Search

Different therapeutic methods for chronic drooling in pediatric patients with neurological problems have been described in the scientific literature. However, there is no consensus on the ideal strategy of treatment. The aim of this study was to compare botulinum toxin injection therapy and surgical modalities to control drooling in pediatric patients with neurological disorders. A systematic literature research was conducted on nine electronic databases, which were published until April 2020. Six articles were included in this systematic review. The total sample consisted of 209 patients, 67.4% (n = 141) with cerebral palsy. All studies used injections of botulinum toxin type A with the application to the submandibular and/or parotid salivary glands. The surgical treatments performed were duct ligation in parotid and/or submandibular salivary glands, duct relocation in submandibular salivary glands and glandular excision of the submandibular and sublingual salivary glands. There were complications in only 16.1% (n = 27) of the sample: 11 cases due botulinum toxin application and 16 due to surgery. The drooling control was assessed by objective measures, and subjective measures.Although surgical procedures presented higher risk of adverse effects than the botulinum toxin type A, in all studies and measurements performed, they presented larger and longer-lasting positive effect on drooling than the botulinum toxin type A injection. We suggest performing bilateral submandibular duct relocation with bilateral sublingual gland excision or isolated bilateral submandibular duct ligation, which are the surgical techniques with the largest sample in this review. Nevertheless, further studies are necessary to compare samples with botulinum toxin type A and surgical treatment.

Hypoglossal nerve schwannomas originating extracranially and mimicking a submandibular salivary gland tumour are extremely rare. A 55-year-old woman presented with a painless, gradually increasing swelling in the right submandibular region for the past 1 year. Fine-needle aspiration cytology and contrast-enhanced CT of the swelling showed features of submandibular gland malignant lesion. Intraoperatively, the right submandibular gland with a hypoglossal nerve swelling was noticed. Right submandibular gland along with the hypoglossal swelling were excised with adequate margins. However, the postoperative histopathology was reported as hypoglossal nerve schwannoma and a normal salivary gland. Accurate preoperative diagnosis of hypoglossal schwannomas may be challenging. A high level of suspicion must be sought for in cases with unusual clinical presentations and imaging characteristics. Herein, we report a rare presentation of submandibular hypoglossal schwannoma along with its clinical features and its management.

Adenoid cystic carcinoma of the submandibular gland is a relatively rare malignancy of the oral and maxillofacial region. It is an insidious disease characterized by regional spread, perineural invasion, and potential distant metastases. Because of the aggressive nature of this lesion, it is often impossible to completely excise the tumor, necessitating combination therapy of surgery and radiation. The consequences of surgical ablation coupled with radiation treatment can result in complex considerations in the dental care of these patients. This case report outlines a patient who has recovered from multiple surgeries and radiation therapy, requiring mandibular dental implant reconstruction for a return to normal comfort and function.

Oncocytic carcinoma of the salivary glands is an extremely rare malignant neoplasm. The parotid is the most frequently involved salivary gland, but tumours in the submandibular gland and minor salivary glands have also been described. It appears that oncocytic carcinoma of an ectopic salivary gland has not been reported so far. The unique case of a 78-year-old male patient diagnosed with oncocytic adenocarcinoma of an ectopic salivary gland is reported here. The patient underwent surgery and adjuvant radiotherapy. The clinical, morphological, and immunohistochemical features of this rare entity are also described.

Mucin in saliva plays a critical role in the hydration and lubrication of the oral mucosa by retaining water molecules, and its impaired function may be associated with hyposalivation-independent xerostomia. Age-dependent effects on salivary gland function and rheological properties of secreted saliva are not fully understood as aging is a complex and multifactorial process. We aimed to evaluate age-related changes in the rheological properties of saliva and elucidate the underlying mechanism. We performed ex vivo submandibular gland (SMG) and sublingual gland (SLG) perfusion experiments to collect saliva from isolated glands of young (12 wk old) and aged (27 mo old) female C57BL/6J mice and investigate the rheological properties by determining the spinnbarkeit (viscoelasticity). While fluid secretion was comparable in SMG and SLG of both mice, spinnbarkeit showed a significant decrease in SLG saliva of aged mice than that of young mice. There were no significant differences in GalNAc concentration between young and aged SLG saliva. Liquid chromatography/tandem mass spectrometry analysis of SLG saliva revealed that (Hex)1 (HexNAc)1 (NeuAc)1 at m/z 793.31 was the most abundant O-glycan structure in SLG saliva commonly detected in both mice. Lectin staining of salivary gland tissue showed that SLG stained strongly with Maackia amurensis lectin II (MAL II) while Sambucus nigra agglutinin (SNA) stained little, if any, SLG. The messenger RNA expression of St3gal1 that encodes an α-2,3 sialic acid sialyltransferase SIAT4-A showed a decrease in SLG of aged mice, confirmed by a Western blot analysis. Lectin blot analysis in SLG saliva revealed that the relative signal intensity detected by MAL II was significantly lower in aged SLG. Our results suggest that spinnbarkeit decreases in SLG of aging mice due to downregulation of sialic acid linked to α-2,3 sialic acid sialyltransferase expression.

The objective of this study was to investigate the clinical manifestations and pathologic appearances of the submandibular gland (SMG) in Stevens-Johnson syndrome (SJS).Patients with autologous transplantation of SMG for treatment of severe dry eye between March 1998 and May 2018 were divided into the SJS group (70 cases) and non-SJS group (50 cases) according to the history of SJS. The SMG weight and computed tomography volume and salivary flow rate were measured. The concentration index and secretion index were estimated using scintigraphy with technetium-99m-pertechnetate. Histopathology studies of SMG tissues were conducted, and the acini parameters were measured using a digital image analyzer.A decreased computed tomography volume and weight was observed in 48.57% the SJS group and 2% in the non-SJS group (P.01). The rest whole, acid-stimulated whole, and SMG rest salivary flow rates decreased in the SJS group (P.05). The normal SMG concentration index (37.5% vs 96.67%, P.001) and secretion index (35% vs 96.67%, P.001) rates were lower in the SJS group than in the non-SJS group. The glandular parenchyma was reduced, the acinar space was widened, and the fat content was increased in the SJS group.SMG atrophic and degenerative changes occurred in the SJS group, with a decrease in salivary secretion function in more than half of the patients.

As the largest salivary gland in oral cavity, the parotid gland plays an important role in initial digesting and lubricating food. The abnormal secretory function of the parotid gland can lead to dental caries and oral mucosal inflammation. In recent years, single-cell RNA sequencing (scRNA-seq) has been used to explore the heterogeneity and diversity of cells in various organs and tissues. However, the transcription profile of the human parotid gland at single-cell resolution has not been reported yet. In this study, we constructed the cell atlas of human parotid gland using the 10× Genomics platform. Characteristic gene analysis identified the biological functions of serous acinar cell populations in secreting digestive enzymes and antibacterial proteins. We revealed the specificity and similarity of the parotid gland compared to other digestive glands through comparative analyses of other published scRNA-seq data sets. We also identified the cell-specific expression of hub genes for Sjögren syndrome in the human parotid gland by integrating the results of genome-wide association studies and bulk RNA-seq, which highlighted the importance of immune cell dysfunction in parotid Sjögren syndrome pathogenesis.

