Update Course Rewind 2025: Neck Pathologies - The Diagnostic Challenge

It can be really hard to differentiate a giant ranula from a lymphatic malformation.

The lab tends to have trouble running thick fluid from aspirated neck masses.

Lymphatic malformations near glandular tissue can have leaching of saliva into them, resulting in false positive amylase testing.

Removal of the sublingual gland has been the best practice for ranula treatment.

When a ranula has a cervical component, you can aspirate that and as long as you remove the sublingual gland, it should go away.

Micromarsupialization is a new technique for treating ranula with an intraoral component, involving placement of silk sutures through the cyst for 30 days to develop a fistula that spontaneously drains into the mouth.

Gene panels now guide medical therapy for lymphatic malformations, particularly PIK3CA mutations which suggest that alpelisib (a PI3K alpha inhibitor) can be useful.

For congenital developmental neck masses, you have to deal with the embryological component and etiology to prevent recurrence, not just excise the mass.