RESUMO
La ránula es una lesión pseudoquística causada por la retención de contenido salival de la glándula sublingual en el tejido conjuntivo subyacente, siendo la patología más frecuente de esta glándula. Su localización es a nivel del suelo de la boca, pudiendo en ocasiones extenderse a través del músculo milohioideo hacia la región submaxilar o cervical (ránula plunging o cervical), presentándose clínicamente como una tumoración laterocervical de crecimiento lento. El apoyo de imágenes mediante ecografía, tomografía computarizada, o RM (resonancia magnética) es fundamental para un correcto diagnóstico. Respecto al tratamiento, el procedimiento más aceptado y con menos tasas de recurrencia es la escisión de la ránula cervical por abordaje laterocervical, asociada a la extirpación de la glándula sublingual implicada vía transoral. Aquí presentamos el caso clínico de un varón de 25 años quien presenta una masa laterocervical derecha de seis meses de evolución de crecimiento progresivo e indoloro. La ecografía y RM confirman una ránula cervical gigante de 62x45x101 mm, que se localiza en espacio submandibular derecho, alcanzando el espacio parafaríngeo en su vertiente más craneal. Debido a las características de la lesión y su anatomía se decide tratamiento quirúrgico.
The ranula is a pseudocystic lesion caused by the retention of salivary content of the sublingual gland in the underlying connective tissue, being the most frequent pathology of this gland. Its location is at the level of the floor of the mouth and can sometimes extend through the mylohyoid muscle towards the submaxillary or cervical region (plunging or cervical ranula), clinically presenting as a slow-growing laterocervical tumor. The support of images by ultrasound, computed tTomography or MRI (magnetic resonance imaging) is essential for a correct diagnosis. Regarding treatment, the most accepted procedure, and with the lowest recurrence rates is excision of the cervical ranula by the laterocervical approach, associated with the transoral removal of the involved sublingual gland. Here, we present the clinical case of a 25-year-old man who presented a six-month-old right laterocervical mass of progressive and painless growth. Ultrasound and MRI confirmed a giant cervical ranula measuring approximately 62x45x101 mm, located in the right submandibular space, reaching the parapharyngeal space in its most cranial aspect. Due to the characteristics of the injury and its anatomy, surgical treatment was decided.
Assuntos
Humanos , Masculino , Adulto , Rânula/cirurgia , Rânula/diagnóstico por imagem , Doenças das Glândulas Salivares/cirurgia , Glândula Sublingual/cirurgia , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
Lesions in the floor of the mouth can be a challenging diagnosis due to the variety of pathological conditions that might be found in this area. Within a broad range of lesions, attention has to be addressed to those that require specific management, such as a dermoid cyst (DC) and a ranula. Especially in pediatric patients, in whom the failure of diagnosis can postpone the correct treatment and cause sequelae later in life. DC, a developmental anomaly, is managed primarily by surgical resection. On the other hand, ranula is a pseudocyst that may be treated by marsupialization. This article reports a large and painful lesion in the floor of the mouth in a pediatric patient. With a diagnostic hypothesis of ranula, two surgical interventions were performed, but there were recurrences of the lesion. Subsequently, the patient was referred to the Oral and Maxillofacial Surgery Unit for re-evaluation. Computed tomography showed a semi-transparent image suggesting a cystic formation. Another surgical procedure was performed where the lesion was completely removed. Anatomopathological analysis confirmed the diagnosis of DC. The five-year follow-up showed no signs of recurrence. This article indicates that although DC in the floor of the mouth is rare, it should be considered in the differential diagnosis of other diseases in this area. This precaution may be particularly important in the following circumstances: 1) Similar lesions that have different therapeutic approaches and, 2) To prevent future sequelae in pediatric patients.
