Abstract

Objective: A ranula is a mucus-filled salivary pseudocyst that forms in the floor of the mouth, commonly arising from the sublingual or submandibular salivary glands following obstruction or trauma. Complete excision of the injured gland and removal of the cyst content is first-choice therapy, but has the potential for complications related to injury to nearby structures. As such, minimally invasive approaches such as percutaneous sclerotherapy have been investigated. We aim to contribute to the literature by assessing the efficacy and safety of our technique through our experience with 18 patients over the last decade.

Methods: This retrospective study evaluated 18 patients with intraoral and plunging ranulas treated by percutaneous bleomycin ablation. The primary endpoint was treatment result. Secondary endpoints included bleomycin dosage and complications.

Results: The study evaluated 12 males and 6 females with a median age of 23.5 years (range, 13–39 years). At a final follow-up of at least 2 months (6.5 ± 5.5 months), 4 patients demonstrated complete response (22%) and 14 patients demonstrated residual presence, recurrence or regrowth of the lesion (78%). There were no statistically significant associations between outcomes and history of prior treatment, number of treatments, and size or type of ranula. No complications were noted.

Conclusions: Our findings indicate that bleomycin, while safe for use in various head and neck malformations, is of limited utility in ranula therapy when the offending gland is not addressed primarily.

Keywords: Ranula; Sclerotherapy; Marsupialization; Bleomycin; Doxycycline

References

1. Nguyen MT and Orloff LA. “Successful ablation of plunging ranula by ultrasound-guided percutaneous ethanol injection”. The Laryngoscope 127 (2017): 2239-2241.
2. Kokong D., et al. “Ranula: Current Concept of Pathophysiologic Basis and Surgical Management Options”. World Journal of Surgery 41 (2017): 1476-1481.
3. Brannan ZJ., et al. “Percutaneous treatment of ranulas: ultrasound-guided drainage with salivary gland chemical ablation”. Pediatric Radiology 49 (2019): 801-807.
4. Aluko-Olokun B and Olaitan AA. “Ranula Decompression Using Stitch and Stab Method: The Aluko Technique”. Journal of Maxillofacial and Oral Surgery 16 (2017): 192-196.
5. Patel MR., et al. “Oral and plunging ranulas: What is the most effective treatment?” The Laryngoscope 119 (2009): 1501-1509.
6. Zhao YF., et al. “Complications associated with surgical management of ranulas”. Journal of Oral and Maxillofacial Surgery: Official journal of the American Association of Oral and Maxillofacial Surgeons 63 (2005): 51-54.
7. Kono M., et al. “Evaluation of OK-432 Injection Therapy as Possible Primary Treatment of Intraoral Ranula”. Journal of Oral and Maxillofacial Surgery: Official Journal of the American Association of Oral and Maxillofacial Surgeons 75 (2017): 336-342.
8. Fukase S., et al. “Treatment of ranula wth intracystic injection of the streptococcal preparation OK-432”. The Annals of otology, rhinology, and laryngology 112 (2003): 214-220.
9. Hanif AM., et al. “Use of percutaneous bleomycin sclerotherapy for orbital lymphatic malformations”. Orbit (Amsterdam, Netherlands) 38 (2019): 30-36.
10. Lee HJ., et al. “Percutaneous sclerotherapy using bleomycin for the treatment of vascular malformations”. International Journal of Dermatology 56 (2017): 1186-1191.
11. Yura J., et al. “Bleomycin treatment for cystic hygroma in children”. Nihon geka hokan Archiv fur japanische Chirurgie 1977 46 (1977): 607-614.
12. Ryu KH., et al. “Ethanol Ablation of Ranulas: Short-Term Follow-Up Results and Clinicoradiologic Factors for Successful Outcome”. AJNR American Journal of Neuroradiology 38 (2017): 1794-1798.
13. Yoshizawa K., et al. “A Case of Sublingual Ranula That Responded Successfully to Localized Injection Treatment with OK-432 after Healing from Drug Induced Hypersensitivity Syndrome”. Case Reports in Dentistry 2016 (2016): 6939568-6939568.
14. Ohta N., et al. “OK-432 treatment of ranula extending to the parapharyngeal space”. Acta Oto-laryngologica 134 (2014): 206-210.
15. Roh JL and Kim HS. “Primary treatment of pediatric plunging ranula with nonsurgical sclerotherapy using OK-432 (Picibanil)”. International Journal of Pediatric Otorhinolaryngology 72 (2008): 1405-1410.
16. Kinoshita M., et al. “Plunging ranula intruding into the parapharyngeal space treated with OK-432”. American Journal of Otolaryngology 33 (2012): 345-348.
17. Lee HM., et al. “Treatment of ranula in pediatric patients with intralesional injection of OK-432”. The Laryngoscope 116 (2006): 966-969.
18. Rho MH., et al. “OK-432 sclerotherapy of plunging ranula in 21 patients: it can be a substitute for surgery”. AJNR American Journal of Neuroradiology 27 (2006): 1090-1095.
19. Ikarashi T., et al. “Cystic lymphangioma and plunging ranula treated by OK-432 therapy: a report of two cases”. Acta oto-laryngologica Supplementum 511 (1994): 196-199.
20. Woo JS., et al. “Recurrent plunging ranula treated with OK-432”. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 260 (2003): 226-228.
21. Patel MR., et al. “Oral and plunging ranulas: What is the most effective treatment?” The Laryngoscope 119 (2009): 1501-1509.

Citation

Citation: Manna Sayan. “Bleomycin Sclerotherapy Following Doxycycline Lavage in the Treatment of Ranulas: A Retrospective Analysis and Review of the Literature". Acta Scientific Otolaryngology 3.1 (2021): 25-31.

Copyright

Copyright: © 2021 Manna Sayan. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.