Sublingual Cyst (Ranula) Causes Symptoms and Treatment

The cyst under the tongue, medically known as a ranula, is a condition that may cause noticeable swelling or enlargement in the area beneath the tongue due to the accumulation of saliva in the surrounding tissues of the sublingual salivary gland. This cyst can vary in size and may sometimes be small and painless. However, it can gradually increase in size, potentially causing difficulty speaking, swallowing, or moving the tongue.Although a ranula is generally considered a benign condition, leaving it untreated may lead to persistent or recurrent swelling, making medical evaluation necessary to determine the most appropriate treatment. What are the causes of a ranula? What are its main symptoms and types? How is it diagnosed and treated with medications or surgical procedures? We will explore all these questions in this article on Dalili Medical.

1. What Is a Ranula (Cyst Under the Tongue)?

A ranula is a cyst or collection of saliva that develops in the tissues beneath the tongue due to the leakage of saliva from the sublingual salivary gland into the surrounding tissues. It may appear as a transparent or bluish swelling.

2. Is a Ranula Dangerous?

A ranula is generally not considered a dangerous condition, as it is a benign, non-cancerous collection of saliva. However, as it grows larger, it may cause problems such as difficulty swallowing, speaking, and moving the tongue. Large ranulas that extend into the neck may also lead to complications requiring medical intervention.

3. Does a Ranula Cause Pain?

A ranula is usually painless, particularly in its early stages. However, it may cause a feeling of pressure or discomfort beneath the tongue as it increases in size or becomes irritated by friction or injury.

4. Can a Ranula Disappear on Its Own?

Some small ranulas may shrink or disappear spontaneously, particularly if the saliva leakage stops. However, others may persist for long periods or recur after temporarily decreasing in size. Therefore, medical evaluation is recommended to determine whether treatment is necessary.

5. Can a Ranula Return After Drainage?

Yes, a ranula may recur after its contents have been drained because removing the accumulated saliva does not necessarily treat the underlying source of leakage from the sublingual salivary gland. Therefore, the doctor may recommend removing the affected gland to reduce the risk of recurrence.

6. Does a Ranula Affect Speech and Swallowing?

Yes, a large ranula may interfere with normal tongue movement, causing difficulty pronouncing certain sounds or swallowing, particularly when it puts pressure on the tissues in the floor of the mouth.

Can a Ranula Turn Into a Cancerous Tumor?

No. A ranula is a benign collection of saliva and does not typically develop into a cancerous tumor. However, any unusual swelling beneath the tongue should be medically examined to confirm the diagnosis and rule out other conditions that may have a similar appearance.

Can Children Develop a Ranula?

Yes, ranulas can occur in both children and adults. They typically appear as a transparent or bluish swelling beneath the tongue. If the ranula becomes large, it may interfere with breastfeeding or eating.

Can a Ranula Affect Breathing?

In most cases, a ranula does not affect breathing. However, in rare instances, a large ranula, particularly a plunging ranula extending into the floor of the mouth or neck, may put pressure on the airway and require urgent medical intervention.

How Long Does Recovery Take After Ranula Surgery?

Recovery time varies depending on the type of procedure, the size of the cyst, and the patient's overall health. Wound healing generally begins within one to two weeks, while complete recovery may take several weeks, particularly after more complex surgical procedures.

Can a Ranula Return After Surgery?

Yes, a ranula may recur after certain surgical procedures, particularly simple drainage, marsupialization, or removal of the cyst without addressing the source of saliva leakage. The risk of recurrence is reduced when the responsible sublingual salivary gland is removed, depending on the doctor's assessment of the condition.

Types of Ranula (Cyst Under the Tongue)

Ranulas are divided into two main types, depending on the location of the saliva accumulation and how far it extends into the surrounding tissues:

1. Oral Ranula

This is the most common type. It appears as a saliva-filled cyst or swelling beneath the tongue due to saliva leakage from the sublingual salivary gland into the surrounding tissues. It is usually transparent or bluish in color and may gradually increase in size, potentially causing discomfort or difficulty moving the tongue and swallowing in larger cases.