Objective Schwannoma is a slowly growing benign neurogenic tumor that develops from the cells of the nerve sheath. The occurrence of schwannoma in the submandibular space is very rare. Materials and Methods From January 2010 to March 2021, we reviewed all patients who had been operated on in the otolaryngology department over 11 years and found 61 patients diagnosed with schwannomas at the final biopsy after surgery. In these patients, only 3 submandibular schwannomas were identified, and their clinical characteristics were analyzed. Results Three schwannomas (4.9%) developed in the submandibular space. The main symptoms were neck swelling followed by neck discomfort. All submandibular schwannomas were removed surgically with a transcervical approach under general anesthesia. Two patients, who were diagnosed preoperative submandibular tumors, were considered to have developed schwannomas from the lingual nerve, and 1 patient was considered to have developed a schwannoma from the hypoglossal nerve. There were no major surgical complications, including postoperative nerve damage. Conclusions Submandibular schwannomas are extremely rare, but they should be included in the differential diagnosis of submandibular tumors.

The burden of diabetes mellitus (DM) and associated complications is increasing worldwide, affecting many organ functionalities including submandibular glands (SMG). The present study aims to investigate the potential ameliorative effect of glycyrrhizic acid (GA) on diabetes-induced SMG damage. Experimental evaluation of GA treatment was conducted on a rat model of type I diabetes. Animals were assigned to three groups; control, diabetic and GA treated diabetic groups. After 8 weeks, the SMG was processed for assessment of oxidative stress markers, autophagy related proteins; LC3, Beclin-1 and P62, vascular regulator ET-1, aquaporins (AQPs 1.4 and 5), SIRT1 protein expressions in addition to LC3 and AQP5 mRNA expressions. Also, parenchymal structures of the SMG were examined. GA alleviated the diabetes-induced SMG damage via restoring the SMG levels of oxidative stress markers and ET-1 almost near to the normal levels most probably via regulation of SIRT1, AQPs and accordingly LC-3, P62 and Beclin-1levels. GA could be a promising candidate for the treatment of diabetes-induced SMG damage via regulating oxidative stress, autophagy and angiogenesis.

Objectives This study aimed to evaluate the level of oxidative stress (OS) in human and rat chronic sialadenitis (CS) of the submandibular gland (SMG). Method We collected human SMG tissues and established a rat CS model using Wharton's duct partial ligation (PL). Morphological changes in the SMG were evaluated by HE, Sirius Red, AB/PAS, TUNEL, and IHC staining. Oxidative damage and antioxidant capacity were detected by ELISA, commercial assay kits, and IHC staining to evaluate their expression levels and locations in the SMG. Results Histopathological damage were observed in the human and rat CS. Compared to the control group, the rat PL group had significantly increased oxidative damage products (8-OHdG, AOPP, 8-iso-PGF2α, and H2 O2 ). For antioxidants, the PL group had markedly decreased T-AOC and CAT activity, but markedly increased SOD activity. IHC staining showed that 3-NT, 4-HNE, and MDA were expressed differently in different stages of CS; and antioxidant enzymes (CAT, SOD1, SOD2, GPX1, and GPX4) were mainly expressed in ducts. Conclusions The oxidative-antioxidant imbalance of CS in human and rats was revealed, the different expression of oxidative damage in different stages of CS was detected, and the different antioxidant reaction in acinar and ductal cells was demonstrated.

The aim of this study was to evaluate the impact of photobiomodulation therapy (PBMT) on histomorphological aspects of submandibular gland (SMG) submitted to salivary gland duct obstruction in hypothyroid rats. Fifty-six male Wistar rats (250 to 300 g) were divided into 4 groups (n = 14): euthyroid (EU), EU + PBMT, hypothyroid (HYPO), and HYPO + PBMT. Duct obstruction of the left submandibular gland (LSMG) was performed in all animals by a ligature procedure. For the induction of hypothyroidism, total thyroidectomy was performed. PBMT groups received irradiation with AlGaInP diode laser (808 nm, 0.04 W, 0.04cm2 spot size, 60 s, 2.4 J per point, 60 J/cm2, 1 W/cm2). Irradiation was performed immediately, 24 h, and 48 h after the obstruction of the salivary gland duct, in one point, extra oral and perpendicular to the gland. Animals were sacrificed after 24 h and 72 h after duct ligature. Our results indicated that salivary duct obstruction and hypothyroidism caused negative modifications on the salivary glands’ histomorphology, especially acinar atrophy, after 24 h and 72 h. HYPO + PBMT showed a significant reduction of the inflammatory infiltrate, congested blood vessels, and acinar atrophy in the SMG submandibular salivary gland in 72 h compared to 24 h (p

Sialolith is the most common obstructive pathology of the salivary gland. Submandidular glands are most commonly affected in its parenchyma. This case report describes a patient presenting with an unusually large submandibular gland sialolith, where sialography was performed locating the lesion. Etiology, diagnosis and various treatment modalities available for management of salivary gland calculi depending on their site and size are also discussed in this case report. Keywords: Sialolith, Submandidular gland, Sialography

Head and neck cancers commonly require radiation as part of treatment. Irradiated patients suffer from severe salivary gland impairment. In this study, we investigated the role of silver nanoparticles (AgNPs) in preventing radiation-induced changes in Albino rats’ submandibular glands (SMG). Thirty adult male Albino rats were divided into three groups ten rats each; group I (control) and group II (irradiated group (IR)) received a single dose of 15 Gray (Gy), and group III (AgNPs + IR) received 150 µg/kg of AgNPs and a single dose of 15 Gy. Sialochemical analysis of salivary function has been evaluated. Salivary levels of 8 hydroxydeoxyguanosine (8-OHdG), nitric oxide (NO), and total antioxidant capacity (TAC) have been measured. Histological and ultrastructural examinations of the salivary gland have been assessed. Immunohistochemical expression of malondialdehyde (MDA), superoxide dismutase (SOD), and inducible nitric oxide synthetase (iNOS) were detected. The results showed a significant decrease in salivary gland function and total protein levels in the IR group, contrary to group III. The 8-OHdG and NO levels and the immunohistochemical expression of MDA and iNOS were significantly increased in the IR group. However, the levels of TAC and SOD were significantly decreased. IR group showed atrophy of acinar cells with signs of degeneration, wide intercellular spaces, and cytoplasmic vacuolizations in addition to apoptotic cells. The results of group III showed protection of the submandibular salivary gland from radiation. We concluded that silver nanoparticles could have a protective role against radiotherapy through their antioxidant activity and scavenging of reactive oxygen species (ROS).

Lymphoepithelial carcinoma (LEC) of the submandibular gland is a very rare neoplasm that constitutes only 0.4 % of the salivary gland neoplasms, mainly involving the parotid glands, and is well known to have a racial prevalence in Southwest Asia, southern China, Africa, and the Arctic Circle. This report describes the case of a 49-year-old Japanese woman who was diagnosed with an LEC of the right submandibular gland. The patient presented with a painless, gradually enlarging mass in the right submandibular gland for 2 years. Computed tomography scanning showed a 20 × 16 mm, slightly enhanced solid mass in the right submandibular gland; magnetic resonance imaging revealed an isointense and hyperintense mass in T1- and T2-weighted images. Fine-needle aspiration cytology revealed a few small salivary gland cells and acidophilic cells against a background of lymphocytes, suggesting Warthin tumor or chronic sialadenitis. The right submandibular gland was resected, and intraoperative frozen section analysis suggested a diagnosis of LEC of the submandibular gland. Histopathological findings from the resected submandibular gland were consistent with a diagnosis of LEC, and a definitive pathologic staging of T3N0M0. Postoperative adjuvant radiation therapy was administered, and the patient was disease free at the 4-year follow-up.

