I have had a ranula removed from the floor of my mouth two times. Unfortunately, it keeps resurfacing in the form of a bubble. My oral surgeon has suggested that removal of the salivary gland might be the next step. Is this the right thing to do? What risks are involved? Why is this happening? Is this due to a lack of vitamins?

Stephanie

A ranula is a large cyst that forms in the floor of the mouth (the soft, squishy area under the tongue), presumably because a salivary-gland duct is obstructed.

Ranula, by the way, means "frog-like," referring to the way frogs inflate the skin below their mouth when they croak. The resemblance is coincidental, not anatomical. Frogs inflate a specialized portion of their larynx known as the ventricle in order to make those little froggy sounds. The salivary glands stay out of it.

Back to the anatomy lesson. We all have several thousand minor salivary glands scattered throughout the mouth, throat and nose. We also have three paired major salivary glands: the parotid glands, located in front of the ears; the submandibular glands, located below the jaw line; and the sublingual glands, located below the tongue, in the floor of the mouth. Minor-salivary-gland cysts typically cause small "bubbles" on the inner surface of the lower lip. Ranulas are Goliath-sized version of these "bubbles." The sublingual gland duct is the usual culprit for ranula formation.

Ranulas are often treated by "marsupialization." Now, some medical terms are completely incomprehensible. (Even if you knew Latin, you would never guess that dura mater, or "tough mother," had anything whatsoever to do with the brain.) But "marsupialization" is actually quite straightforward. Marsupials are mammals with pouches, such as kangaroos. When a surgeon "marsupializes" a cyst, he or she unroofs it to create an open pouch. This deflates the cyst, and the problem is usually solved ... unless the "roof" heals in a closed position, whereupon the cyst will re-form.

From your letter, I would guess that the ranula has been marsupialized twice, yet it keeps coming back. That's why your surgeon is suggesting an approach that is a bit more aggressive. Remove the entire cyst, and that puppy cannot possibly return. Since the gland is usually attached to the cyst wall, removal of the cyst involves removal of the gland, too.

What are the risks? Your oral surgeon needs to answer this question. However, I will tell you that the risks include (but are not limited to): pain, bleeding, infection, persistent swelling and injury to important nerves and blood vessels in the floor of mouth.

Are you cursed with this ranula as a result of a lack of vitamins? As much as the dietary-supplement industry would like you to believe that, I can assure you that ranulas are due to nothing more than bad luck.