# Atypical Multifocal Presentation of Congenital Plunging Ranulas: A Radiological Approach to Diagnosis and Treatment

## TL;DR

A two-month-old baby had an unusual type of congenital ranula, diagnosed using imaging and treated successfully to prevent recurrence.

## Contribution

Highlights the importance of imaging in diagnosing atypical, multifocal congenital plunging ranulas.

## Key findings

- Magnetic resonance imaging and ultrasound revealed a multiseptated submandibular lesion with sublingual extensions.
- Needle aspiration confirmed the diagnosis with mucoid salivary discharge.
- Complete excision of the affected glands and tracts is necessary to prevent recurrence.

## Abstract

Congenital plunging ranulas are pseudocystic lesions affecting the floor of the mouth. This case report presents a two-month-old female with an asymptomatic unilateral cheek swelling, diagnosed with a multifocal congenital plunging ranula. Magnetic resonance imaging, ultrasound, and fluoroscopy revealed an atypical, multiseptated submandibular lesion with multifocal sublingual salivary extensions. Needle aspiration of the submandibular lesions yielded mucoid salivary discharge, confirming the diagnosis. The swelling was significantly reduced and the patient continued to achieve all developmental milestones. An appreciation for the complex, multifocal architecture of the lesion on imaging is essential for management because complete excision of the affected salivary glands and extension tracts is required to prevent the recurrence of the ranula.