Robotic-assisted transoral removal of a bilateral floor of mouth ranulas
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TECHNICAL INNOVATIONS
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Robotic-assisted transoral removal of a bilateral floor of mouth ranulas Rohan R Walvekar1*, Geoffrey Peters1, Elliot Hardy1, Leonard Alsfeld1, Frederick W Stromeyer2, Dwayne Anderson3 and Michael DiLeo1
Abstract Objective: To describe the management of bilateral oral ranulas with the use of the da Vinci Si Surgical System and discuss advantages and disadvantages over traditional transoral resection. Study Design: Case Report and Review of Literature. Results: A 47 year old woman presented to our service with an obvious right floor of mouth swelling. Clinical evaluation and computerized tomography scan confirmed a large floor of mouth ranula on the right and an incidental asymptomatic early ranula of the left sublingual gland. After obtaining an informed consent, the patient underwent a right transoral robotic-assisted transoral excision of the ranula and sublingual gland with identification and dissection of the submandibular duct and lingual nerve. The patient had an excellent outcome with no evidence of lingual nerve paresis and a return to oral intake on the first postoperative day. Subsequently, the patient underwent an elective transoral robotic-assisted excision of the incidental ranula on the left sublingual gland. Conclusion: We describe the first robotic-assisted excision of bilateral oral ranulas in current literature. The use of the da Vinci system provides excellent visualization, magnification, and dexterity for transoral surgical management of ranulas with preservation of the lingual nerve and Wharton’s duct with good functional outcomes. However, the use of the robotic system for anterior floor of mouth surgery in terms of improved surgical outcomes as compared to traditional transoral surgery, long-term recurrence rates, and cost effectiveness needs further validation.
Introduction The ranula is an extravasation mucocele that arises from the sublingual gland, either from a ruptured main salivary duct or from ruptured acini following obstruction [1]. In a study of 580 ranulas, most patients with oral ranula presented with a gradually increasing round or oval, fluctuant swelling of the floor of the mouth. Majority of ranula ranged between 2 to 3 cm in size. Ranulas most commonly occurred as a unilateral swelling but were found to be bilateral in 1.5% cases (9/580). The occurrence as bilateral and simultaneous ranulas was even more uncommon (0.5%; 3/580), as seen in our case [2]. A more advanced presentation of ranula is the plunging ranula that is an extension of the oral ranula into the neck along the deep lobe of the submandibular * Correspondence: [email protected] 1 Department of Otolaryngology Head Neck Surgery, LSU Health Sciences Center, New Orleans, LA, USA Full list of author information is available at the end of the article
gland between the mylohyoid and hyoglossus muscles or through congenital dehiscence in the mylohyoid muscle [3,4]. The therapeutic options for oral and plunging ranulas are aimed at either surgic
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