Abstract

Purpose: To evaluated the outcome, rate of complications and recurrence of Ethanolamine Oleate (EO) for the treatment of plunging ranulas. Background: A ranula is a mucocele formed by trauma or obstruction of the sublingual duct. Although uncommon, when a ranula extends below the mylohyoid muscle into the submandibular space, it is specified as a plunging ranula. It is often accompanied with swelling in the floor of the mouth. Current treatments consist of marsupialization, excision, and drainage with excision. However, these procedures all have recurrence rates above 50%. In addition, these procedures involve potential risks for permanent damage to the submandibular duct, lingual nerve, mandibular nerve, as well as risks of wound infection, stitch granuloma, and cosmetic scarring of the neck. Due to the potential complications of surgical management, new treatment options such as Sclerotherapy are being evaluated. Two agents reported for sclerotherapy are OK 432 and ethanolamine. OK 432 is a lyophilized mixture of low-virulence group A Streptococcus pyogens with penicillin G potassium. It has been reported to be effective for plunging ranula with no significant side effects. Ethanolamine is a type of anionic surfactant, used as sclerosing agent by inducing endothelial injury. It is clinically used in esophageal variceal bleeding and head and neck vascular malformations. Methods: In our study EO is used as the sclerosing agent. EO is mixed with radiopaque Iodixanol, a contrast agent, in a 8:2 ratio to demonstrate the distribution of the sclerosant during injection. Two patients, ages 33 and 46, have participated in this ongoing study. Results: The results criteria depend of the amount of shrinkage of the ranula compared before and after injection. Two patients treated with this therapy, with a total of 4 treatments. All therapies demonstrated complete resolution on early follow up (2 weeks). Recurrence was seen in both patients. In the first patient, the 2 treatments had recurrence. In the second patient, only the first treatment had recurrence. There were no complications. Conclusion: In our cases reports we had favorable results for the use of Ethanolamine Oleate Sclerotherapy as an alternative to surgery. We illustrate two cases that showed initial complete response without complications. The efficacy in terms of recurrence was similar to marsupialization. A larger prospective study is needed to fully evaluate the efficacy of ethanolamine oleate in the treatment of plunging ranulas.