A Rare Presentation of Ranula with Supraglottic and Paraglottic Extension Managed via a Hybrid Minimally Invasive Approach

A ranula is a mucus extravasation pseudocyst typically arising from the sublingual gland, usually confined to the oral floor or submandibular space. Extension into the supraglottic and paraglottic spaces by traversing or defect-bypassing the mylohyoid muscle is an exceedingly rare phenomenon that poses a significant risk of critical airway compromise. We report an exceptional case of a right-sided ranula presenting with progressive dyspnea due to extensive posterior involvement reaching the vallecula and paraglottic region. Definitive diagnosis of the plunging ranula was established through a comprehensive framework combining clinical presentation, multimodal imaging (CT, MRI, and ultrasonography), histopathological identification of a non-epithelialized lesion with mucinous extravasation, and biochemical fluid analysis via fine-needle aspiration (FNA) confirming markedly elevated levels of salivary amylase and total protein. To mitigate surgical morbidity and avoid extensive transcervical dissection, a hybrid, minimally invasive therapeutic strategy was employed, combining intraoral sublingual gland excision with postoperative percutaneous ethanol ablation for the deep paraglottic residual pseudocystic lesion. Complete resolution of the lesion was achieved without nerve injury, recurrence, or airway complications during follow-up. This case demonstrates that a sequential combination of transoral excision and ethanol ablation is a safe, effective, and organ-preserving alternative to aggressive open neck surgery for deep-extending plunging ranulas.