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Salivary gland surgery is a common procedure in otorhinolaryngology. Parotidectomy and submandibulectomy represent the treatment of choice in benign and malignant tumors of the salivary glands. However, as to this point there are no guidelines are concerning diagnostic and therapeutic approaches of benign and malignant tumors of the salivary gland. Since the introduction of sialendoscopy there are new diagnostic and therapeutic procedures available in treating obstructive sialadenitis. The present article provides an overview of anatomical principles, diagnostic approaches and the most important salivary gland surgeries for future otorhinolaryngologists under specialist training., (© Georg Thieme Verlag KG Stuttgart · New York.)

Conclusion The diagnosis of immunoglobulin G4-related disease (IgG4-RD) should be based on the morphology of tissue biopsy, and this study recommends a submandibular gland (SMG) biopsy for accurate diagnosis and to exclude malignant disease. Objective To clarify which type of biopsy specimen (SMG or labial salivary gland [LSG]) should be taken from patients with IgG4-RD. Methods This study included 33 patients with IgG4-RD (21 women; 12 men) who were subjected to both SMG and LSG biopsies at Sapporo Medical University between 2011-2015. Tissues obtained from the SMG and LSG specimens were evaluated. Results All SMG specimens satisfied the diagnostic criteria for IgG4-RD, whereas 19 (57.6%) LSG specimens satisfied the diagnostic criteria for IgG4-RD. Histological evaluation showed fibrosis in all the SMG specimens and in eight LSG specimens (24.2%). Obliterative phlebitis was seen in nine SMG specimens (27.3%), but it was absent in all the LSG specimens.

Purpose: Some believe that the recurrence of sublingual ranula results from incomplete removal of the sublingual gland (SLG), but recurrence remains in some patients who undergo repeated excision of the remnant SLG, and the final solution to the recurrence is to remove the ipsilateral submandibular gland (SMG). In the authors' experience, preoperative aspirate from a sublingual ranula was a thick mucus-like fluid resembling egg white, whereas that from recurrent cyst after removal of the SLG was thin serous fluid. Based on the difference of the aspirated fluids, the authors speculated that the recurrent cystic mass might not be a ranula, but rather iatrogenic saliva leakage from the SMG through the previous surgically damaged excretory duct of the SLG (Bartholin duct) that opens into the SMG duct (Wharton duct)., Materials and Methods: A gross anatomic study was performed of the ductal system of the SLG and the anatomic communication between the Bartholin duct and Wharton duct., Results: Four anatomic SLG duct variants were found. 1) The SLG has 1 Bartholin duct that seems to fuse with the Wharton duct but does not join the Wharton duct, running parallel to the Wharton duct and opening at its own orifice adjacent to and a short distance from the orifice of the Wharton duct (35.8%). 2) The SLG has 1 Bartholin duct that empties into the middle section of the Wharton duct (32.1%). 3) The SLG has 2 Bartholin ducts, one of which joins the Wharton duct and the other opens at its own orifice near that of the Wharton duct on the floor of the mouth (7.1%). 4) The SLG has many fine ducts (Rivinus ducts) that open at the floor of the mouth with no relation to the Wharton duct (25.0%). Of the 4 anatomic SLG duct variations, types 2 and 3 form immediate anatomic communication between the Bartholin duct and Wharton duct (39.2%)., Conclusions: Several conclusions can be made from the present anatomic findings. 1) A certain proportion of Bartholin ducts open into the Wharton duct, and "recurrent ranula" after removal of the SLG can result from iatrogenic saliva leakage from the SMG through the surgically severed Bartholin duct if the aspirated fluid from the "recurrent cyst" is a thin seriflux. 2) The Bartholin duct emptying into the Wharton duct should be ligated during removal of the SLG to prevent local saliva accumulation from the SMG or even caudal "recurrence" as plunging ranula. 3) The surgical incision for SLG removal should be sutured loosely so that the surgically severed Bartholin duct with communication to the Wharton duct can reopen at the floor of mouth as an outlet for possible saliva leakage from the SMG and saliva accumulation can be avoided., (Copyright © 2015. Published by Elsevier Inc.)

Introduction: Submandibular swelling most frequently involves the submandibular gland. It is often due to lithiasis or to tumor. Some rare cases of submandibular swelling have been reported such as submandibular localizations of thyroid lesions. Our case study concerns one of these rare occurrences., Observation: A 47-year-old female patient consulted for a right-sided submandibular mass progressively increasing in size during the previous 2 years. The patient had undergone a total thyroidectomy, 4 years before consulting, for a toxic multinodular goiter THAT had been treated by L-thyroxin replacement therapy per os since the surgery. TSH and LT4 levels were normal. A CT scan revealed a large tumor in the right submandibular space with heterogeneous contrast. Fine needle cytopuncture allowed observing follicular cellules suggesting thyroid origin. The cervicotomy confirmed the diagnosis of an ectopic goiter., Discussion: Thyroid disorders may in rare cases concern the submandibular space. A history of thyroid disorders should be taken into account for the etiological diagnosis of unusual submandibular masses in maxillo-facial surgery., (Copyright © 2014. Published by Elsevier Masson SAS.)

