Marsupialization of Isolated Sublingual Sialoceles

In the Literature

Payne DJL, Pappa E, Burrow R. Outcome of marsupialisation for the management of isolated sublingual sialocoeles in dogs: nine cases (2009-2023). J Small Anim Pract. 2025;66(12):894-900. doi:10.1111/jsap.13908

The Research …

Salivary mucoceles are typically soft, painless swellings that consist of saliva that has accumulated in tissues secondary to damage to individual salivary glands or the shared duct complex. Salivary mucoceles under the tongue (ie, sublingual mucoceles, ranulas) occur when leaked saliva causes irritation within sublingual tissue, stimulating growth of an inflammatory lining of granulation tissue around the saliva that forms a thin-walled, translucent swelling that contains the saliva and prevents further migration.^1,2

The recommended treatment for ranulas is sialoadenectomy with or without marsupialization of the ranula.¹ Marsupialization is accomplished via resection of an ellipse of dorsal mucosa of the ranula and suturing of the remaining rim of oral mucosa to the inflammatory lining of the ranula, creating a route by which leaked saliva can drain directly into the open oral cavity where it is no longer problematic.^1,2 Compared with sialoadenectomy, marsupialization alone is faster and less invasive.^3-5

This retrospective study evaluated outcomes and complications associated with marsupialization alone for the management of isolated ranulas in dogs, hypothesizing that marsupialization would result in long-term resolution in most cases. Of the 9 cases included in this study, 3 dogs experienced recurrence of the ranula after surgery (mean, 20 days); 2 of those dogs required ipsilateral sialoadenectomy, and recurrence progression was not well-documented in the third dog. Follow-up was incomplete and relied on referral records in 7 dogs and pet owner follow-up in 2 dogs.

… The Takeaways

Key pearls to put into practice:

• Ranulas can induce dorsal and lateral deviation of the tongue, cause difficulties with mastication and swallowing that may lead to aspiration pneumonia, and/or lead to partial or complete oropharyngeal airway obstruction (which can be fatal).^1,2

• The study authors concluded that their findings support wide excision of the sublingual mucosa overlying the ranula and marsupialization for initial treatment of isolated ranulas; however, multiple studies have reported marsupialization alone to treat sialoceles is associated with a high risk for recurrence.^3,6,7 In cases of acute ranula formation, the ranula will not have formed an inflammatory lining, making marsupialization impossible. Attempts to marsupialize an immature ranula without an inflammatory lining may lead to leakage of oral contents (eg, nonsterile saliva, food, water) into subcutaneous tissues, causing infection and abscessation.

• Sialoadenectomy is complete and straightforward, especially when the approach is ventral to the mandible, and complications are possible but rare compared to the risks associated with ranula recurrence.¹

• In cases of a mature ranula in which a more prolonged anesthetic period may result in risks to the patient (eg, patients with significant concurrent systemic disease), marsupialization may have a place in treatment. For all other patients (especially those prone to mastication/swallowing concerns or airway obstruction), marsupialization with complete ipsilateral sialoadenectomy remains the recommended procedure.