Oral ranula : An insight in paediatric dentistry.
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Oral ranulas are cystic lesions located on the floor of the mouth that arise from obstruction of the excretory duct of the sublingual gland. It is formed by rupture of excretory duct followed by extravasation of the mucus and accumulation of saliva into the surrounding tissue which forms a pseudo cyst that lacks the epithelial lining

Clinical instance:

An 11 year old boy reported to the Department of Pedodontics and Preventive Dentistry with the chief complaint of a painless swelling below the tongue on the right side of the oral cavity for the past 4 months. The swelling started about 4 months back and increased gradually to attain its present size. There was no history of pain, but the patient had difficulty in speech, mastication and swallowing.

On examination, a 1.5 x 2cm dome-shaped, fluctuant swelling was seen in the floor of the mouth on the right side (Figure 1) swelling was seen attached to the right ventral surface of the tongue. The submucosal swelling was painless and fluctuant on palpation.

Aspiration biopsy yielded thick, viscous fluid and histopathological examination (HPE) revealed it to be mucous. Based on the aspiration & clinical findings the swelling was provisionally diagnosed as ranula. Other hematological and biochemical investigations including Complete Blood Count (CBC), Erythrocyte Sedimentation Rate (ESR) were all within normal limits. Chest x-ray was normal.
After routine preoperative investigations, as the size of the cyst was small (< 2 cm) and it was superficial in nature, a conservative approach of marsupialization of ranula was planned. Local anaesthesia was given. The marking of the cystic swelling of the ranula was done by taking the edges of the cyst to adjacent surrounding mucosa with resorbable suture, followed by de-roofing of the cystic lesion. The cavity which resulted from marsupialization was packed with betadine gauze (10% povidine –iodine topical antiseptic solution) and the pack size was gradually cut short as per the obliteration of the defect. The patient had an uneventful postoperative course and fully recovered. A tissue was sent to HPE for confirmation. HPE report confirmed the specimen to be ranula . The case was followed up for 18 months at a bimonthly interval. There is no recurrence of the lesion. Patient is still under follow up

Conclusively, though sublingual gland excision is considered as the most effective treatment for ranula, in children this procedure is very difficult as it involves an extremely fine mucosa that may rupture on excision also there is risk of injury to the lingual nerve and sublingual duct. Hence marsupialization is suitable and effective treatment for intraoral ranula (<2 cm) in children

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