Annie's Ranula

Annie's salivary gland ablation has been an absolute miracle in our lives!  Since recovering from the procedure, Annie is able to go all day without a bib!  We have been SO thrilled!  However, the other day when I went to brush Annie's teeth, I noticed that the area under her tongue was swollen up again, just like it was shortly after surgery.  I immediately knew that something was wrong and suspected a ranula.  We took her to the ENT here who confirmed it was a ranula and suggested a rather invasive surgery to take care of it.  However, he did not recommend the procedure that would have eliminated the ranula from coming right back.  I left the appointment with a bad feeling and knew I wasn't comfortable with this doctor's plan.

I then paged our doctor in Ohio who did the salivary gland procedure.  He immediately called me back and talked to me for about 45 minutes about all our options and how to best go about treating the ranula.  What a wonderful doctor!  He basically told us that we have two options...

The first option was to stay here and have a qualified ENT do a very invasive surgery to completely remove both of Annie's sublingual salivary glands--a risky procedure that could cause facial nerves to get accidentally cut, causing Annie to lose her smile or have paralysis of her tongue.  This was the exact procedure we were avoiding by going to Ohio in the first place for her salivary gland ablation.

The second option was to return to Ohio to have our doctor give Annie another set of injections into her sublingual glands which would treat the ranula and prevent the ranula from developing again.

I guess I should explain what a ranula is...  A ranula is a build up of fluid from the salivary gland causing lots of swelling under the tongue.  Usually they are caused by a clogged duct from the gland.  In all the salivary gland ablations our doctor (the first and only in the world to do this procedure) has done, never has a patient developed a ranula after.  Of course, leave it to Annie to present an unusual case!  What he thinks has happened is this... when he injects glands for the ablation, he only kills off about 80% of the gland to help prevent over-filling the gland which could cause the solution to seep out and kill surrounding tissues.  So what he thinks happened with Annie is that the remaining 20% of her glands that are still producing saliva are trapped by the "dead" portion of her glands, causing the fluid to be stuck in the gland and swell up.  So the plan is to go back in to each sublingual gland and re-inject each gland to try to kill off the remaining 20%.

If left untreated, the ranula will continue to grow to the point where it ruptures (we had our first rupture already), then it will slowly start to grow back again, rupture, and continue that cycle.  Over time the ranula will start growing deeper into her jaw and pose a risk of infection.  The sublingual glands also don't produce a nice watery fluid that you would expect.  The sublinguals are the glands that produce mucous, so the fluid that drained when the ranula ruptured was more like honey.  Annie had a rough couple of days trying to deal with that drainage and vomited a lot, and now the ranula is growing back.

We didn't want to have to go back to Ohio, but we know our doctor there is the absolute pro on all of this--his new salivary gland ablation method came about because he originally devised that method for the treatment of ranulas.  So we feel much more comfortable with him and are opting for the much less invasive and less risky procedure.  And we'll just keep our fingers crossed that the ranula does in fact stay away!