IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 01 Ver. V January. (2018), PP 72-76 www.iosrjournals.org DOI: 10.9790/0853-1701057276 www.iosrjournals.org 72 | Page Giant Plunging Ranula: A Rare Case Report *Hansraj Ranga 1 , Bhavinder Arora 2 , Meenu Beniwal 3 1,2,3 (General Surgery, University of Health Sciences, Rohtak) *Corresponding author: Hansraj Ranga Abstract: A ranula is a type of mucocele, and therefore could be classified as a disorder of the salivary glands. Usually a ranula is confined to the floor of the mouth (termed a "simple ranula"). An unusual variant is the cervical ranula (also called a plunging or diving ranula), where the swelling is in the neck rather than the floor of the mouth. Plunging ranulas are associated with oral swelling in 34% of cases. Another 21% of the cases occur without any oral involvement. A variety of surgical procedures have been quoted in the literature ranging from marsupialization, excision of the ranula, sclerotherapy, and excision of the sublingual gland. The recurrence rate varies according to the procedure performed. We report a case of giant plunging ranula involving the floor of mouth treated successfully by surgical excision. Keywords: Plunging Ranula; Salivary Gland; Cervical Swelling --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 22-12-2017 Date of acceptance: 06-01-2018 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction The term “ranula” is used to describe a diffuse swelling in the floor of the mouth caused by either a mucous extravasation or, less commonly, a mucous retention cyst derived from the major sublingual or submandibular salivary glands [1]. The name “ranula” is derived from the Latin word “rana” meaning “frog”. These represent for 6% of all oral sialocysts. They are most common in the second decade of life and in females [2]. The most common presentation of ranula is a painless, slow-growing, soft, and movable mass located in the floor of the mouth. Ranula may be simple or plunging. Simple ranula often present as masses in the floor of the mouth, limited to the mucous membranes. Diving ranulas extend through the facial plans, usually posterior to the mylohyoid muscle into the neck, and present as cervical masses. Primary etiology of these lesions is due to partial obstruction of a sublingual duct which leads to the formation of an epithelial lined retention cyst [3]. Congenital anomalies such as duct agenesis, hypoplasia of the sublingual gland and trauma causing direct damage to the duct or deeper areas of the sublingual gland are few of the other etiological factors. [4]. Ranula can present at any age but usually occur in children and young adults, with the peak frequency in the second decade [5]. In upto 45% of the cases, the patient’s first presentation is an oral swelling. Plunging ranulas are associated with oral swelling in 34% of cases. Another 21% of the cases occur without any oral involvement. A variety of surgical procedures have been quoted in the literature ranging from marsupialization, excision of the ranula, sclerotherapy, and excision of the sublingual gland. The recurrence rate varies according to the procedure performed. We report a case of giant plunging ranula involving the floor of mouth treated successfully by surgical excision. II. Case Report A 20 years female reported with a 3 months history of swelling in left submandibular region. Swelling was completely asymptomatic and there was a history of intermittent change in the size of swelling. The patient was in good health and had no history of any systemic disorder. Family history and personal history were not remarkable. On examination, general condition was good and vital signs were stable. A diffuse, soft, fluctuant, nontender swelling, about 10 x 5 cm in size, was present in left submandibular region (FIG 1). Overlying skin was normal in color. Oral mucosa, gingival, was normal and salivary ducts openings were patent. Intra oral examination shows elevated floor of mouth on left side (FIG 2). Ultrasonography of the swelling showed fluid collection in left submandibular region displacing submandibular gland extending to midline anteriorly. CECT shows ill-defined subtle peripherally enhancing hypodense cystic lesion measuring approx. 56 x 57 x 105 mm in the left submandibular, sublingual region extending in floor of mouth (FIG 3A, B). Based upon the clinic- radiological findings a tentative diagnosis of giant plunging ranula was made. Excision of the lesion was done via cervical approach under general anesthesia (FIG 4). The excised specimen is shown in FIG 5 and was subjected to histopathological examination.