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

Area of Science:

• Oral and Maxillofacial Surgery
• Otolaryngology
• Head and Neck Surgery

Background:

• Ranulas, benign cystic lesions of the floor of the mouth, can be simple or plunging.
• Recurrence is a significant concern following ranula treatment, impacting patient quality of life.

Purpose of the Study:

• To systematically review and compare the recurrence rates of different management strategies for simple and plunging ranulas.
• To identify optimal treatment approaches for minimizing ranula recurrence.

Main Methods:

• A PRISMA-guided systematic literature search was conducted across major biomedical databases.
• Seventy-one studies involving 809 patients were included, with data extracted on ranula type, treatment, and recurrence.
• Descriptive synthesis was employed due to study heterogeneity.

Main Results:

• Excision with ipsilateral sublingual gland removal showed recurrence rates under 10%.
• Marsupialization and excision without gland removal had higher, variable recurrence rates (15%-30%).
• Sclerotherapy outcomes varied: bleomycin (3%-10% recurrence) vs. OK-432 (>50% recurrence), especially for plunging ranulas. Most recurrences occurred within 3-6 months.

Conclusions:

• Sublingual gland excision is associated with the lowest ranula recurrence rates.
• Marsupialization and sclerotherapy outcomes are technique- and agent-dependent.
• Further research may be needed to optimize non-excision techniques for ranula treatment.