The Head and Neck 79 



is slow and it may remain quiescent for months. This feature serves 

 to distinguish it from the malignant sarcoma of the periosteum. 



Treatment. The tumor must be freely excised and the wound 

 cauterized with the thermo-cautery. 



Baniila. Retention-Cyst. The term Ranula is generally ap- 

 plied to all cystoid formations appearing in the buccal cavity. The 

 designation is inappropriate and should not be employed in medical 

 or surgical nomenclature. The correct term to employ is reten- 

 tion-cyst and the particular organ or issue concerned should 

 at the same time be specified. Thus, there may be a retention-cyst 

 of Wharton's duct, through cohesion of its margin, or the cyst 

 may be brought about by destruction and dilation of sublingual 

 buccal glands. The latter form is the more common. By augmen- 

 tation, such cysts may burrow into the neck and have for their 

 external limitation the dermis. 



Symptoins and Diagnosis, \yhen the cyst appears in the 

 buccal cavity, one or perhaps two or three swellings are obseryed 

 adherent to the floor of the mouth on either side of the frenum. 

 The tongue is seen to be raised somewhat and displaced to one side. 

 The swellings may vary in size and shape, being sometimes cylindri- 

 cal, at other times round or oval, and may attain the size of a hen 

 or goose tgg. The surface is glairy and slippery and in some cases 

 so translucent as to render the greyish or reddish-yellow, more or 

 less viscid contents plainly visible. 



When the cyst burrows down the neck the formation is charac- 

 terized by its subcutaneous position in the submaxillary region or 

 at the superior extremity of the neck, the mobility of the skin over 

 the cyst, the viscid fluctuating contents, seemingly hard capsule, and 

 entire absence of inflammation. These cysts grow slowly and de- 

 velop without apparent cause. They need not be mistaken for any 

 other condition, excepting perhaps hematomata, but the latter de- 

 velop quickly and have a history of traumatism, and the skin is 

 usually adherent to them. A positive diagnosis can always be made 

 with the aspirator, the thick viscid contents of the retention-cyst not 

 being extractable with a needle of ordinary caliber. 



Treatment. Operative measures are followed with good results. 

 The operator must seek to accomplish the complete excision or des- 

 truction of the cyst wall, and not merely lance and evacuate the 

 contents. Unless the entire capsule is destroyed, secretion will con- 