The mylohyoid hiatus and hernia were discovered in the nineteenth century and were considered to explain the origin of the plunging ranula from the sublingual gland. This formed the rationale for sublingual sialadenectomy for the treatment of plunging ranula. However, a more recent, extensive histological investigation reported that hernias contained submandibular gland, which supported an origin of the plunging ranula from the submandibular gland and submandibular sialadenectomy for the treatment of plunging ranula. We therefore decided to investigate the occurrence and location of the hiatus and the histological nature of the hernia. Twenty-three adult cadavers were dissected in the submandibular region. The locations and dimensions of mylohyoid hiatuses were measured before taking biopsies of hernias. Hiatuses with associated hernias were found in ten cadavers: unilateral in six; and bilateral in four, in one of which there were three hiatuses. Sublingual gland was identified in nine hernias and fat without gland in six. This investigation supports clinical and experimental evidence that the plunging ranula originates from the sublingual gland and may enter the neck through the mylohyoid muscle. It confirms the rationale of sublingual sialadenectomy for the treatment of plunging ranula., (Copyright © 2013 Wiley Periodicals, Inc.)

A 56-year-old man was admitted to our hospital for renal dysfunction and symmetrical swelling of submandibular glands. Laboratory and imaging findings were consistent with immunoglobulin G4-related disease (IgG4RD). Histological findings of the submandibular gland and the kidney were also consistent with IgG4RD. However, the patient did not have elevated serum or tissue IgG4 levels. Oral prednisolone therapy, initially 50 mg/day and gradually tapered over 12 months, improved his laboratory abnormalities and the swelling of his affected organs. These findings prompted our final diagnosis of IgG4RD. IgG4RD is a newly recognised disease with an unknown aetiology. This case suggests that IgG4 antibodies do not play a primary role in the aetiology of IgG4RD. Furthermore, clinicians should not exclude the diagnosis of IgG4RD in patients lacking elevated IgG4 levels in their affected tissues, particularly if they have other features of IgG4RD. Steroid therapy should be considered for such patients.

Wegener's granulomatosis is one of the anti-cytoplasmic autoantibodies (ANCA)-associated vasculitides. Although it typically affects the lungs and kidneys, the head and neck are also involved in most cases but the site usually affected is the upper airway. However, there are 35 cases with well-documented clinicopathological data in which Wegener's granulomatosis manifested in the major salivary glands, most commonly the parotid. Twenty-four patients presented with salivary signs and symptoms, in eight of whom there was no other presenting manifestation. These signs and symptoms may mimic infection or neoplasia and laboratory investigations, including ANCA serology and histopathology, may be non-specific; thus, in 21 of the 35 patients (60%) there was a delay in diagnosis. Amongst the 21 were 11 of the 14 (78.6%) patients who presented with unilateral parotid disease and three of the five who died. Three other patients suffered permanent pulmonary, two renal and five facial nerve damage. This article reviews the literature on major salivary gland involvement in Wegener's granulomatosis, which should be considered in the differential diagnosis of major salivary gland disease particularly if commoner causes have been excluded. A detailed medical history, and persistently inconclusive laboratory tests, could provide the clues that enable prompt diagnosis., (© 2012 John Wiley & Sons A/S.)

Purpose: Salivary glands are significantly affected when head and neck cancer patients are treated by radiation. We evaluated the effect of human keratinocyte growth factor (hKGF) gene transfer to murine salivary glands on the prevention of radiation-induced salivary hypofunction., Experimental Design: A hybrid serotype 5 adenoviral vector encoding hKGF (AdLTR(2)EF1α-hKGF) was constructed. Female C3H mice, 8 weeks old, were irradiated by single (15 Gy) or fractionated (6 Gy for 5 days) doses to induce salivary hypofunction. AdLTR(2)EF1α-hKGF or AdControl was administered (10(8) - 10(10) particles per gland) to both submandibular glands (SG) by retrograde ductal instillation before irradiation (IR). Salivary flow was measured following pilocarpine stimulation. Human KGF levels were measured by ELISA. SG cell proliferation was measured with bromodeoxyuridine labeling. Endothelial and progenitor or stem cells in SGs were measured by flow cytometry. The effect of SG hKGF production on squamous cell carcinoma (SCC VII) tumor growth was assessed., Results: In 3 separate single-dose IR experiments, salivary flow rates of mice administered the AdLTR(2)EF1α-hKGF vector were not significantly different from nonirradiated control mice (P > 0.05). Similarly, in 3 separate fractionated IR experiments, the hKGF-expressing vector prevented salivary hypofunction dramatically. Transgenic hKGF protein was found at high levels in serum and SG extracts. AdLTR(2)EF1α-hKGF-treated mice showed increased cell proliferation and numbers of endothelial cells, compared with mice treated with AdControl. hKGF gene transfer had no effect on SCC VII tumor growth ± radiation., Conclusions: hKGF gene transfer prevents salivary hypofunction caused by either single or fractionated radiation dosing in mice. The findings suggest a potential clinical application., (©2011 AACR.)

