Methods
1) Aspiration
To treate the plunging type of ranula, about 1ml of 1% lidocaine-hydroclorate
was injected into the skin over the submandibular swelling site
for local anesthesia. Then the cyst was punctured using a syringe
with an 18 G needle and the intracystic fluid was aspirated. When
we treated the oral floor type of ranula, we punctured the mucous
membrane of the oral floor at a distance from the cyst wall in
order to avoid outflow of OK-432 from the puncture hole. The intracystic
fluid was highly viscous, so it was necessary to use a large needle
for aspiration. In order to aspirate the contents sufficiently,
compression of the cyst was sometimes needed.
2) Intracystic injection of OK-432
After determining the capacity of the lesion, a sufficient quantity
of OK-432 (Picibanil; Chyugai Pharmaceutical Co., Tokyo, Japan)
diluted with saline (0.1 KE/ml, which means 0.01mg/ml) were prepared.
With the same needle used for aspiration, we injected OK-432 solution
into the cyst by changing the syringe. In a few cases OK-432 was
injected extracystically, so careful maintenance of the needle
position during exchange of the syringe was necessary. There was
no resistance, in case of successful injection into the cyst cavity
and injection of the same quantity of OK-432 solvent was possible.
3)Highly cocentrated OK-432 injection without aspiration
In case of child with oral floor ranula, we sometimes injected
highly concentrared OK-432 without aspiration. In case of small
cyst (<2cm), 0.5KE of OK-432 and in case of large cyst (>2cm),
1.0KE of OK-432 was diluted with 0.2ml of saline. And, it was
injected with 27G needle without aspiration of intracystic fluid.
4) Follow up
To treat fever, we gave analgesics for 3 to 5 days in all patients.
Analgesic suppositories were also used as needed. We treated the
initial four cases with hospitalization for 4 to 5 days. After
the safety of the procedure had been established, however we treated
another sixty eight cases as outpatients. We examined them on
day 2, day 7, day 14, and day 28 after OK-432 injection and judged
the response between 2 to 4 weeks. If the response was insufficient,
we repeated the same therapy with 1.5 times increased OK-432 again.
Intracystic fluid
of ranula. It is very viscous.