The Ranula Chronicles: The transoral approach

In January, the swelling under my left jaw returned. Sigh.

Not the best Facebook profile pic options.

At this point, the inevitable decision to remove the sublingual gland had to be confronted. The sublingual gland has historically been the culprit source of saliva for ranulas - hence, the plan was to remove the actual source.

Optimistically thinking, the sublingual gland provides the least amount of saliva in the other 6 major salivary glands accessing the mouth (a pair of parotids, submandibular, and sublingual glands make up the complete set).

For this procedure, the surgeon discussed a transoral approach. In plainer terms, the plan was to remove my left sublingual gland from within my mouth. Tissues within the mouth tend to recover quickly and my neck wouldn’t need to be re-manipulated. Win. But I would need to be on an all-liquid diet for 10 days after the surgery. Um…

The surgery was scheduled. My left sublingual gland and I would spend our last Valentine’s day together and then "consciously uncouple” shortly thereafter.

Now, having already recovered unremarkably from my last surgery and having the confidence boost [kick in the butt] from my mom, I felt good. As in, I felt that this was going to be a buh-reeeeze. Sure, I’d be swollen but it wasn’t anything that I couldn’t handle [thanks mom!]. Sure, I’d be on a liquid diet, but I’m down for soup soup soup and coffee is a liquid, yippee! Sure, I have an exam in Oral Medicine two days after surgery, but I totally have the situation under control - I am no novice to this any longer.

So, I was obviously set. I even studied for my exam while waiting for my name to be called into the pre-op surgery bay.

Until I woke up from surgery and got my butt whooped.

Folks, I’ve been through extractions and I had a mucocele (the little baby sibling of the ranula) removed from my lower lip. “Inside the mouth surgery” seemed like much ado about nothing.

My tongue and floor of the mouth were super swollen that swallowing was painful. Not to mention I didn’t realize that I wouldn’t be able to open my mouth. The swelling along my jawline was reminiscent of the last surgery, but the discomfort from within my mouth and being limited in function made me not a happy person to be around [sorry mom!]. Also, I quickly got to typing up an email detailing, in as much fancy schmancy detail, the procedure I just underwent and why I probably shouldn’t take a midterm examination quite yet [thank you Dr. Kutcher].

I’ve got good friends…

who not only encourage speedy recovery from surgery, but also returning for beer :)

Thankfully, the initial punch in the face quickly dissipated within 5 or so days, but the liquid diet rule did not go away. Let’s just say, it was both the quickest 10 lbs (4.5kg - yeah yeah, the metric contingent has been heard) but also most difficult 10 lbs (4.5kg) I ever lost. Also, the fastest 15 lbs (6.8kg) I gained [ahem, after the ban was lifted and I celebrated ;) ].

Looking back at it now, and currently working with patients who undergo transoral robotic surgeries quite frequently in my line of work (and frequently with neck dissections), there is really no way to downplay the challenging aftermath of major head and neck surgery. I wonder how best to strike a balance of honesty/reality yet positivity/optimism with those who are about to go through that experience. I still struggle with this particular aspect within the art of communicating with patients. Even though support and encouragement are important, so is full disclosure? And, even with my surgery being now many years ago, it’s surprising to be able to recall some of these pivotal moments and feelings. It makes me realize that our patients will hold onto their experiences similarly.

These are questions that I think will always having open-ended and evolving responses.

But, I can say for sure that in 6 months time, the ranula was back. And finally, we approach the finale.

This post’s lesson: Boards question-answer: What type of saliva does the sublingual gland produce??? MUCOUS. Er.. well mainly mucous.