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Diagnostic difficulties of plunging ranula: case series

  • R Jain (a1), R P Morton (a1) and Z Ahmad (a1)



To evaluate common pitfalls in diagnosing complicated plunging ranula, either due to misidentification of plunging ranula or alternative pathology (i.e. false negatives or false positives, respectively).


A review of cases of plunging ranula seen in Middlemore Hospital, New Zealand, was performed. Diagnostically uncertain cases were identified and reviewed, taking particular note of clinical, radiological and surgical findings.


From our database, 12 cases were found to have had a complicated diagnosis of plunging ranula. Ten cases were false negatives: four were treated as abscesses, four as simple cysts, one as a thyroglossal cyst and one as a cystic hygroma. Two cases were false positives: one was found to be a thyroglossal cyst and the other a lipoma.


The diagnosis of plunging ranula is usually straightforward, with simple surgical management. Misdiagnosis can lead to recurrence of symptoms and inappropriate management, with the associated risks, complications and frustrations of surgery.


Corresponding author

Address for correspondence: Dr Ravi Jain, c/o Leigh Somerville, Department Secretary, Department of Otolaryngology – Head and Neck Surgery, Counties-Manukau DHB, PO Box 98743, South Auckland Mail Centre, Manukau City, New Zealand E-mail:


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1Morton, RP, Ahmad, Z, Jain, P. Plunging ranula: congenital or acquired? Otolaryngol Head Neck Surg 2010;142:104–7
2Jain, P, Jain, R, Morton, RP, Ahmad, Z. Plunging ranulas: high-resolution ultrasound for diagnosis and surgical management. Eur Radiol 2010;20:1442–9
3Samant, S, Morton, RP, Ahmad, Z. Surgery for plunging ranula: the lesson not yet learned? Eur Arch Otorhinolaryngol 2011;268:1513–18
4Huang, SF, Liao, CT, Chin, SC, Chen, IH. Transoral approach for plunging ranula – 10-year experience. Laryngoscope 2010;120:53–7
5Croskerry, P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med 2003;78:775–80
6Miller, MB, Rao, VM, Tom, BM. Cystic masses of the head and neck: pitfalls in CT and MR interpretation. Am J Roentgenol 1992;159:601–7


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Diagnostic difficulties of plunging ranula: case series

  • R Jain (a1), R P Morton (a1) and Z Ahmad (a1)


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