Friday, 10 February 2017

Plunging Ranula (Submental/Submandibular Neck Swelling)

Plunging = Diving 
Ranula = Originated from the word Rana, meaning Frog in Latin

If the swelling exist only in the mouth, then it is called a Ranula (the intra-oral bulge resembles the underbelly of a frog). If the swelling extends into the neck, then it is called a Plunging Ranula (diving frog belly). It is formed because of the blockage of the duct or the opening that brings saliva into the mouth during feeding. There are 3 main salivary glands that produce and secrete saliva into the mouth. The Parotid (1) and Submandibular (2) glands secretes thin, less viscous fluid that drains out through only a single, large duct. However, the Sublingual (3) gland secretes a thick and viscous fluid that drains against gravity through many small ducts that can easily get blocked. The blockage may be caused by dehydration, infection, food particles, etc.

The standard treatment requires surgical excision of the neck portion, followed by the oral portion, including the entire Sublingual gland. It is very difficult to excise the cystic sac alone, preserving the Sublingual gland and the nearby Submandibular gland. There is a high risk of damaging other vital structures, such as the lingual nerve and the duct from the Submandibular gland. The oral part of the procedure is also difficult, because of the narrow field of view and working space.

However, our Sclerotherapy technique is done through a tiny nick (opening) or through an injection and the Sclerosant is introduced into the sac, without harming all other structures that are outside the sac. It is a 20 minutes procedure, compared to the 3-4 hours standard, surgical excision.    

From April 2008 until the recent time, we have greatly improved on our Sclerotherapy techniques and have successfully treated many cases of Plunging Ranula. We have reduced the number of attempts, minimized complications, scars and have increased our patient comfort and positive outcomes. We found that the smaller the maximum diameter (less than 3cm), the easier it is to treat and the better the outcome. 

Most of our cases underwent 2-3 attempts to achieve a positive or successful outcome. If you have any questions, regarding the management of patients with Plunging Ranula, do not hesitate to contact us. Email us on

We carry out the Sclerotherapy technique a
s an outpatient procedure, meaning the patient may go home on the same day, unlike standard surgery, that may admit the patient for 2-3 nights and more if there are complications. Take note that without the proper extensive and meticulous surgical excision, there is a high rate of recurrence despite any surgical procedure.

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