Combined type ranula (7)

Ranula that was turnned to be plunging type after a incision and three OK-432 therapies

She first recognized her left oral floor swelling 15 months before she came to me. 10 months before, she had incision operation at her neiboring hospital. She had recurrence soon. So, she serched another treatment by internet. She found  a dentist who treat ranula by OK-432. She had 3 injections of OK-432. Her ranula raptured within several days in all treatments. But, after 3 injections, her ranula became invisible for 2 months. But, 2 months after, her  left submandibular swelling occured. So, she mailed me for consltaion of her treatment. I asked her to have MRI examination and send it to me. MRI showed that her ranula was combined type. She is living in very far place from my clinic, but she came to me for treatment.

These are her MRI.　White area in MRI is ranula. The main pooling of fluid was submandibular space and a little pooling was seen at the oral floor. So, her ranula was thought to be a combined type. The right photo shows that saliva flows from sublingual gland to submandibular space.

I punctured her lef submandibular swelling . And, I aspirated 3 ml of cyst fluid then injected  1 KE of OK-432 into the cyst.
Left is materals prepared for treatment. OK-432 1 KE solbed with 2 ml saline, 0.5 ml of 1 % lidokine  for local anesthesia, 10 ml syringe with 18 gauge needle for aspiration.
Right are aspirated cyst fluid and its sear. Theses were typical for ranula.

This is her course after treatment. At the next day, her left submandibular swelling was markedly swollen. This means very good response. After 2 weeks, her ranua began to shrink. 5 weeks after OK-432 injection, her ranula was invisible.raptured.

This is her course about oral ranula. At the next day, her left oral ranula was markedly swollen. This means very good response. and oral floor and plunging ranula were conncting each other.  

Till 6 months after treatment,  there was no recurrence.

Important point for this patient are
　1, She had an incision surgery for oral ranula but recurred soon.
　2. She had three OK-432 injectios for oral ranula but raptured within several days.
   3. After OK-432 injection for oral ranula, her ranula turned to be combined type mainly plunging.

About 1, Removal or marspialization of ranula does not promise cure. Ranula is a leakage of saliva, so if the leakage did not stop, it will recurr despite complete removal was performed.

About 2. For good result of OK432 therapy, please do not have surgery. Weak mucous membrane after surgery may increase probabilty of rapture after OK-432 injection.

About 3.  It is sometimes experienced that oral ranula turned to be plunging ranula after surgery. Plunging ranula 1, 10, 14, 15, 17, 26, 29 and combined ranula 3, 5of this home page were also so. After operation, the mucosa of oral floor became hard (scar formation) or the route of saliva flow was changed . So, leaked saliva cannnot go upward, then saliva goes to downward. Regrettably, still now, it is written in some medical textbooks that complete removal is necessary for prevention of recurrence. The strategy of ranula treatment is to stop leakage from sublingual gland. Last year, I examined my cases. 21 % of plunging or combined ranula was occured after surgery of oral ranula. I have experienced more than 200 OK-432 injections for ranula. But, I have never experienced such a case after OK-432 therapy. I think this may from the first incision.