Ball on the lip
Soft, bluish or normal-colored mucous membrane. The average size in a large series is 0.8 cm.
CONDITION / JAWS, MOUTH AND NECK
Salivary gland cyst and wound.
A salivary gland cyst is a soft swelling filled with saliva: on the lip or in the mouth it is called a mucocele, under the tongue it is called a ranula. Mucocele and ranula are not true cysts, but accumulations of saliva that have flowed from the damaged duct. They usually do not need emergency care, they are treated as planned.
CONCEPTUAL VISUALIZATION- What it is
- Swelling filled with saliva: mucocele - on the lip or in the mouth, ranula - under the tongue, diving ranula - on the neck.
- Where it happens
- Mucocele is most often on the lower lip: in a series of 1715 confirmed cases — 81.9%.
- How we treat
- Mucocele is usually excised. Ranula is treated by removing the hypoglossal gland - according to most reviews, recurrences are the least.
- Urgency
- Usually planned. Swelling under the tongue or on the neck, which prevents breathing - 103.
01 / WHAT IS ITWhat is
What is
mucocele and ranula.
In addition to three pairs of large salivary glands, there are many small ones in the lips, cheeks and under the tongue. If the tiny duct is damaged, the saliva leaks into the tissue and collects in a soft ball. This mucocele is most often a lesion of the small salivary glands. It is benign and often occurs in children and young people: the average age in a series of 1715 cases is 24.9 years.
Ranula is the same accumulation of saliva, but from the hypoglossal gland: a swelling at the bottom of the mouth, under the tongue. If the saliva seeps down through the muscles of the floor of the mouth, a swelling appears on the neck under the jaw — this is a diver's, or cervical, ranula. In a series of 80 such ranulae, most of the changes in the mouth were not visible.
True retention cysts — cysts of the duct, that is, enlargement of the duct itself — look similar, but appear, presumably, due to its blockage and at a different age: in a series of 177 such cysts, the median age is 56 years.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow it
How it
presents.
It is usually a soft, benign swelling. It is important where it is, how fast it grows, and whether it comes back after shedding.
It bursts and turns
The ball can flake off, heal, and later fill up again. Such breaks were described in 366 out of 1715 patients.
Bump under the tongue
A soft swelling on the floor of the mouth under the tongue is what a ranula usually looks like.
Swelling in the neck
A soft swelling under the jaw, often without changes in the mouth, is a diving ranula. It should be distinguished from the bones of the neck.
Lateral cyst of the neckOther places
Mucocele is less common on the lower surface of the tongue, cheek or palate.
03 / REASONSWhy does it appear?
Why does it appear?
and why it returns.
Saliva flows from a damaged duct or stagnates in a blocked one. How to treat depends on the source.
Injury
The lip or mucous membrane was bitten or hit - the duct ruptures. In the series of 1715 mucocele injuries were mentioned by 456 patients.
Sublingual gland
She secretes saliva constantly, and the flow does not stop even when a scar forms around the leak. Therefore, ranula is more likely to return if the gland is left.
Structure of the floor of the mouth
For a diving ranula, a gap in the muscle of the floor of the mouth or a part of the gland below it is described. In a series of 80 diving ranulas, a case occurred in a sibling, so the authors assume a hereditary predisposition.
Blockage of the duct
True cysts of the duct are associated with an obstruction within it; in 90.2% of such cysts, chronic inflammation of the gland was seen under the microscope.
Chronic sialoadenitis
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Mucocele and ranula usually do not require emergency care - they are treated routinely. An exception is a large swelling under the tongue or on the neck, which interferes with breathing or swallowing.
103 immediately if:
- it is difficult to breathe;
- difficulty swallowing or speaking;
- a large, rapidly growing swelling under the tongue, in the mouth, or on the neck.
Do not postpone the visit if:
On the same day: the swelling is red and painful, pus has appeared, the temperature has risen or it is freezing - these are signs of infection. Immediately - to the surgeon who operated, and if it does not work - to the waiting room: pain or swelling increases under the tongue or on the neck after surgery. Temperature of 38 °C and above or pus after surgery - on the same day to the surgeon. In the near future: a lump in the mouth or on the lip is hard, growing, bleeding or not like a soft ball with saliva; the swelling on the neck does not decrease in 2 weeks. It should be examined to distinguish it from other formations. Planned: a soft lump on the lip or under the tongue interferes, bursts and reappears.
