An unusual oral swelling

A 7-year-old female was admitted for worsening swelling under her tongue associated with fever and difficulty swallowing. She had sustained head and neck bicycle handlebar trauma 2 weeks before the admission. She was noted to have a cystic and ballotable mass appearing in the floor of mouth. The lesion was evaluated by an otorhinolaryngologist who aspirated 15 mL of mucoid- appearing fluid, which led to collapse of the floor of mouth swelling and alleviation of dysphagia. The patient was placed on a clear liquid diet, which was advanced to a regular diet over 3 days and completed a 10-day course of clindamycin. Neck magnetic resonance imaging revealed persistence of a single cystic mass of approximately 1 cm in diameter medial to the right submandibular gland. At her 2-week post-discharge visit, she was healing well without evidence of recurrence, and there have been no complications at the 3-month follow-up. The diagnosis of an extensive post-traumatic ranula was made based on her clinical history, the neck magnetic resonance imaging findings, as well as the presence of mucin in the aspirate. The term “ranula,” derived from the ancient Latin word “rana” (meaning frog), is descriptive of the translucent swelling of the floor of mouth reminiscent of a frog’s belly. It consists of a mucous extravasation pseudocyst in the floor of the mouth, which arises from the sublingual salivary gland. The pathogenesis is thought to be a result of obstructive scar tissue in sublingual salivary gland ductules, attributable to previous surgery or minor trauma, leading to backpressure of secretions and subsequent extravasation of mucus into the surrounding tissues. There are numerous nonsurgical and surgical methods that have been used to treat ranulas; however, it remains unclear what is the most appropriate treatment procedure. However, recent evidence recommends a conservative approach for no longer than 3 months followed by the surgical resection of a symptomatic and recurrent ranula that exceeds 2 cm in diameter.