Role of ranulas in early diagnosis of Sjögren’s syndrome: A case report

BACKGROUND Although the presentations of Sjögren’s syndrome(SS)are variable,ranging from mild dryness to wider systemic involvement,ranulas as early clinical signs were scarcely reported.Here,we present an adult patient with SS,who developed a unilateral simple ranula and was diagnosed primary SS 3 years later.We also provide a review of cases of SS and ranulas from 1980 to 2020.CASE SUMMARY A 22-year-old girl was found to have a left painless floor-of-mouth lesion 3 years ago,without obvious trauma or inducement.The diagnosis of a unilateral(left)simple ranula was made,and the ranula was surgically treated.Within 3 years after the ranula surgery,she developed acute lymphadenectasis in unilateral parotid twice without inducement,and ultrasonic examination revealed diffuse lesions in bilateral parotids and submandibular glands,which strongly suggested SS.Serologic tests and the unstimulated whole saliva flow rate confirmed the SS diagnosis.CONCLUSION Our study underlines that ranulas are early clinical signs of SS.As early diagnosis and early intervention of SS are important to obtain better outcomes,our findings underline the need for histopathological test after sublingual adenectomy and imaging detection of exocrine glands for the patients with ranulas.

Clinical and Histopathological Review of 229 Cases of Ranula

The purpose of this paper was to evaluate the relationship between the thrombosis and secretory duct dilation, lesion size, clinical types, nature （primary or recurrent） and duration of illness in the development of ranula. A total of 229 cases of sublingual gland cysts were treated with surgical resection from Jan. 1990 to Feb. 2010. The patients＇ data were investigated on histopathological findings, size of ranula, the clinical types, nature of ranula （primary or recurrent） and duration of illness. Sections from the paraffinembeded blocks were HE-stained. CK expression was immunohis-tochemically detected. Among 229 cases the incidence of venous thrombosis was 58.52%. The incidence of venous thrombosis with or without duct dilation was 73.25% and 26.39% respectively, with a significant difference between the two groups （P〈0.005）. The incidence of venous thrombosis of ranulas with diameter larger or less than 3 cm was 72.22% and 46.28% （P〈0.005）. The incidence of venous thrombosis of oral ranula, plunging ranula and mixed ranula was 49.37%, 77.19% and 85.71% respectively, with a significant difference found between oral and plunging or mixed ranula （P〈0.01）. The incidence of venous thrombosis in ranula patients with duration of illness longer or less than 3 months was 69.77% and 51.75% （P〈0.01）. The incidence of venous thrombosis with recurrent and primary ranulas was 51.85% and 64.85%, without a significant difference noted between them （P〉0.05）. It is concluded that the formation of venous thrombosis was related to the dilation of secretory duct, lesion size, clinical types, duration of lesion but formation of venous thrombosis was not related to the nature （primary or recurrent） of ranulas.

Plunging ranula: An interesting case report

Background: Ranula is a retention cyst of the sublingual gland, which enlarges progressively and extends into the surrounding soft tissues. The name “ranula” is derived from the Latin word “rana” meaning “frog”. These represent for 6% of all oral sialocysts. Two variants have described in the literature: simple oral ranula and the deep diving or plunging ranula. The plunging ranula has the potential to spread into deeper parapharyngeal spaces and presents a diagnostic dilemma due to its clinical similarity with other neck masses such as cystic hygroma, thyroglossal duct cyst, intramuscular hemangioma, cystic/neoplastic thyroid disease, branchial cyst. We report a case of large oral ranula involving the floor of mouth treated successfully by surgical excision. Case Report: This case report involves an unusually large ranula involving right floor of the mouth in a 30-year-old female patient. Following detailed clinical examination, radiological interpretation and histopathological diagnosis, surgical excision was performed along with the involved sublingual gland. The patient was followed up on a regular basis and was disease free. Summary and Conclusion: The best treatment for an oral/simple ranula is excision of the lesion along with the involved gland. This case report involving the floor of the mouth, is interesting and unique due to its unusually large size and the complete treatment rendered by us i.e., excision of the lesion along with the involved sublingual gland and the subsequent confirmation with the histopathological findings.

Intralesional pingyangmycin injection sclerotherapy for oral ranulas

Objective: To investigate the efficiency of pingyangmycin (PYM) intralesional injection for the treatment of ranulas in clinical practice. Methods: PYM concentrations were 2.0 mg/ml (8 mg PYM powder + 1 ml normal saline + 2 ml 2% lidocaine + 1 ml dexamethasone). The mixed PYM solution was intralesional injected into ranulas after drawing out isometric cyst fluid in 3 patients. Results: The ranulas of 3 patients showed total disappearance after the sclerotherapy, and no recurrence was found after 6 months to 3 years’ follow-up. Compared to surgical therapy, the PYM sclerotherapy was advocated by clinicians for its advantages of less injury, no scar, less suffering, etc. Conclusions: PYM is an effective sclerosing agent for ranulas. Intracystic injection of PYM may be an optimal method for the treatment of ranulas.

