These are not
common. However they tend to occur in children and young
adults. They arise from minor salivary glands in the lower
lip and the floor of the mouth. The reason is that unlike
the parotid or submandibular gland, the minor salivary glands
can secrete against pressure. If a duct is torn then saliva
will be pumped out of the leak into the surrounding soft
tissues and collect as a fluid filled sac.
Mucocele
These form
mainly in the lower lip and are caused by chewing or
damaging one of the many minor salivary glands that fill the
lip. A blueish balloon then forms which occasionally pops
then refills.
Our Treatment
Treatment is a simple operation to excise the
cyst and is performed under local anaesthesia in an
outpatient setting.
Simple Ranula
The
collection of minor salivary glands in the floor of the mouth
is called the sublingual gland. If one of these minor ducts is damaged then the same process starts as
described for mucocele. But as there is more space in the floor of
the mouth,
these sacs can grow to a large size.
A wide variety of treatments have
been described for simple ranulae
but all are unreliable. The treatment normally offered is still the
removal of the sublingual gland.
This is a tricky operation, usually unnecessary and painful.
Our Treatment
We have developed a simple
and effective technique (85% success) for simple ranulae shown in Prof
McGurk's video opposite. We drain the
cyst using a fine needle, the patient is reviewed the next day at which
time the sac is starting to fill with saliva again. This small collection
of fluid accurately locates the site of the leaking duct. A surgical
stitch (suture) is inserted to strangle the leak. This procedure is easily
tolerated by most children and is carried out under local
anaesthetic.
Our development has been very
welcome since many ranulae occur in children and the traditional
alternatives are often painful.
Plunging Ranula
This is the least common
form of ranula. In this instance the leak of saliva
comes from the under surface of the sublingual gland and collects on the surface of the
muscle that forms the floor of the mouth. Eventually the fluid finds a way
through the muscle fibres to collect in the neck under the lower border of
the mandible to lie next to the submandibular gland.
Historically the leak
of saliva was thought to come from the submandibular gland, this led
surgeons to erroneously remove the this gland instead of the sublingual
gland.
The traditional treatment,
still common in the UK, is to remove both the submandibular gland as well
as the sublingual gland.
It is no longer necessary to remove both glands.
Careful diagnosis is
important because it can be confused with a different condition called a
lymphangioma. It is important to distinguish between the two as they are
treated differently.
Our Treatment
At
surgery, the sublingual gland is freed from the floor of mouth and pulled
upwards. The neck of the sac which is attached to the sublingual gland is
drawn into the mouth. The sac is emptied of saliva, it's neck tied and it is
allowed to descend back below the muscle into the neck where it dissolves.
This approach avoids a second incision in the neck.
The whole procedure can be
done via the mouth.
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Minimall invasive
suture technique
for simple ranula. (Mark McGurk commentary)
" ... most salivary
ranulae occur in children, so our development of a
minimally-invasive, relatively painless suture technique has been particularly
welcome. ... " M.M.
Main salivary glands - image
courtesy of Mayo Foundation
Mucocele
Simple Ranula
Plunging Ranula
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