PDF: Complications Associated With Surgical Management of Ranulas

Ranulas have been managed by marsupialization, excision of the lesion, excision of the sublingual gland, or combined excision of both the ranula and the sublingual gland. 

Treatments that do not include removal of the involved sublingual gland, such as incision and drainage, excision of the ranula, and marsupialization, have high recurrence rates.

There is no question that excision of the offending sublingual gland will cure all ranulas. 

However, some surgeons still prefer to initially treat ranulas by marsupialization, perhaps because of the potential surgical complications when removing the sublingual gland, most notably injury to the lingual nerve, injury to Wharton’s duct with the possibility of stenosis leading to obstructive sialadenitis, and ductal laceration causing salivary leakage.

We retrospectively analyzed 606 procedures in 571 patients with ranulas who underwent several different surgeries between June of 1962 and December of 2002 to determine the results of surgery and the types and rate of complications.

The most common complications were recurrence of the lesion (5.78%) and sensory deficit of the tongue (4.89%), followed by damage of Wharton’s duct (1.82%).

Postoperative hematoma, infection, or dehiscence of the wound were seldom seen. Temporary numbness of the tongue resolved within 2 to 7 months postoperatively. 

Recurrences were often seen after marsupialization and excision of the ranula, with few recurrences after excision of the ranula and sublingual gland or excision of the sublingual gland alone.

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