The effects of Yishen Qutong granula on pain sensitization and bone destruction of rats with bone cancer pain

Objective:To study the effects of Yishen Qutong granula on pain sensitization and bone destruction of rats with bone cancer pain.Methods:Walker256 cells were passaged in ascites and injected into the tibia of female Wistar rats to prepare the bone cancer pain model.On the 14th day after model establishment,60 rats were randomly divided into model group,sham-operated group,Yishen Qutong granula low,middle,high dose group and tramadol hydrochloride positive control group.After continuous administration for 14 days,the mechanical pain threshold,thermal threshold and weight-bearing difference of both hind limbs were observed.Results:Compared with the model group,Yishen Qutong groups increased the mechanical pain threshold,thermal pain threshold and reduced the weight difference of both hind limbs(P<0.05).Compared with the positive drug group,there was no significant difference in increasing the mechanical pain threshold and thermal pain threshold of rats in the medium dose group of Yishen Qutong(P>0.05),and Yishen Qutong granula significantly reduced the weight-bearing difference of hind limbs in all groups(P<0.05).Conclusion:Yishen Qutong granula can relieve pain sensitization and alleviate bone damage in rats with bone cancer pain.

Intracystic injection of pingyangmycin(PYM) might be a more favorable option for treatment of oral and plunging ranulas

Ranulas are mucoceles that develop as a result of mucous extravasation from the sublingual gland and typically present in the floor of mouth. The treatment of ranulas are various, mainly including surgical and nonsurgical methods. The preferred treatment of oral and plunging ranulas is still uncertain. According to the complications associated with surgical therapy, nonsurgical sclerotherapy has been advocated by clinicians for its advantages of less injury, no scar,less suffering, etc. Recently, it was reported that OK-432 was a relatively effective sclerosing agent for both lymphatic malformations and ranulas, although it has a high rate of recurrence after treating ranulas. Pingyangmycin is another reported conventional sclerosing agent for lymphatic malformations. Herein, we hypothesize that intracystic injection of pingyangmycin may be an optimal method for the treatment of ranulas.

潜突型舌下腺囊肿术后复发1例及文献回顾

潜突型舌下腺囊肿是指舌下腺因创伤或阻塞导致其分泌的涎液外溢,外溢的涎液经由下颌舌骨肌后缘或通过该肌的裂隙进入到颌下区及邻近间隙而形成的假性囊肿。本文对在我院接受手术治疗且术后复发的1例潜突型舌下腺囊肿病例进行回顾,并对其发病机制、临床特点、手术入路及复发原因相关的文献进行复习。

微袋形术治疗口内型舌下腺囊肿

目的 观察分析45例口内型舌下腺囊肿的临床特点,探讨缝线微袋形术的治疗效果及影响因素。方法 选择厦门医学院附属口腔医院2019年4月至2022年11月共45位患者、46例口内型舌下腺囊肿。对其进行缝线微袋形术。观察分析其临床特点和治疗效果。结果 经过6~48个月的随访,1人失访,最终对45例舌下腺囊肿缝线微袋形术后观察。35例治愈,治愈率77.8%,其平均最大径1.74 cm。其中薄囊壁型舌下腺囊肿18例,17例治愈,治愈率94.4%。厚囊壁型舌下腺囊肿27例,18例治愈,治愈率66.7%。结论 缝线微袋形术微创,操作简单,并发症少。对薄囊壁型舌下腺囊肿治愈率高,对厚囊壁型,增加辅助切口可提高其治愈率。高效的引流和足够的引流时间是微袋形术治疗成功的关键。

改良梭形切口在舌下腺切除术中的应用

目的探讨改良口底黏膜梭形切口在舌下腺切除术中的应用价值,为临床行舌下腺切除并减少术后并发症提供参考.方法回顾性分析43例因舌下腺囊肿采用改良梭形切口行舌下腺切除病例的临床资料,观察此手术入路的特点及患者术后并发症情况.结果所有患者术后均未出现口底及下颌下区肿胀、舌体麻木及创口出血情况,1例患者术后出现创口感染,其余均一期愈合.术后随访1月~5 a,均无复发.结论改良梭形切口操作简单,能够充分显露术区,降低下颌下腺导管及舌神经损伤风险,安全可行.

