Causes, Symptoms, Diagnosis and Treatment

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Signs & Symptoms

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What is a Ranula? 

A ranula is a fluid collection or cyst that forms in the mouth under the tongue. It is filled with saliva (spit) that has leaked out of a damaged salivary gland. Salivary glands are small structures around the mouth which make saliva. Saliva should drain from these glands directly into the mouth. If one of these glands is damaged then the saliva leaks out into the tissues next to the gland forming a cyst or bubble near the gland. This cyst is called a ranula.

If the ranula stays in the mouth underneath the tongue it is called a simple ranula and if it grows down into the neck under the mouth it is called a plunging ranula.

What Causes a Ranula?

Saliva is fluid formed primarily by three salivary glands on either side of the mouth: the parotid glands, the submandibular glands, and the sublingual glands. If one of the salivary glands, usually the sublingual gland, is injured or diseased the saliva will no longer reach the mouth where it can be swallowed. The saliva leaks out of the injured gland and forms a bubble of fluid in the tissue around the gland which is called a ranula.

How are Ranulas Diagnosed?

The diagnosis is usually easy for an experienced physician to make based primarily on physical examination but often specialized radiology studies such as Ultrasound, Computed Tomography (CT Scan), or Magnetic Resonance Imaging (MRI) are needed to define the full extent of the problem and exclude other causes for swelling. No other laboratory tests are usually needed to make the diagnosis.

What are the Symptoms of a Ranula?

Ranulas are usually discovered by the patient, the patient’s family, or the patient’s medical caregivers like medical doctors and dentists. It usually is a 2-3 inch diameter painless soft swelling under the tongue or chin that is easy to identify. Occasionally, the fluid collection can hurt a little and sometimes is can spontaneously empty into the mouth only to slowly fill back up in the weeks after it empties. Usually, it just slowly grows in size until it is discovered.

How are Ranulas Treated at Nationwide Children’s? 

Rarely, a ranula can spontaneously go away without any treatment but usually a procedure will be needed to treat the problem. Simple drainage of the fluid collection rarely permanently fixes the problem as the diseased gland continues to leak saliva.

Traditionally, open surgical procedures drain the ranula and remove the diseased gland through an incision in the mouth or under the chin. A percutaneous treatment was developed in Interventional Radiology at Nationwide Children’s Hospital around 2004 and has been used successfully since then to treat ranulas without open surgery or incisions.

During a 30 minute procedure while the patient is under Anesthesia, Ultrasound is used to guide needle placement through the skin to drain the cyst and then inject medicine, absolute alcohol, into the diseased salivary gland to make it stop leaking saliva.

What are the Potential Complications of This Treatment?

Our percutaneous treatment is safe and effective. The only common side effect of treatment is mild painless swelling in the treated area for several days after treatment. Patients can eat normally immediately after the procedure and as there are no incisions or stitches, no wound care or dressings need to be managed.

Sometimes, the ranula is not completely cured with one treatment and a second treatment is necessary. Rarely, the diseased gland resists the medication injections and continues to leak saliva necessitating referral to an experienced surgeon for traditional surgical removal.

While our percutanous procedure is very safe, all treatments carry risks. The only serious risk that can occur with alcohol injection under the mouth or chin is injury to a nearby nerve which can result in temporary muscle weakness in the area in rare cases (2-3%).

What is the Outlook for Patients With a Ranula?

Ranulas are benign fluid collections near the mouth which can be effectively treated with our percutanous treatment but also with traditional surgical approaches. Both appraches offer permanent removal of the ranula and resolution of symptoms. We feel our percutanous approach offers a less invasive treatment for this benign condition.

When Should I See a Doctor?

If a ranula is suspected as there is a 2-3 inch diameter soft swelling under the tongue or chin medical attention with the child’s medical provider should be obtained.  If the diagnosis is felt to be a ranula based upon their examination and imaging tests treatment can then be sought from specialists such as interventional radiologists or surgeons.

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Ranulas are salivary pseudocysts in the floor of the mouth adjacent to damaged salivary glands. Current surgical management is drainage of the ranula with removal of the offending gland. An analogous percutaneous procedure could potentially offer similar treatment efficacy in a more minimally invasive way.

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Parents are understandably nervous when they learn their child has been diagnosed with a swelling or growth. Fortunately, many times the growth is not a cancerous life threatening tumor, but is instead a benign collection of abnormal blood vessels or fluid that is swelling and causing pain and

Causes and when to see a doctor

Bumps under the tongue can appear suddenly without an identifiable cause. They may cause no symptoms or may cause pain or discomfort underneath the tongue.

