LAUSR

To the Editors, We wish to appreciate World Journal of Surgery for the excellent editorial and peer-review process that spanned through over a year which led to the publication of our study titled ‘Ranula: Current Concept of Pathophysiologic Basis and Surgical Management Options’ published 13 February 2017 with doi: https://doi.org/10.1007/s00268017-3901-2 [1]. We are glad to inform the Editorial Board of WJS of the tremendous impact the study is already having on the academia globally taking into account the requests so far received from scholars to allow access to the study. We also wish to appreciate Harrison, the author of the Letter-to-the Editor, for the issues raised in his communication, apparently in reaction to our study on which we shall attempt to address. Harrison’s reference to his work on ranula is hereby acknowledged; however, the authors identified an uncommon style with his writing which was not pleasing. We are of the opinion that his message would have still been conveyed without being confrontational. Flexibility with open-mindedness in research is key to learning and future discoveries. His title ‘The pathophysiological basis and surgical management of ranula are established’ is declarative and close-ended. Research on ranula would outlive us as there exists a myriad of unanswered questions considering the dynamics of science/technology today. Our study neither denied the existence of the ‘pathophysiologic basis of ranula’ nor its surgical management but observed the existence of several surgical approaches in somewhat difficult to comprehend combinations by some scholars which we speculate may be the result of a probable gap in scientific knowledge. Our scientific arguments were based on results from our surgical experience over the years contrary to Samant et al. [2] as cited by Harrison, who reported results of different approaches with their outcomes with no clear scientific explanation. The said study cited Patel et al. [3], in an online survey of The American Head & Neck Society which revealed a preference for the removal of the sublingual gland and ranula by 39%—the most preferred, though Harrison was silent on, while sublingual gland resection and evacuation of the contents of the ranula, the least with 13%, yet they drew their conclusion on the latter. The phrase ‘evacuation of ranula contents’ is not clear to us as the technique was not described. Anatomically, there is no direct open connection between the sublingual salivary gland and ranula cyst in a funnel-like fashion that may permit a direct access to the contents and ‘evacuate’. The proponents of the technique are yet to describe the ‘evacuation’ procedure and the ultimate ‘disappearance’ of the cyst. That may be responsible for the reported recurrence rate of 15% with the said study as others had as many as two recurrences with their attendant emotional, social and economic implications. Harrison published in Head & & Daniel Kokong [email protected]