Ranula – Everything You Need to Know About This Salivary Gland Cyst

Definition:

A ranula is a mucous retention cyst that develops in the floor of the mouth due to the obstruction or rupture of the sublingual or submandibular salivary glands, leading to the accumulation of mucus.

Etiology (Causes):

1. Trauma to salivary ducts – Most common cause (e.g., biting the lower lip or cheek).
2. Obstruction of the sublingual gland – Due to salivary stone or scarring.
3. Infections – Chronic inflammation of salivary glands.
4. Congenital malformation – Seen in newborns due to developmental defects in salivary ducts.

Types of Ranula:

1. Simple Ranula:
• Located in the floor of the mouth.
• Appears as a painless, bluish, dome-shaped swelling.
2. Plunging (Cervical) Ranula:
• Extends through the mylohyoid muscle into the neck.
• Causes swelling in the submandibular or submental region.

Pathogenesis:

1. Obstruction or trauma leads to rupture of the salivary duct.
2. Mucus accumulates in the surrounding tissues.
3. Formation of cystic swelling due to encapsulation by fibrous tissue.

Clinical Features:

• Soft, painless swelling in the floor of the mouth.
• Bluish, translucent appearance due to mucous content.
• Fluctuant consistency (fluid-filled).
• Difficulty in speaking, chewing, and swallowing if large.
• No tenderness unless secondarily infected.
• Plunging Ranula:
• Swelling extends into the neck.
• May cause pressure symptoms (difficulty in breathing if large).

Complications:

• Infection leading to pain and pus formation.
• Recurrence if not treated completely.
• Airway obstruction in large ranulas.
• Difficulty in speech and mastication due to large size.

Diagnosis:

• Clinical Examination: Based on characteristic appearance and location.
• Transillumination Test: Positive (fluid-filled lesion glows under light).
• Imaging Studies:
• Ultrasound: To differentiate from other cystic lesions.
• MRI/CT scan: For deeper extension (Plunging Ranula).
• Fine Needle Aspiration Cytology (FNAC): Confirms mucous content.

Differential Diagnosis:

• Mucocele – Similar but located on the lower lip.
• Dermoid Cyst – More solid, not fluid-filled.
• Lymphangioma – Congenital, soft, and involves multiple cystic spaces.
• Salivary Gland Tumors – Firm, solid, and may be painful.

Treatment:

1. Surgical Excision:
• Complete excision of the ranula along with the affected salivary gland to prevent recurrence.
• Marsupialization – Creating a permanent opening to drain mucus.
• Excision via intraoral or extraoral approach for large or plunging ranulas.
2. Aspiration (Temporary Relief Only):
• Aspiration of mucous fluid can reduce size but has a high recurrence rate.
3. Cryotherapy & Laser Therapy:
• Used for small ranulas, but not commonly preferred.

Prevention:

• Avoid trauma to the oral cavity.
• Early treatment of salivary duct infections.
• Good oral hygiene to prevent secondary infections.

Homeopathic Medicines:

1.     Calcarea Fluorica

• Hard, painless cyst under the tongue.
• Salivary gland obstruction with thick mucus discharge.
• Enlargement of sublingual glands with difficulty swallowing.

2.     Baryta Carbonica

• Ranula with slow-growing, firm swelling.
• Sensation of fullness and discomfort in the floor of the mouth.
• Enlarged submandibular glands with increased salivation.

3.     Silicea

• Recurrent ranula with pus formation.
• Tendency to suppuration in salivary glands.
• Swelling under the tongue with difficulty in speech.