Sublingual ranulas, is it time for a new classification? A systematic review and meta-analysis

Objective: Sublingual ranulas present diagnostic and therapeutic challenges due to their heterogenous clinical presentations. This systematic review and meta-analysis aims to synthesize treatment outcomes and proposes a new classification for this condition. Methods: Following PRISMA guidelines, a thorough literature search identified studies on patients with sublingual ranulas receiving medical or surgical treatment. Proportion meta-analysis compared success rates among studies using a random-effects model. Results: 42 studies were included, covering 686 endoral ranulas, 429 plunging ranulas, and 16 ranulas extending into the parapharyngeal space. Sublingual sialoadenectomy with or without pseudocyst wall excision showed low heterogeneity and the highest success rates. Consequently, a new classification system is proposed categorizing ranulas by intraoral (Type 1), cervical (Type 2), or parapharyngeal space (Type 3) extension. Conclusions: This study confirms the role of sublingual gland resection as standard of care and highlights the need for a revised classification to improve patient outcomes.