With healing of the roofing mucosa, recurrences develop. The ranula represents a mucus extravasation phenomenon of the sublingual salivary gland with the mucus pool surrounded by a connective tissue barrier infiltrated with some inflammatory cells. Trauma, obstruction or infection of one of the sublingual salivary gland ducts can lead to leakage with escape of secretion into the surrounding tissue bed. If the involved glandular structure rests on the oral aspect of the mylohyoid muscle, the accumulated secretion will manifest itself intraorally as a simple ranula. Marsupialization of the intraoral ranula, deroofing of the pseudocyst with suturing of its wall to the surrounding mucosa and packing of the lumen, is the initial conservative approach.
Failures require intraoral excision of the culpable sublingual salivary gland lobe.
Since the cervical plunging ranula cannot be managed succesfully via marsupialization, intraoral removal of the sublingual gland is required. Well, frogs have an orally placed vocal air sac which, when distended with air and the contents allowed to escape, creates their distinctive croaking sound. Since the diversity of these salivary conditions presents challenges to the clinician, the SGC is available for referrals.