HPI: This 16 mo Chinese girl presented for evaluation of a lip lesion that has been present for two months. It waxes and wanes in size. The lesion does not appear to bother her. Her mother speaks little English and is very worried about this lesion.
O/E: 6 mm translucent cyst lower lip
Clincal Photo:
Lab/Path: N/A
Diagnosis: Mucous Cyst (Ranula)
Questions: How would you approach this patient? I need to find a translator so that I can have a meaningful discussion with the child's mother. In the past, I have treated a few of these with liquid nitrogen and they did well, but that might be very traumatic for this child (and the mother). Might have to find a pediatric ENT (the closest would be ~ 75 miles from here)
Reference: There are two good chapters on eMedicine.com
and eMedicine2.com The latter is more detailed.
This is the largest study I found, and I'll write to the authors.
Clinical review.com2 of 580 ranulas.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Sep;98(3):281-7.
Zhao YF, Jia Y, Chen XM, Zhang WF.
CONCLUSION: Three patterns of ranula have similar clinical and histopathologic findings, although plunging ranula has some different clinical features. Removal of the sublingual gland via an intraoral approach is necessary in the management of various clinical patterns of the ranula. Recurrence rates of ranulas of any type are excessive unless the involved sublingual gland is removed.
This is a mucocele and poses no problem to this girl. It can be incised, but will, most likely return. This is better treated by an oral and maxillofacial surgeon. We treat these daily. We could possibly remove it under IV sedation. Please send her to our North Adams office with Dr. Holmgren or Bevin. Thanks, John-Michael Stewart
ReplyDeleteAs you mentioned, cryotherapy usually works for mucoceles, and I've had good results with it, too. In my opinion, that is the least traumatic way for this child. Cheers,
ReplyDeleteOmid
Technically, this is a mucocele, not a ranula. The latter is a sublingual cyst, usually found on the floor of the mouth, due to obstruction of the duct of the sublingual salivary glands.
ReplyDeleteI’ve seen these numerous times in young children. They present no problem. Many times I counsel parents not to worry about them. They’re usually relieved to learn that it’s not some sort of oral cancer (something we almost never see in pediatrics). B T Maurer, Enfleid, Connecticut
well
ReplyDeletei may sound little out of the way
i often see such cases and excision under local with marsupilization is not only damn easy way also devoid of any recuerreences.
since pt is a child and lesion is small even radio frequency cauterization can be attempted
dr navin modi