In this article, we cover possible causes of bumps under the tongue and how doctors diagnose and treat them. We also discuss home remedies and when to seek medical treatment.

Share on PinterestUsing medicated mouthwash and practicing good oral hygiene may help relieve symptoms of bumps under the tongue.

There are many possible causes of bumps under the tongue. Some of the more common ones are those below:

Canker sores

Canker sores, also known as aphthous ulcers, are open lesions that can develop anywhere inside the mouth, including under the tongue.

Canker sores appear suddenly. They have no known cause but are not contagious. Some researchers believe that canker sores are a type of immune system response.

Other factors can also trigger canker sores, such as:

• an injury or damage to the tissue underneath the tongue
• exposure to spicy, acidic, or dairy foods
• hormonal changes, such as those during menstruation, pregnancy, or menopause
• gastrointestinal (GI) disorders, such as celiac disease
• nutritional deficiencies, such as low iron, folate, and vitamin B12
• physical or emotional stress
• genetics
• infections

Most canker sores are minor and resolve on their own within 4–14 days.

Learn more about canker sores on the tongue.

Oral mucous cyst

Mucous cysts are fluid filled sacs that form in the tissues of the fingers, toes, and mouth. An oral mucous cyst will develop near one of the openings of the salivary glands under the tongue or on the lips, cheeks, or floor of the mouth.

Mucous cysts appear as soft, swollen lumps that range in color from flesh-colored to dark blue. Mucous cysts tend to periodically disappear when they rupture and reappear when they become irritated by saliva.

Although a person can develop an oral mucous cyst at any age, they usually occur between the ages of 10 and 30 years.

Learn more about mucous cysts.

Human papillomavirus

Human papillomavirus, or HPV, is the most common sexually transmitted infection (STI) in the United States, according to the Centers for Disease Control and Prevention (CDC). Scientists have identified more than 180 HPV subtypes.

HPV infections lead to lesions in the skin and mucous membranes. According to the CDC, about 40 subtypes of HPV can infect the mouth and throat.

People with minor oral HPV infections do not develop symptoms. However, those who do may notice:

• small, hard bumps under the tongue or in the mucous membrane inside the mouth
• bumps that appear white, pink, red, or flesh-colored
• painless, smooth, and slightly raised bumps
• a single bump or cluster of bumps

The body can clear an HPV infection within 2 years without medical treatment. However, HPV is the leading cause of oropharyngeal cancers.

Learn more about HPV in the mouth.

Lymphoepithelial cyst

Lymphoepithelial cysts are slow growing, noncancerous lesions that develop in the salivary glands. They often occur as a symptom of HIV infections.

These small, firm nodules sit just below the mucus membrane that lines the inside of the mouth. Lymphoepithelial cysts usually appear as flesh-colored, white, or yellow bumps under the tongue or on the floor of the mouth.

Sialolithiasis

Sialolithiasis, also known as salivary stones, is a condition in which stones of crystalized minerals form in the ducts of the salivary glands. Sialolithiasis is the most common cause of salivary gland swelling.

A stone that forms in the sublingual gland, located underneath the tongue, can lead to a sore, painful bump.

Other symptoms of sialolithiasis include:

• pain or discomfort in the mouth that worsens when eating
• pain or swelling below the jaw
• infection in or near the affected gland
• dry mouth

Learn more about salivary stones.

Salivary gland tumor

A salivary gland tumor that forms in the sublingual gland can lead to a lump or swelling under the tongue or near the jaw.

Generally, if the tumor develops in a smaller salivary gland, there is a higher probability that it is malignant.

For example, although less than 1% of salivary gland tumors develop in the sublingual gland, 70–90% of sublingual gland tumors are malignant. A malignant tumor grows rapidly and can spread to other parts of the body.

Salivary gland tumors can lead to the following symptoms:

• a lump or painful swelling under the tongue or in the jaw, ear, or neck
• numbness or muscle weakness in part of the face
• difficulty opening the mouth or swallowing
• fluid draining from the ear

Learn more about salivary gland cancer.

A doctor can diagnose most causes of bumps under the tongue by carrying out a physical examination and asking the person to describe their current symptoms. They may also review the medical history of the person and their family for indications of risk factors for certain diseases.

A doctor may use one or more diagnostic tests to confirm a diagnosis or rule out other potential causes. These tests can include:

• blood tests that measure white blood cell counts, to check for an infection
• a swab culture analysis, to identify infectious pathogens, such as bacteria or fungi
• imaging tests, such as a CT scan or MRI scan, to identify structural abnormalities in the mouth
• a biopsy, to analyze tissue samples for cancer cells

Treatment varies depending on the underlying cause. Many types of bumps under the tongue, such as canker sores and mild HPV infections, resolve on their own without medical intervention.