Assuntos
Cisto Dermoide/patologia , Cisto Dermoide/cirurgia , Soalho Bucal/patologia , Soalho Bucal/cirurgia , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , Adolescente , Cisto Dermoide/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Soalho Bucal/diagnóstico por imagem , Neoplasias Bucais/diagnóstico por imagem , Rânula/patologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Abstract Lesions in the floor of the mouth can be a challenging diagnosis due to the variety of pathological conditions that might be found in this area. Within a broad range of lesions, attention has to be addressed to those that require specific management, such as a dermoid cyst (DC) and a ranula. Especially in pediatric patients, in whom the failure of diagnosis can postpone the correct treatment and cause sequelae later in life. DC, a developmental anomaly, is managed primarily by surgical resection. On the other hand, ranula is a pseudocyst that may be treated by marsupialization. This article reports a large and painful lesion in the floor of the mouth in a pediatric patient. With a diagnostic hypothesis of ranula, two surgical interventions were performed, but there were recurrences of the lesion. Subsequently, the patient was referred to the Oral and Maxillofacial Surgery Unit for re-evaluation. Computed tomography showed a semi-transparent image suggesting a cystic formation. Another surgical procedure was performed where the lesion was completely removed. Anatomopathological analysis confirmed the diagnosis of DC. The five-year follow-up showed no signs of recurrence. This article indicates that although DC in the floor of the mouth is rare, it should be considered in the differential diagnosis of other diseases in this area. This precaution may be particularly important in the following circumstances: 1) Similar lesions that have different therapeutic approaches and, 2) To prevent future sequelae in pediatric patients.
Assuntos
Humanos , Feminino , Adolescente , Neoplasias Bucais/cirurgia , Neoplasias Bucais/patologia , Cisto Dermoide/cirurgia , Cisto Dermoide/patologia , Soalho Bucal/cirurgia , Soalho Bucal/patologia , Rânula/patologia , Neoplasias Bucais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Cisto Dermoide/diagnóstico por imagem , Diagnóstico Diferencial , Soalho Bucal/diagnóstico por imagemRESUMO
A mucocele sublingual é uma afecção incomum em cães, porém de grande importância para a medicina veterinária, devido aosprejuízos gerados por suas consequências. Deste modo, o presente relato tem como objetivo descrever o caso de mucocelesublingual em cão com posterior recidiva em glândula mandibular e sublingual, bem como discutir sua importância para a medicinaveterinária. Foi atendido no Hospital Veterinário Dix-Huit Rosado Maia HOVET/ Universidade Federal Rural de Semiárido(UFERSA), um cão macho, com um ano e 10 meses de idade, apresentando aumento de volume bilateral na região sublingualhá, aproximadamente, dois meses. Após exame clínico suspeitou-se de mucocele da glândula sublingual bilateral (rânula)indicando-se o tratamento de ressecção da glândula sublingual esquerda devido ao aspecto nodular e marsupalização da glândulasublingual direita. Passado um mês da alta médica o animal retornou ao HOVET UFERSA com queixa de aparecimento de umnovo aumento de volume sublingual e na região cervico-ventral suspeitando-se de uma possível mucocele cervical e recidivada mucocele sublingual esquerda. Indicou-se como tratamento a sialoadenectomia sublingual e mandibular. Cerca de dez diasapós a última cirurgia o cão não apresentava mais aumento de volume da área afetada e não havia sinais de alteração quanto àprodução de saliva. O tratamento sugerido proporcionou bons resultados promovendo a reparação tecidual e reestruturação dolocal afetado e diminuindo o índice de recidiva.(AU)
The sublingual mucocele is a rare disease in dogs, but very important for veterinary medicine due to losses generated by itsconsequences. Thus, this report aims to describe the case of sublingual mucocele in a dog with subsequent relapse in mandibularand sublingual gland and discuss their importance to veterinary medicine. It was the Veterinary Hospital Dix-Huit Rosado Maia -HOVET / Universidade Federal Rural de Semi-árido (UFERSA), a male dog with one year and 10 months, an increase of bilateralvolume in the sublingual region for approximately two months. After clinical examination was suspected of mucocele of bilateralsublingual gland (ranula) indicating the treatment of sublingual left gland resection due to nodular and marsupalização the rightsublingual gland. After one month of a medical release the animal returned to HOVET - UFERSA with emergence of complaint froma further increase in sublingual volume and cervical-ventral region suspecting it is a possible cervical mucoceles and recurrenceof sublingual mucocele left. It is stated as a treatment to sublingual and mandibular sialoadenectomy. About ten days after the lastsurgery, the dog had no more swelling of the affected area and no signs of change with saliva production. However, the suggestedtreatment provided good results by promoting tissue repair and restructuring of the affected area and decreasing the recurrence rate.(AU)
Assuntos
Animais , Cães , Rânula/veterinária , Recidiva , Mucocele , Glândulas SalivaresRESUMO
La ránula intraoral es una enfermedad benigna seudoquística de extravasación que tiene su origen en las glándulas salivales sublinguales. Es una entidad poco prevalente. Es más frecuente en niños y adolescentes, con características clínicas propias que la diferencian de otras entidades de la boca. Su tratamiento es quirúrgico y varias técnicas han sido descritas en la literatura: marsupialización simple y modificada, enucleación de la lesión, extirpación de la glándula junto con enucleación de la ránula. Si bien la extirpación de la glándula junto con la enucleación de la lesión es el tratamiento definitivo radical y más aceptado, la marsupialización modificada puede ser útil como alternativa de tratamiento quirúrgico conservador en casos de ránulas intraorales gigantes, disminuyendo los riesgos de morbilidad quirúrgica y presentando bajos índices de recurrencia, mientras su aplicación sea cuidadosa. El siguiente reporte de caso describe el manejo clínico de forma quirúrgica conservadora mediante marsupialización modificada, con un seguimiento de 12 meses sin signos de recidiva.
