Refractory Ranula Following Surgery for Tongue Cancer: A Case Report

The postoperative complications of tongue cancer include functional impairment due to tongue removal, sensory and taste disturbances due to damage to the lingual nerve, and intraoral ranula due to damage to the salivary gland duct in the lower part of the tongue. Surgical treatments, such as marsupialization, cystectomy, and sublingual adenectomy, have long been used to treat intraoral ranulae. Sclerotherapy with OK-432, which is less invasive than other treatments, has also recently been used. However, to the best of our knowledge, no case of sclerotherapy with OK-432 for ranulae resulting from postoperative complications of tongue cancer has been reported to date. In this report, we describe a case of a postoperative intraoral ranula that was treated several times with sclerotherapy using OK-432; however, the ranula recurred. Therefore, we performed marsupialization and obtained satisfactory results. A man in his 60s underwent partial tongue resection for right-sided tongue cancer (T2N0M0). The resected area was then covered with polyglycolic acid sheets and fibrin glue. Seven months after surgery, a well-defined, soft, blue-violet mass measuring 38 × 26 mm was observed at the resection site. Contrast-enhanced magnetic resonance imaging (MRI) of the head and neck revealed a cystic high-signal area suggestive of fluid collection in the right sublingual space on T2-weighted images. Local and imaging findings were consistent with those of the right intraoral ranula. OK-432 1 KE/0.2 ml was then injected into the right ranula. After the injection, a temporary resolution was observed; however, an increase in the size of the recurring ranula was noted. Therefore, three OK-432 injections were administered. However, owing to recurrent findings of the ranula in the same area, right-sided ranula marsupialization was performed under general anesthesia five months after the first OK-432 injection. The surgical field performs a tie-over. Contrast-enhanced MRI was performed three months after marsupialization to confirm the absence of recurrence or metastasis of the ranula or tongue cancer. Currently, 12 months after surgery, no recurrence or adverse events have been observed in either the tongue cancer or the ranula. Our case revealed that sclerotherapy with OK-432 is not effective for ranula, which is a postoperative complication of tongue cancer. In such cases, surgical treatments such as marsupialization may be appropriate.