Ranula Under Tongue – Radiology, Treatment at Home, Surgery, Pathology, Excision

A ranula is an oral condition characterized by a mucus retention cyst, typically forming under the tongue in the oral cavity. This cystic lesion is often a result of a damaged salivary gland, specifically the major salivary glands like the submandibular gland or, less commonly, from the minor salivary glands. It’s one of the more common salivary gland disorders and can range from a simple oral ranula to a more complex plunging ranula. Ranulas present as swelling in the mouth, which can range from minor inconveniences to significant obstructions, depending on their size and location. Understanding ranula formation, diagnosis, and treatment is crucial for oral healthcare professionals.

Key Facts

The term ranula is derived from the Latin word rana, meaning frog. It refers to the appearance of the swelling, which resembles a frog’s underbelly

Oral ranulas are typically found on the floor of the mouth, beneath the tongue

It’s a mucous-filled cystic lesion, a result of a rupture in the salivary gland duct and the spillage of mucous into surrounding tissues

It can occur in individuals of any age but is more commonly observed in children and young adults

What is a Ranula?

A ranula is a cystic lesion – bluish, translucent, fluid-filled swelling found on the floor of the mouth, usually on one side, typically forming due to a damaged salivary gland or ductal obstruction in the sublingual glands. It arises when there’s a blockage in the sublingual salivary gland, leading to the accumulation of saliva, which in turn forms the cyst. The blockage can be caused due to trauma, mucus plug formation, or any unknown reason. The term ranula is derived from the Latin word for frog, referring to the bluish, translucent swelling that resembles a frog’s underbelly.

Types of Ranulas

Oral Ranula: Appears as a painless swelling in the floor of the oral cavity, often resulting from mucus extravasation or excretory duct fibrosis of the sublingual gland.
Plunging Ranula: Extends into the neck, potentially involving the submandibular gland, and can cause a cervical ranula, affecting structures like the mylohyoid muscle.
Superficial Mucoceles: Often found on the lower lip or soft palate, resulting from minor salivary gland issues.

Ranulas can be categorized based on their nature:

Simple Ranula: This remains confined to the floor of the mouth.
Plunging or Diving Ranula: This is more complex and extends beyond the mouth floor, sometimes reaching the neck. It plunges or dives past the muscles of the floor of the mouth into the deeper tissues.

The fluid inside the ranula is thick and viscous, resembling the consistency of jelly. The size of a ranula can vary; some remain small and stable, while others can grow large enough to cause difficulty with speech, eating, or even breathing.

Is a Ranula Serious?

While ranulas are benign lesions and not cancerous, their presence can lead to several complications and concerns:

Discomfort: Larger ranulas can be uncomfortable, especially if they exert pressure on nearby structures.
Aesthetic Concerns: A noticeable ranula can lead to self-consciousness or embarrassment due to its appearance.
Difficulty in Eating and Speaking: Particularly large ranulas can interfere with the normal movement of the tongue, making eating and speaking a challenge.
Potential for Infection: Any cystic structure in the body, including a ranula, has a risk of becoming infected. An infected ranula can be painful and may require antibiotic treatment.
Growth Concerns: If left untreated, some ranulas might continue to grow, causing further discomfort and potential complications.

Who Gets Ranulas?

Ranulas can potentially affect individuals of any age group. However, they are more commonly observed in certain demographics:

Age Factor: Ranulas are predominantly seen in younger populations, especially in children and young adults. The highest incidence is typically found in the second decade of life.
Trauma Relation: People who have had trauma or injury to the floor of the mouth or the salivary glands might be at a slightly increased risk.
No Gender Predilection: Both males and females are equally likely to develop ranulas. There is no significant gender difference in their occurrence.

How Common are Ranulas?

Ranulas, in general, are considered uncommon oral lesions. They account for:

Approximately 6% of all salivary gland cysts
Less than 0.2% of all oral biopsies conducted are diagnosed as ranulas

Plunging or diving ranulas are even rarer compared to simple ranulas.

What are the Symptoms of a Ranula?

A ranula presents itself as a distinctive swelling, but associated symptoms can vary depending on its size and location:

Visible Painless Swelling: A hallmark of ranulas, especially in the case of a simple ranula. The most apparent symptom of a ranula is a bluish, clear swelling on the floor of the mouth. It can be of various sizes, from a small pea-sized lesion to a larger swelling that occupies the entire floor of the mouth.
Soft to Touch: When palpated, a ranula feels soft, fluctuant, and is generally painless.
Difficulty Swallowing and Oral Functions: Larger ranulas or plunging ranulas may affect swallowing. If the ranula grows large, it can interfere with speaking, eating, or swallowing.
Discomfort: Some individuals might feel discomfort or a sense of fullness in the floor of the mouth, especially when the ranula is of a significant size.
Extension of Swelling: In the case of plunging ranulas, the swelling can extend beyond the floor of the mouth to the neck area. It might be visible externally below the jawline.
Rare Symptoms: In atypical cases, if the ranula gets infected, it can become red, painful, and might be accompanied by fever.
Oral Habits: Changes in oral habits due to the presence of the cyst.