The intraoral ranula is a benign pseudo-cystic extravasation with its origin in the sublingual salivary glands. It is an infrequent disease. It is more common in children and adolescents, with its own clinical characteristics that differentiate it from other entities in the mouth. The treatment for this condition is surgical, and several techniques have been described in the literature: simple and modified marsupialisation, enucleation of the lesion, and removal of the gland with enucleation of the ranula. While the removal of the gland with enucleation of the lesion is the widely accepted radical and definitive treatment, marsupialisation may be useful as an alternative to conservative surgical treatment in cases of giant intraoral ranula, reducing the risk of surgical morbidity, and presenting with low rates of recurrence, while its application should be performed with care. The case is presented that describes the conservative surgical treatment with marsupialisation in its clinical management, with a 12 months follow up without signs of recurrence.
Assuntos
Humanos , Masculino , Adolescente , Rânula/cirurgia , Doenças das Glândulas Salivares/cirurgia , Glândula Sublingual/cirurgia , Resultado do TratamentoRESUMO
Se presenta una situación clínica de una paciente de sexo femenino, de 12 años de edad, quien concurre al Servicio de Cirugía y Traumatología Bucomaxilofacial del Hospital Zonal General de Agudos General Manuel Belgrano, presentando un aumento de volumen en el piso de boca, renitente, delimitado, de color azulado, indoloro y asintomático (Fig. 1) compatibles con una lesión de la glándula sublingual denominada ránula. Se solicita a la paciente, como estudio por imagen de preferencia, una resonancia magnética con y sin contraste (Fig. 2, Fig. 3). Se procede a su resolución quirúrgica extirpando la lesión conjuntamente con la glándula sublingual, presentando una evolución favorables a corto y largo plazo. Se realiza una búsqueda bibliográfica exponiendo los diferentes tipos de tratamiento posibles, estudios por imágenes de preferencia y posibles complicaciones según tratamiento.
Assuntos
Humanos , Feminino , Criança , Glândula Sublingual/patologia , Rânula/cirurgia , Rânula/complicações , Rânula/diagnóstico , Descompressão Cirúrgica/métodos , Seguimentos , Imageamento por Ressonância Magnética , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Bucais/métodos , Soalho Bucal/patologia , Resultado do TratamentoRESUMO
Rânula é uma patologia não hereditária, indolor, caracterizada por formação de uma bolsa preenchida geralmente por líquido mucinoide, frequentemente resultante de trauma ou obstrução da glândula associada. Geralmente, essas lesões são facilmente identificáveis a partir de um exame clínico minucioso, apesar de existirem outras entidades clínicas com aspectos semelhantes. A variante mergulhante disseca o músculo milohióideo, podendo causar tumefação na região cervical correspondente. Existem várias formas de tratamento, sendo as mais usadas a marsupialização concomitante ou não à excisão cirúrgica da lesão e da glândula salivar envolvida. A proposta deste relato de caso é mostrar ao colega cirurgião-dentista uma visão de plano de tratamento para esse tipo de alteração e as prováveis condutas de acordo com a apresentação e mudanças que, porventura, podem ocorrer, além da importância da proservação e acompanhamentos posteriores a partir de uma experiência do nosso serviço... (AU)
Ranula is a non-hereditary disease, painless, characterized by forming a generally liquid-filled mucina, often resulting from trauma or obstruction associated gland. Generally, these lesions are easily identifiable from a thorough clinical examination, although there are others clinical entities with similar aspects. The variant plunging mylohioideo dissects the muscle, causing swelling in the neck accordingly. There are several forms of treatment, of which the most used are the marsupialization or without concomitant surgical excision of the lesion and the salivary gland involved. The purpose of this case report is to show the dentist colleague of vision treatment plan for this type of change and the likely behavior according to the presentation and changes that may occur, and the importance of proactive observation and subsequent follow from experience of our service... (AU)