Encyclopedia of Pathology

Living Edition
| Editors: J.H.J.M. van Krieken

Ranula

  • Jacqueline E. van der WalEmail author
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-28845-1_771-1

Synonyms

Definition

Ranula, meaning “frog-like” in Latin, is a clinical variant of a mucocele that presents as a large swelling in the floor of the mouth (Fig. 1). It is a mucous retention phenomenon of the large salivary glands, in contrast with mucoceles, which originate from minor salivary glands. They occur as a result of excretory duct disruption, usually of the sublingual gland and less frequently of the submandibular gland.
Fig. 1

A ranula presents as a bluish swelling of the floor of the mouth (Courtesy of Prof. A. Vissink, Dept. of Oral & Maxillofacial Surgery, UMCG, Groningen, The Netherlands)

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”).

Clinical Features

Incidence

Common.

Age

Ranulas generally occur in children or young adults and are most prevalent in the second decade.

Sex

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).

Site

Swelling of the floor of the mouth, usually centimeters in diameter.

Treatment

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.

Outcome

Recurrences often occur after incomplete excision. Marsupialization of the lesion has a failure rate of 61–89%.

Microscopy

A unicystic lesion filled with mucin and with an epithelium lining of cuboidal to columnar cells, with or without mucous cells and squamous epithelium. The surrounding stroma is loose or edematous. In the wall of the cyst, foamy macrophages and/or inflammatory cells may be present (Figs. 2 and 3).
Fig. 2

Low-power view of a ranula with some salivary gland tissue in the upper part of the section (H&E)

Fig. 3

Detail of the cyst wall of Fig. 2. (H&E)

Differential Diagnosis

  • Mucoepidermoid carcinomas are usually multicystic and more solid.

  • (Papillary) cystadenomas are also multicystic with or without intraluminal proliferations.

References and Further Reading

  1. Hayashida, A. M., Zerbinatti, D. C. Z., Balducci, I., Cabral, L. A. G., & Almeida, J. D. (2010). Mucus extravasation and retention phenomena: A 24-year study. BMC Oral Health, 10, 15–18.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Kokong, D., Iduh, A., Chukwu, I., Mugu, J., Nuhu, S., & Augustine, S. (2017). Ranula: Current concept of pathophysiologic basis and surgical management options. World Journal of Surgery, 41, 1476–1481.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Patel, M. R., Deal, A. M., & Shockley, W. W. (2009). Oral and plunging ranulas: What is the most effective treatment? Laryngoscope, 119, 1501–1509.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Zhao, Y. F., Jia, Y. L., Chen, X. M., & Zhang, W. F. (2004). Clinical review of 580 ranulas. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 98, 281–287.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of PathologyThe National Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands