Ranula In A Hiv Patient: A Rare Case Report

Abstract

Ranula is a form of cyst resulting from obstruction of mayor salivary gland which is a phenomenon of duct retention in the sublingual gland located at the floor of mouth, resulting in swelling under the tongue and bluish in color. Ranula may occur in association with HIV. The study reported  38 cases of ranula, 88.5% of patients were HIV positive. This article reports the management of ranula cases in HIV patients. A 20 year old male patient came with complaints of a lump under his tongue. The lump has been felt since 1 month ago, often reccurence. The patient has a history of Human Immunodeficiency Virus (HIV) and regularly takes Tenovofir Lamividine Dolutegravir. Extraoral examination showed a lump in the left submandibula region and painless. Intraoral examination found the sublingual region, translucent, mobile, and painless. Supporting examinations include panoramic radiography, thorax radiography, MRI, laboratory. Treatment is carried out by marsupialization with general anesthesia. In this case the ranula classified as a simple ranula because it was only found on the floor of the mouth, the left submandibular extraoral lump was suspected to be a swollen lymph node due to the patient's systemic condition HIV. Excision of the ranula along with the sublingual gland risks injury to the lingual nerve and submandibular duct due to more invasive dissection. Firstline therapy for oral ranula is marsupialization, although the recurrence rate is higher. Surgeons must take universal precautions when performing surgical interventions, and there is no reason to discriminate against ranula patients with HIV.  Persistent chronic inflammation caused by HIV can lead to blockage of the small ducts, followed by distension that can lead to rupture of the ducts and extravasation of mucus into the surrounding tissue. The treatment in this case was marsupialization with general anesthesia.