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Rare Case of Giant Plunging Ranula without Intraoral Component Presenting as a Subcutaneous Swelling in the Neck: A Diagnostic Dilemma

Journal of Cutaneous and Aesthetic Surgery
Medknow Publications
Publication Date
DOI: 10.4103/0974-2077.101401
  • Letters
  • Biology
  • Communication
  • Medicine


Sir, A 21-year-old male presented with an asymptomatic swelling in the left submandibular region of 1 year duration which was gradually increasing in size. The patient gave history of being operated 45 days back for the same swelling; however, the procedure was abandoned without excision. Subsequently, the patient developed pain in the submandibular region and hence visited our center for definitive management. On examination, an irregular, soft, mildly tender swelling was seen in the left submandibular region measuring 6 × 5 × 3 cm [Figure 1a]. Overlying skin which was otherwise unremarkable showed a scar of previous surgical intervention [Figure 1b]. On oral examination, no swelling was found in the sublingual regions bilaterally. Ultrasonography of the lesion showed an anechoic fluid collection in the submandibular region. Contrast-enhanced STIR and T2-weighted MRI images showed a hyperintense (hypointense on T1W images) cystic lesion in the submandibular region in the subcutaneous plane measuring 4.8 × 3.9 × 3.7 cm [Figure 2]. The swelling was abutting left masseter and medial pterygoid muscles and the left submandibular gland was aseptate and showed no communication with sublingual space. With a preoperative diagnosis of lymphangioma, the swelling was excised under general anesthesia after a course of antibiotics. A horizontal incision of about 8 cm was made in the left submandibular region and the swelling was found to be extending inferiorly into the mid-cervical region, laterally up to angle of mandible and superiorly into the floor of mouth [Figure 1c]. Its superior margin was going behind the inferior border of the mandible into the floor of mouth. All the margins were freed and the excised swelling was sent for histopathology examination. We received a specimen of the cyst containing gelatinous material measuring 5 × 3.5 × 2.5 cm. Microscopic examination revealed a typical extravasation mucocele filled with mucin containing numerous macrophages and no lining epithelium [Figure 3]. The wall foc

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