Ranula

An otherwise healthy 13-year-old girl presented to the office with a complaint that she described as “a few months of a bump under my tongue.” There was no pain or drainage associated with the bump, but the girl reported that it interfered with chewing and speaking, and she was anxious about its appearance. The bump was located on the left side of her mouth, below the tongue (Figure). 

Results of the physical examination revealed a unilateral lesion about 10 mm in diameter. No glands were enlarged, and the lesion was a pale blue color, cystic-like, fluctuant, and semi-transparent. It had a smooth surface, was not tender, and yielded positive results to a transillumination test. The girl was diagnosed with a retention type of mucocele. More specifically, her lesion was an example of a ranula, which is a type of mucocele located on the floor of the mouth.

DISCUSSION

Mucoceles are benign lesions seen in patients of all ages, and they are most commonly found, in order of frequency, on the lower lips, the floor of the mouth (ranula), and the buccal mucosa.¹ They are caused by an obstruction in an excretory duct that results in a backup of mucin in the connective tissue. In the case of our patient, there was no mechanical or obvious trauma, but mucoceles can result from minor trauma or irritation of the draining ducts. 

The diagnosis of mucoceles and ranulas is mostly clinical and descriptive, but ultrasonography and magnetic resonance imaging may be helpful in differentiating ranulas from any neoplasm involving the salivary gland.² In addition, a computerized tomography scan can determine if the ranula is a plunging ranula, which can dissect between the muscle and fascial planes of the base of the tongue and enter the submandibular space.³ Plunging ranulas often present with neck swelling, and their treatment typically includes surgical removal.⁴ 

If the ranula is not a plunging ranula and is small and asymptomatic, the patient may not require treatment. However, if the ranula is symptomatic and large, the patient may be referred to a surgeon for excision or marsupialization.⁵ Our patient’s ranula was interfering with her chewing and speaking, so surgery was recommended.  

Bhagwan Bang, MD, is a pediatrician at South Alabama Pediatrics in Opp, Alabama.

REFERENCES

1. Senthilkumar B, Nazargi, Mahabob M. Mucocele: An unusual presentation of the minor salivary gland lesion. J Pharm Bioallied Sci. 2012;4(Suppl 2): S180-S182.

2. La’Porte SJ, Juttia JK, Lingam RK. Imaging the floor of the mouth and the sublingual space. Radiographics. 2011;31(5):1215-1230.

3. Charnoff SK, Carter BL. Plunging ranula: CT diagnosis. Radiology. 1986;
158(2):467-468.

4. De Visscher JG, van der Wal KG, de Vogel PL. The plunging ranula: pathogenesis, diagnosis, and management. J Craniomaxillofac Surg. 1989;17(4):182-185.

5. Yuca K, Bayram I, Cankaya H, Caksen H, Kiroğlu AF, Kiriş M. Pediatric intraoral ranulas: an analysis of nine cases. Tohoku J Exp Med. 2005;205(2):151-155.