Introduction: Salivary gland malignancies account for 2 to 4% of head and neck cancers. Fine needle aspiration cytology (FNAC) is used in preoperative diagnosis of salivary gland lesions. Although FNAC is a highly reliable technique for preoperative diagnosis, there were no consensus on salivary gland cytopathology reporting. Recently, an international group has recommended a classification system for salivary gland FNAC reporting titled “Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC). In this study, we aimed to evaluate the usability of the Milan System, its ability to determine the risk of malignancy for each category, with comparisons of inital cytologic and final histopathological diagnosis. Materials and Methods: We performed a retrospective analysis of salivary gland lesion FNAC in our department from 2013 to 2019. A total of 578 FNACs were performed in 514 patients. Of these, 85 cases had surgical follow-up (parotid gland, n = 73, submandibular gland, n = 12). The cytological samples were categorized according to the MSRSGC into six categories by two pathologists. The risk of malignancy (ROM) and diagnostic accuracy values were calculated for each diagnostic categories. Results: A total of 85 aspirates of the patients with follow-up, the MSRSGC diagnostic categories were as follows: non-diagnostic in 7 aspirates (8.2%), non-neoplastic in 3 (3.5%), atypia of undetermined significance (AUS) in 9 (10.5%), benign neoplasm in 43 (50.5%), salivary gland neoplasm of undetermined malignant potential in 7 (8.2%), suspicious for malignancy in 10 (11.7%), and malignant in 6 (7%). The ROM for each category was 28, 5%, 0%, 33%, 0%, 28.5%, 90%, and 100%, respectively. Conclusion: FNAC plays a critical role in the evaluation of patients with salivary gland lesions. The MSRSGC helps in the standardization of the process of diagnosis and clinical management of salivary gland lesions, especially of AUS and SUMP categories that are indeterminate categories in nature.

Conventional surgery for submandibular gland tumour is total excision of the gland affected by the tumour. Gland-preserving surgery is commonly used for benign tumours arising in the parotid gland but not in the submandibular gland. This study evaluated long-term oncological and functional outcomes after gland-preserving surgery in patients with pleomorphic adenoma of the submandibular gland via the submental approach. This longitudinal study included 105 consecutive patients with submandibular gland pleomorphic adenoma who underwent the gland-preserving surgery combined with the en-bloc resection of tumours via the submental approach. Salivary scintigraphy was performed 6 months after surgery, and ultrasonography was regularly followed. Intraoperative findings, postoperative complications, cosmetic and salivary functions, and tumour recurrence were assessed in these patients. Median tumour size and submental incision length were 2.0 and 3.3 cm, respectively. Median operation time and amount of blood loss were 25 min and 18.5 mL, respectively. None had marginal or lingual nerve paralysis and most patients were satisfied with incision scar and facial contour. The salivary function of the affected gland was equal to that of the unaffected gland. One patient (0.9%) had single nodular recurrence 54 months after surgery and others had no recurrence for follow-up of median 96 months. Pleomorphic adenoma of the submandibular gland can be safely removed by the gland-preserving surgery via the submental approach which has operation time, cosmetic and functional benefits with compromising oncological outcomes.

Background Viral infection is the most common cause of salivary gland swelling as mumps which mainly affects the parotid glands. Sialolithiasis is another cause of obstruction of the salivary duct. A tumor is another cause of swelling. Around 70% of salivary gland tumors arise from the parotid glands. Benign lesions represent 57% of these tumors. Three to 5% of all tumors affecting the head and neck are represented in the salivary gland. Ultrasonography is considered a basic diagnostic tool in all salivary gland swellings. Our study is to evaluate the role of ultrasound in the evaluation of salivary glands swellings in comparison with a computed tomography scan. Results A total of 80 patients aged more than 1 year old with swellings affecting the salivary glands were collected from the out-patient clinic during the period from February 2020 to February 2021. All patients underwent ultrasonography and computed tomography examination of the neck. All submandibular gland lesions presented with sialolithiasis (40 cases) (100%), and 20 cases (50%) of parotid gland swellings presented as inflammation without stone (16 cases (40%) of acute inflammation and 4 cases (10%) with recurrent inflammation), while 4 patients only presented as sialolithiasis. Neoplastic lesions were diagnosed in 16 cases of the parotid gland group. Stones less than 3 mm were detected only by computed tomography in 5 patients (12.5%) of the submandibular group. Twenty-eight cases (70%) with stones ranged in size between 3 and 6 mm. Only 11 cases (27.5%) with stones ranged in size more than 6 mm. Of the 16 parotid swellings diagnosed with neoplastic lesions, 14 parotid cases (87%) showed well-defined margins by computed tomography and ultrasonography. Conclusions Sonography is the basic diagnostic tool in salivary glands swellings. Ultrasonography should be the initial imaging modality. Only in special cases, such as stones that could not be detected by ultrasonography or a neoplastic lesion in a deep location, or bone infiltration, computed tomography neck should be performed.

Background A sialendoscopy-assisted combined approach is well established in the surgery of sialolithiasis. In cases of proximal salivary stones, transcutaneous sialendoscopy-assisted extractions with parotid and submandibular gland preservation is the primary intention of treatment. We recently added computer tomography (CT) navigation to improve the results of this challenging surgery equally in both localizations. Patients and methods Al l the patients who submitted to sialendoscopy and sialendoscopy-assisted procedures at the tertiary institution between January 2012 and October 2020 were included in the present study. From November 2019, CT navigation was added in cases with sialolithiasis and a presumably poor sialendoscopic visibility. We evaluated the parameters of the disease, diagnostic procedures, sialendoscopic findings and outcomes, with or without optical surgical navigation. Results We performed 178 successful salivary stone removals in 372 patients, of which 118 were combined sialendos-copy-assisted approaches, including 16 transcutaneous proximal, 10 submandibular and 6 parotid stone operations. Surgical navigation was used in six patients, four times for submandibular and twice for parotid sialolithiasis. These were all non-palpable, sialendoscopically invisible or partially visible stones, and we managed to preserve five of the six salivary glands. Conclusions The addition of CT navigation to sialendoscopy-assisted procedures for non-palpable, sialendoscopically invisible and fixed stones is a significant advantage in managing sialolithiasis. By consistently performing sialendoscopy and related preservation procedures, we significantly reduced the need for sialoadenectomies in patients with obstructive salivary gland disease.

The etiology of primary Sjogren's syndrome (pSS) remains unknown, and there is no complete curative drug. In this study, we treated a mouse model of the submandibular gland (SG) protein-immunized experimental Sjogren's syndrome (ESS) with paeoniflorin-6'-O-benzene sulfonate (termed CP-25) to evaluate the potential therapeutic effects of CP-25. Through in vivo experiments, we found that CP-25 increased saliva flow, alleviated the salivary gland indexes, and improved tissue integrity in the ESS model. The viability of splenocytes and B-lymphocyte migration from spleen were reduced in ESS mice. Furthermore, CP-25 decreased the expression of IgG antibodies, anti-SSA and anti-SSB antibodies and modulated the levels of cytokines in the serum of SS mice. The numbers of total B lymphocytes, plasma cells (PCs), and memory B cells diminished in the salivary gland. Increased expression of the JAK1-STAT1-CXCL13 axis and IFNα was found in human tissue isolated from pSS patients. In vitro, after stimulation with IFNα, the levels of CXCL13 mRNA and CXCL13 in human salivary gland epithelial cells (HSGEC) increased, while CP-25 counteracted the secretion of CXCL13 and downregulated the expression of CXCL13. IFN-α activated the JAK1-STAT1/2-CXCL13 signaling pathway in HSGEC, which was negatively regulated by additional CP-25. As a consequence, B-cell migration was downregulated in coculture with IFN-α-stimulated HSGEC. Taken together, this study demonstrated that the therapeutic effects of CP-25 were associated with the inhibition of the JAK1-STAT1/2-CXCL13 signaling pathway in HSGEC, which impedes the migration of B cells into the salivary gland. We identified the underlying mechanisms of the therapeutic effect of CP-25 and provided an experimental foundation for CP-25 as a potential drug in the treatment of the human autoimmune disorder pSS.

