Akademik Veri Yönetim Sistemi
XVIth European Congress of DentoMaxilloFacial Radiology, Luzern, İsviçre, 13 - 16 Haziran 2018, ss.186-188, (Özet Bildiri)
Case 1
A 74-year–old male patient attended to our clinic with a complaint of swelling on the floor of the mouth and difficulty in using denture for five days. The patient’s medical history revealed coronary artery stent implantation 6 years ago, aplastic left kidney and gall bladder operation. Lympadenopathy detected at the left submandibular gland. Intraoral examination revealed a firm, non-fixed swelling located at the left sublingual area. Salivary flow could be seen at left Wharton’s duct after stimulation by palpation. Patient declared the lesion was first seen 3 months ago, but it was resolved later. Panoramic, and occlusal (size 3 phosphor plate used for occlusal projection) imaging showed no findings or signs of calcification at the site. Ultrasonography (US) revealed hypoechoic, welldefined, unicystic mass of sublingual space. Contrast enhanced computed tomography revealed asymetric, mildly hypodense lesion with cyst like structure and dense content at the left side of floor of mouth. Magnetic resonance imaging revealed a cystic structure with proteinaceous content and hyperintense signal characteristics on fat suppresed T1 and hyperintense signal characteristics on fat suppresed T2 images. Lesion was observed with no contrast enhancement after the intravenous administration of gadolinium based contrast agent. Cystic lesion was diagnosed as simple ranula. The patient refused surgical treatment and reported spontaneous drainage after three weeks.
Case 2
A 23-year-old female patient attended to our clinic with a complaint of tooth pain on left mandible. The patient’s medical history revealed panic attacks in the past and thrombocytopenia. There was no extraoral findings. Intraoral examination revealed fluctuant swelling on the right side of the floor of the mouth (Figure 7). Patient declared the lesion started to grow two weeks ago. Lypmhanedopathy detected at the right submandibular area. Tooth number 36 was positive for vertical percussion. Panoramic imaging revealed rarefying osteitis at the apex of tooth number 36 (Figure 8). Occlusal (size 3 plate used with occlusal projection angle) imaging shown no sign of calcification in the sublingual area (Figure 9). Ultrasonography revealed hypoechoic, well-defined, unicystic mass of sublingual space (Figure 10). Magnetic resonance imaging revealed a cycstic structure whose signal characteristics was hypodense on T1 weighted, hyperdense on T2 weighted images, which located between sublingual gland and genioglossus muscle. Lesion was seen non-enhancing after the intravenous administration of gadolinium-based contrast agent (Figure 11). Cyctic lesion was diagnosed as simple ranula. Surgical treatment recommended for treatment. The case underwent surgical operation for ranula at another medical center.
Discussion
‘Rana’ has a meaning of ‘frog’ in Latin (2). The term ‘Ranula’ is used to describe a mucous extravasating cyst of the sublingual gland without an epithelial lining (3). A simple ranula is restricted to the floor of the mouth (4). When extravasant mucus extend to cervical structures in the submandibular space through the mylohyid muscle, it is called ‘Plunging ranula’ and that can cause submental swelling (4,5). The differential diagnosis for ranula are oral cavity lymphatic malformation, oral cavity dermoid & epidermoid, 2nd branchial cleft anomaly, suppurative lymph nodes, oral cavity abscess, submandibular gland mucocele and oral cavity sialocele(6). Diagnosis is based on clinical evaluation and imaging methods like MRI, CT and US with fine-needle aspiration (7). US is a good choice for projecting the sublingual space at simple ranula cases (4). MRI is a valuable option for determining the borders, content and relation of the cystic lesions with adjacent structures in this region. In our case, there was no ‘tail sign’ as decribed by Coit et al (3). The reason for high signal characteristics on T1 images of first patient might be due to the condition that lesion is long life chronic. High protein content can be a sign of sublingual gland origin since it produces highly protein saliva than the submandibular gland (2). Both cases diagnosed as ‘simple ranula’ and reffered for surgically extraction of the lesion.
Conclussion
Ranula is a pseudocyst located at the floor of the mouth. Diagnosis is based on clinical evaluation and imaging methods like MRI, CT and US with fine-needle aspiration. MRI is a good choice for projecting the content and borders of the lesion.