Transoral Complete vs Partial Excision of the Sublingual Gland for Plunging Ranula

Objectives Plunging ranula is a pseudocyst of saliva extravasated from the sublingual gland (SLG) to the submandibular space. This is treated by transoral excision of the SLG or transcervical cyst excision that might differently affect surgical morbidity and recurrence. This study compared the clinical outcomes of complete vs partial excision of the SLG for plunging ranula. Study Design A nonrandomized comparative study. Setting Academic medical center. Methods This study included 42 patients with plunging ranula who underwent complete or partial excision of the SLG with the evacuation of cystic content. Two surgical methods of complete or partial SLG resection were alternatively allocated to consecutive patients without randomization. The primary outcome was a postoperative recurrence. Secondary outcomes were operation time and complications. Results Complete and partial excision of the SLG was performed in 22 and 20 patients, respectively, without injury to the Wharton’s duct or the lingual nerve. Postoperative complications in 42 patients were minor with temporary events: hematoma, 1 (5%); tongue numbness, 2 (5%); dysgeusia, 4 (9%); and dysphagia, 2 (5%), which did not differ between patients with complete and partial excision of the SLG ( P > .1). However, recurrence occurred in only 5 of 20 patients with partial SLG excision but none of 22 patients with complete SLG excision for a median follow-up of 36 months. Conclusions Complete SLG excision is preferred over partial SLG excision to treat plunging ranula for reducing postsurgical risks of complications and recurrence.

Myoepithelial Carcinoma ex Pleomorphic Adenoma: Rare Case Report with Clinicopathologic and Immunohistochemical Features

Introduction/Objective Myoepithelial carcinoma is identified by nearly exclusive myoepithelial differentiation and evidence of malignancy. It may arise de novo or in preexisting benign tumors including pleomorphic adenoma and benign myoepithelioma. It occurs most commonly in the parotid gland followed by submandibular glands, minor salivary glands, and occasionally in the sublingual gland. Nasopharyngeal origin has been rarely reported. Methods/Case Report An afebrile 19-year-old female presented to the emergency department with persistent facial pressure, otalgia (right side greater than left side), rhinorrhea, and several episodes of epistaxis. One month before, she has been treated with Amoxicillin for three days with no relief, where Augmentin started for her for five days. About four days prior presentation, she was placed on Prednisone and Cefdinir. Over the next several days, she began having throat pain with difficulty swallowing. Routine blood work revealed a leukocytosis of 14.2 with normal differentiation. CT of the neck showed a large soft tissue mass centered at the right nasopharynx. Flexible nasal endoscopy performed bilaterally to reveal the nasopharynx is entirely obstructed with a lobulated mass filling the nasopharynx. On the right side, it extends into the posterior nasal passage filling the sphenoethmoid recess and the posterior floor of the nasal passage. Outpatient biopsy from nasopharynx mass is also performed. Results (if a Case Study enter NA) Mass biopsy reveals a mucinous and chondromyxoid background with mixed epithelial and myoepithelial differentiation. The is squamous metaplasia of myoepithelial cells and prominent mitotic activity and apoptotic activity. Immunohistochemistry was positive for CK5/6, calponin, BCL2, SMA, BerEp4, Sox10, and a proliferative index up to 40%. Based on this information Myoepithelial Carcinoma ex-pleomorphic adenoma of the nasopharynx is the diagnosis. Conclusion Carcinoma ex pleomorphic adenoma is usually a high-grade malignancy. It occurs most commonly in the parotid gland, followed by submandibular glands, minor salivary glands, and occasionally in the sublingual gland. Our case is one of the few cases of myoepithelial carcinoma arising in nasopharyngeal pleomorphic adenoma.

The Challenges of Treating Lipoblastoma in the Sublingual Space – A Case Report

The presence of lobulated tumour arising from immature adipose tissue is called lipoblastoma when occurring as localised or discrete lesion, and lipoblastomatosis when spread diffusely. The purpose of this case study is to report a case of an 18 – year old man who presented with lipoblastoma in the left sublingual space which was found to be in close proximity with the left sublingual gland. Magnetic resonance imaging (MRI) was taken and showed the tumour was confined within the sublingual space and no penetration was noted inferiorly through the mylohyoid muscle. Tumour dimension measured clinically was 3 cm x 2 cm x 2 cm and the anterior margin of the tumour crossed the midline and entered into the right sublingual space. Complete excision with sparing of neurovascular bundle was performed under general anaesthesia. Follow-up of 2 months showed complete remission of the lesion without any complications.

Kaposiform Hemangioendothelioma of the Sublingual Gland in an Adult: Resection is the Key.

Introduction: Kaposiform haemangioendotheliomas (KHE) are extremely rare, borderline malignant, locally aggressive vascular tumours. Although more commonly seen in childhood and adolescents, some very rare reports in adults do exist. KHE is usually found in the retroperitoneum, over the extremities and the soft tissues of the trunk, mediastinum and the head and neck regions. Prior published reports have shown a strong association with the Kasabach-Merritt phenomenon (KMP). We present a very rare case of KHE of the sublingual gland in an adult, which was not associated with KMP and was resected completely without any sequelae. Case report: A 42-year-old female presented with a painful swelling over the floor of the mouth on the right for a year. Clinical examination revealed a bi-digitally palpable, non-transilluminant lesion on the right side of the lingual frenulum. Radiological investigations suggested the possibility of a benign soft tissue tumour arising from the sublingual gland. The patient underwent an intraoral excision of the lesion. The biopsy revealed spindle-shaped tumour cells in fascicles, surrounded by vascular spaces, suggestive of a KHE. The patient was offered radiation therapy, which she declined and continued to be on follow-up for two years. She remains symptom-free to date.Conclusion: Excision of a KHE of the floor of the mouth proved to be sufficient, without the evidence of any residual lesion or progression of symptoms. To the best of our knowledge, our case represents the first reported case in the literature of a KHE arising from the salivary glands in an adult.

Ranula as the First Symptom of HIV Infection in Young Patients

Introduction. Oral manifestations are often the earliest HIV signs. Salivary gland diseases are a common form of HIV expression. A ranula can occur in association with HIV. However, this manifestation is rarely considered as the disease sentinel sign. We present two cases of children consulting for a ranula, leading to the diagnosis of a previously unknown HIV infection. Case Reports. Two children, respectively, 5 and 13, were treated for a ranula by marsupialization. Relapse occurred in both cases, and thereafter, a ranula excision was performed. While the follow-up was uneventful, HIV infection was diagnosed during the patients’ care. The only sign or symptom observed was the ranula. A routine HIV testing of ranula patients would have allowed earlier care. Conclusion. Routine HIV testing of patients with a ranula is justified and may be recommended, especially for children. Ranula excision associated with the sublingual gland resection is suggested in order to avoid recurrence.