Plunging ranula (29)

Ranula that was appeared after removal of salivary stones and turned to be a plunging ranula after several treatmens including removal of sublingual gland.

She had surgery on her neck when she was infant. The wound (scar) seen in these pictures is due to this surgery. So, this wound has no relationship to ranula.
She felt her right submandibuler swelling and tongue pain 2 years ago. There were salivary stones. So, she had removal operation of salivary stones from mouth. After this surgery, she had oral floor ranula. Her oral ranula repeated swellings and raptures. So, she had removal operation of sublingual gland from mouth. But, her ranula was not improved. So, she had drainage tube insertion operation. But, after removing drainage tube, her ranula turned to be a plunging ranula. So, her doctor recommended her to remove submandibular gland. She worried that she would never improve and mailed me for asking treatment of ranula.

Left is her MRI. White lesion means fluid collection. The shape of white lesion is typical to ranula. Her ranula seemed to be multi cystic. Right is aspirated cyst fluid. Yellowish mucous fluid. This is typical for ranula. After aspiration of 5 ml cyst fluid, 1 KE of OK-432 suspended with 2 ml of saline was injected.

This is the course of her treatment. The next day, her ranula was not swollen and the color of local skin did not become red. And fever up was not observed. This dose not mean good response. One week after, her ranula became slightly hard, then  gradually became small. But, after 5 weeks, soft swelling appeared again.

If she lives near my clinic, I would treat her again with OK-432 at the point of 6 weeks after the first OK-432 injection. But, she was living in very far place and very hard to come again. So, she only sent me her pictures sometimes.
3 months after, her ranula went down in her neck. At first, her ranula existed upper from her operation wound, but at 3 months after her ranula existed across operation wound.
Her ranula gradually went down and down.  At 11 months after, her ranula existed obviously below from operation wound.
16 months after treatment, I received a mail fom her. She wrote that ranula was not observed from 3 days ago,

This case resembles to plunging ranula 14. I t seems that ranula will go to cure when the swelling went down,
This course may be spontaneous healing. But, such a case that ranula was cured with long time duration after OK-432 injection was also reported.
At least, she did not need to have removal operation of submandibular gland.

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