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The aim of this study is to investigate salivary gland involvement in patients with anti-centromere antibody (ACA)-positive primary Sjögren's syndrome (pSS). We retrospectively evaluated 134 patients with pSS. Patients were divided into four groups based on the results of ACA and SSA antibodies. We compared clinical manifestations, laboratory findings, salivary gland shear wave elastography, minor salivary gland biopsy results, and EULAR Sjögren's syndrome disease activity index (ESSDAI) scores among the four groups. A total of 134 patients were classified as having pSS and divided into three groups based on serum ACA and anti-SSA antibody status: ACA + SSA + , ACA + SSA-, ACA-SSA + , and seronegative. The primary analysis focused on comparing the clinical and SWE findings between the ACA + SSA + and ACA + SSA- groups. In the double-positive group, SWE revealed fewer minor salivary glands along with higher mean (Emean) and maximum (Emax) values of Young's moduli than those in the ACA-negative group. Patients in the positive group had increased occurrence of Raynaud's phenomenon, liver involvement, and a higher incidence of malignancy (P < 0.05). ACA-positive pSS patients are a subgroup with different clinical manifestations and more pronounced involvement of the minor salivary glands. SWE findings revealed that ACA-positive patients exhibit significantly higher mean and maximum stiffness values compared to ACA-negative patients, indicating more extensive glandular fibrosis and involvement. These results underscore the utility of SWE as a valuable method for evaluating salivary gland pathology and supporting the stratification of pSS patients., (© 2024. The Author(s).)

To identify the value of salivary gland ultrasound (SGUS) combined with magnetic resonance imaging (MRI) and magnetic resonance sialography (MRS) in predicting the results of labial salivary gland biopsy (LSGB) in patients with suspected primary Sjögren syndrome (pSS), and construct a nomogram model to predict LSGB results. A total of 181 patients who were admitted with suspected pSS from December 2018 to April 2023 were examined and divided into a training set (n = 120) and a validation set (n = 61). Baseline data of the two groups were examined, and the value of SGUS, MRI, and MRS in predicting LSGB was analyzed. Multivariate logistic analysis was used to screen for risk factors, and nomogram prediction models were constructed using these results. In the training set, the SGUS, MRI, and MRS scores of patients in the LSGB + group were higher than those in the LSGB - group (all P < 0.001). The positive prediction value (PPV) was 91% for an SGUS score of 3, and 82% for MRI and MRS scores of 2 or more. We developed a nomogram prediction model based on SGUS, MRI, and MRS data, and it had a concordance index (C-index) of 0.94. The Hosmer-Lemeshow test (χ 2  = 3.17, P = 0.92) also indicated the nomogram prediction model had good accuracy and calibration for prediction of LSGB results. A nomogram model based on SGUS, MRI, and MRS results can help rheumatologists decide whether LSGB should be performed in patients with suspected pSS., (© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Purpose: To summarize the CT and MR imaging features of carcinoma ex pleomorphic adenoma(Ca-ex-PA) in minor salivary gland, and analyze the correlation between various features and pathological classification., Methods: Forty-three patients with Ca-ex-PA in minor salivary gland were collected. The CT and MRI findings were retrospectively analyzed and correlated with their pathological types. Fisher's exact test was used to analyze the correlation between various imaging features (tumor morphology, boundary, internal structure, bone invasion, cervical lymph node metastasis) and pathological types with SPSS 25.0 software package., Results: Among the 43 patients with Ca-ex-PA, 83.7%(36/43) of the tumors were lobulated; 81.4%(35/43) showed cystic degeneration or necrosis, with heterogeneous enhancement. Coarse calcification or mixed calcification was found in 37.2%(16/43), 25.6%(11/43) had compressive absorption of adjacent bone. 75%(12/16) of type Ⅰ/Ⅱ tumors had regular morphology (round or oval), and 77.8%(21/27) of type Ⅲ tumors had irregular morphology, 93.8%(15/16) of type Ⅰ/Ⅱ tumors had well-defined margin and 66.7%(18/27) of type Ⅲ tumors had ill-defined margin. Osteolytic bone resorption occurred in 59.3%(16/27) of type Ⅲ tumors. The average maximum diameter of type Ⅰ/Ⅱ tumors was significantly shorter than that of type Ⅲ(P＜0.05). Fisher's exact test showed the characteristics of tumor morphology, boundary and osteolytic bone resorption were related to pathological grouping(P＜0.001)., Conclusions: Most Ca-ex-PA in minor salivary glands is characterized by lobular and heterogeneous enhanced neoplasm on CT and MR imaging. A round or oval tumor with well-defined margin usually correlates with typeⅠ and Ⅱ, contrarily, an irregular mass with ill-defined margin and osteolytic bone destruction usually correlates with type Ⅲ. Combining the three characteristics of morphology, boundary and osteolysis is more helpful to distinguish type Ⅰ/Ⅱ and type Ⅲ tumors.

