WordNet

a cyst on the underside of the tongue
become granular (同)grain
form into grains (同)grain
form granulating tissue; "wounds and ulcers can granulate"

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〈砂糖など〉‘を'粒[状]にする / 〈紙・革など〉‘の'表面をざらざらにする / 粒[状]になる / 表面がざらざらになる

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/01 22:51:32」(JST)

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A ranula is a type of mucocele found on the floor of the mouth. Ranulas present as a swelling of connective tissue consisting of collected mucin from a ruptured salivary gland caused by local trauma. If small and asymptomatic further treatment may not be needed, otherwise minor oral surgery may be indicated.

Classification

A ranula is a type of mucocele, and therefore could be classified as a disorder of the salivary glands. Usually a ranula is confined to the floor of the mouth (termed a "simple ranula").^[1] An unusual variant is the cervical ranula (also called a plunging or diving ranula), where the swelling is in the neck rather than the floor of the mouth.^[2] The term ranula is also sometimes used to refer to other similar swellings of the floor of mouth such as true salivary duct cysts, dermoid cysts and cystic hygromas.^[2] The Latin word rana means "frog" (ranula = "little frog"), and also now refers to a genus of frogs. The etymology of the term is usually explained by a resemblance with the underbelly,^[2] or the bulging throat of a croaking frog.^[3] Alternatively, ranula is described as being derived from the Greek word for "the swollen area below the mouth of a frog".^[1]

Signs and symptoms

Ranula in a female

A ranula usually presents as a translucent blue, dome-shaped, fluctuant swelling in the tissues of the floor of the mouth. If the lesion is deeper, then there is a greater thickness of tissue separating from the oral cavity and the blue translucent appearance may not be a feature. A ranula can develop into a large lesion many centimeters in diameter, with resultant elevation of the tongue and possibly interfering with swallowing (dysphagia). The swelling is not fixed, may not show blanching and is non-painful unless it becomes secondarily infected. The usual location is usually is lateral to the midline, which may be used to help distinguish it from a midline dermoid cyst.^[2] A cervical ranula presents as a swelling in the neck, with or without a swelling in the mouth. In common with other mucoceles, ranulas may rupture and then cause recurrent swelling. Ranulas may be asymptomatic, although they can fluctuate rapidly in size, shrinking and swelling, making them hard to detect.

Content of Ranula

Viscid and glairy of jelly like fluid.

Causes

Minor trauma to the floor of the mouth is thought to damage the delicate ducts that drain saliva from the sublingual gland into the oral cavity.^[4] The lesion is a mucous extravasation cyst (mucocele) of the floor of mouth, although a ranula is often larger than other mucoceles (mainly because the overlying mucosa is thicker).^[5] They can grow so large that they fill the mouth. The most usual source of the mucin spillage is the sublingual salivary gland, but ranulas may also arise from the submandibular duct or the minor salivary glands in the floor of the mouth. A cervical ranula occurs when the spilled mucin dissects its way through the mylohyoid muscle,^[2] which separates the sublingual space from the submandibular space, and creates a swelling in the neck. It may occur following rupture of a simple ranula.^[6] Rarely, ranulas may extend backwards into the parapharyngeal space.^[6]

Diagnosis

The histologic appearance is similar to mucoceles from other locations. The spilled mucin causes a granulation tissue to form, which usually contains foamy histiocytes.^[2] Ultrasound and magnetic resonance imaging may be useful to image the lesion.^[6] A small squamous cell carcinoma obstructing Warton's duct may require clinical examination to be distinguished from a ranula.^{[medical citation needed]}

Diagnostic criteria

Mostly seen in young children and adolescents, Both of sexes are equally affected. Swelling in floor of mouth, which may be painful. Mostly unilateral, on one side of frenulum.
Shape is spherical
Size varies from 1 - 5 cm in diameter
Color is pale blue with characteristics semi transparent appearance.
Surface is smooth and mucous membrane is mobile over the swelling.
Tenderness is absent
Fluctuation test is positive
Transillumination test is positive
Cervical lymph nodes are not enlarged.
May or may not have prolongation in the neck.

Treatment

Treatment of ranulas usually involves removal of the sublingual gland. Surgery may not be required if the ranula is small and asymptomatic.^[4] Marsupialization may sometimes be used, where the intra-oral lesion is opened to the oral cavity with the aim of allowing the sublingual gland to re-establish connection with the oral cavity, but it is often unsuccessful. Excision of sublingual sailavary gland is often needed.

Complication

Infection
Repeated trauma
Bursting and reformation
Dysphagia in case of big Ranula

Epidemiology

The lesion is usually present in children.^[4] Ranulas are the most common pathologic lesion associated with the sublingual glands.^[5]

Other animals

Ranula in a dog
excision of both mandibular and major sublingual glands in a dog

References

Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.

