Combined type ranula (6)

Ranula that was improved with long duration after OK-432 injection. Spontaneous cure ?

She first had her oral floor swelling 8 months before first contact to me. Then, she had surgery from mouth. After surgery, her ranula reccured as a combined type. She was recommended to have another surgery. She found this home page and came to me. She was living very far place from my ckinic.

Left is her MRI.@White area in MRI is ranula. Ranula was spreded both oral floor and submandibuler space. deeply and widely. Submandibular ranula existed behind submandibular gland. so her submandibular swelling was not so obvious compair to ranula size. Her ranula was big. So,. I decided to use 1.5 KE for her. 1.5 KE of OK-432 susupended with 0.2ml saline was injected from mouth.

This is her course after treatment. At the next day, oral ranula became red and swollen and her submandibular swelling became markedly  big. This means good response. But, between 1 week and 2 weeks, her ranua was raptured. Dark blue lesion is rapture point. Regrettably. the effect was not enough at 6 weeks after treatment.

If she was living near my clinic, I would treat her again. But, she was living in very far place from my clinic, it was very hard to come again. So, only watching the course was perfomed. 5 months after treatment, the effect was still not enough. So, I recommended her to go to the doctor who treat ranula by OK-432 and his clinic is more close than my clinic.
After then, her mail was stopped.

4 years after treatment, I got a mail from her. She went to the doctor to whom I recomended to go. But. she hesitated to have treatment. So, there was no treatment after my OK-432 injection. She wrote that her ranula repeated bacoming big and shrinking. When she was very tired her ranula became big and after haviung enough rest her ranula became small. And, one year before, her ranula was gone.

Important points for this patient are
@1, She had a surgery for oral ranula but recurred as big combined ranula.
@2. Why and how her ranula was cured in a long time?

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. 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, 5 of 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.

About 2, The size of ranula is determined by the balance between increase factor (saliva leakage) and decrease factors (compression, absorption), If the balance lean to decrease, spontaneous regression occurs. The same case was reported by other physicians. ( A case of plunging ranula cured very slowly by local injection of OK-432. Japanese. Kinki medical Journal. vol. 34; 143-147, 2009)

I have treated many ranula patients with OK-432. I sometimes think my treatment may only speed spontaneous cure and surgeries excluding removal of sublingual gland may complicate spointaneous cure of ranula in some cases.

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