Sublingual ranulas, is it time for a new classification? A systematic review and meta-analysis

Area of Science:

• Oral and Maxillofacial Surgery
• Otolaryngology
• Surgical Pathology

Background:

• Sublingual ranulas exhibit diverse clinical presentations, posing diagnostic and therapeutic difficulties.
• Existing classifications may not fully capture the spectrum of sublingual ranula extension.

Purpose of the Study:

• To systematically review and synthesize treatment outcomes for sublingual ranulas.
• To propose a novel classification system for sublingual ranulas based on anatomical extension.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines.
• Literature search for studies involving medical or surgical treatment of sublingual ranulas.
• Proportion meta-analysis with a random-effects model to compare treatment success rates.

Main Results:

• Forty-two studies encompassing 1131 ranulas were analyzed.
• Sublingual sialoadenectomy, with or without pseudocyst wall excision, demonstrated the highest success rates with low heterogeneity.
• A new classification system categorizes ranulas into Type 1 (intraoral), Type 2 (cervical), and Type 3 (parapharyngeal space) extension.

Conclusions:

• Sublingual gland resection is confirmed as the gold standard treatment for sublingual ranulas.
• A revised classification is crucial for standardizing diagnosis and improving patient management and outcomes.