05 / DIAGNOSTICSAs defined,
As defined,
what is it
- Discussion and review
The doctor examines the mouth and neck, asks whether there was an injury, how long ago the swelling appeared and whether it burst.
- Ultrasound, MRI or CT scan
First of all, they are needed for diving ranula: they show where the saliva has spread - under the tongue, on the neck or deeper, to the pharynx - and that it comes from the hypoglossal gland.
- Histology
The removed tissue is examined under a microscope. In a large series, mucoceles were mostly (78%) treated as such — they were removed completely and sent for research.
06 / TREATMENTHow we treat
How we treat
salivary gland cyst.
The goal is to remove the source of the saliva, not just empty the ball. Comparative randomized trials are few, so the method is chosen based on size, location, and whether there has been recurrence.
01
Mucocele
Lip, cheek, tongue.
- Excision
- The most common method is to excise the mucocele completely and examine the tissue under a microscope.
- Other methods
- Micromarsupialization (through the wall of balls form a passage for the outflow of saliva), laser, cryotherapy, steroid injections, sclerosing substances. In a meta-analysis of randomized trials, the recurrence rate after scalpel, CO2 laser, and marsupialization did not differ significantly.
- Complications
- In a meta-analysis of 6 studies, relapses occurred no more often after minimally invasive methods than after surgery, and there were fewer overall complications and nerve damage.
- Relapse
- In a series of 1901 cases, repeated mucoceles accounted for 6.2%; more often — in patients under 20 years old, with a size of more than 2 cm, on the lower surface of the tongue, and also after laser treatment compared to conventional surgery.
02
Ranula
The floor of the mouth under the tongue.
- Together with the gland
- In a review of 71 studies (809 patients), ipsilateral sublingual excision resulted in less than 10% recurrence. Another meta-analysis of 42 studies also showed the highest success rate of this operation.
- Without removing the gland
- After excision without a gland and marsupialization, recurrences in different groups of patients were 15–30%; most relapses — in the first 3–6 months.
- Sclerotherapy
- A substance is injected into the ranula, which causes the discharge to scar. The result depends on the drug: in the review, relapses after bleomycin — 3–10%, after OK-432 — more than 50%, especially with diving ranula. It can be done only when the tumor has been reliably excluded.
- What we don't know
- In a network meta-analysis of 18 non-randomized studies, no method had a clear advantage and the quality of evidence was low or very low.
03
Diving ranula
Swelling in the neck.
- Oral access
- The hypoglossal gland and the oral part of the ranula are removed. In a meta-analysis of 39 series, the frequency of treatment through the mouth and through a neck incision did not differ significantly; no significant difference in complications was found either, although there were more of them after access through the neck.
- What's nearby
- The duct of the submandibular gland, the lingual nerve and an artery pass near the hypoglossal gland. Possible complications — nerve dysfunction and hematoma; the doctor will explain the risks before the operation.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Mucocele, ranula and cysts of the salivary glands at Dr. Valikhnovskyi's Institute of Surgery are treated in the "New Face" direction: the surgeon assesses where the saliva is flowing from and chooses a treatment method together with you.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Consultation and assessment — the surgeon examines the mouth and neck, finds out how long ago the swelling appeared, whether it burst and returned after treatment.
- Personal plan — the method of treatment, taking into account the location, size and recurrences, as well as the fact that the removed tissue should be examined.
- CT - if necessary - for swelling in the neck to see where the fluid has spread.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a photo of the swelling in the mouth or neck and the results of the ultrasound, if any - the doctor will evaluate the situation beforehand.
- ConsultationExamination of the mouth and neck; if necessary, ultrasound, MRI or CT scan.
- PlanWhat is the method, is it necessary to remove the hypoglossal gland, what to expect after the intervention.
- Follow-upControl examinations, especially in the first months, when relapses occur more often.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Can a mucocele pass itself?
It happens that the balloon bursts and deflates, but later fills up again: in a series of 1715 cases, such ruptures were described in 366 patients. If it interferes or returns, it is removed.
Why is the ranula removed together with the gland?
