Plunging ranula (31)

Very big plunging ranula

Young man. He first noticed left lower cheek swelling 6 months before coming to me. Then his swelling gradually became bigger. One months after, he went to a hospital and got some examinations including MRI. He was said  that he might be ranula or lympnangioma and needed removal operation. He did not want to have operation. He found my website and came to me very long way by changing superexpress trains.


These are his MRI. White lesion means fluid collection. The shape of white lesion is very irreguler and seemes multicystic. Ranula is a saliva leakage from sublingual gland. Saliva spreads into weak resistanse lesion, so the shape sometimes become irreguler. At his dorsal site, white lesion reaches to prarapharyngeal space. Removal operation might be very difficult. I this this is typical ranula MRI.


I punctured his left submandibular swelling with big (18 gauge) needle. After aspiration of 30 ml cyst fluid. 1.5 KE of OK-432 suspended with 4 ml saline was injected. Upper left are cyst fluid and upper right are  its smear. Cyst fluid was a little bit bloody, but typical ranula fluid.

This is the course of his treatment. 30 ml of cyst fluid was removed and then 4 ml of OK-432 susupensioin was injected. So, his submandibular swelling was a little reduced at just after treatment. But at the next day, his ranula was swollen. This means good response. 1 week after treatment, swelling was maximum. But, he could work as usual at this point. Then, his ranula began to shrink. 5 weeks after treatment, there was no swelling.

There was no recurrence till 6 months after treatment.

Operation is difficlt when the ranula is big. But, OK-432 treatment is easy and safe when the ranula is big.
20 yeras ago OK-432 therapy for lymphangima and 5 yerars ago OK-432 therapy for ranula was accepted national medical insurance in Japan.
Regrettably, even in Japan, the doctors who believe this therapy are limitted.

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