(A645) Transoral Approach to Management of Plunging Ranulas - A Case Series

Introduction: The decision on how to manage plunging ranulas has significant implications for patients in terms of complications and recurrence. The purpose of this case series is to share our experience in managing plunging ranulas; to discuss the nuances of diagnostics and post-operative management; and to validate a combined approach of transoral sublingual gland excision with transoral drainage or external needle aspiration of the cervical component, nullifying the need for a transcervical approach for ranula management.

Methods: A retrospective chart review of adult and pediatric patients who had undergone operative management of plunging ranulas via ipsilateral sublingual gland excision with transoral drainage or external needle aspiration of the cervical component between the dates of January 1, 2013, to January 1, 2023, was performed. All the procedures were performed by a single surgeon. In total, 10 patients were identified. Clinical presentation, demographic details, imaging, surgical approach, and intraoperative details were reviewed in detail. Follow-up information to assess post-operative course, complications or recurrences were obtained via electronic medical record or telephonic interview.

Results: The plunging component of the ranula involved the ipsilateral submandibular triangle in all 10 patients. In two cases, the cervical component was found to extend to the submental triangle, and in two additional cases, ranulas extended to the ipsilateral parapharyngeal space. In the postoperative course, additional intervention was required in three cases. All of these procedures were performed without the need for surgical intervention. In all cases, no ranula recurrence was recorded within a minimum follow-up of one year post-intervention.

Conclusions: This study illustrates the variable presentations of plunging ranulas and provides further evidence that transoral sublingual gland excision with transoral drainage or external needle aspiration of the cervical component provides excellent long-term results while avoiding known complications associated with a transcervical approach.