Plunging ranulas – not quite a “frog” in your throat

What causes ranulas and plunging ranulas?

The short answer is that nobody knows. We do know, however, they tend to be more common in men than women, and there is a higher incidence in Polynesian populations.

What does this have to do with frogs?

I promised a discussion about the name and its relationship to frogs. I was taught the term ranula is borrowed from the Latin, meaning a little frog or tadpole. French physician and surgeon Guy de Chauliac is credited with coining the term in the Middle Ages, around 1300. Ranula comes from the Latin word rana which means frog. Medical students are taught ranulas look like frog bellies, hence the name. But it might not be so simple. In 2014, French medico Dr Phillippe Albou revealed some convincing evidence to the contrary in his paper “La présence des volatiles, des animaux aquatiques et des insectes dans le langage medical”, or in English, “The presence of birds, water animals and insects in medical terminology” (Albou 2014).

Albou agrees the term ranula is based on a very old metaphor. “Frog” in Greek was already used in the 6th century by Aetius of Amida, a Byzantine Greek physician and medical writer, to designate “a swelling under the tongue, which is called frog” (Skoda 1988). A century later, Paul of Aegina, another Byzantine Greek physician, added that “the ranula is an inflammatory cyst which occurs under the tongue, especially in small children” (Dechambre 1864-1880). Albou’s research among the published works of ancient medical practitioner-writers offers a number of alternative explanations:

Operation for removal of ranula from a 15th Century Turkish Manuscript

1. Avicenna, a Persian polymath born in 980 AD, and Abulcasis, an Arab Andalusian surgeon and physician born 936 AD, both compare a simple ranula to a “small frog” (Dechambre 1864-1880);
2. Actuarius, a Byzantine physician at the beginning of the 14th century, claims the name ranula is derived from “the shape of the neck of the sick, which would be similar to the shape of an amphibian” (Dechambre 1864-1880);
3. other authors, like Ambroise Paré, a French barber surgeon who served royalty in the 16th Century, thought that ranula was used, “because the patients can hardly articulate and interpret their language if not by croaking” (Paré 1630);
4. Lazare Rivière, a physician who served Louis XIII in the 17th Century, provides another explanation that may be a bit far-fetched. According to him, the tumour develops under the tongue “in this part where it is attached to the ligament or net”, so that “the middle seam separating the right part of the tumour from the left, represents the posterior part of a frog, hence the name for the disease “ (Rivière 1702).

I have to say, Rivière’s theory makes as little sense to me as the translation. The best I can do is suggest he is referring to frenulums and frog’s bums. I’ve included a couple of pictures so you can make up your own mind.

Generally, this amphibious metaphor was adopted in other European medical terminology: rana in Latin and Spanish, ranula in English and Italian, and German: Ranula, Frosch (frog), Fröschlein (little frog) or Froschgeschwulst (literally: “frog tumour”).