Objectives: Our aim was to evaluate the association between salivary gland scintigraphy and the clinical parameters, including histological characteristics of salivary glands, in patients with primary Sjogren's syndrome (pSS)., Methods: Forty-one pSS patients were included in the study. The patients who had received salivary gland scintigraphy and minor salivary gland biopsy were retrospectively analyzed. Salivary gland scintigraphy was interpreted via semi-quantitative methods obtained by calculating the peak uptake and washout of each gland using regions of interest. All specimens were examined by pathologists for focus scores and leukocyte common antigen (LCA) to determine the degree of inflammatory infiltration., Results: The mean age of pSS patients was 46.4 years, 82.9% were female, and the mean duration of symptoms was 2.5 years. The focus score was negatively correlated to the mean peak uptake (r = ‒0.396; p = 0.019), mean uptake (r = ‒0.388; p = 0.021), and mean percentage washout (r = ‒0.391; p = 0.02). In addition, the focus score and number of LCA positive cells per mm 2 were correlated with the clinical parameters including erythrocyte sedimentation rate, globulin, rheumatoid factor, unstimulated whole saliva, and stimulated whole saliva flow. The number of LCA positive cells per mm 2 was negatively correlated to leukocytes and hemoglobin., Conclusion: Although the diagnostic role of salivary gland biopsy is widely accepted and features in the classification criteria of Sjogren's syndrome, salivary gland scintigraphy may be an acceptable alternative method especially if a non-invasive test is required., (© 2022. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Introduction: Secretory carcinoma (SC) is a malignancy of the salivary glands, which is similar to SC of the breast regarding its association with neurotrophic tyrosine receptor kinase fusion-positive gene. SC is a recently described salivary gland tumor, and there are a few reports describing oral minor salivary gland-derived SC. We reported two cases of SC in the oral cavity and reviewed the literature., Patient Concerns: The patients included a 65-year-old Japanese woman who presented with a mass of the upper lip and an 84-year-old Japanese man who presented with a mass on the buccal mucosa., Diagnosis: Diagnosis was based on histomorphological and immunohistochemical findings and identification of a specific translocation of the ETS variant 6-neurotrophic receptor tyrosine kinase 3 gene fusion. Case 1 was finally diagnosed using reverse transcription-polymerase chain reaction with formalin-fixed paraffin-embedded tissue samples, while case 2 was diagnosed using fluorescence in situ hybridization analysis., Interventions and Outcomes: In case 1, excisional biopsy was done and there was no recurrence observed in five-year follow-up. In case 2, tumor resection was done and there was no recurrence observed in two-year follow-up., Conclusion: It is highly likely for many cases of SC to be initially diagnosed as acinic cell carcinoma (AciCC) owing to their similar histological findings. The treatment strategy for minor salivary gland-originated SC is similar to that of AciCC; however, SC is often highly malignant and involves a high risk of cervical lymph node metastasis. Thus, establishing an accurate diagnosis together with pathologists and confirming the presence of the ETS variant 6-neurotrophic receptor tyrosine kinase 3 fusion gene using genetic analysis is important., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Aim and Objective: To examine the clinical signs, radiographical features, and demographics of pediatric pleomorphic adenoma (PA) in the minor salivary glands., Materials and Methods: Several databases were searched for relevant studies. The included studies were assessed for methodological quality. Demographic, clinical, and radiographic data were collected., Results: Sixteen of 3,121 articles met the inclusion criteria (17 lesions). The mean age was 9.7 ± 3.9 years and majority were females n = 10 (59%). It is commonly presented as asymptomatic swelling n = 16 (94.1%), in the hard palate 13 (76.5%). Radiographically, most were well-defined n = 15 (93.7%) and 8 (47%) caused erosion or displacement of surrounding tissues., Conclusion: The small size and asymptomatic nature of pediatric PA can render these lesions undiagnosed. On rare occurrences, PA can show calcifications, MRI, or CT enhancement. MRI is the best imaging modality to depict soft tissue content but not subtle erosion of adjacent bony structures., Clinical Significance: The dentist can be the first to detect PA in the mouth of a child. Augmenting clinical examination with radiographic examination is paramount to ensure adequate diagnosis of PA, examine effects on surrounding bone, and maintain close follow-up as watchful waiting is not safe in this population.