Objective: To assess the histopathological, immunohistochemical (IHC), and in situ hybridization (ISH) features found in the submandibular (SM) and sublingual (SL) glands of 105 acquired immunodeficiency syndrome (AIDS) patients at autopsy., Study Design: Gender, age, CD4 cell level, and clinical histories were obtained from clinical charts (SM: n = 103; SL: n = 92). Histologic analysis of hematoxylin and eosin, Gomori-Grocott, and Ziehl-Neelsen stained tissues, IHC to detect infectious agents and characterize inflammatory cells in sialadenitis, and ISH for EBER-1/2 were performed., Results: The mean age of the patients and CD4 cell count were 36 years and 76 cells/microL, respectively. Fifty-eight cases (SM: n = 51 [49%]; SL: n = 54 [59%]) were considered to be microscopically normal. The most common infectious conditions were mycobacteriosis (SM: n = 11 [10%]; SL: n = 7 [7%]), followed by cytomegalovirus (CMV) (SM: n = 14 [13%]; SL: n = 2 [2%]), and cryptococcosis (SM: n = 3 [3%]; SL: n = 4 [4%]). Human immunodeficiency virus (HIV) p24 (SM: n = 2 [2%]; SL: n = 1 [1%]) and EBER-1/2 (SM: n = 9 [39%]; SL: n = 4 [20%]) were seen only in macrophages and lymphocytes, respectively. The most prevalent cells seen in chronic nonspecific sialadenitis (SM: n = 25; SL: n = 25) were CD8+ T lymphocytes, whereas CD68+ macrophages were predominant in the mycobacteriosis-associated granulomatous and nonspecific diffuse macrophagic sialadenitis. Concomitant infections occurred in 5 cases (SM: n = 4; SL: n = 1) and non-Hodgkin lymphoma in 1 case., Conclusions: Infectious diseases and chronic nonspecific sialadenitis were the main alterations found in the SM and SL glands. These alterations were greater in the SM than in the SL glands. CD8+ T lymphocytes and CD68+ macrophages might be relevant to the pathogenesis of the sialadenitis. Clinicians should consider these diseases when assessing the major salivary glands in advanced AIDS patients and follow biosafety procedures to avoid contamination by HIV, CMV, mycobacteriosis, and cryptococcosis.

The present study was performed for determining the optimal timing of MR sialography by use of the Japanese pickled plum (umeboshi) for promoting secretion by the salivary glands. MR sialography was performed in four healthy male volunteers. The four volunteers were examined before and 10 min after stimulation with umeboshi. On the next examination, three volunteers were examined before and after umeboshi stimulation every 1 min up to 5 min to allow assessment of the temporal changes in duct visualization. Dilatation of the salivary gland ducts and improvement of the visualization of the ducts were obtained after stimulation with umeboshi. The difference in the dilatation of the parotid duct was statistically significant. In the temporal study, the salivary gland ducts were shown to be dilated at 2 min after stimulation. As a result, 2 min after stimulation is the optimal timing for MR sialography by use of umeboshi as a stimulator of salivary secretion.

The utility and cost effectiveness of salivary gland fine-needle aspiration (FNA) is controversial. Some authorities argue FNA has no added value over clinical-radiographic study because most salivary gland nodules occur in the parotid and the tumor's relationship to the facial nerve determines the operative procedure rather than the histology. Other experts contend FNA is of value by reducing the overall number of operative procedures performed. We studied 306 salivary gland nodules (214 parotid and 92 submandibular gland) undergoing FNA. One hundred and seventy one were subsequently surgically resected and the remaining 135 followed clinically. A 16% error rate was associated with the nonoperative group, necessitating later surgical resection. The cost of the FNAs and surgical resections (when performed) was calculated based on Medicare reimbursement rates. Costs were based on all cases undergoing initial FNA. The expense of initial resection was based on the observed percentage of patients undergoing resection in our series. The costs of resections related to erroneous FNA diagnoses were based on the error rate associated with FNA diagnoses clinically followed (i.e., chronic sialadenitis). Costs of FNAs, initial resections, and subsequent resections related to FNA errors were summed and compared with the cost which would have occurred if all nodules had been primarily resected.FNA reduced the number of operative procedures by approximately 65% for submandibular nodules and 35% for parotid nodules. Diagnoses which resulted in nonsurgical management included chronic radiation-induced sialadenitis, intraparotid lymph node, recurrent lymphoma, and accessory nodules or lobes of the parotid gland. Pure surgical management was associated with a cost of $275,750.00 per 100 patients. FNA management was associated with an expenditure of $206,632.00 per 100 patients, representing a savings of $69,118.00 (33% savings over surgical management alone). Based on these data, FNA appears to be cost effective in addition to supplying preoperative diagnoses helpful in counseling, operative planning, and allaying patient anxiety.

