Left: Before treatment. Right: After treatment
8 years old girl. She came to me because she had suffered from
ranula for 3 years.
At first, she had oral ranulas
at both sides. She had 2 surgeries from oral cavity with general
anesthesia. But, recurred as plunging ranula of both side. After
that, she had OK-432 therapy twice. After first OK-432 therapy,
ranula was disappeared for 3 months then recurred. The second
OK-432 therapy was not effective. At that point, 2 years had passed
from the start of treatment.
So, her parents decided
to go to Tokyo. She visited a very famous hospital and had a surgery
with general anesthesia. The operation was removal of right ranula,
right submandibular gland and right sublingual gland. But, ranula
was recurred within one month after operation. After that, she
had OK-432 therapy. But, rapture occurred at the neck wound of
surgery. From the ruptured skin, saliva was always flowing out,
so she had to take gauze on her neck for 6 months.
Upper :
From Left: Attached with first
e-mail, When she first come to my clinic, Cyst Fluid
Lower : From
Left: After aspiration, 8 weeks after first aspiration, After
2nd aspiration
Upper left is a photo attached with their parent's first e-mail. There was a fistula on the operation scar. She came to me one month after first e-mail. The fistula was spontaneously closed with crust a few days ago. MRI showed that ranulas were existed on both side. It was obvious that rapture would occur if I inject OK-432. So, I decided to wait until the scar became strong. Only aspiration was done, the first day and 8 weeks after.
Upper :
From Left: Before treatment,
2 days, 6 days after treatment
Lower: From Left: 9 days, 12 days, 15 days, 24 days
after OK-432 injection
This is a course after treatment.
We waited 3 months and then started to treat. For this patient
alone, I treated her in hospital for 2 nights for fear of air
way stenosis. I punctured her right neck and aspirated 30 ml of
cyst fluid, then injected 1 KE of OK-432. Upper middle is 2 days
after treatment. Her neck was markedly swollen but air way stenosis
was not observed. So, she discharged 2 days after treatment, and
then her father took photographs and sent me. On day 6 and 9,
the swelling of anterior neck was obvious. After that swelling
of anterior neck was gradually reduced. But, the swelling of her
left chin was gradually increased. This means that her right ranula
was diminished by the treatment, but her left ranula was getting
big.
Upper: From Left, Before aspiration, Just
after aspiration, 3 days, 2 weeks after aspiration
Lower: From Left, 3 weeks, 8 weeks,
9 weeks, 10 weeks, 4 months after aspiration
Additional aspiration therapy. 30 days after OK-432 injection, she came to me again. Her right ranula was disappeared but her left ranula was markedly swollen. I wanted to inject OK-432 into her left ranula, but this time only aspiration was done because of her school schedule. 3 days after aspiration, ranula became bigger. And 3 weeks after aspiration, the swelling was going down. After 8 weeks, the swelling continued. But, after 9 weeks, the swelling was spontaneously reduced. At the period of 10 weeks after aspiration, the swelling was completely disappeared.
After that, there was no recurrence for one year.
10 years after treatment, I called her mother. She told that there was no recurrence and no other problems for 10 years.
Important points for this patient
are
@1, Ranula was bilateral.
@2.
She had 3 surgeries with general anesthesia but recurred and changed
to plunging ranula.
@3. She had 3 OK-432 therapy
but failed and fistula was formed by the last injection.
@4.
Why and how her left ranula was cured,
About 1,
I have experienced 4 cases of bilateral ranula. They were all
young. Ranula is a saliva leakage from sublingual gland. I guess
constitution of lability of salivary gland might be thought .
About 2, Removal
of ranula does not promise cure. Ranula is a leakage of saliva,
so if the leakage did not stop, it will recur after complete removal.
It is sometimes experiences that oral ranula turned to be plunging
ranula. Plunging ranula 1, 10 and combined ranula 3 were so. After
operation, oral floor became scared, saliva goes to downward.
Regrettably, still now, some book wrote that complete removal
was necessary for prevention of recurrence. The aim of treatment
of ranula is to stop leakage from sublingual gland. If you have
a operation, removal of sublingual gland is the best. She had
removal of sublingual gland but it was done from neck. I think
it was not perfect removal.
About 3, the efficacy
was different if they think main treatment is surgery or OK-432.
And, if there is weak lesion of skin or mucous membrane by surgery,
rapture sometimes occurs after OK-432 injection. Many doctor think
that if OK-432 therapy was performed, the following operation
will be difficult. But, it is not true. Removal
of sublingual gland can be done after OK-432 therapy. OK-432
therapy must be done before surgery.
About 4, The size of ranula is determined
by the balance between increase factor (saliva leakage) and decrease
factors (compression, absorption), If the balance go to decrease,
spontaneous regression occurs.
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