Systematic Review and Meta-Analysis of the Management and Outcomes of Recurrent Ranulas

To systematically review and compare recurrence rates associated with different management strategies for simple and plunging ranulas.

A PRISMA-guided search of PubMed, Embase, Web of Science, Scopus, and CINAHL was performed. Studies reporting post-treatment outcomes of ranulas with clearly defined initial management strategies were included. Two reviewers independently screened studies and extracted data on ranula subtype, treatment details, duration of follow-up, and recurrence. Risk of bias was assessed using study design-appropriate tools. Given the predominance of retrospective case series with heterogenous designs and incomplete outcome reporting, quantitative pooling was not feasible; results were synthesized descriptively.

Seventy-one studies comprising 809 patients (563 simple, 246 plunging) met inclusion criteria. Excision with ipsilateral sublingual gland removal (30%) was associated with recurrence rates below 10%. Excision without gland removal and marsupialization demonstrated higher and more variable recurrence rates, ranging from 15%-30% across cohorts. Sclerotherapy outcomes varied by agent, with recurrence rates of 3%-10% for bleomycin and over 50% for OK-432, particularly in plunging ranulas. Most recurrences occurred within 3-6 months.

Sublingual gland excision was consistently associated with the lowest recurrence rates, while outcomes following marsupialization and sclerotherapy varied by technique and agent.