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Have submental swelling. Ranula surgery done. Should I get my tonsil removed?

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ENT Specialist
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Hello. I am a 25 yo female and I have had a submental swelling for 3 1/2 years. My first ENT specialist diagnosed me with a RANULA and operated 2 surgeries to drain the liquid from my neck but it would always come back eventually. When it would get too big he would drain it with a needle.
I went to see a new ENT specialist today and after seeing some of my old MRI he said it's an ABSCESS most likely connected to my tonsils (which annoy me a few times a year). He told me I should have the tonsils removed first and then worry about the abscess.
My blood tests are always fine and the swelling is never been painful. But I thought an abscess is an infection and is always painful?
PS antibiotics won't do anything for the swelling (is like mucus, almost jelly consistency)

Thanks to anyone who would like to give me an opinion

XXXXXX
Posted Fri, 10 May 2013 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 2 hours later
Hi,

Thank you for your query.

1. If the swelling was only in the neck and not in the floor of the mouth under the tongue, then it probably a special type of ranula known as a plunging ranula. A ranula is a mucus retention cyst usually arising from a damaged salivary duct and hence is rarely painful unless infected.

2. It is odd that you have beeen operated twice without a tissue diagnosis. Normally a biopsy is sent from the tissue operated upon. Check you discharge card or operative notes for an HPE report.

3. If there is a possibility that this cyst was connected to the tonsil, then it may be a second brancial arch cyst or fistula. In such as case operating first on the tonsil will shut off the opening of the fistula, causing further retention of the contents of the csyt.

4. Other possibilities are a thyroglossal cyst, ectopic thyroid, epidermoid cyst, lymph node and so on.

5. If you could share the above mentioned reports and the MRI images along with a close up images of the neck. it may be posssible to narrow down the diagnosis. Treatmenbt options may be discussed thereafter.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Have submental swelling. Ranula surgery done. Should I get my tonsil removed? 4 hours later
Thanks for your prompt reply doctor.

1.If this is a special case of plunging ranula, what would be the best solution to get rid of it once for all? Drainage of the liquid only of perhaps removal of the damaged salivary gland as well?

2. Would be the tonsils removal not a good move?Would that make the situation worse?

3. Is an abscess always painful?

Thank you very much

 
 
Answered by Dr. Sumit Bhatti 2 hours later
Hi,

Thank you for writing back.

1. In recurrent cases without an intra-oral presence, a cervical approach with removal of the associated sublingual salivary gland will be the best solution.

2. I recommend that a FNAC (Fine Needle Aspiration Cytology) and imaging (Ultrasound, CT Scan) be performed before any new treatment and the removed tissue be sent for HPE (Histo Pathological Examination).

3. Removal of only the tonsils would worsen the situation if this is a brancial cyst and the XXXXXXX opening is near the tonsil.

4. Abscesses are usually painful, unless they are chronic.

5. Some of the treatment options besides a third surgery or repeated aspiration are:
a. No further treatment (observation)
b. Sclerosing injections
c. Cryosurgery
d. Radiofrequency ablation
e. Homotoxicological agents
f. Low dose radiation, Gamma Knife or Cyber Knife
g. Marsupialization

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
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