顎下型ガマ腫の１症例と当科における過去６年間のガマ腫の臨床的検討

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  • Plunging ranula: Report of a case and a clinical investigation of ranula in our department for the past six years.

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The authors report a case of plunging ranula with cumulative cases of ranula which had been treated in our department from January 1983 to December 1988. The patient, a 27-year-old male, had been aware of a swelling in the left submandibular region for the preceeding several months. At the first visit to us, the face of the patient was asymmetrical with a diffuse swelling from left submandibular to mental regions. The overlying skin of the lesion was normal in color, and palpation gave us an impression of existence of a soft mass with fluctuation. Fine-needle aspiration prior to the surgery yielded 3 ml of yellowish mucinous material. Sialography on lateral view and ultrasonography disclosed a cystic mass with lobulation and regular margin in the left submandibular region. The computed tomography revealed a radiolucent mass at the sublingual region in contact with ipsilateral sublingual and submandibular glands. The patient was operated on with a clinical diagnosis of plunging ranula on October 21, 1988. During the operation, blunt dissection was performed between the fibers of the mylohyoid muscle toward the sublingual and submandibular glands. Consequently the ranula was extirpated with the ipsilateral sublingual and submandibular glands. Postoperative course, about four months after the operation, was uneventful without recurrence. Consequently the ranula was extirpated with the ipsilateral sublingual and submandibular glands.<BR>Our 52 cumulative cases including the present one were 83% sublingual type, 15% sublingual-submandibular type and 2% plunging type. Distribution of age of the patients had two peaks in the first to third decades, and at the fifth decade. The occurrence of plunging type of ranula was assumed to be low and rare from our review of the literature and evaluation of our cumulative cases. Marsupialization should be performed for the treatment of sublingual and sublingual-submandibular types of ranula, whereas dissection of the lesion with involved salivary gland for the plunging type and the recurrent case. W hile it is difficult to differentiate the plunging entity from the sublingual-submandibular ranula, the precise diagnosis should be taken from sialography, computed tomography, ultrasonography, and characteristics of the constituents.

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