The aims of this pilot investigation were to calculate the levels of sensitivity and specificity of salivary glands ultrasonography (SGUS) in diagnosing Sjögren syndrome (SS) and to assess the ultrasonographic findings of parotid and submandibular glands.Patients diagnosed with SS or dry mouth and healthy controls were enrolled. Bilateral parotid and submandibular glands were assessed for (1) parenchymal inhomogeneity (PIH), (2) median size of the glands, (3) visibility of glandular posterior borders, and (4) size of sialolith, if present.This study included 34 female patients, of whom 12 had SS (35.3%), 12 had dry mouth (35.3%), and 10 were healthy controls (29.4%). Patients with SS showed higher PIH scores in all glands with the median differences being statistically higher in the right and left parotids and left submandibular glands (P.001, P = .012, and P.001, respectively). SGUS, with a PIH cutoff ≥2, showed a sensitivity of 100% and a specificity of 81.6% for detecting SS. The majority of SS had invisible glandular posterior borders (P.001). Median size of the glands and size of the sialolith did not show any statistically significant differences between groups.SGUS is a noninvasive imaging modality with good sensitivity and specificity that might be valuable as a diagnostic aid for SS.

Chronic sclerosing sialadenitis of the submandibular gland (also known as Küttner tumor) is characterized by concomitant swelling of the submandibular glands secondary to strong lymphocytic infiltration and fibrosis. The pathogenesis of this disease has been unclear, but it is associated with immune disorders. ADAMTS18 is a member of the ADAMTS superfamily of extracellular proteinases. In this study, we showed that Adamts18 is highly expressed in submandibular salivary gland (SMG) during embryonic development and decreases but is retained in adult SMG tissue in mice. Adamts18 deficiency led to reduced cleft formation and epithelial branching in embryonic SMG before embryonic day 15.5 in mice. No significant histologic changes in the later stages of branching or the morphology of SMG were detected in Adamts18−/− mice. However, Adamts18 deficiency causes spontaneous SMG fibrogenesis and fibrosis in adult mice. At 8 wk of age, Adamts18−/− mice began to manifest the first signs of pathologic changes of mild fibrosis and CD11b+ cell infiltration in SMG tissues. At ≥8 mo, all male and female Adamts18−/− mice developed unilateral or bilateral SMG scleroma that is similar to patients with chronic sclerosing sialadenitis of the submandibular gland. Adamts18−/− mice also showed secretory dysfunction and severe dental caries. Histologically, SMG scleroma is characterized by progressive periductal fibrosis, acinar atrophy, irregular duct ectasis, and dense infiltration of IgG-positive plasma cells. A significant infiltration of CD4+ T lymphocytes and CD11b+ monocytes and macrophages was also detected in the SMG scleroma of Adamts18−/− mice. The levels of TGF-β1, IL-6, and IL-33 were significantly increased in Adamts18−/− SMGs, which induces chronic inflammation and myofibroblast activation, ultimately leading to fibrosis. This study indicates that Adamts18 regulates the early branching morphogenesis of embryonic SMG and plays a role in protecting from spontaneous SMG fibrogenesis via modulating local inflammation, autoimmune reaction, and myofibroblast activation in adult mice.

Although there have been several reports of the diagnostic accuracy of frozen section biopsy (FSB) for parotid gland tumors, few studies have focused on its diagnostic accuracy for submandibular gland tumors.This study aimed to investigate the necessity of FSB with regard to its diagnostic accuracy for submandibular gland tumors (SGTs).About 42 SGT patients underwent both fine-needle aspiration cytology (FNAC) and FSB between 2005 and 2020. The results of FNAC and FSB were analyzed and compared with the final histological diagnoses.The respective sensitivity and specificity in detecting malignant tumors in 38 cases, excluding the four indeterminate FNAC cases, they were 0 and 97% for FNAC, and 100 and 97% for FSB. Considering the four indeterminate FNAC cases to be malignant, the respective sensitivity and specificity in detecting malignant tumors in the 42 cases were 50 and 92% for FNAC, and 100 and 95% for FSB.FSB may be useful for malignancy detection as a final histological diagnosis in cases that are diagnosed as benign or indeterminate by FNAC in SGTs.

The present case study reports contrast-enhanced magnetic resonance findings in three patients with histopathologically proven IgG4-related chronic sclerosing sialadenitis of the submandibular gland. All three patients presented with painless swelling of the submandibular region. The contrast-enhanced T1-weighted images showed reticular enhancement of the swollen submandibular gland. Radiological–pathological correlation revealed that the characteristic reticular enhancement corresponded to fibrosis and to inflammatory cell infiltration in the interlobular septa and in the periductal region of the submandibular gland.

Introduction This study examined whether time-activity curves (TAC) can be used to differentiate between patients with and without Sjogren's syndrome using SPECT/CT. Methods Thirteen xerostomia patients (5 with Sjogren's syndrome and 8 without Sjogren's syndrome) underwent SPECT/CT. Salivary gland secretion data were digitally observed, producing separate time-activity curves (TAC) for the submandibular glands and parotid glands using SPECT/CT. The salivary gland secretion fraction was defined as A (before stimulation test [counts/frame]) divided by B (after stimulation test [counts/frame]). The A/B ratios of patients with Sjogren's syndrome and those without Sjogren's syndrome were compared using the Mann-Whitney U test for nonparametric data. Results The A/B ratio of parotid glands with Sjogren's syndrome (1.3 ± 0.2) was significantly lower than for those without Sjogren's syndrome (2.7 ± 0.7). The A/B ratio of submandibular glands with Sjogren's syndrome (1.3 ± 0.4) is significantly lower than for those without Sjogren's syndrome (1.8 ± 0.6). Conclusion The TAC for the submandibular glands and parotid glands using SPECT/CT may be useful for the objective and quantitative diagnosis of Sjogren's syndrome.

Obstructive sialadenitis of the submandibular gland is most often caused by sialolithiasis and rarely by a foreign body. Here, we describe a patient with acute submandibular inflammation caused by a bamboo splinter. Transcutaneous and transoral ultrasound precisely located the splinter within Wharton's duct. Shortly thereafter, the bamboo splinter was spontaneously discharged while eating, which allowed complete remission of pain and swelling. Ultrasound confirmed the absence of the foreign body within Wharton's duct and relief of sialadenitis. Combined use of transcutaneous and transoral ultrasound can provide detailed information regarding the submandibular gland and foreign bodies, which enables proper treatment planning and adequate follow-up.

INTRODUCTION Children who require submandibular gland excision for ptyalism often have multiple associated comorbidities, including neurodevelopmental disorders and respiratory risk factors. The purpose of this study is to utilize a large multicenter database to elucidate the perioperative profile of submandibular gland excision in children, with particular focus on children who require submandibular gland excision for ptyalism. METHODS The American College of Surgeons National Surgical Quality Improvement Program Pediatric dataset was queried for submandibular gland excision performed from 2012 through 2018. Indications were subclassified based on International Classification of Disease (ICD)-9 and ICD-10 codes. Complications, readmissions, and reoperations were analyzed with appropriate statistics. RESULTS During the study interval, 304 pediatric patients underwent submandibular gland excision, which was mostly performed for ptyalism (56.9%), followed by inflammatory conditions (20.7%). Patients requiring submandibular gland excision for ptyalism were significantly younger (P

Secretory carcinoma (SC) is a rare salivary gland tumor and has been recently included in the fourth edition of the World Health Organization classification of head and neck tumors. To understand the histopathologic findings and clinical behavior of mammary analogue secretory carcinoma (MASC) of the submandibular gland in a 23 year old female. MASC is an intriguing and rare malignant salivary gland tumor first described in 2010. It shares histologic, immunohistochemical and genetic features with secretory carcinoma of the breast. The clinical behavior of MASC ranges from slowly growing tumors to aggressive tumors that can cause widespread metastasis. Many cases of MASC were discovered in archived cases previously classified as pleomorphic adenoma, acinic cell carcinoma, mucoepidermoid carcinoma, and adenocarcinoma. They are only a few reported in submandibular gland. MASC is a newly recognized variant of salivary gland malignancy. Further research is needed to better delineate its overall prevalence and to define an appropriate treatment algorithm for this new clinical entity.

