The Ranula Chronicles: Surgery #1
After consulting with an ENT specialist, the differential (aka, probable) diagnosis included a “deep plunging ranula”. It usually presents as a localized swelling of fluid (saliva) in the floor of the mouth and is technically (i.e. fancy-schmancy lingo) a mucous retaining pseudo-cyst, lacking an epithelial-lining, contained within surrounding tissues approximating the main and many minor salivary glands’ drainage ducts.
As most things in healthcare, time is frequently spent in “waiting mode”. Which, for a pre-doc student who’s learning about head and neck pathology in my Oral Pathology course, really meant that I wanted the ranula out and out fast.
Sooooooo…. the option of a non-invasive, non-general anesthesia based surgery was brought up. Known as a sclerotherapy, the idea was to locally anesthetize around are around the ranula, aspirate (suck out, but with a needle. No vampires) fluid out, inject medication (sclerosing agent, frequently Picibanil, interestingly an immunotherapy agent used for cancer) to scar the area so that it would essentially be sealed so that fluid wouldn’t be able to spill.
It was a no-brainer to me. It was the first time since finding the lump that I felt like I was in control. And I felt pretty good to make an important decision about my body for the first time: “Weeeeee! I’m a real adult!”
“Not bad huh?” - said no one
I sent my brother (my ride) off to grab a Starbucks coffee and went along my merry business of checking off “Get rid of ranula” from my to-do list.
Reality can be reaaaaalllly humbling.
The resident and attending physician completed the procedure with ultrasound guidance. As reassuring as they tried to be, I wasn’t prepared to feel how painful and scary seeing a HUGE needle coming right at me to numb my facial nerve. In dental school, my classmates and I learned to administer anesthesia to one another so of course there were nerves (pun!), but getting the outside of your face numbed was a totally different level of “THAT IS A HUGE NEEDLE COMING RIGHT AT ME”.
The good thing is that it worked. … Up until the actual sclerosing medication was injected.
The best way to describe how I felt is that, I could feel the pain seeping deep into my bones as the medication entered. It worsened as the anesthesia wore off on the way back home. When my brother and I went to the grocery pharmacy to get some pain medications, I cried right in between the bread aisle and freezers because the pharmacist said it’d take 30 minutes to get the prescription filled and I was in so much pain.
Do I regret it?
No. I tried and I truly tried to do what I felt was the best and most conservative option.
Would I do it again?
No. But I am biased because a few months later, the ranula was back. I still shudder thinking about the sclerotherapy.
Nonetheless, in reflecting back on this part of my experience, I’m learning the importance of taking responsibility for decision-making and also looking forward, even after the decision ended up not turning out the way I wanted. I tried, my care providers tried, and we were optimistic for the best.
Also, I’m better understanding how to appreciate just how challenging even a “simple” procedure can be for patients. I find myself overlooking the importance and power of empathy - sometimes it’s hard to stop and refocus on that aspect while in the hustle and bustle of working within healthcare. Writing this is a good reminder.
This post’s lesson: I found a retrospective study on treating Ranulas that was published from the hospital I was treated and it recounted all their cases and I now kind of feel famous even though all the info is de-identified. It’s the small things :)