• HPV mouth sore: A doctor can freeze an HPV mouth sore using cryotherapy or inject it with an antiviral drug called interferon alfa-2B.
• Cysts: A doctor may attempt to drain lymphoepithelial cysts and oral mucous cysts. They may recommend removing a cyst using laser therapy or freezing it with cryotherapy.
• Sialolithiasis: A doctor may treat salivary stones with anti-inflammatory drugs. They can push the stone out by massaging the salivary gland or gently probing the affected area with a blunt object. A doctor may recommend surgery to remove a large salivary stone.
• Salivary gland tumors: A doctor will likely recommend surgery for salivary gland tumors. During surgery, they will remove the tumor along with some of the surrounding tissue. If they identify cancer cells elsewhere in the body, they may recommend a systemic treatment, such as radiation therapy or chemotherapy.

The following home remedies may promote healing and help relieve uncomfortable symptoms of tongue bumps:

• practicing good oral hygiene
• using medicated mouthwash
• avoiding acidic, spicy, and sugary foods
• using topical gels and numbing solutions on painful oral sores
• quitting smoking, if a smoker, and avoiding secondhand smoke

Most causes of bumps under the tongue heal on their own. However, people should speak with a doctor if they have a bump under the tongue that does not heal within 10 days.

People should also seek medical attention if they have a bump under the tongue or swelling in the mouth that interferes with their ability to speak, swallow, or chew.

Bumps under the tongue can appear suddenly and without an apparent cause. These bumps often resolve on their own without treatment.

Some bumps heal and reappear months or years later. Other types of tongue bumps resolve and never occur again.

People with more serious underlying conditions, such as HPV infections and salivary gland cancer, can have very positive outlooks if doctors catch the condition at an early stage.

Most HPV infections resolve within 2 years. Localized salivary gland cancer has a 94% 5-year relative survival rate if it has not had time to spread.

Bumps can develop under the tongue due to a mouth injury, exposure to viruses, eating certain foods, or salivary stones, among other causes.

Regardless of the underlying cause, most bumps under the tongue resolve relatively quickly and do not require medical treatment. More serious tongue bumps, such as tumors, salivary stones, and infections, are easily treatable with medication or surgery.

causes and treatment (Well, you and an ulcer! Where do sores in the mouth come from and how to get rid of them)

Each of us met with mouth ulcers at least once in our lives. These unpleasant pimples can occur almost anywhere in the oral cavity: on the cheeks, tongue, gums, palate. For what reason they arise, what to do with them and why in the spring and during stressful situations we are vulnerable to their appearance, says Ekaterina Andreevna Smirnova, Candidate of Medical Sciences, dentist at the Studio32 Expert Dentistry Center.

Ulcers in stomatitis

Sores on the mucous membrane in the mouth can appear for several reasons. One of them is a decrease in human immunity. The inhibition of the protective properties of the body may be associated with seasonal changes, acute stressful situations, prolonged emotional overstrain, as well as malfunctions of the endocrine system or systemic diseases, such as, for example, tuberculosis and syphilis. It is with the suppression of immunity that the appearance of stomatitis and herpetic sores is associated.

Aphthous stomatitis is one of the most common types of lesions of the oral mucosa. White or yellow in the center and red along the edges of the sores from 3 to 10 mm (scientifically called aphthae) can appear on the tongue, inside of the cheeks, palate and at the base of the gums. As a rule, they cause moderate soreness and heal within 7-10 days. But there are also larger aphthae that hurt a lot, heal longer and require more careful attention and treatment.

Aphthous stomatitis is not an infection, therefore it is not transmitted by kissing or through dishes. What can not be said about herpetic stomatitis. It is caused by a virus and is therefore extremely contagious. Unlike aphthous, herpetic stomatitis is not manifested by sores, but by painful vesicles that pour out on the oral mucosa.

Ulcers due to trauma

Another reason for the appearance of ulcers is trauma to the oral mucosa, as a result of which the infection enters the wound. Most often this occurs if a person, for example, bites his nails, or has a habit of biting the tip of a pen or pencil. At risk are lovers of seeds and hard toothbrushes. It is a misconception that the harder the brush, the cleaner the teeth will be. Not at all, but injuring the gums and causing inflammation is very real. Ulcers caused by microtraumas usually occur on the tongue and gums, that is, in those places where there is contact with the aggressor from the outside.

The mucosa can also be injured due to malocclusion. Wounds on the cheeks and on the side of the tongue can cause anxiety when a person constantly bites his cheek and tongue. In addition, during a stressful situation during a period of psycho-emotional stress, in which we are all now due to a pandemic and quarantine, some people experience uncontrolled biting, a kind of “laying their cheeks”, tongue or lips between their teeth. These factors can exacerbate the appearance of wounds during the isolation period.

Manifestation of inflammatory processes in the gums

Ulcers often include inflammation of the gums, in particular the formation of a fistula. If a person has chronic inflammation on the root of the tooth, during the period of its exacerbation, a wound may appear on the gum, so the abscess on the root of the tooth opens the fistulous passage outward. Here, of course, one cannot do without professional treatment and elimination of the root cause.

How to treat “pimples” on mucous membranes

The appearance of sores in the mouth is not a reason to panic, but you should not leave everything to chance either. If the wounds are small and do not cause much concern, then they do not require special treatment. Will be gone in 1-2 weeks. At home, you can rinse your mouth with a decoction of chamomile, which has a mild antiseptic effect. It must be remembered that excessive use of antiseptics can cause burns to the oral mucosa. It is definitely impossible to “fill in” with chlorhexidine or rinse your mouth with hydrogen peroxide. Miramistin works quite well, this antiseptic is designed just for mucous membranes, so it acts sparingly. Alternatively, you can use antiseptic prophylactic rinses such as Listerine, Forest Balsam, Paradontex, and so on. Of the gels, Holisal, Metrogil Denta works well.

Drugs should be used in a rationed and yet under control. Even in isolation due to the coronavirus, you can consult with a specialist remotely. For example, on Yandex Health there is an opportunity to ask the dentist your questions online. Based on the description of the symptoms and photos, the doctor will be able to give recommendations on therapy.

It is necessary to consult a dentist if there is no improvement within a week, if the ulcers are large, very painful or accompanied by fever.

Until recovery, spicy, acidic and rough foods should be avoided. It is better to give up chewing gum, and do not brush your teeth with hard brushes.

If sores in the mouth occur periodically, it is worth thinking about the correct selection of preventive hygiene products: pastes and brushes.

Do not forget about strengthening the immune system, the state of which is closely related to the state of our nervous system. Against the background of stress and tension, not only sores can occur, but also bleeding gums – this is what was called scurvy in the Soviet Union in wartime, and in modern dentistry it is called gingivitis. The elimination of gingivitis, as well as aphthous stomatitis, largely depends on the normalization of personal oral hygiene.

Aphthous stomatitis – causes, symptoms, diagnosis

Classification of aphthous stomatitis

Aphthous stomatitis differs in the nature of the course. He can be:

Acute aphthous stomatitis

It begins with a general malaise, accompanied by fever and apathy. Then, single or multiple sores appear on the oral mucosa. Aphthae are quite tiny – they usually do not exceed the size of a lentil grain. Ulcers are oval or round in shape. They have clear borders in the form of a narrow red border. A greyish-yellowish coating can be seen in the center of the aphthae. The appearance of ulcers is accompanied by burning, and while eating, the patient feels pain. Complete self-healing of aphthae occurs within 1–1.5 weeks.

Chronic aphthous stomatitis

Characterized by a change in periods of exacerbations and remissions. Ulcers appear, heal, after a while they reappear. Concomitant symptoms are not pronounced, and in some periods, even in the presence of aphthae, may be absent. The mucous membrane of the mouth swells from time to time. Chronic aphthous stomatitis is a consequence of acute and develops in people with weak local and general immunity or in patients suffering from systemic diseases.

Causes of aphthous stomatitis

The exact causes of the development of the disease are still not known. However, it has been established that all patients with aphthous stomatitis have malfunctions of the immune system. The most common is the autoimmune theory. It is believed that the human immune system begins to take some components of saliva for foreign chemical agents and begins to attack them. The result of this struggle is the aphthae.