2. Plunging Ranula (Cervical Ranula)

This is a less common type that develops when leaked saliva from the sublingual salivary gland extends into the tissues beneath the mylohyoid muscle. It may spread into the area below the lower jaw or into the neck.

It typically appears as swelling beneath the chin or jaw and may occur without noticeable swelling beneath the tongue. If it increases in size, it may cause difficulty swallowing or speaking.

What Is the Difference Between an Oral Ranula and a Plunging Ranula?

Oral Ranula: The saliva accumulation is limited to the floor of the mouth, specifically the area beneath the tongue.
Plunging Ranula: The saliva accumulation extends into the tissues beneath the mylohyoid muscle and may reach the area below the jaw or into the neck.

Causes of a Ranula (Cyst Under the Tongue)

A ranula develops when saliva leaks from the sublingual salivary gland into the surrounding tissues. This is often associated with damage to the gland or its ducts. Some of the most common factors that may contribute to its development include:

Salivary Duct Obstruction: Blockage of the ducts responsible for draining saliva may interfere with its normal flow, causing saliva to accumulate or leak into the surrounding tissues, eventually leading to ranula formation.
Injury to the Sublingual Salivary Gland: Trauma or direct injuries to the area beneath the tongue may damage the salivary gland or its ducts, allowing saliva to leak and accumulate in the surrounding tissues.
Salivary Stones: Stones that develop inside the salivary ducts may obstruct saliva flow, potentially causing gland swelling or interfering with the normal drainage of salivary secretions.
Salivary Gland Infections: Infections may affect the tissues of the salivary glands or their ducts, leading to swelling and disrupting the normal process of saliva drainage.
Surgical Procedures or Oral Injuries: The sublingual salivary gland or its ducts may become damaged during certain surgical procedures or injuries involving the floor of the mouth, potentially causing saliva leakage and ranula formation.

Symptoms of a Ranula (Cyst Under the Tongue)

The symptoms of a ranula vary depending on the size and location of the cyst and how far the saliva accumulation extends into the surrounding tissues. Small ranulas may not cause noticeable symptoms, while larger ones may produce several uncomfortable signs, including:

Swelling Beneath the Tongue: This is one of the most common symptoms. It appears as a soft swelling or fluid-filled cyst beneath the tongue due to saliva accumulation in the tissues surrounding the salivary gland.
Changes in the Cyst's Color: The swelling may appear transparent blue or purplish, particularly when it is close to the surface of the tissues. In some cases, it may have the same color as the normal oral mucosa.
Gradual Increase in Cyst Size: The cyst may initially remain small but gradually increase in size over time due to continued saliva leakage and accumulation in the tissues beneath the tongue.
Sensation of a Foreign Body in the Mouth: The affected person may feel a lump or swelling beneath the tongue, causing discomfort, particularly when moving the tongue or eating.
Difficulty Moving the Tongue: As the ranula grows larger, it may interfere with normal tongue movement, making it more difficult to raise the tongue or move it in different directions.
Difficulty Chewing and Swallowing: Large cysts may cause discomfort while chewing food and can also make swallowing difficult due to pressure on the surrounding tissues.
Speech Difficulties: A large swelling may interfere with tongue movement and flexibility, making it difficult to pronounce certain letters and words clearly.
Pain or Discomfort: Ranulas are usually painless. However, pressure or discomfort may develop as the cyst increases in size or becomes irritated by injury or friction while eating.
Swelling Beneath the Jaw or in the Neck: In some cases, the ranula may extend into the tissues beneath the mylohyoid muscle. This condition is known as a plunging ranula and may cause swelling beneath the lower jaw or in the neck.

