We thank Professor John D. Harrison for his expert comments regarding our recent case report “Giant submandibular gland mucocele as a complication of previous sialolith removal”. We agree with most of the points raised by Prof. J. D. Harrison. From the clinical-surgical practice point of view though, we have the following comments:

• (1)
  

  Mucoceles originating from the submandibular gland are extremely rare .

  
  
• (2)
  

  Differential diagnosis from plunging ranulas can be difficult due to their similar appearance, they are both cervical masses located to the submandibular space. The transcervical approach was the treatment of choice in most cases of submandibular gland mucocele we found in the literature. In our case, the cystic mass was emanating from the submandibular gland, which was also removed due to chronic inflammation. No complications regarding vital structures such as lingual, hypoglossal and facial nerves were noted and the patient remains disease free more than a year later.

  
  
• (3)
  

  As regards to the radiographic tail-sign, the presence of a smooth tapered tail sign is not always pathognomonic for ranula . It has been found also in other neck cystic masses. We should also take under consideration the limitations of CT and MRI in the diagnosis of plunging ranula .

  
  
• (4)
  

  Mucous extravasation cysts are in fact pseudocysts devoid of true epithelial lining, while mucous retention cysts are caused by ductal obstructions from inflammation, calculi and stricture. The cystic walls are line with cyboidal or columnar epithelium. Both types can lead to the development of oral, plunging or cervical and mixed ranulas .

  
  
• (5)
  

  Irradiation has been described as a treatment of ranula in the rare patient who cannot tolerate surgery, as a viable alternative. Low doses, from 20–25 Gy are effective .

Yours sincerely

K Markou

S Dova

A Krommydas

S Blioskas

G Psillas

PD Karkos

Conflicts of interest: No.