Plunging ranula: an unusual multilocular presentation

Area of Science:

• Oral and Maxillofacial Surgery
• Sialology
• HIV Medicine

Background:

• Plunging ranulas are rare, benign cystic lesions originating from the sublingual salivary gland.
• HIV-positive individuals may present with diverse oral manifestations, necessitating comprehensive diagnostic approaches.

Observation:

• A 32-year-old HIV-positive male presented with a 3-year history of a large, nontender, doughy left submandibular swelling crossing the midline.
• The lesion caused significant elevation of the oral floor, impaired salivary flow, and bilateral lymphadenopathy.
• MRI revealed a multilocular cystic lesion disrupting the mylohyoid muscle; aspirate was positive for salivary amylase.

Findings:

• A plunging ranula was provisionally diagnosed based on clinical and aspirate findings.
• The multilocular nature of the cyst, visualized on MRI, indicated a complex presentation.
• Surgical excision involved intraoral sublingual gland removal and submandibular dissection for complete cyst removal.

Implications:

• This case highlights the importance of advanced imaging (MRI) in diagnosing complex plunging ranulas.
• Aggressive surgical management, including gland excision, is crucial for preventing recurrence in extensive cases.
• Management of oral lesions in HIV-positive patients requires a multidisciplinary approach, considering potential systemic influences.