The term mucocele is referred to two concepts: the extravasation cysts resulting from salivary glandular duct rupture, with mucin leakage into the surrounding peri-glandular soft tissue, and the retention cysts, caused by a glandular duct obstruction and resulting in a decrease or even an absence of glandular secretion. Mucocele can not be considered as a true cyst because its wall lacks an epithelial lining. These lesions are very common in the minor salivary glands (particularly in the labial glands), but are very infrequent in the major salivary glands--including the submaxillary glands. The present study describes a clinical case of a right submaxillary gland mucocele resolved by surgical treatment and reviews the differential diagnosis with other clinical entities.

Sjögren's syndrome is an autoimmune disease in which lymphocytic infiltrates develop in the exocrine glands. Pathogenetic aspects of the disease can be studied in the nonobese diabetic (NOD) mouse strain, a spontaneous model for Sjögren's syndrome. Apoptosis may play a role in the initation phase and in the effector phase of autoimmune diseases. Here, we have examined the role of apoptosis in the development of sialoadenitis in the NOD mouse. Apoptotic cells and the expression of apoptosis-related molecules were studied in submandibular glands (SMG) of NOD and NOD-scid mice before and after the onset of sialoadenitis. Numbers of apoptotic cells were not increased as compared with control mice, at any age. By immunohistochemistry, we demonstrated increased expression of Fas, Fas ligand (FasL), and bcl-2 on SMG epithelial cells of NOD and NOD-scid mice, as early as 3 days of age. mRNA expression of Fas and FasL was also examined in SMG by RQ-PCR. Low-level expression of Fas and FasL mRNA was observed in all mouse strains, from 1 day of age onward. We conclude that increased protein expression of Fas and FasL on SMG epithelial cells of NOD and NOD-scid mice probably indicates a genetically programmed abnormality in these cells that may form a trigger for the development of sialoadenitis in NOD mice. Because increased numbers of apoptotic cells were not observed, a role for actual apoptosis in the initiation or effector phase of sialoadenitis in the NOD mouse is unlikely.

Background and Purpose: MR sialography has become an alternative imaging technique for ductal salivary gland diseases. We compared the diagnostic accuracies of MR sialography and digital subtraction sialography in patients with successful completion of both examinations and benign salivary gland disorders., Methods: In a prospective study, we attempted to examine salivary glands in 80 patients with clinically suspected diagnoses of sialadenitis and/or sialolithiasis. Each patient underwent digital subtraction sialography and MR sialography. MR sialography was obtained with a T2-weighted single-shot turbo spin-echo sequence (TR/TE 2800/1100 msec, acquisition time 7 seconds), with use of a quadrature head coil. Final diagnoses were confirmed by clinical follow-up and results of biopsy (n = 9) or surgery (n = 19)., Results: Failure rate was 5% (four of 80) for MR sialography and 14% (11 of 80) for digital subtraction sialography. Eighty-one salivary glands (48 parotid, 33 submandibular) in 65 patients were successfully visualized with both modalities. MR sialography depicted the main ductal system and first- and second-order branches, whereas digital subtraction sialography was able to depict third-order branches. Sensitivity and specificity to diagnose chronic sialadenitis were 70% and 98% with MR and 96% and 100% with digital subtraction sialography. MR sialography enabled diagnosis of sialolithiasis with a sensitivity of 80% and a specificity of 98% versus 90% and 98% for each with digital subtraction sialography., Conclusion: MR sialography with a heavily T2-weighted sequence is highly successful in the noninvasive visualization of the ductal system of major salivary glands. It is useful for diagnosing sialolithiasis and sialadenitis. Digital subtraction sialography, an invasive technique, had a substantial procedural failure rate, particularly for the submandibular duct. However, because of its higher spatial resolution, successfully completed digital subtraction sialography achieved superior diagnostic information compared with that of MR sialography.

