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I discussed the entity of ranula when we were doing

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our anatomic review of the floor of the mouth

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and sublingual gland and submandibular gland.

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Remember that there are two

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different types of ranula.

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One is a simple ranula which lies above the

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mylohyoid musculature and does not

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perforate through it posteriorly,

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generally medial to the genioglossus muscle.

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Then there is the plunging ranula.

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So plunging ranula going into the submandibular

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space usually coursing more posterior and

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perforating through that mylohyoid musculature.

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These are usually thin-walled cysts and

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they usually have fluid intensity.

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Occasionally, they can be traumatized and have some

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hemorrhage or some inflammation associated with it.

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The differential diagnosis is the thyroglossal

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duct cyst that is in the tongue.

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Those thyroglossal duct cysts are usually at the

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foramen cecum in the midline of the tongue as

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opposed to the ranula which are

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in the floor of the mouth.

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Off midline, you may have a differential diagnosis

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of a lymphangioma which is a cystic lesion.

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Again, generally off midline, you may see epidermoids also

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but those are not minor salivary gland or glandular

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lesions whereas the ranula is due to

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obstruction of ducts and glands.

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Let's see a diagram here of the ranula.

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So this ranula, which is the green thing,

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is still confined by the mylohyoid musculature

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and therefore is considered a simple ranula.

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And here we see that ranula.

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Again, a simple ranula in the sublingual space sublingual

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gland due to obstruction of the ductal

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outflow into the sublingual space.

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Here we have the ranula which is

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below the mylohyoid muscle.

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Usually it wraps a little bit around here

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posteriorly and that would be our plunging ranula.

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Here, for example,

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you have a nice example of a ranula which

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is lateral to the genioglossus muscle

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adjacent to the geniohyoid muscle but perforating

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through the mylohyoid muscle.

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So this is a plunging ranula.

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Again, when it perforates behind the border of the

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mylohyoid muscle and gets into the submandibular

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space, it's going to be called a plunging ranula.

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So this is a ranula that has perforated through the

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boutonniere and becomes a plunging ranula with a boutonniere

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not too simple but plunging.

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This example I showed previously.

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Here we have the ranula confined

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by the mylohyoid muscle.

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Here we have the ranula that

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is perforating through the

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incompetent mylohyoid muscle. Simple ranula.

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Plunging ranula very similar in size.

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This one treated intraorally.

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This one treated with a transcervical approach.

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Another example ranula cyst coming back,

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going around the mandible and below

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the mylohyoid muscle.

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This is a plunging ranula extending into the

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submandibular space after having perforated

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through the mylohyoid muscle.