Modified micro-marsupialization as an alternative treatment for ranulas

Modified micro-marsupialization as an alternative treatment for ranulas | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Modified micro-marsupialization as an alternative treatment for ranulas Ayhan Yildirim, René Hertach, Ali Yildirim, Vedat Yildirim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2285086/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The anatomical location of ranulas poses an enormous treatment challenge for the dentist. Due to a number of elementary structures, the regional complexity of the area requires a very high level of expertise on the part of the practitioner. The correction of surgical interventions in this area requires great effort. Although complete excision with removal of the sublingual gland remains the gold standard of treatment, recent literature highlights successful results through simple modification of the conventional technique of granular marsupialization. This micromarsupialization option is minimally invasive and beneficial due to the shorter procedure time, minimal discomfort, and lack of postoperative complications. The following case report highlights the successful management of a case using a modified micro-marsupialization technique in an adult. Adult modified micro-marsupialization ranula Figures Figure 1 Figure 2 Figure 3 Introduction Ranulas are rare mucoceles found on the floor of the mouth. The treatment of ranulas is a challenging and divisive issue. There are still conflicting statements about which treatment method is best. The standard procedure used today is complete excision of the lesion together with excision of the sublingual gland. This intervention ensures a high level of protection against recurrence, as advocated by Pandit and Park [ 1 ]. Epidemiologically, these lesions are most common in the first two decades of life; therefore, the treatment approach is generally conservative. In this regard, there have been developments over the last three decades regarding modification of the marsupialization technique that have drastically reduced the likelihood of recurrence [ 2 ]. Case Report A 43-year-old man presented to the KLINIK, a specialist clinic for oral and maxillofacial surgery and facial plastic surgery, with a feeling of pressure due to swelling on the floor of the left side of the mouth for two weeks. Two weeks ago, the man noticed a small swelling on the floor of the mouth on the left, which expanded to the size of a cherry in circumference. The swelling was painless, with no associated dysphagia, paraesthesia or anaesthesia. The man noticed a slight change in the size of the existing swelling, especially during and after meals. Intraoral examination revealed a prominent swelling on the left side of the floor of the mouth, measuring approximately 2 cm × 2 cm × 1.5 cm in length, width and depth. Its anteroposterior margin extended from the mesial surface of the mandibular first molar to the distal aspect of the mandibular lateral incisor. The swelling appeared translucent, reddish and dome-shaped, with some fluid retention therein. No secondary changes, such as ulceration, fistula formation, infection or discharge, were observed [Figure 1 ]. No similar swelling had been noted in the past, and the medical history was unremarkable. There was no associated head and neck swelling. Consent and clinical technique The patient was informed about the various treatment options in such a case, and he decided on the least invasive treatment method. The patient gave written informed consent. The area was disinfected with a 0.1% povidone iodine solution. The affected area was anesthetized with an inferior alveolar nerve block. Four interrupted sutures of 1 − 0 silk were passed superficially through the lesion and secured with loose knots [Figure 2 ]. The patient was instructed to maintain good oral hygiene and to rinse with chlorhexidine mouth rinses twice daily. Follow-up was performed weekly to determine if the sutures were still in place and if the patient was maintaining satisfactory oral hygiene. On the second day, 1 stitch had already been lost. The remaining three sutures were removed after 30 days as described by Matondkar et al. [ 3 ]. It was observed that the lesion had already subsided without complications in the first week and did not reappear thereafter. Currently, over nine months have passed since the procedure, with no evidence of recurrence of the lesion [Figure 3 ]. Discussion Ranulas are a rare disease that occurs mainly in the first two decades of life and is a going concern for every dentist. Ranulas typically have a high risk of recurrence. Currently, the only widespread form of therapy is complete excision with removal of the sublingual gland [ 4 ]. It should be mentioned that this therapy option is associated with numerous complications and risks. The difficulties mentioned in every surgical explanation are bleeding/hematoma (1%), neuropathic pain due to damage to the lingual nerve and damage to the Wharton duct (2%). In addition, there is a risk of dehiscence in the mylohyoid muscle, which generally leads to recurrence. There is also a risk of restricted mobility of the tongue due to scarring in the surgical site [ 5 ]. The surgical field requires careful hygiene postoperatively to prevent secondary infection. In 1995, Morton and Bartley began to modify the conventional marsupialization approach, placing a single suture of silk on the dome of the ranula. In 2000, Delbem et al. reported the successful use of a micro-marsupialization technique in the successful treatment of 38 cases of mucus retention phenomena at different sites. The procedure involved the use of a single 4 − 0 silk suture across the inner portion of the lesion to its widest diameter. This suture was maintained for a week [ 6 ]. However, reports of recurrences within 30 days of surgery have appeared in the literature [ 3 ]; therefore, this micro-marsupialization technique has undergone further modifications. In 2007, Sandrini et al. made additional modifications by increasing the number of sutures and reducing the distance between the entry and exit of the needle. The residence time of the sutures in the mucosa was increased to 30 days. Care was taken in tightening the knots to avoid tissue necrosis due to stagnation of blood flow. The mechanism of action in the placement of the large silk suture over a 30-day period is the formation of new, durably epithelialized pathways that serve as additional outlets for the release of the retained mucus [ 7 ]. Patient selection plays an important role in the success of therapy. It should not be used in large ranulas that completely fill the floor of the mouth or where the site of origin is difficult to locate [ 8 ]. However, it appears to be an ideal approach in cases involving primary lesions up to 4–5 mL in volume. The number of sutures depends on the size of the ranula. The seams should be about 1cm apart. Very thick silk sutures should be made with 1 − 0 silk so that the epithelization of the replacement duct should be as wide as possible. Conclusion The discussion of the aforementioned procedure underscores the fact that a modified micro-marsupialization technique is a viable alternative to other, more invasive, techniques. The benefits of the procedure are that it is a quick, easy, chairside procedure with minimal postoperative discomfort and complications. As such, it should be explored further as an alternative treatment. The technique definitely deserves wider application. Declarations Ethics approval and consent to participate Ayhan Yildirim, René Hertach, Ali Yildirim and Vedat Yildirim certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published, and due efforts will be made to conceal the patient’s identity, but anonymity cannot be guaranteed. Consent for publication Ayhan Yildirim, René Hertach, Ali Yildirim and Vedat Yildirim give their consent for publication. Competing Interests Not applicable Author contributions (Ensure all authors are referred to in the statement) Ayhan Yildirim, René Hertach and Vedat Yildirim wrote the main text of the manuscript. Ali Yildirim made and prepared the introduction and the figures 1-3. Ayhan Yildirim, René Hertach, Ali Yildirim and Vedat Yildirim reviewed the entire manuscript. Funding Not applicable Availability of data and materials Not applicable References Pandit, R.T. and A.H. Park, Management of pediatric ranula . Otolaryngol Head Neck Surg, 2002. 127 (1): p. 115–8. Baurmash, H.D., Treating oral ranula: another case against blanket removal of the sublingual gland . Br J Oral Maxillofac Surg, 2001. 39 (3): p. 217–20. Matondkar, S.P., C. Yavagal, and P.S. Mandroli, Modified micro-marsupialization as an alternative treatment for the management of ranulas in children . Natl J Maxillofac Surg, 2019. 10 (1): p. 95–97. Crysdale, W.S., J.D. Mendelsohn, and S. Conley, Ranulas–mucoceles of the oral cavity: experience in 26 children . Laryngoscope, 1988. 98 (3): p. 296–8. Zhao, Y.F., J. Jia, and Y. Jia, Complications associated with surgical management of ranulas . J Oral Maxillofac Surg, 2005. 63 (1): p. 51–4. Delbem, A.C., et al., Treatment of mucus retention phenomena in children by the micro-marsupialization technique: case reports . Pediatr Dent, 2000. 22 (2): p. 155–8. Sandrini, F.A., M. Sant'ana-Filho, and P.V. Rados, Ranula management: suggested modifications in the micro-marsupialization technique . J Oral Maxillofac Surg, 2007. 65 (7): p. 1436–8. Goodson, A.M., et al., Minimally invasive treatment of oral ranulae: adaption to an old technique . Br J Oral Maxillofac Surg, 2015. 53 (4): p. 332–5. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2285086","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":154346780,"identity":"c7c8e687-fd75-4e2a-8fb9-41ac4cdaa0fe","order_by":0,"name":"Ayhan Yildirim","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIie3OsWrDMBCA4RMH6hIyy6jUr3AmQzqY5lVUDN5CH6EGgzJ5T5c8Q8d2UzDYix7AW10KmT0mYEgdN0MXtenWQf90iPs4Afh8/zAOrIVuGMQVy0CZr1czzEBOgsTWJ4KXEhgITkYy7p4ffyJTmbOPuI9vghx121pYUF28m8MLhHPXx65LnC11OpPIVqSa4aitaVtYiF4zBxEPlVxm5f0GmRaqO3JqUiiZBkXGRRIub/vj45nAhN52FxDgRsmRNCCo4b8SjAqdRE/5iVigwKawLbSInh0kXCes3fd3oahXu2BfwWJaV9gddBy6rjgTf9z3+Xw+3/c+ATOLVsQ1vfLcAAAAAElFTkSuQmCC","orcid":"","institution":"SEEKLINIK ZÜRICH","correspondingAuthor":true,"prefix":"","firstName":"Ayhan","middleName":"","lastName":"Yildirim","suffix":""},{"id":154346781,"identity":"0809ae1f-0465-48a6-95e3-2709bbf5659c","order_by":1,"name":"René Hertach","email":"","orcid":"","institution":"Praxis für Zahnprothetik","correspondingAuthor":false,"prefix":"","firstName":"René","middleName":"","lastName":"Hertach","suffix":""},{"id":154346782,"identity":"4e7c2b54-5b28-4c70-992e-aec8fd7e1b9d","order_by":2,"name":"Ali Yildirim","email":"","orcid":"","institution":"Spital Affoltern","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Yildirim","suffix":""},{"id":154346783,"identity":"1b9bd380-fb3e-446c-8d72-8341b0ea49d3","order_by":3,"name":"Vedat Yildirim","email":"","orcid":"","institution":"Kieferchirurgie München","correspondingAuthor":false,"prefix":"","firstName":"Vedat","middleName":"","lastName":"Yildirim","suffix":""}],"badges":[],"createdAt":"2022-11-17 15:44:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2285086/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2285086/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":29617899,"identity":"519211c7-d92b-44bf-b691-7fa48a2d4400","added_by":"auto","created_at":"2022-11-28 21:32:12","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":106908,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative view\u003c/p\u003e","description":"","filename":"1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2285086/v1/a918e3c81bdb94aa91291fd8.jpeg"},{"id":29617900,"identity":"c777ed4f-b2d0-426d-9cad-a7fe8c0292c3","added_by":"auto","created_at":"2022-11-28 21:32:13","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":91939,"visible":true,"origin":"","legend":"\u003cp\u003ePost suture placement\u003c/p\u003e","description":"","filename":"2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2285086/v1/4f649c36ef2a7c4b97555f02.jpeg"},{"id":29617898,"identity":"c020ef8e-cb30-424f-94e0-5b90b1c4304b","added_by":"auto","created_at":"2022-11-28 21:32:12","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":75835,"visible":true,"origin":"","legend":"\u003cp\u003eNine monthspostoperative\u003c/p\u003e","description":"","filename":"3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2285086/v1/25664eedb20906bd6687dc57.jpeg"},{"id":29872249,"identity":"4ae9d31a-8516-471c-a347-2af381bb2566","added_by":"auto","created_at":"2022-12-04 14:59:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":254035,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2285086/v1/0b882a65-11fb-497e-b97e-8e40698963da.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Modified micro-marsupialization as an alternative treatment for ranulas","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRanulas are rare mucoceles found on the floor of the mouth. The treatment of ranulas is a challenging and divisive issue. There are still conflicting statements about which treatment method is best. The standard procedure used today is complete excision of the lesion together with excision of the sublingual gland. This intervention ensures a high level of protection against recurrence, as advocated by Pandit and Park [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Epidemiologically, these lesions are most common in the first two decades of life; therefore, the treatment approach is generally conservative. In this regard, there have been developments over the last three decades regarding modification of the marsupialization technique that have drastically reduced the likelihood of recurrence [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 43-year-old man presented to the KLINIK, a specialist clinic for oral and maxillofacial surgery and facial plastic surgery, with a feeling of pressure due to swelling on the floor of the left side of the mouth for two weeks.\u003c/p\u003e \u003cp\u003eTwo weeks ago, the man noticed a small swelling on the floor of the mouth on the left, which expanded to the size of a cherry in circumference.\u003c/p\u003e \u003cp\u003eThe swelling was painless, with no associated dysphagia, paraesthesia or anaesthesia. The man noticed a slight change in the size of the existing swelling, especially during and after meals. Intraoral examination revealed a prominent swelling on the left side of the floor of the mouth, measuring approximately 2 cm \u0026times; 2 cm \u0026times; 1.5 cm in length, width and depth. Its anteroposterior margin extended from the mesial surface of the mandibular first molar to the distal aspect of the mandibular lateral incisor. The swelling appeared translucent, reddish and dome-shaped, with some fluid retention therein. No secondary changes, such as ulceration, fistula formation, infection or discharge, were observed [Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNo similar swelling had been noted in the past, and the medical history was unremarkable. There was no associated head and neck swelling.