Plunging ranula of the submandibular area
An 18-year-old man, with a large swelling on a left side of his face and neck was coming to the Department of Oral Radiology, School of Dentistry.\nThe chief complaint was the asymmetry of his face. The patient history showed that he had severe accident 2 years ago and had hospitalized. At that time such a lesion was appearance on the left side of his face and became bigger. He did not report any pain or paresthesia and loosing of teeth.\nBecause the lesion had grown slowly and there were no pain and loosing teeth, so it seems that it was not a malignant lesion.\nIn extraoral examination, a diffuse, soft, fluctuant, nontender swelling, about 7×5 cm in size, was present in the left submandibular region, which was extended to the neck. There was no redness, heat, and pain [].\nIn intraoral examination there was a small, smooth surface, and movable mass in the floor of the mouth, to one side of the lingual frenum []. The mucous color was normal. Oral mucosa, gingival, was normal and salivary ducts openings were patent. Oral hygiene was poor. The tooth number 47 was carious. There was no displacement and loosing teeth.\nIn a panoramic radiography, the tooth number 47 had caries, but there was no lesion in the left side of radiography [].\nAccording to no redness, heat, pain, and no lesion in the bone in panoramic view, it seems that there was no infection associated with teeth such as abscess or osteomyelitis. On the other hand, salivary duct openings were present and he did not had history of any enlargement of lesion during meals, so we could roll out sialoliths.\nThe patient had taken Computed tomography (CT) from this field, 4 months ago, which showed a well-defined cystic mass lesion in submandibular space without peripheral enhancement []. It causes posterior displacement of the left submandibular gland and obliteration of the left vallecula and preform sinus.\nSince the high-resolution ultrasound is an ideal initial imaging investigation for neck tumors and it is readily available, relatively inexpensive, and does not involve ionizing radiation,[] sonographic examination was done for the patient. It revealed a space occupying mass with 62×25 mm, which was cyst like with capsule []. It contained concentrated liquid. There was no blood vessel. The cyst was across the midline slightly and had a pressure effect on surrounding structures. From these findings, solid tumors such as pleomorphic adenoma and monomorphic adenoma could be rejected.\nThe patient was referred to oral surgery department for treatment. In Alzahra hospital, the lesion was treated with the marsupialization technique.\nHistopatological findings show an area of spilled mucin surrounded by a granulation tissue response. The inflammation includes numerous foamy histiocytes (macrophages) [].