Head and Neck Clinic
Ear, Nose & Throat Journal
Plunging Ranula
Abdul Ruhi Ul Azim Liman, MD1, Geng Ju Tuang, MBBS, MRCSEd (ENT)1,
and Masaany Mansor, MD, MS (ORL-HNS)1
Figure 1. Clinical photography of a swelling over the submental
region (arrow).
A 67-year-old lady presented with 6-month history of progres-
sive, painless submental swelling (Figure 1). Clinical exam-
ination revealed a nontender, soft swelling, which was not
mobile upon swallowing or tongue protrusion. Transillumina-
tion test was positive. The floor of mouth examination was
unremarkable, and the mass was not ballotable with bimanual
palpation. Computed tomography (CT) of the neck unveiled a
well-circumscribed nonenhancing homogenous submental
lesion. The presence of a ‘‘tail sign’’ supports the diagnosis
of a plunging ranula (Figure 2). She subsequently underwent
surgical excision along with the removal of the right sublin-
gual gland (Figure 3). No recurrence was observed 6 months
after the operation.
A plunging ranula occurs when a mucous content pseudo-
cyst situated in the floor of mouth herniates through the mylo-
hyoid muscle. Any obstruction along the outflow tract may
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DOI: 10.1177/0145561320927828
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Figure 2. Contrasted computed tomography of the neck in coronal
view: presence of ‘‘tail sign’’ (arrow).
predispose to traumatic rupture of the excretory salivary duct,
thereby resulting in extravasation of saliva and potentially
ranula formation.1 Ranula generally occurs between the sec-
ond and third decade of life, with a slight male preference
ratio of 2:1.2 The diagnosis can be made clinically, with the
aid of CT neck to access the extension. A ‘‘tail sign,’’ which
1
Department of Otorhinolaryngology, Head and Neck Surgery, Hospital
Selayang, Batu Caves, Malaysia
Received: January 4, 2020; accepted: January 15, 2020
Corresponding Author:
Abdul Ruhi Ul Azim Liman, MD, Department of Otorhinolaryngology, Head
and Neck Surgery, Hospital Selayang, Hospital Selayang Lebuh Raya, Lebuh
Raya Selayang- Kepong, 68100, Batu Caves, Selangor, Malaysia.
Email: abdulruhi89@gmail.com
2 Ear, Nose & Throat Journal

indicates the communication between the collapsed sublin-

gual and submandibular space over the posterior edge of the
mylohyoid muscle, is pathognomonic of plunging ranula.2
Surgical excision is preferred over sclerotherapy with low
recurrence rate.3

References
1. Packiri S, Gurunathan D, Selvarasu K. Management of paediatric
oral ranula: a systemic review. J Clin Diagno Res. 2017;11(9):
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2. Kokong D, Iduh A, Chukwa I, Mugu J, Nuhu S, Augustine S.
Ranula: current concept of pathophysiologic basis and surgical
management options. World J Surg. 2017;41(6):1476-1481.
3. Yang Y, Hong K. Surgical results of the intraoral approach for
Figure 3. Inoperative finding. plunging ranula. Acta Otolaryngol. 2014;134(2):201-205.