Background: Sjögren's syndrome (SS) is an autoimmune disease characterized by an inflammatory infiltrate of exocrine salivary and lachrymal glands. Diagnosis is complex, and minor salivary gland biopsy and subsequent focus score (FS) calculation appear of extreme importance in the diagnostic work-up of the disease. Ultra-high frequency ultrasonography (UHFUS) is a recently introduced diagnostic technique, which is gaining an increasingly important role in intraoral imaging. This study aims at exploring the usefulness of UHFUS for obtaining valuable labial salivary gland samples to assess the histopathological features of SS patients., Methods: Patients with clinical suspect of SS and eligible for minor salivary gland biopsy were enrolled. UHFUS scan of the lower lip was performed. Glandular echostructure was classified according to Outcome Measures in Rheumatology (OMERACT) scoring system. The glands to be sampled were selected on the basis of UHFUS evaluation and biopsied. The areas of the samples were recorded and compared with those obtained without UHFUS guidance. The correlation between UHFUS grade and labial gland FS was also assessed., Results: The areas of the samples obtained with UHFUS guidance were significantly higher (7.25 ± 3.98 mm 2 ) than those obtained by conventional procedures (5.79 ± 3.49 mm 2 , P = .02). UHFUS correlated significantly with the salivary gland FS (r = .532, P = .001)., Conclusion: UHFUS seems a promising tool in SS diagnostic algorithm, being able to provide a valuable support to the biopsy procedure. Further studies are mandatory to confirm the role of UHFUS in SS., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: A 52-year-old woman presented with shortness of breath and cough. An endobronchial sialolipoma was found at the left entrance of the main bronchus. Sialolipoma is an exceedingly rare type of lipoma reported of the minor salivary glands, especially within the bronchus., Case Presentation: A 52-year-old woman presented with shortness of breath and cough with 6 months´ evolution. Endobronchial endoscopy revealed a tumour at the left entrance of the main bronchus. The entire removal of the tumour was removed using a cryoprobe device. Pathological examination showed a tumour consistent with the diagnosis of sialolipoma due to the presence of mature adipose cells blended with acinar, ductal, basal, and myoepithelial cells. The patient had a favourable outcome., Conclusion: The infrequent tracheobronchial presentation of this tumour can be challenging for correct diagnosis.

Objective: Minor salivary gland carcinoma (MiSGC) is rare, and the understanding of this disease is insufficient. This study aimed to identify independent risk factors and develop a nomogram for evaluating the overall survival (OS) and cancer-specific survival (CSS) of patients with MiSGC., Study Design: Retrospective cohort study., Setting: SEER database (Surveillance, Epidemiology, and End Results)., Subjects and Methods: We collected data from patients diagnosed with MiSGC between 2004 and 2015 from the SEER database. According to patient registration, all patients were randomly allocated to training sets and validation sets (2:1). Then, Kaplan-Meier product limit curves and Cox proportional hazard regressions were performed to estimate the prognostic effect of variables. Nomograms based on Cox proportional hazard regressions were established to estimate 3- and 5-year OS and CSS. Finally, the nomogram was developed by the training set, and validation was performed with the concordance index, calibration curves, and decision curve analyses., Results: In total, 1787 MiSGC cases were registered in SEER. The concordance index for internal validation of OS and CSS prediction was 0.842 and 0.816; that of external validation was 0.871 and 0.831. The calibration plots showed good consistency between nomogram prediction and actual survival. The decision curve analysis showed substantial net benefits of the new predictive model., Conclusions: We constructed nomograms and a corresponding risk classification system predicting the OS and CSS of patients with MiSGC. These tools can generate simple-to-use clinical risk grouping and determine the relationship between adjuvant therapy and active surveillance.

