulting in cyst formation.

Symptoms of Ranula

Recognizing the symptoms of ranula is essential for prompt diagnosis and treatment. The primary symptoms include:

Differentiating Ranula from Mucocele

It is important to differentiate ranula from mucocele, another type of mucous cyst. While both conditions involve the accumulation of saliva, mucoceles are typically smaller and occur in the inner lining of the lips, cheeks, or the floor of the mouth.

Diagnosis of Ranula

Clinical Examination

A thorough clinical examination by a healthcare professional is the first step in diagnosing ranula. The characteristic bluish swelling in the floor of the mouth is usually indicative of the condition.

Imaging Studies

Imaging studies such as ultrasound, MRI, or CT scans can provide detailed information about the size, extent, and location of the ranula. These studies are particularly useful in diagnosing plunging ranulas, which extend into the neck.

Fine Needle Aspiration (FNA)

Fine needle aspiration (FNA) can be used to confirm the diagnosis by extracting fluid from the cyst for analysis. This procedure helps in differentiating ranula from other cystic lesions in the oral cavity.

Treatment of Ranula

Treatment options for ranula vary based on the type, size, and symptoms of the cyst. The primary goal of treatment is to remove the cyst and prevent recurrence.

Marsupialization of Ranula

Marsupialization is a common surgical procedure used to treat ranula. The procedure involves creating a small incision in the cyst and suturing the edges to form a permanent opening, allowing continuous drainage of saliva.

Excision of Ranula

Complete excision of the ranula and the affected salivary gland is another treatment option. This procedure is often recommended for larger or recurrent ranulas to prevent recurrence.

Sclerotherapy

Sclerotherapy involves injecting a sclerosing agent into the cyst to induce fibrosis and shrink the cyst. This minimally invasive procedure is often used for smaller ranulas.

Laser Treatment

Laser treatment is an emerging option for the treatment of ranula. The laser is used to create an opening in the cyst, promoting drainage and reducing the size of the cyst.

Plunging Ranula Management

The management of plunging ranula is more complex due to its extension into the neck. Treatment may involve a combination of surgical excision and marsupialization to ensure complete removal and prevent recurrence.

---

Post-Treatment Care and Follow-Up

Monitoring for Recurrence

Regular follow-up appointments are essential to monitor for recurrence of ranula. Patients should report any new swelling or symptoms to their healthcare provider promptly.

Oral Hygiene

Maintaining good oral hygiene is crucial to prevent infections and complications after treatment. Patients should follow their healthcare provider’s instructions regarding oral care and any prescribed medications.

Managing Post-Surgical Discomfort

Post-surgical discomfort can be managed with over-the-counter pain relievers and warm saline rinses. Patients should avoid spicy and acidic foods that may irritate the surgical site.

---

What are the Complications of Ranula Treatment?

The most common side effect is mild, painless swelling in the treated area, which may last for several days after the procedure. Patients can resume normal eating immediately, and since there are no incisions or stitches, no wound care or dressings are needed.

In some cases, the ranula may not be completely resolved with a single treatment, and a second session may be required. On rare occasions, the affected gland may resist the medication injections, causing continued saliva leakage, which may require referral to an experienced surgeon for traditional surgical removal.

---

When Should I See a Doctor?

If a ranula is suspected, characterized by a 2-3 inch soft swelling under the tongue or chin, it is important to seek medical attention from the child’s healthcare provider. While ranula treatment at home may offer temporary relief, professional care is recommended for proper diagnosis and management. If the diagnosis is confirmed as a ranula through examination and imaging tests, treatment can be pursued from specialists such as an interventional radiologist or doctor for ranula. Be aware of the potential complications of ranula treatment and ensure proper follow-up care.