Plunging ranula (13)@iComplication after removal of submandibular glandj

Left: before treatment. Right: After treatment

Thirties woman. She had sialolithiasis of right submandibular gland. She got surgery, removal of right submandibular gland. After operation, her submandibular legion began to swell. Ranula was occurred after surgery. She got marsupialization operations three times, but recurred soon. She hoped to have OK-432 therapy and come from far away Tokai area.

Upper : From Left: Before, The next day,1 week after treatment
Lower :
From Left: 3 weeks, 4 weeks, 6 weeks, 10 weeks after treatment

This is the course of first treatment. MRI showed atypical shape of ranula. This is from removal of submandibular gland. I punctured her right jaw and injected 1 KE of OK-432. The next day, her submandibular swelling became big and skin was reddened. From the next day to 4 weeks after treatment, ranula was bigger than that of before treatment. Then, the ranula was going to shrink. You can see that ranula became small 8 weeks after treatment. But, the swelling did not disappear. So, the second treatment was done 11 weeks after first treatment.

Upper : From Left: Before, 5 days, 9 days after treatment
Lower :
From Left: 12 days, 3 weeks, 5 weeks, 2 months, 4 months after treatment

This is a course of second treatment. Upper left is before treatment. Intracystic fluid was slightly bloody. Upper right is 9 days after treatment, The top of swelling was peaked. Lower left is 12 days after treatment. Wound of operation (submandibular gland removal) was ruptured. For a while, saliva was flowed from the ruptured hole. But. it stopped within 3 weeks. And, simultaneously, the swelling was disappeared. After 4 months treatment, there was no recurrence.


Important points of this case are
1, Ranula occurred as a complication of surgery.
2, As a complication of OK-432 therapy, rapture of the skin occurred
.
About 1, postoperative ranula is rarely recognized after surgery around submandibular area. Ranula is saliva leakage from sublingual gland, If sublingual gland was injured, ranula can occur. But, the frequency is very rare. I know only two cases including this case.
About 2 , if there was weak parts like wound. sometimes rapture occurs. I know 4 cases including this case. One of the reason why I don't recommend operation with cervical incision is OK-432 therapy becomes difficult in case of recurrence. @

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