The Ranula Chronicles: Time to Marsupialize, aka Surgery #2
Mini life update: For those who keep track of my happenings, I attended the Future Leaders in Prosthodontics (FLIP) foundational workshop in Mahwah, NJ. It was a very insightful and interesting experience that I will get to summarizing, but need some time for digestion after a literal and figurative feast (literal for all the food I ate, because.. well food, but figurative as in the great quality and quantity of content!)
Also, no idea what this blog post is about? Check out Part 1 & Part 2!
So, in spite of the thrill of experiencing a fine needle aspiration and sclerosing-therapy under local anesthesia, the swelling to my left submandibular area returned and this time, with some dull aches.
These guys also happen to be marsupials https://en.wikipedia.org/wiki/Pouch_(marsupial)
Being the diligent student that I was (hopefully still am!), I knew that major surgery was next and that that surgery would be likely either a marsupialization or sublingual gland removal.
Marsupialization is the process by which an enclosed bag-like object is opened up and modified to be a pouch.
The idea is that by creating an opening, the contents of a cyst would be able to drain as opposed to collecting.
Pros: Still relatively conservative
Cons: No recurrence is not 100% guaranteed and surgery would require an incision on the neck
J. Marley, C.G. Cowan, 9 - Cysts, Ed: Jonathan Pedlar, John W. Frame, Oral and Maxillofacial Surgery (Second Edition), Churchill Livingstone, 2007, Pages 115-126, ISBN 9780443100734, https://doi.org/10.1016/B978-0-443-10073-4.50013-6. (http://www.sciencedirect.com/science/article/pii/B9780443100734500136)
I got the basic work-up for surgery under general anesthesia and surgery was scheduled at a fortuitously good time when school was out of session.
So in I went. And out I came.
To put the above image in context, it looked a lot worse than it felt. The lower left side of my face was very numb after the surgery, especially at the submandibular region. Pinching the skin felt foreign - I could feel the act of the pinch but not the resulting pain of it.
But, whoa did I learn the power of swelling. As I warn my patients with tooth extractions, the first day of swelling is bad, but the subsequent 48-72 hours is usually worse. It’s true for necks too.
The procedure was outpatient - so I returned home (into the arms of a very caring mom :) ) with a drain attached to my neck. That was removed after a couple of days or so.
Surgery went without complications, but recovery was a bit of a different story.
You see this person? No, not the person in the back who is minding his own business - all he wants to do is read the newspaper.
I’m talking about this individual who is beaming of sweetness and joy and is basically the living definition of being a nice person and is probably 100% sugar and honey all put together. This is my mom.
This is also the person who gives zero f**ks about her terribly swollen daughter being mopey about looking like a Quasimodo and feeling sorry for herself.
My mom, as sweet and nice as she is, is a believer that speedy recovery comes in the form of being positive, keeping to your normal routine, going out and about, and carrying on with life.
I was a bit (i.e. really really really) embarrassed by my appearance and had no desire to do anything outside of the four walls of my house. Confinement and deficiency of vitamin D (natural sunlight) leads to a very whiney, gripe-y, and “sorry for myself” Sarah.
My mom quickly shut this down as she dragged me out and about to run errands with her. At the time, I remember being veeeerrry unpleased by this and mortified. But as the phrase “Mother knows best” suggests, after the initial concern and shock of having to expose myself in this sort of condition to the world, it soon dawned on me that it didn't matter.
I mean, first of all, what’s going on with my face is no one’s business unless I want to share. Second off, clearly something was going on with my face, so my expectation to pretend that everything is fine and that people shouldn’t notice wasn’t very realistic. I was placing limits on myself (and how I felt about myself) based off of my assumptions of other people’s perception of me. And if people did notice, go back to the first point.
My mom taught me a big lesson on empathy. I was (and still am) fortunate enough to not have to live with a permanent condition that makes my appearance markedly different from the average person. Albeit inconvenient, the crazy swelling would eventually pass and go away. But, for those who have had no choice live with some kind of abnormality or defect - it’s a “wow, I really can’t imagine” kind of realization. I gained a deeper respect for the braveness an individual must need to face the judgments of a world that can sometimes be unkind, ignorant, or unlearned.
In trying to lose a ranula, I gained a better sense of understanding how to be a better person. So really, as much as this post is about an interesting surgical procedure, it’s really a big thank you to my mom for teaching me a lesson while also making me feel better at my time of need.
As nice as it’d be to say, “That’s all folks!”, this is a chronicle. I gave our ranula friend and myself another 6 months break before the next round. Coming soon, the continuation of The Ranula Chronicles.
This post’s lesson: While marsupials (i.e. kangaroos and wallabies) are very prevalent in Australia, their origins are in North America! Apparently they migrated to Australia via Antartica when the Earth’s continents were bound as a single mass of land!