Minor salivary gland carcinomas (MSGCs) are nonminor tumors in the head and neck region and account for about half of all salivary gland carcinomas. Imaging evaluation based on the anatomy of minor salivary and mucous glands in the head and neck region as well as invasion patterns in each site helps in identifying optimal treatment modalities and planning suitable treatment strategies. MSGCs can be divided radiologically into localized and invasive subtypes on the basis of the clinical utility of such categorization. Characteristic invasion patterns of the invasive type include deep submucosal extension, bone marrow infiltration, and perineural spread, which are difficult to assess clinically. MSGCs easily invade adjacent structures because of their submucosal location and may spread along the muscles, nerves, periosteum, and dura mater. Moreover, the tumor may spread into the bone marrow without obvious bone destruction. In addition to imaging classification, examining the anatomy and distribution of the minor salivary glands, including the palatal, lingual, buccal, labial, and retromolar glands, as well as other mucous glands, including the glands of the sinonasal cavity and nasopharynx, lacrimal glands, ceruminous glands, laryngeal glands, and tracheal glands, facilitates MSGC diagnosis and tumor extension assessment. The authors review the precise anatomy of the minor salivary and mucous glands in the head and neck region, discuss the MSGC imaging classifications, and describe how to evaluate the extent of MSGCs in each site on the basis of the imaging classification and invasion patterns. © RSNA, 2020.

Objectives: Ultra-high frequency ultrasonography (UHFUS) has been recently introduced in oral medicine due to its ability to image small anatomical structures including labial salivary glands (LSG). To date no ultrasonography morphological studies of labial salivary glands (LSG) have been carried out in SS. In this pilot study we aimed at analysing the distribution of UHFUS findings in LSG of patients with suspected SS, focusing in particular on the association with patients' oral dysfunction, antibody profiles and histopathology., Methods: Consecutive patients undergoing a LSG biopsy for clinically suspected SS were included in this study between January 2018 and January 2020. Intraoral UHFUS scan of the lip mucosa was performed with Vevo MD equipment, using a 70 MHz probe with a standardised protocol. LSG were assessed by using a four-grade semiquantitative scoring system (0-3), similar to the OMERACT scoring system used for major salivary glands. The distribution of UHFUS grades was compared in patients stratified according their final diagnosis, patients antibody profiles and LSG histopathology., Results: We included 128 patients with suspected SS: out of them, 54 (42.2%) received a final diagnosis of SS, made according to the ACR 2016 criteria and 74 (57.8%) were diagnosed as no-SS sicca controls. We found that LSG inhomogeneity was significantly greater in patients with SS than in no-SS subjects (p<0.0001). We also found that higher UHFUS pattern of inhomogeneity (i.e. grade 2 and 3) were significantly more frequent in both SSA+/SSB- and SSA+/SSB+ patients (p=0.001). A normal UHFUS pattern, by contrast, was significantly more common in SSA-/SSB- subjects (i.e. 15/83 (18.1%) vs. 1/33 (3%) vs. 0/12 (0%), p=0.001). Finally, LSG inhomogeneity was significantly associated with both the number of foci (p<0.001) and focus score (p<0.001). Particularly, we found that both the number of foci and the FS were significantly higher in patients presenting a UHFUS grading of 2 and 3 with respect to those presenting a UHFUS grading of 0 and 1 (p=0.01)., Conclusions: This preliminary study demonstrates the optimal feasibility of UHFUS and its high sensitivity in identifying negative patients on subsequent lip biopsy, thus avoiding invasive procedures in selected cases. Further studies are in progress to define the clinical and predictive role of the various patterns observed and their added value with respect to traditional salivary gland ultrasonography.