\u003c/p\u003e \u003cp\u003eConsent and clinical technique\u003c/p\u003e \u003cp\u003eThe patient was informed about the various treatment options in such a case, and he decided on the least invasive treatment method. The patient gave written informed consent.\u003c/p\u003e \u003cp\u003eThe area was disinfected with a 0.1% povidone iodine solution. The affected area was anesthetized with an inferior alveolar nerve block. Four interrupted sutures of 1\u0026thinsp;\u0026minus;\u0026thinsp;0 silk were passed superficially through the lesion and secured with loose knots [Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e]. The patient was instructed to maintain good oral hygiene and to rinse with chlorhexidine mouth rinses twice daily. Follow-up was performed weekly to determine if the sutures were still in place and if the patient was maintaining satisfactory oral hygiene. On the second day, 1 stitch had already been lost. The remaining three sutures were removed after 30 days as described by Matondkar et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It was observed that the lesion had already subsided without complications in the first week and did not reappear thereafter. Currently, over nine months have passed since the procedure, with no evidence of recurrence of the lesion [Figure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eRanulas are a rare disease that occurs mainly in the first two decades of life and is a going concern for every dentist. Ranulas typically have a high risk of recurrence. Currently, the only widespread form of therapy is complete excision with removal of the sublingual gland [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. It should be mentioned that this therapy option is associated with numerous complications and risks. The difficulties mentioned in every surgical explanation are bleeding/hematoma (1%), neuropathic pain due to damage to the lingual nerve and damage to the Wharton duct (2%). In addition, there is a risk of dehiscence in the mylohyoid muscle, which generally leads to recurrence. There is also a risk of restricted mobility of the tongue due to scarring in the surgical site [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The surgical field requires careful hygiene postoperatively to prevent secondary infection.\u003c/p\u003e \u003cp\u003eIn 1995, Morton and Bartley began to modify the conventional marsupialization approach, placing a single suture of silk on the dome of the ranula.\u003c/p\u003e \u003cp\u003eIn 2000, Delbem et al. reported the successful use of a micro-marsupialization technique in the successful treatment of 38 cases of mucus retention phenomena at different sites. The procedure involved the use of a single 4\u0026thinsp;\u0026minus;\u0026thinsp;0 silk suture across the inner portion of the lesion to its widest diameter. This suture was maintained for a week [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, reports of recurrences within 30 days of surgery have appeared in the literature [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]; therefore, this micro-marsupialization technique has undergone further modifications.\u003c/p\u003e \u003cp\u003eIn 2007, Sandrini et al. made additional modifications by increasing the number of sutures and reducing the distance between the entry and exit of the needle. The residence time of the sutures in the mucosa was increased to 30 days. Care was taken in tightening the knots to avoid tissue necrosis due to stagnation of blood flow. The mechanism of action in the placement of the large silk suture over a 30-day period is the formation of new, durably epithelialized pathways that serve as additional outlets for the release of the retained mucus [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatient selection plays an important role in the success of therapy. It should not be used in large ranulas that completely fill the floor of the mouth or where the site of origin is difficult to locate [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, it appears to be an ideal approach in cases involving primary lesions up to 4\u0026ndash;5 mL in volume. The number of sutures depends on the size of the ranula. The seams should be about 1cm apart. Very thick silk sutures should be made with 1\u0026thinsp;\u0026minus;\u0026thinsp;0 silk so that the epithelization of the replacement duct should be as wide as possible.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe discussion of the aforementioned procedure underscores the fact that a modified micro-marsupialization technique is a viable alternative to other, more invasive, techniques. The benefits of the procedure are that it is a quick, easy, chairside procedure with minimal postoperative discomfort and complications. As such, it should be explored further as an alternative treatment. The technique definitely deserves wider application.