What are the treatment options for oral ranulas?

Updated: Apr 17, 2018
  • Author: Catherine M Flaitz, DDS, MS; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Answer

With most oral ranulas, surgical management is preferred. Isolated reports demonstrate that oral ranulas have been successfully treated with intracystic injection of the streptococcal preparation, OK-432. Lesion resolution or marked reduction was documented in almost all of the patients following this sclerotherapy. Local pain at the injection site and fever were noted in about 50% of the patients. Only limited studies have demonstrated the effectiveness of this management approach, and the results have been variable. Currently, the use of this sclerosing agent for the treatment of oral ranulas is considered experimental. [43, 44]

Another injectable drug used to treat ranulas is botulinum toxin A, which results in the denervation of the parasympathetic nerves responsible for salivation. Only a small case series has been reported on this novel, but experimental, treatment approach. [45]

Some clinicians use a tiered approach to the management of oral ranulas. The first attempt at management may be marsupialization of the ranula with packing of the entire pseudocyst with gauze for 7-10 days. The entire ranula is unroofed, and the packing material is firmly placed into the entire cavity of the pseudocyst. This technique allows for re-epithelialization of the pseudocyst cavity; seals the mucinous leak; and provokes a foreign body inflammatory reaction, leading to fibrosis and atrophy of the involved acini. The procedure may be effective with the sublingual gland because it has multiple draining excretory ducts. If this does not eliminate the ranula, additional surgical therapy is initiated with removal of the ranula and the offending major salivary gland. [46]

The more traditional method of surgery for an oral ranula is complete excision of the ranula and associated major salivary gland. Laser ablation and cryosurgery, either alone or after marsupialization, have been used for some patients with oral ranula. Micromarsupialization has also used for the management of oral ranulas. [26, 27, 28]

Routine postsurgical care is required for patients who undergo the surgical procedure under general anesthesia. Typical wound care after surgical management is required. Patients who receive marsupialization with gauze packing should be informed that the dressing is spontaneously expelled in 7-14 days.


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