1435 A Review of Literature Reviews: What Is the Quality of Publications That Dictates Best Practice for Managing Plunging Ranulas?

We present a case of an extensive plunging ranula in a 10-year-old boy with a review of literature reviews with a focus on pathophysiology, diagnosis, and the best treatment options. Method PubMed was used as the search engine and the phrase “plunging ranula” was used. The search dates were between 2000-2020. 124 articles were found by the search. Systematic review and review articles in English were then selected and duplicates removed, which narrowed the search down to 10. The abstracts were then reviewed by two data extractors as per PRISMA review guidelines and full articles were then scrutinised for quality control as per AMSTAR2 tool. Results Using the AMSTAR2 tool the overall quality of the reviews was low as most did not fulfil multiple sections in the evaluation tool. Based on case series and meta-analysis of observational studies, opinions varied on the use of diagnostic tools with 80% of the literature reviewed using CT over Ultrasound (60%) and MRI (60%) scans. In all review articles, expert opinion suggested surgery as the best treatment and 50% discussed the benefits of Sclerotherapy as an alternative. 60% discussed the use of aspiration as an intermediate tool in diagnosis and treatment. Conclusion For plunging ranulas, CT scan was most commonly used in the reviews. However, the best evidence for diagnosis and treatment was MRI, US scans and surgery. Temporary symptomatic relief has been achieved with aspiration and enabled the fluid to be analysed for amylase content to aid diagnosis. Evidence is mainly from retrospective observational studies.