A variable response following ductal ligation of feline salivary glands corresponds to the human condition but contrasts with a predictable atrophy in obstructed salivary glands of rodents popularly used as a model for human salivary problems. The present investigation is concerned with a possible reason for the variable response, namely the preservation of the innervation. Ducts of feline submandibular and sublingual salivary glands were ligated with or without the inclusion of the chorda tympani. Inclusion led to a delayed initial response followed by progressive atrophy until the parenchyma was extremely atrophic, whereas avoidance of the chorda led to the variable response in which variable numbers of acini of a similar form to normal persisted. The results establish the atrophic effect of inclusion of the chorda tympani in ductal ligation and indicate the caution that should be exercised in the extrapolation of the rodent model to the human condition.

The salivary gland is considered to be a reservoir of many growth factors in rodents. In humans, the epidermal growth factor, basic fibroblast growth factor, and insulin and insulin-like growth factor family have also been detected in this gland, but their physiological role remains unclear. In this study, we focused on bFGF, which is a well-known mitogen for various types of cells, and is present in the salivary gland as well as in saliva. The roles of bFGF in the salivary gland were investigated by three different procedures. First, the effects of bFGF on the salivary gland cells were investigated with a monolayer culture of normal submandibular gland cells. The effects of different concentrations of bFGF on the second passage of these cultured cells were examined. In both human and rat cultured submandibular gland cells, bFGF accelerated the cell proliferation at a concentration of 100 ng/mL or higher. Next, an atrophic model of the rat submandibular gland was used to examine the ability of bFGF to accelerate tissue repair. Two weeks after ductal ligation, the ligature was removed, and various amounts of bFGF, isoproterenol, or saline were administered via a retrograde duct instillation. Both isoproterenol and bFGF increased acinar and ductal cell proliferation significantly. To determine the role of bFGF in saliva, we investigated its effect on the healing process of oral mucosal defects. Four-millimeter mucosal defects were made to the depth of the periosteum in the rat palate under anesthesia. bFGF or vehicle alone was applied once only at the time of surgery as a suspension. At days 3, 5, and 7 in the bFGF group, significant increases in the degree of re-epithelialization were found in treated groups. These results indicate that its action as a mitogen stimulus is the major effect of bFGF on salivary gland cells and mucosal epithelium.

Trefoil factors are wound-healing peptides important in protection and healing of the human gastrointestinal tract. Their potential for therapy of gastrointestinal ulcers has been established. This study investigated the hypothesis that trefoil factors are also present in human salivary gland. Tissues from surgical biopsy specimens were collected fresh into ice and stored in liquid nitrogen. Breast, stomach, and colon constituted positive controls. Trefoil factor mRNAs were detected by reverse transcription polymerase chain reaction (RT-PCR) or by in situ hybridization (ISH) with formalin-fixed, paraffin-embedded sections. Amplified DNA fragments were ligated into pGEM-T Easy vector and used to transform competent Escherichia coli JM109, allowing sequencing to confirm identity of cloned fragments. Generation of amplifiable cDNA was confirmed using primers specific to the ubiquitously expressed abl gene. By RT-PCR, TFF1 (pS2) mRNA was detected in 14 of 15 glands, TFF3 (hITF) mRNA in 13, and TFF2 (hSP) in only 1 gland. ISH of 15 glands (7 of which had been studied by RT-PCR) showed the same pattern of expression and indicated that TFF1 mRNA was usually expressed at low levels by a few mucous cells, whereas TFF3 was produced abundantly by most mucous cells. There was no difference in patterns of expression comparing parotid, submandibular, and minor mucous glands. Nor was there an obvious relationship between trefoil factor expression and pathology, but those glands not expressing TFF1 or TFF3 had evidence of chronic inflammation or atrophy. Trefoil factors are likely to be important in healing, predisposition to, and therapy of, oral diseases.

This article discusses the embryology and surgical treatment of diseases of the salivary glands, which require precise knowledge of anatomy. Knowledge of the course of the facial nerve enables safe removal of parotid tumors. The submandibular gland is associated intimately with the lingual and hypoglossal nerves.

Aims: Microlithiasis was investigated in parotid sialadenosis and chronic submandibular sialadenitis to determine if it relates to the glandular microenvironment as has been found experimentally., Methods and Results: Semithin sections were stained by a mixture of methylene blue and Azure II followed by basic fuchsin, which stains calcified parts of microliths red and organic parts green, and ultrathin sections were examined electron microscopically and microanalytically. Microliths in sialadenosis were found in periacinar stroma, in which necrotic acinar cells were found, and in parenchyma, and consisted of consolidated organic material with little or no crystalline calcium. Microliths in sialadenitis were found in stroma, particularly around intercalary ducts, in lumina and in parenchyma, and contained much crystalline calcium. Macrophages enclosed some microliths., Conclusions: The paucity of calcium in microliths in sialadenosis and the abundance in sialadenitis relates to the glandular calcium. The periacinar distribution of microliths in sialadenosis possibly relates to formation in periacinar necrotic debris. The distribution of microliths in sialadenitis around intercalary ducts possibly relates to formation in matrix vesicles formed from atrophic parenchyma, and in lumina to formation in stagnant secretory material. Microliths appear to be scavenged by macrophages. Thus the experimental finding that salivary microlithiasis relates to the microenvironment pertaining in humans.

