A ranula is a type of mucocele found on the floor of the mouth.

Ranulas present
as a swelling of connective tissue consisting of collected mucin from a ruptured
salivary gland caused by local trauma. If small and asymptomatic further
treatment may not be needed, otherwise minor oral surgery may be indicated.

Contents
1 Classification
2 Signs and symptoms
3 Content of Ranula
4 Causes
5 Diagnosis
6 Diagnostic criteria
7 Treatment
8 Complication
9 Epidemiology

A ranula is a type of mucocele, and therefore could be classified as a disorder of

the salivary glands. Usually a ranula is confined to the floor of the mouth (termed
a "simple ranula").[1] An unusual variant is the cervical ranula (also called a
plunging or diving ranula), where the swelling is in the neck rather than the floor
of the mouth.[2] The term ranula is also sometimes used to refer to other similar
swellings of the floor of mouth such as true salivary duct cysts, dermoid cysts
and cystic hygromas.[2] The Latin word rana means "frog" (ranula = "little frog"),
and also now refers to a genus of frogs. The etymology of the term is usually
explained by a resemblance with the underbelly,[2] or the bulging throat of a
croaking frog.[3] Alternatively, ranula is described as being derived from the
Greek word for "the swollen area below the mouth of a frog".[1]

Signs and symptoms[edit]

A ranula usually presents as a translucent blue, dome-shaped, fluctuant swelling

in the tissues of the floor of the mouth. If the lesion is deeper, then there is a
greater thickness of tissue separating from the oral cavity and the blue
translucent appearance may not be a feature. A ranula can develop into a large
lesion many centimeters in diameter, with resultant elevation of the tongue and
possibly interfering with swallowing (dysphagia). The swelling is not fixed, may
not show blanching and is non-painful unless it becomes secondarily infected.
The usual location is usually is lateral to the midline, which may be used to help
distinguish it from a midline dermoid cyst.[2] A cervical ranula presents as a
swelling in the neck, with or without a swelling in the mouth. In common with
other mucoceles, ranulas may rupture and then cause recurrent swelling.
Ranulas may be asymptomatic, although they can fluctuate rapidly in size,
shrinking and swelling, making them hard to detect.

Content of Ranula

Viscid and glairy of jelly like fluid.

Causes

Minor trauma to the floor of the mouth is thought to damage the delicate ducts
that drain saliva from the sublingual gland into the oral cavity.[4] The lesion is a
mucous extravasation cyst (mucocele) of the floor of mouth, although a ranula is
often larger than other mucoceles (mainly because the overlying mucosa is
thicker).[5] They can grow so large that they fill the mouth. The most usual
source of the mucin spillage is the sublingual salivary gland, but ranulas may
also arise from the submandibular duct or the minor salivary glands in the floor
of the mouth. A cervical ranula occurs when the spilled mucin dissects its way
through the mylohyoid muscle,[2] which separates the sublingual space from the
submandibular space, and creates a swelling in the neck. It may occur following
rupture of a simple ranula.Rarely, ranulas may extend backwards into the
parapharyngeal space

Diagnosis

The histologic appearance is similar to mucoceles from other locations. The

spilled mucin causes a granulation tissue to form, which usually contains foamy
histiocytes.[2] Ultrasound and magnetic resonance imaging may be useful to
image the lesion.[6] A small squamous cell carcinoma obstructing Warton's duct
may require clinical examination to be distinguished from a ranula.

Diagnostic criteria
Mostly seen in young children and adolescents, both sexes are equally affected.
Swelling in floor of mouth, which may be painful. Mostly unilateral, on one side of
frenulum.
Shape is spherical
Size varies from 1 5 cm in diameter
Color is pale blue with characteristics semi transparent appearance.
Surface is smooth and mucous membrane is mobile over the swelling.
Tenderness is absent
Fluctuation test is positive
Transillumination test is positive
Cervical lymph nodes are not enlarged.
May or may not have prolongation in the neck.

Treatment

Treatment of ranulas usually involves removal of the sublingual gland. Surgery

may not be required if the ranula is small and asymptomatic.[4] Marsupialization
may sometimes be used, where the intra-oral lesion is opened to the oral cavity
with the aim of allowing the sublingual gland to re-establish connection with the
oral cavity, but it is often unsuccessful. Excision of sublingual salivary gland is
often needed.

Complication
Infection
Repeated trauma

Bursting and reformation

Dysphagia in case of big Ranula