A Rare Case of Congenital Simple Cystic Ranula in a Neonate

Congenital ranula in a neonate is an uncommon occurrence. We present one such case of the said lesion where the clinical presentation and management were found to be interesting, hitherto unreported in the medical literature. This clinical record also reviews the scant medical literature on congenital ranula in neonates. 1. Introduction Ranulas are cystic dilatations in the floor of the mouth and a result of obstruction of one of the sublingual salivary glands. It is basically a retention cyst. Ranula may be congenital or acquired. Congenital ranula in newborn infants is a rarity [1–3] and thus there is a marked paucity of the literature on the cited subject. With this background we present one such case of congenital ranula in a neonate which was symptomatic and required surgical management. To the best of our knowledge, such a case has not been previously reported in the medical literature. With this case, we illustrate a rare entity that is present in an extremely rare manner. 2. Case Record A full-term male neonate was referred to our teaching hospital 20 days after birth with a swelling in the sublingual region since birth (Figure 1). The swelling had increased over a period of time causing difficulty in feeding and noisy breathing leading to failure to thrive. The differential diagnosis of lymphatic malformations, teratoma, dermoid cyst, and thyroglossal duct cysts was considered. But finally a diagnosis of “congenital ranula” was concluded upon clinical examination and radiological investigations [2]. The CT scan and MRI scan delineated a well-defined cystic lesion ( ？cm) in the midline of the floor of mouth above the level of mylohyoid (Figures 2 and 3). As the ranula was symptomatic and more than 1？cm in diameter, a complete excision of the ranula was done [1, 4]. Post-op period was uneventful, with no recurrence for the last 9 months. The histopathology of the excised lesion revealed a simple cyst lined by stratified squamous epithelium with the presence of mucus glands within the wall consistent with simple cystic ranula (Figure 4). Figure 1: Clinical photograph of the patient with congenital ranula. Figure 2: MRI scan: midline sagittal fat suppressed T2 weighted image showing the cystic lesion above the mylohyoid with no extension. Figure 3: CT scan showing the cystic lesion in the axial cut. Figure 4: Cyst wall lined by stratified squamous epithelium with presence of mucus glands within the wall. 3. Discussion It would be prudent to note that ranulas are of two types [5]: the uncommon simple cystic ranula which represents partial