Objective The purpose of this study was to quantitatively assess normal submandibular glands and submandibular sialadenitis (SS) using computed tomography (CT) texture analysis as part of radiomics quantitative analysis. Study Design In total, 31 patients with unilateral SS who underwent head and neck magnetic resonance imaging (MRI) and CT and were retrospectively reviewed. Submandibular glands with abnormal signals (STIR: high, T2-weighted image: high, T1-weighted image: low) on MRI were identified as SS. The radiomics features of the contralateral normal submandibular glands and SS were analyzed using an open-access software, MaZda Version 3.3. Sixteen radiomics features were selected with Fisher and probability of error and average correlation coefficient methods in MaZda from 279 original parameters calculated for each of the normal and SS glands. The results were statistically analyzed with the Wilcoxon rank sum test. Results One gray-level co-occurrence matrix feature and 9 gray-level run length matrix features displayed significant differences between normal submandibular glands and glands with SS (P Conclusions CT texture analysis was able to quantitatively distinguish between normal and diseased submandibular glands. It therefore may have the potential to detect SS.

Purpose The normal submandibular gland (SMG) and parotid gland (PG) are thought to have similar homogeneous ultrasound (US) hyperechogenicity; however, this has not been extensively investigated. The aim of this study was to determine whether the normal SMG and PG have similar US echogenicity. Methods We included 969 consecutive adult patients with normal salivary glands. The patients were categorized into three age groups: group 1 (19 to 29 years, n=27), group 2 (30 to 49 years, n=273), and group 3 (≥50 years, n=669). The echogenicities of the SMG and PG were prospectively evaluated by an experienced radiologist. Computed tomography (CT) attenuation in Hounsfield units (HUs) was quantitatively measured for the SMG, PG, and sternocleidomastoid muscle in 140 patients. Results Relative to the PG, the echogenicity of the SMG was similar in 706 (73.0%) and homogeneously hypoechoic in 263 patients (27.0%). The frequency of SMG hypoechogenicity decreased with increasing age (group 1, 59.3%; group 2, 36.3%; group 3, 22.1%; P

Mucoepidermoid carcinoma (MEC) is generally characterized by an admixture of mucous, epidermoid and intermediate type cells. Numerous variants morphologies are described and defined by stromal and/or cytoplasmic tinctorial characteristics. We now report 11 cases of MEC with serous acinar differentiation, reflecting a distal intercalated duct/acinar phenotype, which we designate as mucoacinar carcinomas. Seven patients were female while 4 were male with a mean age of 55 years (range: 21 to 72 y). Ten cases were from the parotid while 1 was from the submandibular gland. Mean size of the tumors was 1.8 cm (range: 0.7 to 4.5 cm). Three cases were low grade, 7 were intermediate grade, and 1 was high grade. Low to intermediate grade cases demonstrated prominent clear to vacuolated cells with focal serous acinar differentiation. The high-grade case showed a distinctive scattering of acinar cells interspersed between epidermoid cells. Periodic acid Schiff after diastase (9/9), SOX-10 (9/9), and DOG-1 (9/10) highlighted the acinar component. Six of 7 cases showed a focal acinar predominant NR4A3 expression. MAML2 fluorescence in situ hybridization was positive in all cases, in both acinar and mucoepidermoid components. Two cases tested by next generation sequencing showed standard CRTC1-MAML2 fusions. MSANTD3 and NR4A3 fluorescence in situ hybridization on the other hand were negative. Evidence thus suggests that mucoacinar carcinoma represents an acinar variant morphology in MEC, rather than a true MEC-acinic cell carcinoma hybrid, or collision tumor. The acinar differentiation, SOX-10, DOG-1, and even focal NR4A3 reactivity may thus be diagnostic pitfalls.

Over 80% of sialoliths form in the submandibular glands. Well-recognized complications include blockage or narrowing of salivary ducts leading to pain, edema, and infection. Less commonly, fistulas may develop into the oral cavity and very rarely, sialoliths may migrate to the skin’s surface. Our literature review revealed only five reported cases of migrating sialoliths with two reporting stones migrating down the neck prior to eroding through the skin. An 89-year-old woman with a history of chronic sialolithiasis in the right submandibular gland with a sialolith documented on CT 2 years prior, presented with a rapidly growing skin lesion overlying her right sternocleidomastoid in level three. Repeat CT showed a similar sized sialolith underneath the skin lesion and atrophy of the right submandibular gland. This is a rare case of a sialolith eroding through the submandibular gland, tracking down the neck and through the skin. We propose the mechanism of this complication is that the stone causes inflammation and scarring within the gland obstructing Wharton’s duct leading to increased pressure from salivary back flow. The gland becomes ischemic and the stone is slowly forced through the gland. We believe that the stone then migrates along the investing fascia of the submandibular gland and sternocleidomastoid muscle. This paper is the first to propose a mechanism for this complication and is one of the few cases with pre- and post-migratory imaging. This case helps provide further evidence to support appropriate treatment and follow-up on patients with chronic sialolithiasis.

Purpose This study aims to explore the radioprotective effects of recombinant human erythropoietin (rhEPO) on rats' submandibular gland hypofunction induced by irradiation (IR). Materials and Methods Thirty rats were divided into 3 groups: 1) control group, 2) IR group, and 3) IR + rhEPO group. The IR group and IR + rhEPO group received a single dose of 15 Grays (Gy) (0.98 Gy/min), plus, the IR + rhEPO group also received subcutaneous administration of rhEPO at a dose of 3,000 IU/kg body weight 3 days before irradiation and then repeated every 24 hours for the first 2 weeks after irradiation. Immunohistochemistry analysis to erythropoietin receptor was performed to detect the levels of erythropoietin receptor in submandibular glands with or without radiation. Ninety days after irradiation, the salivary flow rates were assessed, and the submandibular gland of every rat was subjected to hematoxylin and eosin staining and immunohistochemical staining with antiaquaporin 5 and anti–proliferating cell nuclear antigen antibodies. Apoptosis was examined by the terminal deoxynucleotidyl transferase biotin-dUDP nick end-labeling assay. In addition, to examine the protective role of rhEPO on human submandibular gland cells, the apoptotic and proliferation rate of cells under a radiation dose of 8 Gy was detected. One-way analysis of variance was carried out to analyze the results of each group, and the P value was set at 0.05. Results Erythropoietin receptor was expressed in the submandibular glands at a low level under normal conditions but upregulated after irradiation. rhEPO administration remarkably alleviated gland atrophy, increased salivary flow rates with upregulation of aquaporin-5 compared with the IR group. In addition, fewer apoptotic cells and more proliferative cells were observed in the IR + rhEPO group compared with the IR group, both in vivo and in vitro. Conclusions rhEPO administration may be a useful countermeasure to mitigate submandibular gland hypofunction after therapeutic radiation exposure.