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthics approval and consent to participate\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAyhan Yildirim, Ren\u0026eacute; Hertach, Ali Yildirim and Vedat Yildirim certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published, and due efforts will be made to conceal the patient\u0026rsquo;s identity, but anonymity cannot be guaranteed.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAyhan Yildirim, Ren\u0026eacute; Hertach, Ali Yildirim and Vedat Yildirim\u0026nbsp;give their consent for publication.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting Interests\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthor contributions (Ensure all authors are referred to in the statement)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAyhan Yildirim, Ren\u0026eacute; Hertach and Vedat Yildirim wrote the main text of the manuscript. \u0026nbsp;Ali Yildirim made and prepared the introduction and the figures 1-3. Ayhan Yildirim, Ren\u0026eacute; Hertach, Ali Yildirim and Vedat Yildirim reviewed the entire manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAvailability of data and materials\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePandit, R.T. and A.H. Park, \u003cem\u003eManagement of pediatric ranula\u003c/em\u003e. Otolaryngol Head Neck Surg, 2002. \u003cb\u003e127\u003c/b\u003e(1): p.\u0026nbsp;115\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaurmash, H.D., \u003cem\u003eTreating oral ranula: another case against blanket removal of the sublingual gland\u003c/em\u003e. Br J Oral Maxillofac Surg, 2001. \u003cb\u003e39\u003c/b\u003e(3): p.\u0026nbsp;217\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatondkar, S.P., C. Yavagal, and P.S. Mandroli, \u003cem\u003eModified micro-marsupialization as an alternative treatment for the management of ranulas in children\u003c/em\u003e. Natl J Maxillofac Surg, 2019. \u003cb\u003e10\u003c/b\u003e(1): p.\u0026nbsp;95\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrysdale, W.S., J.D. Mendelsohn, and S. Conley, \u003cem\u003eRanulas\u0026ndash;mucoceles of the oral cavity: experience in 26 children\u003c/em\u003e. Laryngoscope, 1988. \u003cb\u003e98\u003c/b\u003e(3): p.\u0026nbsp;296\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao, Y.F., J. Jia, and Y. Jia, \u003cem\u003eComplications associated with surgical management of ranulas\u003c/em\u003e. J Oral Maxillofac Surg, 2005. \u003cb\u003e63\u003c/b\u003e(1): p.\u0026nbsp;51\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelbem, A.C., et al., \u003cem\u003eTreatment of mucus retention phenomena in children by the micro-marsupialization technique: case reports\u003c/em\u003e. Pediatr Dent, 2000. \u003cb\u003e22\u003c/b\u003e(2): p.\u0026nbsp;155\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSandrini, F.A., M. Sant'ana-Filho, and P.V. Rados, \u003cem\u003eRanula management: suggested modifications in the micro-marsupialization technique\u003c/em\u003e. J Oral Maxillofac Surg, 2007. \u003cb\u003e65\u003c/b\u003e(7): p.\u0026nbsp;1436\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoodson, A.M., et al., \u003cem\u003eMinimally invasive treatment of oral ranulae: adaption to an old technique\u003c/em\u003e. Br J Oral Maxillofac Surg, 2015. \u003cb\u003e53\u003c/b\u003e(4): p.\u0026nbsp;332\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adult, modified micro-marsupialization, ranula","lastPublishedDoi":"10.21203/rs.3.rs-2285086/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2285086/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe anatomical location of ranulas poses an enormous treatment challenge for the dentist. Due to a number of elementary structures, the regional complexity of the area requires a very high level of expertise on the part of the practitioner. The correction of surgical interventions in this area requires great effort. Although complete excision with removal of the sublingual gland remains the gold standard of treatment, recent literature highlights successful results through simple modification of the conventional technique of granular marsupialization. This micromarsupialization option is minimally invasive and beneficial due to the shorter procedure time, minimal discomfort, and lack of postoperative complications. The following case report highlights the successful management of a case using a modified micro-marsupialization technique in an adult.\u003c/p\u003e","manuscriptTitle":"Modified micro-marsupialization as an alternative treatment for ranulas","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-28 21:32:08","doi":"10.21203/rs.3.rs-2285086/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d4796582-da62-4bea-951e-98792d7d3fc8","owner":[],"postedDate":"November 28th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-12-04T14:59:22+00:00","versionOfRecord":[],"versionCreatedAt":"2022-11-28 21:32:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2285086","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2285086","identity":"rs-2285086","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}