What Causes a Cyst Under The Tongue (Ranula)?

A ranula is a cyst under the tongue. It happens when a saliva gland leaks saliva into the surrounding tissue, forming a cyst.

A ranula can appear as a clear bump under the tongue or small bubble under the tongue. A plunging ranula grows downward into the neck and may appear as a bulge in the neck. Ranulas sometimes resolve independently, but they often need treatment, which involves draining the cyst and preventing the saliva gland from leaking. Ranulas should never be popped or drained at home.

Who Gets Ranula Cysts?

Anyone can get a ranula. However, they’re most common in children and adolescents. Ranulas occur when a saliva gland becomes blocked or leaks saliva into the surrounding tissue. Often, there’s no clear cause for this. However, having trauma to the head or mouth can damage the gland, and lead to a ranula. Hits to the face, biting the lower lip, or having oral surgery can all contribute to getting a ranula.

Ranula Appearance

While ranulas usually appear as a small, clear bump under the tongue, they also can be blue-ish bubble. Ranulas are not painful, so they often go unnoticed until they’re big enough to cause discomfort.

A plunging ranula is a variation that grows downward into the neck, rather than upward into the floor of the mouth. Plunging ranulas can be hard to see, but may appear as a pump or lump on the neck or below the chin.

Reasons to Avoid Popping a Ranula at Home

You should never pop a cyst, since doing so can lead to infection. The same is true for a ranula. In addition, most ranulas will reappear even if you pop or drain them. A healthcare provider needs to address the leaking gland in order to stop the ranula from reforming.

In addition, your healthcare provider will want to examine the ranula carefully using ultrasound and other imaging. This helps rule out other, more serious causes of tongue bumps and will be used to create a treatment plan.

Will a Ranula Go Away on Its Own?

It’s rare for a ranula to go away on its own. Even if the ranula drains or pops on its own, it will likely reappear. That’s because the damaged gland is still leaking saliva. Very small ranulas might not need treatment, but your healthcare provider will likely want you to seek treatment if the ranula causes any changes to swallowing or talking.

How a Specialist Treats a Ranula

A healthcare provider treats a ranula in two ways: they drain the ranula, and also stop the salivary gland from leaking, to prevent reoccurrence.

If a healthcare provider only makes an incision to drain the cyst, the ranula will reoccur in two-thirds of cases because the gland still makes saliva. Your primary care physician might refer you to an ear, nose, and throat specialist (otolaryngologist) or an oral surgeon. for treating a ranula.

Treatment options include:

• Marsupialization: During this procedure, a surgeon makes a slit in the cyst and cauterize (burns the area to prevent bleeding) the edges of the incision, allowing the cyst to drain continuously. The gland continues to leak saliva, but the saliva drains into the mouth rather than forming a cyst.
• Gland removal: During this surgery, the healthcare provider removes both the cyst and the damaged gland. The other saliva glands in your mouth can continue to produce enough saliva that you should not notice changes from the missing gland.
• Percutaneous treatment: This treatment avoids open surgery but is still performed under anesthesia. Healthcare providers place a needle to drain the cyst. They then inject absolute alcohol into the damaged gland so that it stops producing saliva.
• Needle aspiration: A needle is used to withdraw fluid from the ranula.
• Salivary gland ablation: Ablation is a procedure that can cure a ranula in 85% of cases.
• Ethanol ablation: A needle is used to aspirate the fluid from the ranula, then ethanol is injected and re-aspirated after 10 minutes.

Complications Related to Removal

Treating a ranula usually is very safe. Because there is a risk of recurrence, though, you may need a second procedure. There is also a small risk of nerve damage to the area surrounding the gland that is being removed or treated.

Aftercare and Oral Hygiene

Your healthcare provider will instruct you on aftercare. If you have a percutaneous treatment, you shouldn’t need to make any special adjustments. After surgery, you may have to avoid certain foods or beverages.

There’s no way to prevent ranulas entirely, but if yours was caused by trauma to the face, take precautions, if possible. For example, wear a mouth guard during sports and try to avoid biting your lower lip.

Summary

A ranula is a cyst under the tongue that happens when a damaged salivary gland leaks into the surrounding tissue. Ranulas should never be popped or drained at home. Doing so can cause infection and they will likely recur. Instead, talk with your healthcare provider about the ranula, and choose a treatment plan that drains the cyst while also addressing the leaking gland.