Context: Madelung disease has been literally classified as a rare disease, more common in Mediterranean population. It is characterized by the presence of multiple symmetrical, non-capsulated storages of adipose tissue. Case description: We present a 56 year old woman with a sudden unexplained progression of swelling in the neck and upper thorax region associated with severe dyspnea. She was admitted with angioedema in the Allergology Department. Radiology images identified a bilateral adipose degeneration of the parotid and minor salivary glands. Conclusions: The diefinitive diagnosis concluded was Type 1 Madelung Disease. The decision was to keep the patient under periodic observation and if any deterioration takes place, surgical intervention will be taken under consideration. Despite non previous findings of Madelung disease in our population this case presented a challenge of emergency diagnosis.

Background: Sialolithiasis is the most common disease of the salivary glands. Sialolithiasis usually develops in the major salivary glands, and rarely in the minor salivary glands, with only 2% of all cases of sialolithiasis occurring in the minor salivary glands and sublingual glands. Sialoliths in the minor salivary glands result in few or no clinical symptoms and are seldom identified on imaging., Case Presentation: We report herein our experience with a case of minor salivary gland sialolithiasis in a 67-year-old woman. On examination, an elastic soft, mobile, and well-circumscribed mass was palpable within the left upper lip. Ultrasound examination revealed a hypoechoic mass with heterogeneous internal echoes. The mass was excised under local anesthesia. Based on histopathological findings, a diagnosis of minor salivary gland sialolithiasis was established., Conclusions: Diagnosis of minor salivary gland sialolithiasis is challenging due to the difficulty of detecting sialoliths on imaging. A well-circumscribed mass was detected in the upper lip, and ultrasound examination revealed a round lesion, raising the suspicion of a benign tumor. Other diseases that can develop at the upper lip are calcified lymph node, phlebolith, fibroma, pleomorphic adenoma, myxoma, vascular malformation, salivary gland tumor, non-specific sialadenitis, and malignant tumor. Surgical excision is the favored approach for confirming a diagnosis of intramucosal nodular lesions.

The aim of the study was to describe the anatomical location and the topographic relationship of the major salivary glands to associated tissues in six dog cadavers by high-field magnetic resonance imaging (MRI) and gross anatomical dissections and sections. Spin-echo T1-weighted and T2-weighted magnetic resonance (MR) images were obtained in transverse, sagittal, and dorsal planes with a 1.5 T magnet. The digastric muscle, the external auditory canal, the eyeball, and the medial pterygoid muscle were the most consistent topographic landmarks for the identification of the mandibular, parotid, and zygomatic salivary glands, respectively. The best differentiation and contrast of the glands was observed in the T2-weighted images. In contrast with the osseous and muscular tissues, the salivary glands appeared hyperintense in greater or lesser measure except for the parotid gland, which displayed a hypointense signal. The rostral part of the monostomatic sublingual gland was precisely located between the tongue and the mylohyoid muscle. The best delineation between the caudal part of the monostomatic sublingual gland and the cranial aspect of the mandibular gland was observed in dorsal MRI at the level of the palate and the branches of the superior dental arcade. Good evaluation of the mandibular, parotid, caudal part of the monostomatic sublingual, zygomatic and buccal ventral glands was possible in sagittal MRI in close relation with the external auditory canal and the temporomandibular joint. The ventral buccal glands were also observed near the buccal vestibule as was the palatine glands within the soft palate., (© 2018 Blackwell Verlag GmbH.)