Bilateral dysgenetic polycystic disease of parotid glands is an extremely rare pathologic condition in which salivary parenchyma is partially replaced by multiple epithelial-lined cysts arising from intercalated ducts. Review of the fourteen cases published in literature shows that it affects nearly exclusively women with an history of asymptomatic progressive enlargement of almost always both parotid glands. We report here the first case, to our knowledge, of a polycystic disease involving both submandibular salivary gland in a man.

Actynomicosis of the submaxillary gland is a very uncommon infectious disease. In this article one case of submaxillary sialolithiasis by actynomices israelii in a young girl is presented. We discuss several aspects of its diagnosis and therapeutic possibilities and review the literature on the subject. We emphasize the interest and value of performing a microbacteriological, mineralogical and pathological study of the calculi.

Benign connective tumours of the canine salivary glands are rare. This report describes lipomatous infiltration of parotid or submandibular salivary glands in seven dogs in which the glands were enlarged as a result of infiltration by fat cells; they appeared to have been successfully treated by local excision. The precise cause of the lipomatous infiltration in the dogs is unclear but different causes of similar lesions in humans are discussed.

We describe a patient in whom bilateral swelling of submandibular glands was the initial manifestation of limited Wegener's disease. The diagnosis was based on positive anti-neutrophil cytoplasmic antibody [C-ANCA], dense inflammatory infiltrate predominantly of lymphocytes in submandibular glands, presence of non-caseating ill-formed granulomas in transbronchial biopsy and resolution of symptoms following immuno-suppressive treatment.

In a 29 year old Japanese woman with SLE, a bilateral submandibular mass was detected. Computed tomographic (CT) scan suggested inflammatory changes around the submandibular glands. Histological findings of the deep skin biopsy showed typical changes of lupus erythematosus profundus (LEP). LEP should be considered in the differential diagnosis of an unexplained submandibular mass in a subject with SLE.

Sialolithiasis with obstruction of major salivary gland ducts can lead to clinical tumefaction related to cystic dilatation. In addition to mucus accumulation, these pseudoneoplasms feature hyperplasia and squamous metaplasia of the ductal lining epithelium, with varying degrees of inflammation. The authors report five examples of this lesion aspirated from two males and three females ranging in age from 45 to 80 years (median 65 years). Three were in the submaxillary gland, and two were in the parotid. In three cases, stone fragments were identified, and diagnoses of sialolithiasis were rendered; two of these patients underwent surgical excision. The remaining two cases showed prominent foam cells and metaplastic squamous cells in a mucoid background that mimicked low grade mucoepidermoid carcinoma. Stone fragments were not identified and a differential diagnoses of sialolithiasis versus low grade mucoepidermoid carcinoma were suggested. Surgical excision revealed sialolithiasis in both instances. When stone fragments are identified in aspirated material, these cases pose little diagnostic difficulty. However, when this material is not present, epithelial changes and mucus accumulation may be difficult to distinguish from low grade mucoepidermoid carcinoma. Cautious interpretation is suggested in this setting.

Fine needle aspiration biopsy (FNAB) has been widely used for a number of years and offers considerable advantages in comparison to conventional surgical biopsy. A number of organs can be subject to this diagnostic procedure with good results, including the salivary glands. This paper aimed to compare the cytological diagnosis of biopsy material obtained using FNAB and the subsequent histological diagnosis formulated after surgery in 49 patients with swellings in the parotid or submandibular region who were referred to the Department of Anatomy and Pathological Histology in L'Aquila. Cytohistological concordance was present in 87.7% of the cases in this series, a percentage that is in line with that reported by other authors. The most frequent causes of diagnostic error may be ascribed to moderate nodule size and/or the scanty material obtained not suitable for diagnosis. In this series all cases of malignant neoplasia were correctly diagnosed. In spite of the limitations of this method, the authors consider that it plays an important role in the preoperative diagnosis of salivary gland pathologies.

