An unusual oral swelling

A7-year-old female was admitted for worseningswelling under her tongue associated with fever anddifficulty swallowing. She had sustained head andneck bicycle handlebar trauma 2 weeks before the admission.She was noted to have a cystic and ballotable mass appearingin the floor of mouth. The lesion was evaluated byan otorhinolaryngologist who aspirated 15 mL of mucoid-appearing fluid, which led to collapse of the floor of mouthswelling and alleviation of dysphagia. The patient wasplaced on a clear liquid diet, which was advanced to aregular diet over 3 days and completed a 10-day course ofclindamycin.Neck magnetic resonance imaging revealed persistence ofa single cystic mass of approximately 1 cm in diametermedial to the right submandibular gland. At her 2-week post-dischargevisit, she was healing well without evidence of recurrence,and there have been no complications at the 3-monthfollow-up. The diagnosis of an extensive post-traumaticranula was made based on her clinical history, the neckmagnetic resonance imaging findings, as well as thepresence of mucin in the aspirate. The term “ranula,”derived from the ancient Latin word “rana” (meaningfrog), is descriptive of the translucent swelling of the floorof mouth reminiscent of a frog’s belly.It consists of amucous extravasation pseudocyst in the floor of themouth, which arises from the sublingual salivary gland.The pathogenesis is thought to be a result of obstructivescar tissue in sublingual salivary gland ductules,attributable to previous surgery or minor trauma, leadingto backpressure of secretions and subsequent extravasationof mucus into the surrounding tissues.There arenumerous nonsurgical and surgical methods that havebeen used to treat ranulas; however, it remains unclearwhat is the most appropriate treatment procedure.However, recent evidence recommends a conservativeapproach for no longer than 3 months followed by thesurgical resection of a symptomatic and recurrent ranulathat exceeds 2 cm in diameter.