A 2-month-old boy was brought for evaluation of a bluish swelling under the tongue. The parents had noticed the lesion at 3 weeks of age and were concerned that it had enlarged. The infant had been sucking and swallowing well. He was born at term via normal spontaneous vaginal delivery after an unremarkable prenatal course. He had been healthy since birth and had no history of oral trauma.
This infant has a ranula—a rare unilateral cyst located in the floor of the mouth that develops when mucus leaks into the surrounding tissues as a result of obstruction of the excretory ducts of the major salivary glands. Mucoceles, in contrast, arise from the minor salivary glands and often present on the lip. Ranulas can occur at any age and may be congenital. They are frequently asymptomatic, although a plunging ranula may impinge on neck mobility.
Excision of the ranula along with the involved sublingual gland can be curative. Marsupialization and drainage may be offered depending on the location and size of the cyst; however, recurrence after this treatment is common. The parents of this infant chose observation, with surgical intervention only if airway obstruction or feeding difficulties arose. The ranula resolved spontaneously in about 6 months.
FOR MORE INFORMATION:
• Coles MA, Sobol SE. 14-year-old boy with nonpainful swelling under his chin. Consultant for Pediatricians. 2003;4:375.
• Shah BR, Laude TL. Atlas of Pediatric Clinical Diagnosis. Philadelphia: WB Saunders; 2000:464-465.
• Steelman R, Zimmerman A. Congenital ranula. Consultant for Pediatricians. 2003;2:255.
• Zhao YF, Jia Y, Chen XM, Zhang WF. Clinical review of 580 ranulas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98:281-287.