Sublingual gland removal for plunging ranula

A plunging ranula is an extravasation of saliva from the sublingual gland due to trauma or obstruction of the duct. Fluid from the obstructed gland dissects between the fascial planes and myelohyoid muscle to the submandibular space. 


The exact prevalence of plunging ranula is not known, however, these lesions appear to more common in Maori and Pacific Islanders. Some plunging ranulas either accompany a swelling in the floor of mouth or are associated with a history of treatment of intraoral ranula. On the other hand most plunging ranula in New Zealand there is no clinical evidence of an oral connection, and are sometimes difficult to diagnose.

Treatment involves surgical removal of the sublingual gland and exposure of the pseudocyst. See video above

Endoscopic treatment of Pharyngeal pouch

We recently treated a patient with a Pharyngeal pouch.

His symptoms were  dysphagia, regurgitation, aspiration, chronic cough and slight weight loss.
Usually there are no clinical signs but there may be a lump in the neck that gurgles on palpation. There may also be halitosis from food decaying in the pouch.


A pharyngeal pouch(Zenkers diverticulum) represents a posteromedial pulsion diverticulum through Killian's dehiscence. It is a herniation between the thyropharyngeus and cricopharyngeus muscles that are both part of the inferior constrictor of the pharynx.

The aetiology is unknown but malfunction of the upper oesophageal sphincter probably contributes. They occur in the elderly.

The diagnosis is confirmed with a Barium swallow.

traditionally we have treated these by an external operation which involves exposing the pouch in the neck and excising it. As we don't see too many of these it can be a difficult procedure with some risks. 

Recent endoscopic techniques are now favoured so we asked a specialist colleague to come from Auckland to show us how it is done. 

The video shows the dividing wall between the pouch and the oesophagus being divided. We used a harmonic scalpel which seals and cuts the bridge which includes the cricopharyngeus muscle creating a single large cavity.