Neoplastic and non-neoplastic lesions may involve the minor salivary glands. Tumors of minor salivary glands are commonly seen in the oral cavity. Malignant tumors are more common than benign minor salivary gland tumors. The most common malignant tumors are adenoid cystic carcinoma and mucoepidermoid carcinoma, and the most common benign tumor is pleomorphic adenoma. Non-neoplastic lesions may involve minor salivary glands such as Sjogrene disease, immunoglobulin G4-related disease, necrotizing sialometaplasia, and subacute necrotizing sialadenitis. Contrast MR imaging and computed tomography are adequate for localization and extension of neoplastic and non-neoplastic lesions of minor salivary glands., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Fatty infiltration of minor salivary gland parenchyma is relatively frequent, but not extensively examined histopathological phenomenon in biopsy samples. Its extent and relation to several suspected background diseases are not well understood., Methods: In this study, we examined the presence and extent of fatty infiltration on digitally scanned versions of the periodic acid/Schiff-stained minor salivary gland slides of 275 patients. As a result of the image analysis, fatty infiltration was expressed in per cent of the whole selected area. The presence and extent of this change were compared to age, diabetes mellitus and body mass index in various statistical analyses., Results: Significantly higher age and body mass index values were found in the fatty infiltration positive than in the negative group. We also found that not only the number of fatty infiltration positive cases was increased significantly in the gradually worsened body mass index groups, but the extent of fatty infiltration also increased as the obesity worsened. Age also showed significant correlation with the extent of fatty infiltration., Discussion: All of these findings support that the age (which seemed the only independent variable) shows strong correlation with the presence of the fatty infiltration but obesity may also play important role in the development and the extent of this change. Because of its frequency in elderly, at least partly, the fatty infiltration might be responsible for the xerostomia. We also think that presence of fatty infiltration should be mentioned in the histopathological report of salivary gland biopsies., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

An 80-year-old male presented with painless blurred vision from the right eye following endoscopic biopsy of a right maxillary sinus mass with the otolaryngology service. The patient admitted to progressive right-sided proptosis over the past few weeks. Past medical history was significant for acinic cell adenocarcinoma of buccal space origin with resection 3 years prior. Orbital CT revealed a large, poorly circumscribed destructive mass in the right masticator space with extension to the paranasal sinuses, inferior and medial orbit, and middle cranial fossa. Histopathology confirmed the mass to represent a recurrent acinic cell carcinoma. The patient was treated with chemotherapy, and at last follow-up 2 years after presentation had stable painless globe dystopia and visual acuity. The authors describe a very rare case of a recurrent minor salivary gland acinic cell carcinoma with secondary orbital extension.

Introduction: Cribriform adenocarcinoma of the tongue and minor salivary glands (CATMSG) is a recently described entity, with most cases previously published as polymorphous low-grade adenocarcinoma (PLGA). Typical cases share some main characteristics, such as oral sites (mainly tongue), regional lymph node metastasis, and morphology resembling solid and follicular variants of papillary thyroid carcinoma., Objective: To present a CATMSG and emphasize the importance of reclassifying PLGAs with unusual behavior., Case Report: A 78-year-old male presented with an ulcerated mass in the soft palate treated as PLGA. The patient developed 5 regional metastases over 11 years of follow-up, all diagnosed as PLGA. He died due to the disease, and because of the very aggressive behavior of PLGA, all histopathologic slides were revised and the tumor was reclassified as CATMSG., Conclusion: This report emphasizes the importance of reevaluating aggressive PLGA and contributes to a better understanding of CATMSG., (Copyright © 2016 Elsevier Inc. All rights reserved.)