Factors that increase the risk of developing the disease:

• Genetic predisposition – close relatives of a third of patients with aphthous stomatitis also suffered from this pathology, and if there are twins in the family, the disease is detected in both in 91% of cases if they are identical, and in 57% of cases in fraternal ones.
• Mechanical injuries of the oral cavity – in about 40% of cases precede the development of pathology.
• Food allergy – aphthous stomatitis often occurs after eating certain foods, most often containing gluten, as well as seafood, spices, cheeses, tomatoes, citrus fruits.
• Avitaminosis – Patients with this disease often have a lack of folic acid, iron, zinc, selenium, vitamins C and group B.
• Hormonal imbalance – aphthous stomatitis often occurs in pregnant women and women during menstruation.
• Systemic diseases – many patients are diagnosed with immunodeficiencies, dysfunction of the gastrointestinal tract, malfunctions of the circulatory system, after treatment of which the signs of aphthous stomatitis disappear.
• Viral and bacterial infections.
• Wrong choice of oral care products – in particular, in many cases, the disease develops in people who use toothpastes with sodium lauryl sulfate (foaming component), which contributes to the drying of the mucous membrane.
• Non-steroidal anti-inflammatory drugs.
• Stress.

Chronic aphthous stomatitis can also occur against the background of diseases such as pharyngitis, inflammatory bowel pathologies, Behçet’s disease, and celiac disease. In some cases, it accompanies HIV infection.

Help! Pathology can develop in patients of any gender and age, but is most often detected in adolescents and young women.

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Symptoms of aphthous stomatitis

Signs of aphthous stomatitis depend on the form and stage of the disease.

There are the following stages of aphthous stomatitis:

1. Initial.
2. External manifestations.
3. The appearance of pathological foci.
4. Healing.

The initial stage of is characterized by general malaise and enlarged lymph nodes in the neck, occiput and jaws. The patient’s body temperature rises and appetite worsens, he feels weak.

At the stage of external manifestations , local symptoms (changes in the oral mucosa) join the above signs. These include:

• Edema.
• Soreness, aggravated by eating and hygiene procedures.
• Redness and congestion with blood (hyperemia).
• Sensible itching.

Also, the patient may experience sleep disorders.

During the stage of appearance of pathological foci, single or multiple aphthae occur. They can develop anywhere in the oral mucosa, but are most commonly seen on the cheeks, lips, palate, and tongue. Ulcers are usually very painful.

At the stage of healing, aphthae are gradually covered with epithelial tissue. In most cases, there are no scars.

Forms of aphthous stomatitis:

Fibrinous aphthous stomatitis – the mildest form that occurs due to circulatory disorders in the surface layer of the mucous membrane. Solitary painful sores appear in the mouth, covered with a white coating. Healing of aft occurs within 1-2 weeks.

The granular form develops due to lack of saliva. With this type of disease, the minor salivary glands are affected, causing them to produce less secretions. Due to the dryness of the mucous membrane, painful and long-lasting ulcers appear in the excretory ducts of the glands. In patients prone to frequent colds, granular stomatitis can flow into a chronic form. Treatment is quite long – it takes from 1 to 3 weeks.

Necrotizing aphthous stomatitis is characterized not only by the presence of ulcers, but by the slow destruction of the outer layer of the oral mucosa, resulting in tissue death. Unlike other forms of the disease, this one is not accompanied by pain and discomfort. This type of pathology is rare. Usually observed necrotizing aphthous stomatitis in adults suffering from any severe systemic diseases.

Scarring form occurs when the small salivary glands and connective tissue are affected, caused by genetic failures. The sores are small at first, but increase over time. They are very painful. Aphthae with this type of disease are located in the projection of the salivary glands, the mucous membrane of the pharynx and the anterior palatine arches.

Deforming – the most complex form. It gives the patient a lot of inconvenience, as it is accompanied by general malaise and significant pain. The ulcers are deep enough and do not go away for a long time. They lead to deformation of the lips, anterior palatine arches and soft palate. A microstoma (narrowing of the oral fissure) may also develop if the corners of the mouth are affected.

Help! A complication of aphthous stomatitis is the spread of infection through the tissues, as well as the flow of an acute form into a chronic one.

Diagnosis of aphthous stomatitis

Aphthous stomatitis is usually diagnosed after examining the patient, based on the clinical picture and the results of the history taking. However, if the doctor suspects the presence of concomitant diseases, then additional studies are prescribed to identify them (blood and urine tests, ultrasound, etc.).

Differential diagnosis may also be needed. It is important to differentiate aphthous stomatitis from herpetic and from chronic injuries of the oral mucosa. For this, virological studies are prescribed and the method of immunofluorescence (ELISA) is used.

Treatment of aphthous stomatitis

Treatment of pathology is carried out in a complex manner, using methods of local and general therapy. Local therapy includes:

• Antiseptics.
• Antimicrobial ointments, gels, sprays.
• Mouth rinses to speed up the healing process of sores.

General therapy includes methods to eliminate the cause of the development of aphthous stomatitis, as well as generally alleviate the patient’s condition. Antiviral, antipyretic, antihistamine, sedative drugs may be prescribed.