舌下腺囊肿145例临床病例分析

目的:对舌下腺囊肿临床病理资料进行回顾性分析,评价手术方式与疗效的关系。方法:术前行穿刺、超声等检查,在全麻或局麻下经口内进路、颌下进路或口内联合颌下进路行舌下腺及囊肿摘除术,术后标本进行组织病理观察。结果:87例穿刺液淀粉酶检查阳性76例,88例单纯型舌下腺囊肿经口内行舌下腺及囊肿摘除术均无复发;18例哑铃型舌下腺囊肿经口内或颌下联合口内进路行舌下腺及囊肿摘除术,术后无复发;32例口外型舌下腺囊肿分别经口内、颌下进路及颌下联合口内进路行舌下腺及囊肿摘除术,其复发率分别为0、50%、0。病理切片镜下观察,143例中82例(57.3%)囊肿有纤维囊壁,但只有4例有部分上皮衬里。结论:舌下腺囊肿的囊壁无上皮衬里,完整摘除舌下腺是治愈的关键。

高频超声在潜突型舌下腺囊肿中的作用

目的:评价超声对潜突型舌下腺囊肿的诊断价值及临床意义。方法:对36例术前经超声检查、术后经病理诊断的潜突型舌下腺囊肿进行回顾性分析总结。结果:超声正确诊断32例,误诊4例,正确率88.9%。囊肿边界尚清晰,无明显包膜或包膜纤细且不连续。24例囊肿外形呈“漏斗形”改变。28例内部液性暗区清晰,8例欠清晰且内伴数量不等的中等粗光点或线状分隔。36例囊肿均显示与患侧舌下腺无关,24例囊肿致同侧颌下腺受压或变形且致其向外下方移位。结论:超声是诊断潜突型舌下腺囊肿的重要辅助手段,其方法高效无创并对临床诊治具有重要的指导意义。

舌下腺囊肿治疗方法综述

舌下腺囊肿是一种唾液腺黏液囊肿。多因腺体或导管损伤破裂，黏液溢入组织内形成，无上皮衬里；少数是舌下腺导管远端阻塞，近段分泌液潴留形成，有上皮衬里。临床上分为单纯型、口外型和哑铃型。单纯型又称蛤蟆肿，位于口内舌下区；口外型又称潜突型，位于口外下颌下区；哑铃型则是前两者的混合型。

不同手术方式治疗舌下腺囊肿118例临床观察

目的探讨舌下腺囊肿(sublingual gland cyst,SGC)不同手术方式的治疗效果。方法回顾性分析2010年4月—2014年2月接受手术治疗的SGC 118例的临床资料。其中口内入路93例,袋形缝合术5例,颌下入路15例,口内联合颌下入路5例。将手术切除组织行病理学检查,观察不同术式临床疗效、并发症及随访2年复发情况。结果所有患者舌下腺组织与囊壁均可见慢性炎症表现。口内入路、袋形缝合术、颌下入路和口内联合颌下入路治疗SGC总有效率分别为94.6%、60.0%、86.7%和100.0%,并发症发生率分别为29.0%、40.0%、20.0%和40.0%。口内入路和口内联合颌下入路治疗者术后2年复发率低。结论单纯型、口外型舌下腺囊肿采用口内入路与口内联合颌下入路手术,疗效均较高,并发症发生率及复发率均低。

75例潜突型舌下腺囊肿临床分析

目的:分析75例潜突型舌下腺囊肿的临床表现及治疗。总结其诊断及治疗特点。方法:收集1998年1月至2008年8月期间因潜突型舌下腺囊肿在武汉市第一医院口腔科接受手术治疗的病例75例,收集病史。使用彩色超声检查及局部穿刺辅助诊断。经口内手术摘除舌下腺,颌下区囊肿穿刺抽吸后持续加压包扎,促进囊肿吸收。结果:75例患者中有30例患者入院前曾于别处就诊,其中26例发生误诊。75例患者中有70例患者术前患侧颌下区彩色超声检查明确提示颌下区囊肿,术前局部穿刺均抽吸出淡黄色囊性液。75例患者中有65例在术后1周内囊肿消退。10例患者在术后1个月内囊肿消退。结论:潜突型舌下腺囊肿易发生误诊,彩色超声检查和局部穿刺是有效的辅助检查手段,完整摘除舌下腺并辅以颌下区囊肿抽吸后持续加压包扎是治疗该病的有效方法。

平阳霉素注射治疗785例舌下腺囊肿疗效分析

目的:评价平阳霉素注射治疗舌下腺囊肿的临床效果。方法:1997年1月—2009年1月,应用平阳霉素及地塞米松混合液注射治疗舌下腺囊肿785例。采用DXM 5mg/1mL配PYM 8mg加2%利多卡因3mL,按每1cm×1cm的囊肿内注入1mL混合药液(含PYM 2mg,DXM 1.25mg)酌情用药。7～10d注射1次,1～4次为1个疗程。囊肿完全消失者为治愈;囊肿基本消失,但患侧可触及变硬舌下腺者为基本治愈;囊肿缩小一半以上,不能完全消失需手术治疗者为好转。结果:785例患者中,男270例,女515例,年龄7个月～74岁,平均年龄为33.5岁。经6个月～48个月随访,治愈756例(96.31%),基本治愈26例(3.31%),好转3例(0.38%)。治愈和基本治愈率为99.62%,有效率为100%。31例(3.95%)注射区肿痛,舌缘麻木21例(2.68%),下颌下区肿痛11例(1.4%);未见高热、皮疹、休克等过敏反应。结论:平阳霉素联合地塞米松注射治疗舌下腺囊肿,安全有效,可作为某些病例的首选治疗方法。