In the present study 162 patients with clinically suspected diseases of the major salivary glands were examined via sonography (n = 162), sialography (n = 111) and CT-sialography (n = 49). The reliability of the three radiological procedures was assessed in diagnosing sialoadenitis, sialolithiasis and glandular and extraglandular tumors. Forty-seven patients were examined with all three methods, 64 patients with sonography and sialography, 2 patients with sonography and CT-sialography and 49 patients with only sonography. The results were compared retrospectively with histologically (70%), cytologically (26%) and clinically proven diagnoses. A sialoadenitis was diagnosed via sonography at a sensitivity of 58%. Sialography frequently produced a false diagnosis of "glandular tumor", which resulted in a comparatively lower sensitivity of 54%. This finding contrasted with the experiences of other authors. A glandular tumor was correctly diagnosed by all three methods and had approximately the same sensitivity (sonography 89%, sialograph 91% and CT-sialography 92%). The correct diagnosis of salivary gland tumors was found by sonography and CT-sialography in 76% of cases and by sialography in 83% of cases. CT-sialography was clearly the superior diagnostic method for detecting extraglandular tumors. Sonography proved its worth as the fundamental procedure for special diagnostic testings of the salivary glands. Sialography is necessary for obtaining important additional information, especially in cases with suspect glandular tumors. CT-sialography is indispensable in the diagnosis of tumors, especially if a malignant, extraglandular or medially localized process is suspected.

A 16-year-old boy with epilepsy developed hypertrophy of the submandibular salivary glands, with high phenytoin (PHT) serum levels. The submandibular salivary glands became normal in 12 days after discontinuation of PHT. Other causes of salivary gland hypertrophy were excluded and we suggest that the hypertrophy was due to PHT.

Three cases of post-traumatic sialocele involving the parotid region and one case of post-traumatic mucocele involving the submandibular region are presented. Computed tomography (CT) with contrast showed enhancing borders after a few weeks. Cases earlier than 2 weeks from occurrence showed no enhancement because of the absence of a well-developed capsule. Patients who had the disease longer showed better enhancement of the periphery with contrast because of capsule development. By CT scanning alone it is difficult to differentiated these lesions from other cystic lesions of the face and neck, although certain characteristics like location and rim enhancement may favor one lesion over the other.

Piezoelectric lithotripsy was performed in 14 patients with salivary stones. None of the patients required anaesthesia, analgesics or sedatives. All of the salivary stones could be fragmented totally during the first lithotripsy procedure. Three months after treatment with extracorporeal shock waves all the patients were free of symptoms and in 7 out of 14 patients no concrement could be found by sonography. The piezoelectric lithotripsy of salivary stones had caused no serious side effects as proved by clinical, biochemical, sonographic and magnetic resonance imaging examinations. Extracorporeal piezoelectric lithotripsy is a new and promising non-surgical therapy for selected cases of sialolithiasis of the large salivary glands of the neck.

The case of salivary calculi of the submandibular gland and of its duct is very frequent, anyway, in this field it is very unusual to find a calculus heavier than 1 g. In this report the Authors relate about a particularly interesting case of a giant calculus. This kind of calculus is very interesting because of its large size, its position and some morphological peculiarities. In the end the experts confirm the necessity, in these cases, of a surgical intervention, including the extirpation of the gland.

Submandibular glands were examined from three autoimmune-disease-prone strains of mice (NZB/W, MRL/l and MRL/n) and controls (C57BL/6J). Focal lymphocytic adenitis was more prevalent and more severe in autoimmune-disease-prone strains than controls and in females than males. Lymphocytic foci were more frequent in older age groups, but female MRL/1 mice exhibited high levels of focal lymphocytic adenitis irrespective of age. Salivary parenchyma was generally well preserved. In the strain-age groups with the highest focal lymphocytic scores proportional acinar volumes were significantly less than in controls. However, the proportion of acinar tissue showed no consistent relation to the severity of focal lymphocytic adenitis across all strains and age groups of either sex. Sexual dimorphism in granular duct prominence was weakened in NZB/W and MRL/l strains compared to controls.

Pathological observations were carried out on 100 male rats of Sprague-Dawley strain obtained from 5 outbreaks of sialodacryoadenitis (SDA). In accordance with clinical and macroscopic findings, principal microscopic changes were found in the salivary (submaxillary and parotid) and Harderian glands. Lesions observed in these different glands were essentially similar to each other, and characterized by degenerative changes in the epithelial cells of the ducts and acini associated with marked and extensive serous inflammation in the interstice. Furthermore, squamous metaplasia of the ductal epithelia was a common feature to these glands in the late stage of the disease. Some differences, however, were detected between the changes of the salivary glands and those of the Harderian glands. Firstly, the ductal epithelial cells were affected at first and the acinous epithelial cells were damaged only secondarily in the active inflammatory process in the salivary glands, while both ductal and acinous epithelial cells were involved equally in the primary lesion in the Harderian glands. Secondly, the increase in connective tissue elements in the reparatory process was extremely marked in the Harderian glands as compared with the salivary glands. Consequently, in the lesion of Harderian glands in the late stage, original construction was almost indiscernible, and the ducts and acini were only recognized as disseminated islets in actively proliferated connective tissue elements.