Because saliva flows precisely from the hypoglossal gland, and it secretes saliva constantly. If the gland is left, the ranula is more likely to return: in a review of 71 studies, 15–30% after operations without the gland versus less than 10% with it.
Can the cyst return after treatment?
Maybe The frequency depends on the method; with ranula, most relapses occur in the first 3–6 months, so follow-up examinations are important.
Will there be an incision on the neck with a diving ranula?
Not necessarily. In a meta-analysis of 39 series, oral and cervical treatment were comparable, and there were fewer complications after oral access, although the difference was not significant. The method is chosen after the examination.
Is it not cancer?
Mucocele and ranula are benign. But a lump in the mouth, on the lip or on the neck that does not go away, grows or hardens, should be shown to the doctor, and the removed tissue is examined under a microscope.
The child has a ball on his lip. What to do?
Mucocele often occurs in children and young people. Show the child to the doctor: he will assess whether removal is necessary and in what way.
Sources
19 sources · reviews, meta-analyses, case series and NHSshowCollapse
- Management of Mucoceles, Sialoceles, and RanulasOtolaryngologic Clinics of North America, 2021doi:10.1016/j.otc.2021.03.002 ↗
- Modern management and pathophysiology of ranula: literature reviewHead & Neck, 2010doi:10.1002/hed.21326 ↗
- Systematic Review and Meta-Analysis of the Management and Outcomes of Recurrent RanulasOral Diseases, 2026doi:10.1111/odi.70274 ↗
- Treatments to Avoid Ranula Recurrence: A Network Meta-AnalysisJournal of Oral Pathology & Medicine, 2025doi:10.1111/jop.70041 ↗
- Sublingual ranulas, is it time for a new classification? A systematic review and meta-analysisJournal of Laryngology & Otology, 2025doi:10.1017/S0022215124001464 ↗
- Comparison of outcomes of treatment for ranula: a proportion meta-analysisBritish Journal of Oral and Maxillofacial Surgery, 2019doi:10.1016/j.bjoms.2019.06.005 ↗
- Excision of Sublingual GlandOral and Maxillofacial Surgery Clinics of North America, 2021doi:10.1016/j.coms.2020.12.001 ↗
- Ranula in children: Retrospective study of 25 years and literature review of the plunging variableInternational Journal of Pediatric Otorhinolaryngology, 2021doi:10.1016/j.ijporl.2021.110810 ↗
- Plunging ranula: congenital or acquired?Otolaryngology–Head and Neck Surgery, 2010doi:10.1016/j.otohns.2009.10.014 ↗
- Sclerotherapy for Benign Cystic Lesions of the Head and Neck: Systematic Review of 474 CasesOtolaryngology–Head and Neck Surgery, 2021doi:10.1177/01945998211000448 ↗
- Evaluating the outcomes of minimally invasive therapy vs surgery for oral mucoceles: a systematic review and meta-analysisJournal of Evidence-Based Dental Practice, 2023doi:10.1016/j.jebdp.2023.101841 ↗
- Comparison of the recurrence rate of different surgical techniques for oral mucocele: A systematic review and Meta-AnalysisMedicina Oral, Patología Oral y Cirugía Bucal, 2023doi:10.4317/medoral.26015 ↗
- Oral mucoceles: a clinicopathologic review of 1,824 cases, including unusual variantsJournal of Oral and Maxillofacial Surgery, 2011doi:10.1016/j.joms.2010.02.052 ↗
- Oral mucoceles: A Brazillian Multicenter Study of 1,901 CasesBrazilian Dental Journal, 2022doi:10.1590/0103-6440202204965 ↗
- Intraoral Salivary Duct Cyst: Clinical and Histopathologic Features of 177 CasesHead and Neck Pathology, 2017doi:10.1007/s12105-017-0810-5 ↗
- Dental abscessNHS, 2026nhs.uk/conditions/dental-abscess ↗
- Symptoms of mouth cancerNHS, 2023nhs.uk/conditions/mouth-cancer/symptoms ↗
- LumpsNHS, 2024nhs.uk/symptoms/lumps ↗
- Salivary gland stonesNHS, 2023nhs.uk/conditions/salivary-gland-stones ↗
The figures on the page are from these sources.
Ball on the lip
or under the tongue?
Send a photo of the swelling. The doctor will tell what it can be and how to treat it.