A 33-year-old woman presented with an unusual subglottic bulging mass accompanied by prolonged cough and wheeze. Laryngeal endoscopy revealed a bilateral, symmetrical mass immediately below the vocal cords with marked airway obstruction. Chronic subglottic laryngitis with inflammation or another condition such as amyloidosis was initially suspected. Cervicothoracic computed tomography revealed an obvious reduction of laryngeal caliber caused by an engulfing mass extending from just under the vocal cords to the cricoid ring, which was associated with thyroid, arytenoid, and cricoid cartilage destruction. Histopathological diagnosis of a biopsy specimen collected via a tracheotomy revealed that the lesion was a cT4aN0M0 adenoid cystic carcinoma (ACC) originating from the laryngeal minor salivary glands. The patient was treated by total laryngectomy with elective bilateral neck dissection under general anesthesia. Gross inspection of resected tissue confirmed yellowish-white, solid tumor mainly circumferentially encompassing the lumina of the cricoid ring. The histopathological findings confirmed typical ACC accompanied by a predominant cribriform appearance with no evidence of lymph node metastasis. The patient remains well and free of recurrence or metastasis. We herein describe laryngeal ACC and discuss radiological images and the surgical pathology., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Mucocele of the anterior lingual salivary glands is a more common cystic lesion, especially in patients aged less than 20 years. The study is aimed to observe the effect of treatment by injection of absolute ethanol instead of surgery. Fourteen outpatients diagnosed as mucocele of the glands of Blandin-Nuhn were selected. These patients, after blood investigation, were treated by injection of absolute ethanol into a mucous cavity of lesion under superficial anesthesia with 2% lidocaine once a week and followed up from 3 months to 2 years. Mucocele of the glands of Blandin-Nuhn was extirpated in all patients after 1 to 3 injections. There were no other complications except slight distending pain occurred on the same day when the patients were treated. The recurrence was not observed during the follow-up period. In conclusion, the study suggests that injection of absolute ethanol may be an alternative means for treating mucocele of the glands of Blandin-Nuhn, because it is mininvasive, safe, effective, economic, and simply manipulated compared with surgical treatment., Competing Interests: The authors report no conflicts of interest.

It is generally accepted that ultrasound is now the first line of imaging of palpable lumps of the neck. Standardized protocols exist for the evaluation of thyroid, salivary gland and nodal disease, and sonography is increasingly being used in the characterization of intraoral soft tissue lesions. Here, we present two cases where intraoral sonography was invaluable in the early detection of oral malignancy.

Introduction: Mucoceles are benign lesions associated with the pathology of the oral mucosa of minor salivary glands. Two types of cysts are distinguished depending on their pathogenesis. Most often they occur as a result of mechanical trauma and mucus extravasation into tissues or obstruction of the gland ducts., Aim: The aim of the study was to present our own experiences regarding mucoceles of minor salivary glands in the oral cavity taking into account how frequently the individual types of cysts occur in children., Material and Methods: The research was carried out based on medical files from the years 2005-2015. These were: medical case records, operating books and the medical registry of patients treated at the Clinic of Maxillofacial Surgery, Frederic Chopin Clinical Regional Hospital in Rzeszow. In that period 64 children and teenagers, 28 girls and 36 boys were treated. What was considered was the age and gender of the patients, the reason for their appointment with a doctor, the location, size and histopathological type of the cysts, as well as the course and results of the diagnostic and therapeutic process., Results: In the group analyzed, the reasons for referral to the Clinic were: in 25 patients accidental ascertainment of a non-symptomatic tumor in the oral cavity during examination by a dentist, pediatrician or laryngologist which had not caused any discomfort to the children; in 13 patients concern had been raised by a gradually increasing tumor; in 18 cases there was an increased tissue tension surrounding the tumor, while in 3 children red oedema was observed in the oral cavity (suspicion of abscess). The most frequent mucocele location was the lower lip (34 children). The most frequent size was 2.1-3 cm (28 children). The most frequent histological type was MEP. All the patients were treated at the Clinic in the one-day surgery mode, with good outcome., Conclusions: Mucocele ascertainment in children's oral cavity could be made accidentally in routine pediatric examination, therefore it is necessary to extend pediatricians' knowledge about small salivary gland mucoceles. The most frequent type of MEP could be related to different types of trauma in the oral mucose.

Objective: This paper reports the case of a 13-year-old girl with a 2-year history of left cervical lymph node swelling that was diagnosed as metastatic cribriform adenocarcinoma of the tongue and minor salivary gland., Case Report: A 13-year-old girl with a left, level II cervical lymph node underwent excisional biopsy after an ultrasound suggested suspicious features. The histology indicated polymorphous low-grade adenocarcinoma, and a primary lesion in the left palate was identified. The patient underwent left maxillectomy, neck dissection and reconstruction. Histological analysis of resection specimens led to a revised diagnosis of cribriform adenocarcinoma of the tongue and minor salivary gland., Conclusion: Cribriform adenocarcinoma of the tongue and minor salivary gland has recently been described as a separate entity to polymorphous low-grade adenocarcinoma in light of histological and behavioural differences, including higher rates of metastasis at presentation. This is the first report in the world literature of an adolescent with this entity. It is possible that some previous reports of polymorphous low-grade adenocarcinoma in childhood would have been more accurately described as cribriform adenocarcinoma of the tongue and minor salivary gland.