^ ^a ^b Shaw, JHF. "Salivary Gland Surgery". unsupplied. Retrieved 8 February 2013.
^ ^a ^b ^c ^d ^e ^f Bouquot, Brad W. Neville , Douglas D. Damm, Carl M. Allen, Jerry E. (2002). Oral & maxillofacial pathology (2. ed. ed.). Philadelphia: W.B. Saunders. pp. 391–392. ISBN 0721690033.
^ Rao, PLNG. Problem Based Approach in Pediatric Surgery. New Delhi, India: Jaypee Brothers Publishers. p. 109. ISBN 8171795498.
^ ^a ^b ^c Newlands, edited by Cyrus Kerawala, Carrie (2010). Oral and maxillofacial surgery. Oxford: Oxford University Press. p. 199. ISBN 9780199204830.
^ ^a ^b Hupp JR, Ellis E, Tucker MR (2008). Contemporary oral and maxillofacial surgery (5th ed.). St. Louis, Mo.: Mosby Elsevier. pp. 410–411. ISBN 9780323049030.
^ ^a ^b ^c La'Porte, S. J.; Juttla, J. K.; Lingam, R. K. (14 September 2011). "Imaging the Floor of the Mouth and the Sublingual Space". Radiographics 31 (5): 1215–1230. doi:10.1148/rg.315105062. PMID 21918039.

External links

DermAtlas 259163774
CT Scans

UpToDate Contents

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1. 下顎、口、口腔、および咽頭の先天異常 congenital anomalies of the jaw mouth oral cavity and pharynx
2. 頚部腫瘤の鑑別診断 differential diagnosis of a neck mass
3. 唾石症 salivary gland stones
4. 小児における身体的診察：HEENT the pediatric physical examination heent
5. 新生児の評価 assessment of the newborn infant

English Journal

The plunging ranula: diagnostic difficulties and a less invasive approach to treatment.

O'Connor R, McGurk M.SourceDepartment of Oral and Maxillofacial Surgery, Guy's, King's and St. Thomas' Hospitals, London, UK.
International journal of oral and maxillofacial surgery.Int J Oral Maxillofac Surg.2013 Nov;42(11):1469-74. doi: 10.1016/j.ijom.2013.03.019. Epub 2013 May 29.
Plunging ranulas arise when a simple ranula extends beyond the floor of the mouth into the neck. Diagnosis is difficult even with modern imaging techniques as they mimic other neck lesions, and traditional treatment involves enucleation of the cyst from the neck. Despite this invasive surgery they t
PMID 23726274

Bilateral plunging ranula: two case reports and a review of the literature.

McKinstry S, Lewis C.SourceOral and Maxillofacial Surgery Department, Middlemore Hospital, Private Bag 93 311, Otahuhu, Auckland, New Zealand. stevemckinstry@yahoo.co.nz.
The New Zealand medical journal.N Z Med J.2013 Nov 1;126(1385):81-6.
AIM: Presentation of two bilateral plunging ranula cases and then review of the plunging ranula literature to understand current concepts on aetiology, imaging for diagnosis and management.METHOD: A literature review using PubMed (92 papers) and Google Scholar (18 papers) has revealed only 18 cases
PMID 24217595

Review of unusual intraoperative and postoperative complications associated with endosseous implant placement.

Wanner L, Manegold-Brauer G, Brauer HU.AbstractOBJECTIVES: Common complications associated with dental implant surgery are well recognized and are usually explained to patients during the process of informed consent. For the general dental practitioner, the periodontist, and the oral and maxillofacial surgeon, it is relevant to also be familiar with less frequent complications. This review gathers unusual complications of this surgical procedure and presents unique complications from single case reports.
Quintessence international (Berlin, Germany : 1985).Quintessence Int.2013 Nov-Dec;44(10):773-81. doi: 10.3290/j.qi.a29936.
OBJECTIVES: Common complications associated with dental implant surgery are well recognized and are usually explained to patients during the process of informed consent. For the general dental practitioner, the periodontist, and the oral and maxillofacial surgeon, it is relevant to also be familiar
PMID 23772438

Japanese Journal

粘液囊胞に対する微小開窓法(micro-marsupialization)の臨床的検討

梯裕恵,白石剛士,河井洋祐 [他]
日本口腔外科学会雑誌 = Japanese journal of oral and maxillofacial surgery 60(12), 672-676, 2014-12
NAID 40020316237

14歳女児に発生したplunging ranulaの1例

山野由紀男,鵜澤一弘,小池博文 [他]
日赤医学 = The Japanese Red Cross medical journal 64(2), 439-442, 2013-09-20
NAID 40019821464

口腔底に発生した類皮囊胞の1例

栢野香里,鯉田篤英
頭頸部外科 23(2), 175-179, 2013
ガマ腫と術前診断され，術中に類皮囊胞と判明した口腔底発生の1例を報告する。症例は34歳男性で1年前からの左口腔底腫脹を主訴に受診した。CT，MRIで左舌下間隙に6×5×3.5cm大の囊胞性腫瘤を認め，粘性貯留液10mlを吸引，細胞診はclass Iでガマ腫と診断，舌下腺全摘を行った。術中，舌下腺深部に被膜を伴う囊胞を認め，壁に小切開を入れると毛髪を含む乾酪様内容物を認め，類皮囊胞と診断した。内容物 …
NAID 130003385969