Carcinoma adenoide cistico. Un tumore indolente ma aggressivo. Parte A: dalla eziopatogenesi alla diagnosi.Il carcinoma adenoide cistico (ACC) è un tumore relativamente raro ad origine dalle ghiandole salivari minori e maggiori. È poco frequente nella parotide mentre lo è molto di più nella ghiandola sottomandibolare, nelle ghiandole salivari minori e in quelle mucinose del cavo orale, orofaringe e seni paranasali. Esso può anche insorgere nelle ghiandole secretrici localizzate in altri tessuti come l’albero tracheo-bronchiale, l’esofago, la mammella, il polmone, la prostata, la cervice uterina, la cute, le ghiandole lacrimali e quelle del Bartolini. La sua storia naturale è caratterizzata da una lenta crescita, da rare metastasi linfonodali e da frequenti metastasi a distanza. Dal punto di vista istologico esso è stato tradizionalmente suddiviso in tre forme (cribriforme, tubulare e solido). Alcuni studi hanno dimostrato che i tumori con una prevalente componente solida hanno una prognosi peggiore rispetto a quelli con prevalente componente cribriforme o tubulare ma altri studi hanno contestato questa affermazione. Il proposito di questa review è quello di analizzare il grande numero di pubblicazioni (talvolta contraddittorie) sul carcinoma adenoide cistico. In questa prima parte saranno discusse l’eziologia, l’epidemiologia, l’istopatologia, la presentazione clinica e l’iter diagnostico.Adenoid cystic carcinoma (ACC) is a relatively rare tumour of the minor and major salivary glands. It is uncommon in the parotid gland while it is much more frequent in the submandibular gland and in minor salivary and mucinous glands (oral cavity, oropharynx, and paranasal sinuses). ACC may also arise in secretory glands located in other tissues, such as in the tracheobronchial tree, oesophagus, breast, lungs, prostate, uterine cervix, lachrymal and Bartholin’s glands, and skin. The natural history of ACC is characterised by an indolent growth rate, a relatively low probability of regional lymph node metastases and a high likelihood of haematogenous dissemination. ACC has been traditionally subdivided into three histological groups (cribriform, tubular, and solid) based on solid components of the tumour. Some studies have shown that tumours with a solid growth component have a rapid fatal course, compared to tumours without a solid growth component, but other studies have failed to correlate growth patterns with clinical course. The purpose of this review is to analyse the very large number of studies (sometimes contradictory) on ACC. In this first part, the aetiology, epidemiology, histopathology, clinical behaviour and diagnostic workup are examined.

The chorda tympani typically utilises the lingual nerve and submandibular ganglion to transmit parasympathetic fibres to the submandibular gland. During a routine anatomy dissection, the submandibular gland was found to be innervated by both the lingual nerve and the nerve to mylohyoid. The clinical implications of this variant dual innervation to the submandibular gland is not clear due to its rarity: however, recognising such a variation should be borne in mind during surgical intervention near the nerve to mylohyoid.

Involvement of the submandibular gland in actinomycotic osteomyelitis in the absence of sinus is rare. Cervicofacial form is characterized by contiguous spread, suppurative osteomyelitic & granulomatous inflammation of the mandible and formation of multiple abscesses and hallmark discharging sinuses draining serosanguinous fluid containing sulphur granules. As the imaging finding of this entity is rarely described, in this case report, a rare case of mandibular actinomycotic osteomyelitis, with a submandibular swelling, but without draining sinus is reported. The imaging findings of cone beam computed tomography (CBCT) & ultrasonography (US) of the case are discussed with a review. In subacute stage, mandibular actinomycosis may show no hallmark sinuses. Sclerotic margins around the lesion may be found on radiograph. Imaging is useful in ruling out clinical diagnostic challenge when it includes involvement of mandible & submandibular region. Cervicofacial actinomycosis commonly occurs as perimandibular infection, rarely as osteomyelitis of the mandible.1 It may present as two distinct morphological patterns; first, "lumpy jaw," and second, simulating an acute pyogenic infection affecting the submandibular area, discharging sinus being a hallmark finding.1 Other variant reported include chronic osteitis, osteolytic lesion, hard nodule on the tongue, lockjaw, periapical, or paradental abscess. Diagnosis of cases presenting in multiple areas in the absence of multiple discharging sinuses is a challenge.2 Usefulness the imaging findings are rarely enumerated. This report is of a twin presentation of a non - sinus forming actinomycotic mandibular osteomyelitis and a submandibular swelling, along with a review of various diagnostic imaging features.

The parotid, submandibular, and sublingual glands represent a trio of oral secretory glands whose primary function is to produce saliva, facilitate digestion of food, provide protection against microbes, and maintain oral health. While recent studies have begun to shed light on the global gene expression patterns and profiles of salivary glands, particularly those of mice, relatively little is known about the location and identity of transcriptional control elements. Here we have established the epigenomic landscape of the mouse submandibular salivary gland (SMG) by performing chromatin immunoprecipitation sequencing experiments for 4 key histone marks. Our analysis of the comprehensive SMG data sets and comparisons with those from other adult organs have identified critical enhancers and super-enhancers of the mouse SMG. By further integrating these findings with complementary RNA-sequencing based gene expression data, we have unearthed a number of molecular regulators such as members of the Fox family of transcription factors that are enriched and likely to be functionally relevant for SMG biology. Overall, our studies provide a powerful atlas of cis-regulatory elements that can be leveraged for better understanding the transcriptional control mechanisms of the mouse SMG, discovery of novel genetic switches, and modulating tissue-specific gene expression in a targeted fashion.

Background Sclerosing polycystic adenosis (SPA) is a rare disease of salivary glands, similar to fibrocystic disease of the breast. It occurs over a wide age range and exhibits a slight female preference. Most SPA cases have occurred in the parotid gland. The exact nature of SPA is unclear, but its tumor nature has recently been proposed. Although SPA has a good prognosis after adequate surgery, atypical lesions might occur, ranging from mild dysplasia to carcinoma in situ in some cases. To the best of our knowledge, only five cases of SPA in the submandibular gland have been reported to date. Here, we present two new cases of SPA involving the submandibular gland. Case summary A 50-year-old woman and a 52-year-old woman were referred to Tongji Hospital in Wuhan, China, with complaints of moderate pain, recurrent swelling, and a mass in the submandibular area. After admission, the two cases of the submandibular mass were examined physically. The boundary of the submandibular tumor was clear, and the range of motion was good. After preoperative examinations, surgery was performed on a selective basis. Postoperative histopathological examination revealed a well-defined mass with acinar structures, ducts, or cystic dilated glands of various sizes scattered in a large number of proliferative sclerosing stroma. There were flat and cuboidal cells, and eosinophils in the duct epithelium. There was also a eosinophilic substance in the lumen of dilated cysts. No atypical epithelial hyperplasia, invasive growth, or carcinoma in situ was found. Based on the above findings, the mass was diagnosed as SPA. Both patients have remained asymptomatic and no recurrence or distant metastasis had occurred by the 7-mo and 5-year follow-up, respectively. Conclusion SPA is a rare disease of the salivary gland. Even though it has a good prognosis after adequate surgery, atypical lesions may occur from mild dysplasia to carcinoma in situ. However, no recurrence, distant metastasis, or mortality has been reported for submandibular gland SPA. Clinicians and pathologists should be familiar with the characteristics of SPA in the submandibular gland to avoid misdiagnosis and overtreatment.