舌下腺囊肿口外型36例诊治分析

舌下腺囊肿口外型易被误诊误治,应用B超结合穿刺检查对舌下腺囊肿口外型的诊断和鉴别诊断具有重要价值。舌下腺的完整摘除是其唯一的根治手段。本文回顾36例舌下腺囊肿口外型临床资料。

CO2激光治疗舌下腺囊肿309例临床分析

目的:观察CO2激光治疗儿童单纯舌下腺囊肿的效果,探讨该疗法术中、术后显示的优点。方法:对我院门诊2001年1月至2013年3月就诊的309例儿童舌下型舌下腺囊肿实施CO2激光治疗,术后进行随访12个月,分析CO2激光首次治疗的治愈率、复发率及二次激光治疗的效果。结果CO2激光治疗的309例舌下型舌下囊肿中治疗后失访18例,其余291例首次治愈219例,首次治愈率75.3%,首次治疗后复发72例,首次治疗后复发率24.7%。复发患儿接受第2次激光治疗,全部治愈。结论:CO2激光治疗儿童舌下腺囊肿具有手术时间短,术中不出血,术后无明显水肿,无感染,复发率低,患儿痛苦小的优点。

上颈部囊性病变的MRI分析

目的：探讨MRI检查在上颈部囊性病变中的诊断价值。方法：36例上颈部囊性肿物,术前行穿刺检查和MRI检查以明确囊液性质、嚢肿范围、来源及信号强度。根据囊液性质及MRI检查特点,决定手术方法,术后病理确诊。结果：穿刺囊液为蛋清样黏液23例,为淡黄色水样液体6例,为灰色脓汁样液体5例。另有2例患者不配合未能行穿刺检查。MRI检查T1低信号、T2高信号且囊肿有＂尾状征＂与口底关系密切者25例,诊断为潜突型舌下腺囊肿,采用口内入路摘除舌下腺,其余11例采用颈部入路。术后病理证实潜突型舌下腺囊肿25例,淋巴管瘤6例,鳃裂囊肿5例。所有术后病理确诊与术前诊断相符,随访3~36月,未见有患者复发。结论：上颈部囊性病变术前MRI检查,有助于术前明确诊断,以正确指导手术,避免盲目颈部探查手术。

B超、穿刺、CT、MRI检查对潜突型舌下腺囊肿的诊断价值

目的探讨B超、穿刺、CT和MRI检查对潜突型舌下腺囊肿的诊断价值。方法 36例颏下/颌下囊性肿物术前应用B超检查,穿刺检查,再行CT或MRI检查以明确嚢肿壁是否来自舌下腺。明确诊断的患者行口内切口摘除患侧舌下腺,不能明确的行颈部探查,术中发现为囊肿内容物为黏液成分后改为口内入路切除舌下腺。术后病理确诊。采用SPSS 13.0软件分析确诊率差异。结果 B超、穿刺、CT及MRI四种方法判断潜突型舌下腺囊肿的确诊率分别为53%、62%、87%和100%。统计分析显示4种检查方法确诊率有显著性差异（P〈0.05）。所有术后病理确诊与术前诊断相符,随访3~36个月不等,未见有患者复发。结论位于颏下/颌下区的囊性肿物可行MRI检查,明确囊肿来源,有助于术前明确诊断,以正确指导手术,避免颏下/颌下区探查手术。尤其对于不能配合穿刺造影检查的儿童患者,MRI检查更有优势。

碘酊囊腔注射治疗口腔粘液腺及舌下腺囊肿

目的 了解碘酊治疗口腔粘液腺及舌下腺囊肿的疗效。方法 常规消毒 ,穿刺抽出囊液 ;根据囊肿大小注射 2 .5 %碘酊 0 .1～ 1 .0ml,囊肿较大者可加 0 .1ml的地塞米松一起注射。一周后复诊 ,囊肿未完全消除者用同样方法行囊腔内注射 ,每周一次直到囊肿消失。结果 2 3例中注射次数最多者 3次 ,平均 1 .2 2次。注射后局部和全身无不良反应。 1例 3月后复发 ,治愈率95 .65 %。结论 碘酊囊腔注射治疗口腔粘液腺及舌下腺囊肿 ,具有无需麻醉、创伤小、疗效好、儿童及老年体弱患者易耐受。