A Pain in the Neck 7 th Annual Pediatric Otolaryngology Symposium October 4, 2012 Melissa M Dziedzic APRN, CORLN

This is Laura Both inside….. Both inside…..

…and out

History 10 day h/o right sided neck mass with pain 10 day h/o right sided neck mass with pain Started with swelling underneath the tongue Started with swelling underneath the tongue No fever or preceding illness No fever or preceding illness Decreasing tenderness-using Advil Decreasing tenderness-using Advil Affecting ability to eat Affecting ability to eat Evaluated by her PCP and prescribed Augmentin Evaluated by her PCP and prescribed Augmentin

Physical Examination Swelling on the right side of her neck Swelling on the right side of her neck Soft palpable mass in the right sublingual area (tender) Soft palpable mass in the right sublingual area (tender) Semi-firm mobile mass in the right submandibular area (tender) Semi-firm mobile mass in the right submandibular area (tender) Diagnosis: Sialectasis vs Infected Ranula Diagnosis: Sialectasis vs Infected Ranula Plan: Extend Augmentin and add heat, Plan: Extend Augmentin and add heat, massage and sialogogues massage and sialogogues

2 weeks later…

MRI

Ranula Cyst underneath the tongue Cyst underneath the tongue formed when the salivary formed when the salivary duct is obstructed duct is obstructed Commonly d/t trauma>secretory back pressure >acini rupture>mucous extravasation >cystic formation Commonly d/t trauma>secretory back pressure >acini rupture>mucous extravasation >cystic formation Most frequently stems from sublingual gland Most frequently stems from sublingual gland Normally above mylohyoid muscle Normally above mylohyoid muscle

Excision of the Ranula

Postoperative Care Pain Management Pain Management Oral Antibiotics Oral Antibiotics Antibiotic Rinses Antibiotic Rinses No Diet Restrictions No Diet Restrictions No Activity Restrictions No Activity Restrictions

Postoperative Visit

Questions?