BACKGROUND Salivary duct carcinoma (SDC) is a rare, extremely aggressive malignancy that arises in the submandibular gland. It can metastasize locally early and therefore is an important differential diagnosis of metastatic disease in cervical lymph nodes or specific lymphadenitis such as tuberculous cervical lymphadenitis. CASE SUMMARY We report a case of SDC in the submandibular gland that presented diagnostic difficulty. The lesion was coincidentally discovered through examination of the radiolucent area of the maxilla. Imaging failed to confirm the possibility of specific inflammation, leading us to execute an open biopsy to verify the diagnosis. The surgical specimen showed that the submandibular gland was primarily replaced with a calcified body. Following histological analysis and confirmation, we performed surgical resection, radiotherapy, and various chemotherapies. CONCLUSION Radiographic imaging characteristics of lymph node metastases of salivary gland cancer, especially of SDC, may resemble other cervical lymphadenitis; calcification at the submandibular gland is the landmark of SDC occurring at the subman-dibular gland.

Forkhead box O1 (FoxO1) is a multifunctional initiator, mediator, and repressor of autoimmune diseases in an organ- or disease-specific manner. However, the role of FoxO1 in the salivary gland has not yet been elucidated. In this study, we discovered that FoxO1 and aquaporin 5 (AQP5) are both significantly downregulated in the patients with primary Sjögren syndrome, an autoimmune disease accompanying salivary gland dysfunction. Pharmacologic or genetic perturbation of FoxO1 in the rat salivary gland acinar cell line, SMG-C6, induced a significant downregulation of AQP5 expression, as observed in clinical specimens. There was a strong correlation between FoxO1 and AQP5 expression because FoxO1 is a direct regulator of AQP5 expression in salivary gland acinar cells through its interaction with the promoter region of AQP5. Serial injection of a FoxO1 inhibitor into mice induced a reduction of AQP5 expression in submandibular glands and, consequently, hyposalivation, which is one of the major clinical symptoms of primary Sjögren syndrome. However, there was no sign of inflammation or cell damage in the submandibular glands harvested from mice treated with the FoxO1 inhibitor. In conclusion, our findings indicate that FoxO1 in salivary gland tissue acts as a direct regulator of AQP5 expression. Thus, downregulation of FoxO1 observed in primary Sjögren syndrome is a putative mechanism for hyposalivation without the involvement of previously reported soluble factors in primary Sjögren syndrome patient sera.

Purpose To verify clinical significance of submandibular gland (SMG)-sparing during helical tomotherapy (HT) for nasopharyngeal carcinoma (NPC) from the perspective of imaging by using diffusion weighted imaging (DWI). Materials and methods In this prospective study, 60 NPC patients scheduled for radical SMG-sparing HT were enrolled. All patients underwent DWI examinations prior to HT (pre-HT) and 1, 3, 6, 9, 12 months post HT. Mean apparent diffusion coefficient (ADC) values of bilateral parotid glands (PGs) and submandibular glands (SMGs) were measured. Differences of ADC and changes of ADC pre and pro HT (ΔADC) among SMG-spared, SMG-unspared and PGs were compared and the associations betweenΔADC and variations of patient-rated xerostomia questionnaire summary scores (XQ-sum) were further tested. Results ADCpost-HT and ΔADCpost-HT of SMG-spared were both much lower than of SMG-unspared and a strong dose–response relationship was detected between mean radiation dose and ΔADC of SMGs. Dynamic change trends of PGs, SMG-spared and SMG-unspared were similar, with initial increase at 1 m-post-HT followed by little change at 3 m-post-HT and then gradual decrease over time. But for SMG-unspared, there was no obvious change of ADC from 6 m-post-HT to 12 m-post-HT. The dynamic change trend of XQ-sum was nearly in line with that of ADC on the whole. And a positive correlation between mean ΔADC1m-post-HT of bilateral SMGs and variation of XQ-sum1m-post-HT in patients with bSMG-unspared were found (r = 0.693, P Conclusion SMG-sparing technique could significantly improve subjective xerostomia post HT in NPC patients from the perspective of imaging.

Objectives: Nowadays there is great evidence of the possible health benefits of olive oil. 2-Nitropropane (2-NP) is a rat liver carcinogen. The present work is focused on the effect of olive oil on the nitropropane-induced submandibular gland changes and to determine the role of TNF-.α. Methods and materials: BALB/c mice were divided into three groups (10 mice each): control mice, 2- Nitropropane inject group mice, and 2- Nitroprobane inject group treated with Olive. Submandibular gland tissues in the previous groups were histologically studied. TNF-α is investigated by using immunohistochemical technique. Results: Administration of 100 mg/kg 2-NP to BALB/c mice resulted in well-documented histopatholgical changes in the submandibular salivary glands manifested as degeneration, atrophy and preductal inflammatory cell infiltration. Olive oil administration reduced the 2-NP deleterious effect on the submandibular salivary glands. This was manifested less degenerative and atrophic changes. Immunohistochemical analysis for TNF α was more intense in the second group and weak in the third group. Conclusions: The findings conclude that 2-NP caused significant tissue damage. Olive oil may attenuate the alterations of 2-NP in BALB/c mice. The expression of TNF-α may be useful as an indicator of 2-NP effect.

Background Salivary gland tumors constitute about 3% of all head and neck tumors. We present a series of 104 cases of various salivary gland pathologies and the various modalities of surgeries done between January 2007 and July 2017. Materials and methods Total 104 patients with salivary gland tumors were included in this study, of which 76 patients had parotid tumors and 28 were submandibular gland tumors. The presence or absence of coexisting salivary gland stones, involvement or noninvolvement of ducts were all considered. Preoperatively, patients underwent fine needle aspiration cytology (FNAC) and imaging studies along with routine blood investigations. Results All patients underwent surgery and subsequent histopathological examination (HPE). The preoperative FNAC and postoperative HPE were not correlating in 6.5% of parotid tumors and in 3.5% of submandibular gland tumor. Anomalies in the fasciovenous planes were seen in 3% of the patients, which caused intraoperative difficulties. Postoperatively, five patients had salivary leak and three patients had neuropraxia, which was managed conservatively and the patients recovered subsequently between 3 months and 6 months postoperatively. Conclusion Surgery for salivary gland tumors has its own threats due to the close proximity of nerve, vessels, and ducts. Postoperative complications like nerve palsy is seen more common in malignant tumors in both parotid and submandibular gland tumors. A proper methodical assessment and awareness of the various anatomical anomalies intraoperatively may give good surgical outcomes in surgeries of salivary gland tumors. In our study, various anomalies were encountered and dealt appropriately. How to cite this article Vemuru T, Mohanty S, Manimaran V, et al. Clinical Outcomes of Salivary Gland Tumor Surgery: A 10-year-chart View. Int J Head Neck Surg 2021;12(1):11–14.

Background: The salivary glands are the site of origin of a variety of neoplasm and are also relatively uncommon accounting for Materials and Methods: this study was conducted for two years (Nov 2018-Nov 2020) in the department of pathology KBNIMS, kalaburagi. Total number of salivary gland lesions included were 50. Specimens were processed and stained by hematoxylin and eosin stain followed by microscopic examination. Results: out of total 50 cases 54% were non neoplastic and 46% were neoplastic. Predominantly salivary gland lesions were found in the 3rd -4th decade. Male predominance was seen in all salivary gland lesions. In non neoplastic lesions chronic sialadenitis was predominant (32%) followed by mucocele (10%). In neoplastic lesions, Pleomorphic adenoma was commonest benign tumor accounting for 22%. Mucoepidermoid carcinoma was most common malignant salivary gland tumor. Most of the salivary gland lesions were found in the submandibular gland. Conclusion: Histopathological examination remains gold standard because of their varied histomorphological features Keywords: Sialadenitis, Salivary gland lesions, Pleomorphic adenoma, Mucoepidermoid carcinoma.

