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Ranula (Sublingual Mucocele)

Bluish translucent cystic swelling in the floor of the mouth arising from sublingual gland mucus extravasation, with simple (oral) and plunging (cervical) variants requiring excision of the sublingual gland for definitive cure.

Written by: Saygı Hospital Health Guide Editorial Board
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This content is for general information; please consult your physician for diagnosis and treatment.

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What is Ranula (Sublingual Mucocele)?

Ranula is a pseudocyst (no true epithelial lining) of mucus extravasation originating from the sublingual gland or its ducts. Two clinical types exist: simple ranula (intraoral, confined to floor of mouth) presenting as a bluish translucent cystic swelling lateral to lingual frenulum, and plunging ranula (cervical) extending through or around mylohyoid muscle into the submandibular space.

Pathogenesis involves rupture of sublingual gland duct or acini causing mucus extravasation into surrounding tissues with surrounding granulation tissue forming pseudocyst wall. Trauma, ductal obstruction, or congenital weakness of mylohyoid may predispose. Plunging ranula causes painless submandibular neck swelling that may be confused with branchial cyst or lymphatic malformation.

Diagnosis is clinical for simple ranula; ultrasound or MRI confirms plunging variant and demonstrates connection through mylohyoid. Treatment of choice is excision of the involved sublingual gland (definitive); alternatives include marsupialization, micro-marsupialization, or sclerotherapy with OK-432, but recurrence rates are higher without gland removal.

Symptoms

Bluish translucent swelling in floor of mouth (simple ranula)
Painless submandibular or cervical swelling (plunging ranula)
Tongue elevation, displacement, or speech difficulty
Difficulty eating or swallowing if large
Drooling or saliva pooling
Cyst may rupture spontaneously and recur
Slow gradual enlargement over weeks to months

Risk Factors

Trauma to floor of mouth or sublingual gland
Sublingual gland duct obstruction
Congenital weakness or dehiscence of mylohyoid muscle
Previous oral surgery or biopsy
Young age (children, adolescents, young adults)
Asian or Pacific Islander ethnicity (higher plunging ranula incidence)
Oral piercing or repeated mucosal trauma

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent bluish floor of mouth swelling
  • Painless submandibular neck mass
  • Difficulty eating, swallowing, or speaking
  • Recurrent cyst formation after rupture
  • Tongue displacement
  • Asymmetric oral cavity swelling
  • Any persistent oral or neck swelling unexplained

Treatment Methods

01
Excision of sublingual gland (treatment of choice, lowest recurrence)
02
Marsupialization for simple ranula (higher recurrence than gland excision)
03
Micro-marsupialization with silk suture passed through cyst
04
Intracystic OK-432 sclerotherapy as alternative
05
Complete cyst excision with sublingual gland for plunging variant
06
Imaging (MRI/ultrasound) before plunging ranula surgery
07
Avoid simple incision and drainage (very high recurrence)

Which Department to Visit?

You can visit our KBB (Kulak Burun Boğaz) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.