Complications and Risks of a Ranula (Cyst Under the Tongue)

Small ranulas may not cause serious complications. However, persistent saliva leakage and an increase in cyst size or extension into the surrounding tissues may lead to several health problems. The most common complications include:

Increase in Cyst Size: The cyst may continue to grow due to ongoing saliva leakage and accumulation in the surrounding tissues. This can cause increased swelling beneath the tongue and may interfere with normal oral functions.
Difficulty Moving the Tongue: A large cyst may put pressure on the tongue and restrict its normal movement, causing discomfort or difficulty moving it while speaking or eating.
Difficulty Swallowing: Enlargement of the ranula may put pressure on the tissues in the floor of the mouth, making it more difficult to swallow food or liquids, particularly in advanced cases.
Speech and Pronunciation Problems: An increase in cyst size may restrict tongue movement, making it difficult to pronounce certain letters and words clearly and potentially affecting normal speech.
Pain and Discomfort: Although ranulas are usually painless, an increase in their size or exposure to friction and injury may cause pressure or pain in the area beneath the tongue.
Cyst Rupture and Drainage: The cyst may rupture spontaneously or following an injury, causing the accumulated saliva to drain and the swelling to temporarily decrease in size. However, the ranula may recur if saliva continues to leak from the salivary gland.
Extension of Swelling Beneath the Jaw and Into the Neck: In cases of plunging ranula, saliva accumulation may extend into the deeper tissues beneath the jaw, causing swelling below the chin or in the neck, sometimes accompanied by pressure or discomfort.
Difficulty Breathing in Severe Cases: In rare cases, significant enlargement of a ranula and its extension into the deeper tissues of the floor of the mouth and neck may put pressure on the airway, causing breathing difficulties and requiring urgent medical intervention.

Medical Treatment of a Ranula (Cyst Under the Tongue)

Treatment of a ranula depends on the size and type of the cyst and how much it affects the surrounding tissues. There are no medications that can guarantee its permanent removal because the underlying problem is related to saliva leakage from the sublingual salivary gland. However, doctors may prescribe certain medications to relieve symptoms or manage specific conditions, including:

Pain Relievers: Doctors may prescribe pain relievers such as Paracetamol to relieve pain or discomfort caused by the cyst pressing against the surrounding tissues, particularly when the swelling is large or accompanied by pain.
Anti-Inflammatory Medications: Certain anti-inflammatory medications, such as Ibuprofen, may be used to help reduce pain and swelling associated with the condition, provided the patient has no medical contraindications. However, these medications do not eliminate the ranula or treat the underlying cause.
Antibiotics: Antibiotics are not routinely used to treat ranulas because the condition is not primarily caused by a bacterial infection. A doctor may prescribe them only if an accompanying bacterial infection is present or suspected.
Injection of Sclerosing Agents (Sclerotherapy): In selected cases, doctors may use this procedure by injecting a specific substance into the cyst to trigger a localized reaction that helps shrink it and reduce its size. One substance used in some medical centers is OK-432 (Picibanil). The choice of this procedure depends on the type and size of the ranula and the patient's overall health. Its effectiveness may vary from one case to another.
Medications That Reduce Saliva Production: Certain medications that decrease saliva production may be used in specific cases under careful medical supervision to limit saliva accumulation. However, they are not considered a primary treatment for ranulas and may cause side effects such as dry mouth and difficulty swallowing. Therefore, they should not be used without consulting a doctor.

Surgical Treatment of a Ranula (Cyst Under the Tongue): Types and Procedures

Surgical treatment of a ranula depends on the type, size, and location of the cyst, how far it extends into the tissues beneath the jaw or neck, and whether it has recurred following previous treatment. Surgical options vary from draining the cyst and removing the salivary gland responsible for saliva leakage to using minimally invasive techniques.

The following are the main surgical procedures used to treat ranulas and how each one is performed:

1. Marsupialization

This procedure is used in some cases of oral ranula, particularly large cysts that cause discomfort or difficulty swallowing and speaking. It aims to create an opening that allows saliva to drain and prevents it from accumulating inside the cyst.