Plunging ranula (18)

She was was recommended to have surgery from neck. She found this HP and sent me an e-mail. Before she came to me, she sent me her MRI. White area in MRI means fluid collection. The shape of white area was irregular. This is typical for ranula. But, the deformity of submandibular gland was also observed. This is atypical for ranula. So, I was thinking the possibility of diagnosis for ranula was fifty percent before she came to me. (Differential diagnosis of ranula. Please click)
In conclusion, her diagnosis was ranula. Upper right are after OK-432 treatment. Her neck swelling was completely disappeared and there was no white lesion in MRI. And also, the deformity of submandibular gland was disappeared. (Change of MRI in detail. Please click.)

Upper left is test aspiration. Marked area is submandibular gland. Aspirated material by test aspiration was yellowish mucous fluid. So, the diagnosis of ranula was consisted. Then, aspirated 10 ml of cyst fluid and injected 1 KE of OK-432 suspended with 2 ml of saline.

The upper is the course after OK-432 injection. From the next day to 2 weeks after OK-432 injection, her neck was swollen. Then, the swelling began to shrink. 6 weeks after treatment, her neck swelling was disappeared.

The upper is the course of lateral view.

Her course of OK-432 therapy was typical. But, the diagnosis was difficult. I have been thinking that the deformity of adjacent organ was not caused by ranula. I have to change my thought for this point.

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