A 31-year-old black male experienced severe recurrent urticaria and angioedema during meals. An abnormal sialographic pattern indicated submandibular sialoadenitis, and surgical excision of the gland resulted in complete resolution of the urticaria. This report describes the association of sialoadenitis and urticaria and possible mechanisms involved.

Mycobacterium tuberculosis and atypical mycobacterium are well-known causes of cervical lymphadenopathy, most often presenting without symptoms of systemic infection. These organisms may also directly involve the parenchyma of the major salivary glands and their periglandular or intraglandular nodes. The diagnosis of mycobacterial infections of the major salivary glands, compared to cervical lymph nodes, is equally--if not more--difficult to make. The differential must include the same spectrum of inflammatory and neoplastic diseases as well as lesions unique to the salivary glands. Selected cases are presented and discussed to show that principles established for the treatment of cervical mycobacterial infections must also be applied to major salivary gland infections. In particular, cutaneous fistulas may result from incisional biopsy or incision and drainage of the involved gland. Partial parotidectomy or submaxillary gland excision may be required, followed by multidrug, antituberculous chemotherapy for one to two years. Culturing of the organisms is extremely difficult, and the diagnosis of either mycobacterium tuberculosis or atypical mycobacterial infection must be based on a combination of history and clinical examination, skin testing, histopathology, acid-fast stains, culture, and response to surgery and antituberculous chemotherapy.

A case of plasma-cell dyscrasia with polyneuropathy and endocrine disorders that showed dysfunction of the salivary glands is reported. A 49-year-old Japanese man noticed swelling of the cervical lymph nodes and numbness in the lower extremities in May 1983. Histological examination of the enlarged cervical lymph nodes revealed many follicles penetrated by radial capillaries and proliferation of capillaries and plasma cells in the interfollicular area, forming Castleman disease-like lesions. The patient complained of a dry mouth and noticed swelling of the submandibular salivary gland in April 1984. Microscopic examination of this gland revealed an angiofollicular lymphoid lesion resembling that in the lymph nodes. He also suffered from an endocrine disturbance characterized by increased serum adrenocorticotropic hormone and impotence. This is the second reported case of plasma-cell dyscrasia with polyneuropathy and endocrine disorders that showed dysfunction of exocrine secretion. This case indicates that attention must be paid to organs of exocrine secretion as well as of endocrine secretion in this disease.

Necrotizing sialometaplasia, being a rare, nonspecific reaction to ischaemic injury in salivary gland tissues of the head, is discussed in connection with a case of our own. In contrast to former reports concerning such lesions above all in minor salivary glands the following report concentrates on a case of necrotizing sialometaplasia in the submaxillary salivary gland of a 57-year old woman who noticed after exstirpation of a pleomorphic adenoma in the submaxillary gland a swelling that presented histologically as necrotizing sialometaplasia. Emphasis is placed on a detailed morphological knowledge of this innocuous, self-repairing process, since the extensive squamous cell metaplasia of minor excretory ducts as the essential finding could be easily misdiagnosed as a squamous cell carcinoma and, therefore deserves special consideration in differential diagnosis of salivary gland tumours.

A case of hydatic cyst of the thyroid and submandibular salivary glands was presented. The epidemiology, pathogenesis, clinical features of the cervical hydatic cysts and treatment of this rare combination of the hydatid disease were discussed.

Major salivary glands have been rarely reported as sites of necrotizing sialometaplasia, a disease primarily affecting minor salivary tissue, particularly that of the palate. Eight cases of necrotizing sialometaplasia of the parotid and submandibular glands are presented and added to six reported earlier by Donath (1979). The clinical and pathologic findings in the 14 cases give strong support to the vascular-based-infarct genesis of necrotizing sialometaplasia.

The aim of this study was to investigate immunological aspects of the inflammatory reaction in the submandibular gland during chronic sialadenitis. Specimens of 54 patients registered at the Institute of Pathology at the University of Hamburg were stained according to the indirect immunoperoxidase method. The distribution patterns of Ig-secreting plasma cells (IgA, IgG, IgM) and of the enzymes lactoferrin, lysozyme, and secretory component were analysed. The formation of lymph follicles was also examined. The results were as follows: Stage 1 of the chronic sialadenitis starts as a simple inflammation with an increase of IgA-secreting plasma cells around the ducts. During stage 2 the unspecific, humoral part of the immune system is stimulated. The production of lactoferrin and lysozyme is enhanced. The titer of IgA rises due to activation of the local, specific immune system. The simultaneous rise of the IgG titer is probably caused by production at different sites. During the course of stage 3--4, the cells involved in the local, unspecific immune system are destroyed. The number of IgG secreting plasma cells also decreases. The formation of lymph follicles and the infiltration of the gland by lymphocytes is interpreted as a transition to the cellular immune response. Stage 4 of the Küttner tumor shows similarities to the autoimmune disease of Sjögren's syndrome.