Evolution of the management of ranulas: change in a single surgeon's practice 2001-14

Excision of the sublingual gland is the traditional cure for ranulas, but is invasive with considerable morbidity. We report techniques that have been developed to minimise this by targeting their specific pathophysiology, which include an intraoral approach to plunging ranulas, and gland-preserving selective excision with a highly conservative suture technique for simple ranulas. Fifty-four ranulas in 53 (20 male and 33 female, mean age 29 (range 7-57) years) consecutive patients were treated by a single surgeon between 2001-14 and their records reviewed retrospectively. Their personal details, operations, types of ranula, and outcomes were recorded. Follow up was for a minimum of six months without recurrent disease before discharge. Of the 54 ranulas treated, 26 had standard traditional sublingual gland excision (17 simple and 9 plunging), nine simple ranulas were selectively excised, 10 were treated with the new suture technique, and nine plunging ranulas were aspirated, after which they were ligated and the sublingual gland excised. Two of the 10 treated by the new suture technique had residual ranulas. The procedure was repeated in both cases, and one had a small residual ranula for which further intervention was declined. One complication developed after excision of a plunging ranula using the traditional intraoral and extraoral approaches, and two developed after aspiration of the sac, ligation, and excision of the gland. Traditional excision of simple ranulas was followed by three complications, but none were reported after simple ranulas had been treated with selective excision or suture. Minimally invasive techniques offer cure, with a lower risk of morbidity.