Combined type ranula (3)

Left : Before treatment, Right : After treatment

9 years old girl. She had ranula for 2 and a half years. She had two surgeries before at a university hospital. At first, her ranula was oral ranula. After marspialization operation, her ranula turned to be a combined type.

Upper: Before treatment
Middle: left: The next day after treatment, right: 3 days after treatment
Lower: left: 5 days after treatment, right: 10 days after treatment

This is the course after OK-432 treatment. Upper row is the status before treatment. Oral floor was swollen bilaterally and right jaw was also swollen. 1 KE of OK-432 was injected from mouth with highly concentrated OK-432 injection without aspiration method. At the next day after treatment, her oral ranula became red and markedly swollen. 5 days after treatment, oral ranula was ruptured. This means the same as marspialization operation. Slight swelling was observed 10 days after treatment.

Left: one and a half months after treatment, Right: 2 and a half months after treatment

The is the course after that. But, one and a half months after OK-432 injection, her swelling was disappeared completely. There was no recurrence 6 months after treatment.

The important points of this case were as follows.
1, She had a surgery for small oral ranula but recurred as big combined ranula.
2. Rapture occurred several days after OK-432 injection.
About 1, Removal or marspialization operation for ranula does not promise cure. Ranula is a leakage of saliva, so if the leakage did not stop, it will recur in spite of complete removal was done. It is sometimes experienced that oral ranula turned to be plunging ranula. Plunging ranula 1, 10, 15 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.
About 2, if there is weak lesion of skin or mucous membrane with 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.

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