A minority of lesions extend through the musculus mylohyoideus and deeper soft tissue resulting in a submental or lateral neck swelling (“plunging or cervical ranula”).
Ranulas generally occur in children or young adults and are most prevalent in the second decade.
Ranulas are slightly more common in females (male-to-female ratio 1:1, 2). A male predilection has been reported for the plunging ranula (Zhao et al. 2004).
Swelling of the floor of the mouth, usually centimeters in diameter.
Marsupialization, meaning removal of the roof of the intraoral lesion, can be successful for small, superficial ranulas associated with the ducts of Rivinus. However, complete excision including the involved (sublingual) gland is required to prevent recurrences for larger ranulas (Kokong et al. 2017).
Sclerotherapy might be effective as well. A cervical approach is advocated in plunging ranulas.
Recurrences often occur after incomplete excision. Marsupialization of the lesion has a failure rate of 61–89%.
Mucoepidermoid carcinomas are usually multicystic and more solid.
(Papillary) cystadenomas are also multicystic with or without intraluminal proliferations.