I read your article on ranulas,as I was told that my baby girl (now almost eight months) has a ranula or a hematoma. I discovered it about three months ago, and the doctor said to wait and see if it would go down or go away by itself. In the past week or so it has gotten considerably smaller. My doctor said that he will have to "marsupialize" it, as it is simply rooted too deeply. Is this really a ranula? It is on the inside of her cheek near her lower gum. I understood that a ranula is usually under the tongue. Can its cause be a lack of iron? Can it disappear on its own?

Ellen

Your daughter's doctor is being messy with his medical terminology. A mucocele is a common, cyst-like lesion of the oral cavity caused by the rupture of a salivary gland duct. (The duct is the "straw" that drains saliva from the gland to the oral cavity.) Because of this injury, saliva spills into the surrounding tissues. Mucoceles are usually round, bluish, and rubbery.

A ranula (the plural is "ranulae") is a mucocele that occurs in the floor of the mouth. Other floor-of-mouth cystic swellings (such as true salivary duct cysts) are also often called ranulae. The word "ranula" ought not to be used if the lesion is on the inside of your daughter's cheek.

Mucoceles are usually due to injury. If your daughter's lump is at the level where her teeth come together, then she may have caused this problem by biting her cheek. If it is much lower than this, then (for it to be a true mucocele) she must have injured this tissue in some other way.

In contrast, salivary duct cysts (also known as mucus retention cysts) can arise wherever there are salivary glands. We all have thousands of minor salivary glands scattered throughout our oral cavity, nasal cavity and throat; any one of these tiny glands can give rise to a salivary duct cyst. Some of these cysts may arise due to obstruction of the duct. The gland keeps producing saliva, and the duct inflates with saliva like a little water balloon.

Let's get back to your daughter's problem. Obviously, I cannot make even a reasonable guess as to the true nature of this lump, since you have given me only a few clues and I have not actually seen the lump. However, I do have one important comment: It concerns me that her doctor has described it as "a ranula or hematoma." As I have already stated, "ranula" is an inappropriate term for a cheek lesion. Hematoma is a collection of blood within the tissues, usually following trauma. Did this lump arise suddenly, after some traumatic event? If not, then I would question the possibility that it is a hematoma.

But ... could it be a hemangioma? You may have misunderstood your doctor, mistaking hematoma for hemangioma. Or maybe he really DID say hematoma.

Hemangiomas are benign (noncancerous) tumors that are composed of blood vessels. Oral cavity hemangiomas are not very rare; they typically grow slowly over the course of several months, and then spontaneously shrink. They require treatment only if they grow so large as to cause problems (bleeding, difficulty feeding, difficulty breathing). If they do not cause problems, it is wise to "wait them out," since they almost always get smaller as the child gets older.

Now, finally, I can answer your questions:

1. Is this really a ranula? No, but it might be a mucocele. (It could be MANY things -- as I noted above, without more information, I cannot even begin to list all of the possibilities. But it is NOT a ranula.)
   
2. Could it be due to low iron? I cannot think of any connection between low iron and this lump.
   
3. Can it disappear on its own, with time? Depends on what it is. The fact that it is getting smaller is obviously encouraging.
   

What of your doctor's plan to marsupialize the lump? Marsupialize means "to create a pouch." In other words, he is not planning to remove the lump; he is only going to "unroof" it so that the liquid trapped within can escape. This maneuver can work with mucoceles/ranulae and salivary duct cysts, but the same strategy would be disastrous if the lesion were a hemangioma or a minor salivary gland tumor. He needs to be fairly certain of what he's dealing with before choosing a surgical plan. Also, is he aware that she has been getting better over the past week? When he learns this, he may rethink his plan.

You need to discuss these issues with your daughter's doctor. He is in a much better position than I am to generate a differential diagnosis of this lump (i.e., a list of "what this lump could be"), since he knows her complete history and has actually seen and felt this lump. He should be able to explain the treatment plan to you so that it makes sense, and he should also be able to discuss other treatment options. A good doctor will welcome such a discussion.