Causes and Risk Factors: What Causes a Ranula?

A ranula is essentially a mucus-filled cyst, and its development is tied to the salivary glands located under the tongue, known as the sublingual glands. Here are the primary causes:

Salivary Gland Blockage: The most common cause of a ranula is the blockage of a salivary duct. When the duct through which saliva drains into the mouth gets obstructed, saliva accumulates, leading to the formation of a cyst.
Trauma to the Gland: Damage to the sublingual gland or minor salivary glands can lead to ranula formation. Any form of trauma or injury to the floor of the mouth, whether accidental (like biting the area) or surgical, can result in damage to the salivary gland or its duct, causing saliva leakage into the surrounding tissues and the eventual formation of a ranula.
Anatomical Variations: Certain individuals might have ducts that are narrower or differently structured, making them more susceptible to blockages and, consequently, ranulas.
Ductal System Anomalies: Conditions like ductal stenosis or ductal hypoplasia can obstruct saliva draining, leading to fluid collection.
Underlying Pathologies: In rare cases, ranulas might form due to salivary gland tumors or other pathologies, though this is not common.
Chronic Inflammation: Long-standing inflammation can cause excretory duct obstruction, contributing to ranula development.
HIV Infection: This and other systemic conditions may increase the likelihood of such lesions.

Are Ranulas Contagious?

No, ranulas are not contagious. They result from internal factors such as blockages or trauma to the salivary gland or duct and are not caused by infectious agents. Hence, one cannot catch or transfer a ranula from one person to another.

Diagnosis: How is a Ranula Diagnosed?

The diagnosis of a ranula involves a combination of clinical examination and specific tests:

Clinical Examination: Initial assessment involves a thorough examination of the oral cavity and surrounding tissue. A healthcare professional will evaluate the size, location, and consistency of the swelling. A typical ranula is a bluish, translucent swelling on the floor of the mouth.
Medical History: Discussing any recent trauma or surgeries in the mouth area can aid in the diagnosis.
Imaging Test: Ultrasound is a common imaging technique used to assess the nature of the cyst. Magnetic resonance imaging (MRI) and computed tomography (CT) scans are helpful in evaluating deeper or plunging ranulas, especially if they spread into the neck area.
Fine Needle Aspiration (FNA): In cases where the diagnosis is uncertain, a small amount of fluid can be aspirated from the cyst using a fine needle. The aspirated fluid’s appearance, typically clear and thick like mucus, can confirm the diagnosis.
Histopathological Examination (Biopsy): While not routinely done for typical ranulas, in uncertain cases, a biopsy may be necessary to differentiate a ranula from other cysts like dermoid cysts or to rule out malignancies.

Treamtment: How is a Ranula Treated?

The treatment for ranulas depends on their size and the degree of discomfort they cause. Minor oral mucoceles often resolve on their own. However, larger or persistent lesions typically require intervention.

1. Needle Aspiration

This involves using a syringe and needle to aspirate or draw out the mucus from the ranula. It’s a relatively simple and quick procedure.

Pros: Immediate reduction in size and relief from discomfort.

Cons: High recurrence rate as the underlying cause, such as a blocked duct, is not addressed.

2. Incision and Draining

A small cut or incision is made on the ranula, and its contents are drained out.

Pros: Provides immediate relief.
Cons: Similar to needle aspiration, there’s a significant chance of recurrence since the root cause remains unaddressed.

3. Marsupialization

For a large ranula, this procedure creates a new duct to help saliva drain properly, thereby reducing the cyst’s size. This procedure involves creating a small pouch by stitching the edges of the incision made on the ranula to the surrounding oral mucosa. This allows for continuous drainage of saliva and prevents reaccumulation. There is also a procedure called Sclerotherapy, which involves injecting sclerosing agents into the cyst to reduce its size.

Pros: Lower recurrence rates than aspiration or simple incision and draining.
Cons: More invasive than the previous methods, longer healing time, potential discomfort during recovery.

4. Surgical Removal of Ranula

Surgical excision is the primary treatment for ranulas. This involves the complete excision of the cyst and, in some cases, the associated salivary gland tissue to prevent recurrence. The primary treatment for ranulas involves removal of the offending gland or complete surgical excision of the cyst. In cases of plunging ranula, more extensive surgery may be required to remove the cyst and affected glands directly.

