A Pain in the A Pain in the NeckNeck77thth Annual Annual
Pediatric Otolaryngology Pediatric Otolaryngology SymposiumSymposium
October 4, 2012October 4, 2012Melissa M Dziedzic APRN, Melissa M Dziedzic APRN,
CORLNCORLN
This is LauraThis is Laura
Both inside…..Both inside…..
……and outand out
HistoryHistory
10 day h/o right sided neck mass with 10 day h/o right sided neck mass with painpain
Started with swelling underneath the Started with swelling underneath the tonguetongue
No fever or preceding illnessNo fever or preceding illness Decreasing tenderness-using AdvilDecreasing tenderness-using Advil Affecting ability to eatAffecting ability to eat Evaluated by her PCP and prescribed Evaluated by her PCP and prescribed
AugmentinAugmentin
Physical ExaminationPhysical Examination
Swelling on the right side of her neckSwelling on the right side of her neck Soft palpable mass in the right sublingual Soft palpable mass in the right sublingual
area (tender)area (tender) Semi-firm mobile mass in the right Semi-firm mobile mass in the right
submandibular area (tender)submandibular area (tender)
Diagnosis: Sialectasis vs Infected RanulaDiagnosis: Sialectasis vs Infected Ranula Plan: Extend Augmentin and add heat,Plan: Extend Augmentin and add heat,
massage and sialogoguesmassage and sialogogues
2 weeks later…2 weeks later…
MRIMRI
RanulaRanula
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 Commonly d/t trauma>secretory back
pressure >acini rupture>mucous pressure >acini rupture>mucous extravasation >cystic formationextravasation >cystic formation
Most frequently stems from sublingual Most frequently stems from sublingual glandgland
Normally above mylohyoid muscleNormally above mylohyoid muscle
Excision of the RanulaExcision of the Ranula
Postoperative CarePostoperative Care
Pain ManagementPain Management Oral AntibioticsOral Antibiotics Antibiotic RinsesAntibiotic Rinses No Diet RestrictionsNo Diet Restrictions No Activity RestrictionsNo Activity Restrictions
Postoperative Visit Postoperative Visit
Questions?Questions?