Mucoceles originating in submandibular gland (SMG) which are extravasation type are extremely rare. Because the extraoral approach with potential risks of facial nerve injury and scar formation is commonly performed, we report endoscopically-assisted intraoral removal of submandibular gland mucocele as minimally invasive surgery. A 28-year-old female was referred to our department with an eight-week history of left submandibular painless swelling. Radiological diagnosis was not plunging ranula but SMG mucocele. The patient underwent endoscopically-assisted intraoral removal of SMG under general anesthesia as minimally invasive surgery. A mucosal incision on the left oral floor was made. After soft tissues surrounding the SMG were dissected bluntly, the mucocele and SMG were exposed more prominently by digital pressure applied beneath the lower border of the mandible by an assistant. The SMG was gripped with forceps after aspiration of mucocele, and pulled up through the incision by gland dissection. Because the facial artery penetrated the SMG, the facial artery was ligated and cut. The SMG with mucocele was removed completely in intraoral approach. Although there was no continuity with SMG and sublingual gland (SLG), the SLG was also removed preventively. The pathological diagnosis was SMG mucocele. Although lingual nerve paresthesia occurred postoperatively, the paresthesia was recovered completely 3 weeks after surgery. There was no recurrence 2.5 years after surgery. Because intraoral removal of SMG can be performed without cervical scar and facial nerve injury, this intraoral approach with endoscopic assistance can be an alternative to transcervical approach.

Plunging ranulas are recognized as soft cystic swellings in the submandibular gland area of the upper cervical region. Here, we report the case of a patient who had a large plunging ranula that extended to the inferior lingular segment of the left lung. A surgical excision of the sublingual gland was performed, and a drainage tube inserted in the neck. After two years of follow-up, there was no evidence of recurrence of the ranula. Although there are several methods of treating plunging ranulas, we demonstrate here that sublingual gland excision is an appropriate treatment modality for cases of large plunging ranula.

Background Organogenesis is regulated by morphogen signaling and transcription networks. These networks differ between organs, and identifying the organ-specific network is important to clarify the molecular mechanisms of development and regeneration of organs. Several studies have been conducted to identify salivary gland-specific networks using a mouse submandibular gland model. The submandibular glands (SMGs) of mice manifest as a thickening of the oral epithelium at embryonic day 11.5 and invaginate into the underlying mesenchyme. The network between Fgf10 and Sox9 is involved in SMG development in mice. Highlight Sox9, a member of the Sox family, is expressed in the SMG in mice from the embryonic stage to the adult stage, although the distribution changes during development. A null mutation of mouse Sox9 is lethal during the neonatal period due to respiratory failure, whereas deletion of Sox9 in the oral epithelium using the Cre/lox P system, can lead to smaller initial buds of SMGs in conditional knockout (cKO) mice than in normal mice. In addition, we showed that adenoviral transduction of Sox9 and Foxc1 genes into mouse embryonic stem cell–derived oral ectoderm could induce salivary gland rudiment in an organoid culture system. ChIP-sequencing revealed that Sox9 possibly regulates several tube- and branching-formation–related genes. Conclusion Sox9 may serve as an essential transcription factor for salivary gland development. The Sox9-mediated pathway can be a promising candidate for regenerating damaged salivary glands.

Vascular anomalies in infants and children were separated into hemangiomas and vascular malformations based on their clinical appearance, histopathologic features, and biologic behavior. Whereas vascular malformations are structural abnormalities of capillary, arterial, venous, or lymphatic elements, vascular tumors are characterized by increased endothelial cell turnover. However, misdiagnoses and misperceptions persist around the use of the term "hemangioma". Although venous malformations arising in the submandibular gland are extremely rare, the most have been diagnosed as “hemangioma”. We report a rare submandibular gland venous malformation with multiple phleboliths. A 54-year-old female visited a private dental clinic for the pain of the right mandibular third molar. Panoramic radiograph showed multiple radiopaque lesions below the right mandibular angle. After the diagnosis of submandibular gland stones, she was referred to our department for the treatment. Ultrasonography showed a heterogeneous, hypoechoic lesion with multiple hyperechoic lesions and blood flow in the right submandibular gland. CT showed a well-circumscribed, heterogenous, low-density lesion with multiple calcifications in the right submandibular gland. MRI showed a lesion with signal intensity similar to that of the muscle in the right submandibular gland had multiple low signal intensity lesions on gadolinium-enhanced T1-weighted images. Radiological diagnosis was submandibular gland venous malformation with multiple phleboliths. She underwent intraoral removal of submandibular gland lesion under general anesthesia. Pathological diagnosis was submandibular gland venous malformation with multiple phleboliths.

Purpose In a combined retrospective and prospective study, human salivary glands were investigated after radiation treatment for head and neck cancers. The aim was to assess acinar cell loss and morphologic changes after radiation therapy and to determine whether irradiated salivary glands have regenerative potential. Methods and Materials Irradiated human submandibular and parotid salivary glands were collected from 16 patients at a range of time intervals after completion of radiation therapy (RT). Control samples were collected from 14 patients who had not received radiation treatments. Tissue sections were analyzed using immunohistochemistry to stain for molecular markers. Results Human submandibular and parotid glands isolated less than 1 year after RT showed a near complete loss of acinar cells. However, acinar units expressing functional secretory markers were observed in all samples isolated at later intervals after RT. Significantly lower acinar cell numbers and increased fibrosis were found in glands treated with combined radiation and chemotherapy, in comparison to glands treated with RT alone. Irradiated samples showed increased staining for duct cell keratin markers, as well as many cells coexpressing acinar- and duct cell–specific markers, in comparison to nonirradiated control samples. Conclusions After RT, acinar cell clusters are maintained in human submandibular glands for years. The surviving acinar cells retain proliferative potential, although significant regeneration does not occur. Persistent DNA damage, increased fibrosis, and altered cell identity suggest mechanisms that may impair regeneration.

Purpose: This study investigated the effectiveness of major salivary gland ultrasonography (MSGUS) using a new grading system and shear wave elastography (SWE) in evaluating the major salivary glands of patients with Sjögren syndrome (SjS).Methods: This prospectively-designed cross-sectional study included 49 SjS patients and 49 healthy controls. Major salivary glands were examined with gray-scale ultrasonography and SWE. A new grading system for salivary glands was developed using MSGUS findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MSGUS and shear wave velocity (SWV) values were investigated. The MSGUS grading system and SWV values were evaluated together by logistic regression analysis. A cutoff value of SWE for salivary glands was determined.Results: The sensitivity, specificity, PPV, and NPV of MSGUS were 69.4%, 73.5%, 72.3%, and 70.6% for the submandibular gland and 69.4%, 65.3%, 66.7%, and 68.1% for the parotid gland, respectively. The mean SWV values of the parotid and submandibular glands were significantly higher in SjS patients than in controls (P

Recurrent sialadenitis of submandibular gland can have multiple causes, one of the rare being foreign bodies. Motor vehicle accidents, assaults, bullet wounds and iatrogenic surgical fault are the most common causes of traumatic foreign bodies. Fish bone is one of the most common foreign bodies that gets lodged in the upper digestive tract, often located in the tonsil, base of tongue, epiglottis, pyriform fossa and esophagus, where it may be easily identified on routine inspection and removed. The forcible swallowing of food such as rice balls after ingesting fish bones by mistake may lead to the migration of the fish bone from the pharynx, throat or esophagus to the surrounding tissues. Migration most commonly occurs to the soft tissues of the neck, even to the thyroid gland, but migration to the submandibular gland has rarely been reported. Here, we present a case of submandibular sialadenitis due to unusual migration of ingested fish bone to submandibular gland. Foreign body ingestion may cause a series of complications and endanger a patient's life. Cases require high awareness and attentiveness on the part of the first physician to diagnose and manage the condition and appropriate health education should be imparted to the patient. Faridpur Med. Coll. J. 2021;16(1):55-57