Unless you’re imitating Rose and Jack and trying to spit off the deck of the Titanic, you probably don’t think too much about your saliva. Normally, there’s not much to think about. Saliva travels through your ducts and empties out through the front of your mouth. Your body generates it when you see, smell or sometimes think about food, or when you begin chewing. It’s mostly made of water, with some other substances that help you digest your food. The process of generating saliva usually goes smoothly, but what if it doesn’t? What happens if you develop a blockage?
What is a ranula?
Sometimes, you can develop a problem with your salivary gland or duct called a ranula. “A ranula is a cyst that can form underneath the tongue or under the jaw,” said Shethal Bearelly, MD, an ear, nose and throat specialist with Banner Health. It can look like a bubble if it extends into your mouth or feels like a swollen area under your jaw if it develops below the bottom of your mouth.
If you develop a ranula, your saliva doesn’t flow normally. Instead of running from the duct or gland into your mouth, it flows into a nearby space, forming a cyst. These cysts, which generally aren’t dangerous or cancerous, usually develop under the tongue.
Who is likely to get a ranula?
Ranulas aren’t that common, and when they do develop, they’re found in people of any age or gender. You’re more likely to have a ranula if you’re under age 40. They aren’t contagious, so you can’t get one from any type of contact with another person who has one.
What symptoms do they cause?
Sometimes these blocked salivary gland cysts are small, and they don’t cause any symptoms, but as they get bigger, they can be uncomfortable and interfere with your ability to speak or swallow.
In rare cases, you could develop what’s called a “plunging ranula.” Dr. Bearelly said, “That’s where the ranula starts under the tongue but eventually leaks through the floor of the mouth into the upper neck.” Plunging ranulas usually appear as large lumps underneath the jaw rather than in the mouth.
How are they diagnosed?
If you think you have a ranula, you should check with your doctor to make sure you don’t have some other type of medical problem. Your doctor can often diagnose a ranula by observing it. Imaging tests such as a CT scan, MRI, or ultrasound can confirm the diagnosis if necessary.
How can you treat ranulas?
Some ranulas go away on their own. And sometimes, with smaller ranulas that don’t bother you, you can observe them to make sure they don’t change, and you don’t need to treat them.
Smaller ranulas that need treatment can be aspirated. That’s where a doctor can drain the fluid in it through a small needle. The ranula will likely recur, though, so you may need to repeat this treatment.
For larger, recurring or plunging ranulas, there’s another treatment option. It’s called a transoral sublingual gland excision. “This removes the source of the salivary leak and the ranulas quickly go away,” Dr. Bearelly said.
It’s a one-hour outpatient surgery where your doctor removes the sublingual gland under general anesthesia (a medicine that makes you sleep and prevents you from feeling pain). The gland is removed through your mouth—there’s no external incision in your neck. Recovery takes one to two weeks. Because you have many other salivary glands, removing this one doesn’t adversely affect the amount of saliva you produce.
You may need to follow a liquid diet immediately after your surgery—as you heal, your doctor will let you know when you can return to a normal diet. This operation typically keeps ranulas away for good.
The bottom line
It’s not common, but sometimes you could develop a blocked salivary gland or duct, called a ranula. Ranulas develop when your saliva drains into a cyst-like bubble instead of into your mouth. They’re usually not serious, and sometimes they go away on their own. If they don’t, your doctor can drain or surgically remove them.