Transoral robotic surgery—excision of a ranula
by Rohan R Walvekar

Jaypee’s Video Atlas of Operative Otorhinolaryngology AND Head & Neck Surgery

by Vicky S Khattar, Bachi T Hathiram
About Video

This procedure is indicated for the removal of floor of mouth ranulas, and offers the benefits of magnification, excellent exposure, stable surgical viewline of sight surgery and the ability of the surgical team to view surgical steps and, hence, better assistance over the traditional transoral approach. The removal of a Ranula from the floor of the mouth using the da Vinci Robotic system with three arms docked into the oral cavity has been demonstrated in this video. A mucosal incision is made approximately one centimeter medial to the surface of the mandible over the ranula. All precautions are taken to preserve the mucosa of the floor of the mouth. The incision is typically 4 to 5 cm long in the anteroposterior direction. Care is taken to avoid damage to the submandibular gland papilla in the floor of the mouth. The sublingual gland is dissected submucosally from the sublingual fossa exposing the main trunk and the terminal branches of the lingual nerve. The gland is retracted medially and freed from the underlying mylohyoid muscle which is the deep limit of the dissection. The posterior limit is the anterior portion of the submandibular gland. Following removal of the ranula, the mucosa, which was preserved in the floor of the mouth, is now sutured, taking care not to use continuous sutures, thus allowing for drainage of blood/saliva which may collect in the dissected space. Closure can be accomplished with the use of a robot or by traditional methods.

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