Pros: Lowest recurrence rate among all treatments because the root cause is eliminated.
Cons: Most invasive procedure, longer recovery time, potential damage to nearby structures such as nerves.

5. Cauterization and Cryotherapy

These are other options for treating superficial mucoceles, especially those occurring on the lower lip or other easily accessible areas.

Are There Side Effects or Complications Regarding Ranula Treatment?

Any medical procedure has potential risks and complications. Postoperative care is crucial to prevent complications like wound infection or recurrence. Regular Follow-Ups are necessary to monitor the healing process and ensure no recurrence of the cyst. While complications from ranula treatments are relatively rare, they can occur:

Infection: As with any surgical procedure, there’s a risk of infection. Signs include increased pain, redness, swelling, and pus discharge.
Damage to Nearby Structures: Especially with surgical removal, th

ere’s a risk of injury to nearby structures such as nerves, which can result in numbness or tingling.

Scarring: Any surgical intervention carries a risk of scarring, which can be of cosmetic concern especially if the ranula is large or if there are complications during healing.
Recurrence: Even after treatment, there’s a chance the ranula can come back, especially if the root cause isn’t addressed.
Hematoma or Bleeding: Accumulation of blood in the surgical area can occur, leading to pain and swelling.
Difficulty in Swallowing or Speaking: This can occur temporarily after surgery due to swelling or discomfort.

How Long Does It Take to Recover from Ranula Treatment?

The recovery time largely depends on the treatment method chosen:

Needle Aspiration: Recovery is usually immediate, but there might be minor discomfort for a day or two.
Incision and Draining: Generally, patients recover within a few days. There might be slight discomfort, and it’s essential to keep the area clean to prevent infection.
Marsupialization: Recovery can take up to a week or two. Proper oral hygiene and following post-operative instructions are crucial for a smooth recovery.
Surgical Removal: The recovery time can range from one to three weeks, depending on the surgery’s extent and individual healing factors.

How Can I Reduce My Risk for Ranulas?

While ranulas can sometimes develop without an apparent reason, there are a few steps to potentially reduce your risk:

Oral Hygiene: Maintain good oral hygiene by regular brushing and flossing.
Avoid Oral Trauma: Try not to bite the inner parts of your mouth, and be cautious while eating to avoid any injury.
Regular Dental Checkups: Regular visits to the dentist can help in early detection and prevention.

Do Ranulas Go Away?

Spontaneous Recovery: Small ranulas might resolve on their own over time without treatment. However, larger ones generally do not.
Recurrence: Even after treatment, especially less invasive ones like aspiration or incision and draining, ranulas can come back. Surgical removal offers the least chance of recurrence.

When Can I Go Back to Work or School?

Your return to work or school primarily depends on the treatment method and your comfort level:

Needle Aspiration & Incision and Draining: Most individuals can return to work or school within a day or two, given there’s no significant pain or discomfort.
Marsupialization: It’s advisable to take off for at least 3-5 days to ensure proper healing and to avoid any undue stress or trauma to the operated area.
Surgical Removal: After a surgical removal, you might need to rest for up to a week. Depending on your job’s demands or school activities, you may need to adjust your schedule or responsibilities temporarily.

Regardless of the procedure, always follow the advice of your healthcare provider, and ensure you feel comfortable and pain-free before resuming your routine.

When Should I See My Healthcare Provider?

After undergoing a procedure to treat a ranula, you should keep an eye out for signs that warrant a visit to your healthcare provider:

Persistent Swelling: If the swelling doesn’t subside or appears to get larger.
Pain: Any prolonged pain or discomfort not managed with prescribed or over-the-counter pain relievers.
Signs of Infection: Increased redness, warmth, pus discharge, or if you develop a fever.
Difficulty Eating or Speaking: If the ranula or its treatment starts affecting your ability to chew, swallow, or talk.
Recurrence: If the ranula seems to return after treatment.

It’s essential to attend any scheduled follow-up appointments to ensure everything is healing as it should. If you’re in doubt or concerned about any symptoms, it’s always better to seek medical advice sooner rather than later.

Bottom Line

Ranulas are a unique oral health challenge primarily associated with the sublingual gland and other salivary glands. While often benign, ranulas require appropriate medical attention to prevent complications and ensure patient comfort. They require careful diagnosis, often involving a combination of physical examination and imaging tests like MRI or CT scans. Treatment strategies vary from conservative management to more aggressive surgical interventions. With advancements in oral surgery and a better understanding of the secretory apparatus of salivary glands, the prognosis for ranula patients is generally positive. Continuous research and clinical practice guidelines are further refining the management strategies for this unique oral condition.

This article is complete and was published on October 25, 2023, and last updated on December 27, 2023.

Key Facts