Mucinous adenocarcinoma (MAC) is commonly found in the gastrointestinal tract but head and neck localisations are very rare. This article presents the case of a 67-year-old patient suffering from a minor salivary gland MAC of the left buccal mucosa, who was treated in the Department of Cranio-Maxillofacial Surgery in Krakow due to multiple recurrences of the tumour. The results of immunohistochemical staining, the course of surgical treatment and follow-up, as well as a review of literature are also discussed.

We present a case of de novo polymorphous low-grade adenocarcinoma (PLGA) arising in a minor salivary gland with a relatively large radiographic extent compared with that of most of the PLGAs reported. This paper describes the radiographic extent of the lesion and the findings of CT imaging.

Minor salivary gland carcinoma of the hard palate is rare, and its long-term survival rate is high, making it difficult to evaluate the prognostic factors and the efficacy of treatment. This study was designed to evaluate the treatment outcome of minor salivary gland carcinoma of the hard palate. 103 cases of minor salivary gland carcinoma of the hard palate treated with surgery alone or underwent surgery combined with post-operative radiotherapy hospitalized in Cancer Center, Sun Yet-Sen University, from 1968 to 2008 were reviewed retrospectively. The most common histologic types were adenoid cystic carcinoma in 48 patients(46.6%), mucoepidermoid carcinoma in 37(35.92%), malignant mixed tumor in 15(14.56%), and acinic cell carcinoma in 3(2.91%). The median follow-up time was 74.83 months (range 0.9-356.57 months). Overall outcomes at 5 and 10 years were overall survival (OS), 77.9% and 65.7%; recurrence-free survival (RFS), 64.4% and 53.2%; and disease specific survival (DSS), 77.9% and 67.7%, respectively. There was no significant difference in overall survival (P=0.52), recurrence-free survival (P=0.762) and disease specific survival (P=0.449) between patients who underwent surgery alone and those who underwent surgery plus post-operative radiotherapy. Surgery has been accepted as the primary treatment for minor salivary gland carcinoma of hard palate. Sufficient surgical excision with adequate margins is essential for a favorable outcome. We advocate using radiotherapy in the post-operative context for patients with poorly differentiated, cervical lymph node metastasis, positive or close margins, and large primary lesions., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

A rare case of congenital salivary gland fistula is reported. A 3-year-old girl presented with clear discharge from a dimple on the left cheek. An ectopic salivary gland fistula was unexpectedly diagnosed during operation. This is the first case of congenital salivary fistula draining from a minor salivary gland to a cutaneous pit. We completely excised the lesion, and the patient remains complication free., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: World literature suggests parapharyngeal space lesions account for only 0.5% head and neck tumours and the majority of the minor salivary gland tumours are malignant. The parapharyngeal space is very rare site for this tumour., Case Presentation: Two cases of primary pleomorphic adenomas arising de novo from minor salivary glands in the para pharyngeal space are reported. Review of literature, clinical features, pathology, radiological findings and treatment of these tumours are discussed., Conclusion: Pleomorphic adenoma arising de novo in the parapharyngeal space is of rare occurrence. High index of suspicion and an adequate clearance of the tumour with a cuff of surrounding dispensable normal tissues is the key to successful treatment of such tumours.

Canalicular adenomas are uncommon, benign epithelial neoplasms of the salivary glands that usually involve the upper lip and buccal mucosa of elderly people. Differential diagnosis of the canalicular adenoma versus adenocarcinoma is important, as it may result in unjustified radiotherapy or extensive and aggressive surgery. Despite the benign nature of canalicular adenomas, complete surgical removal and a regular clinical follow-up are recommended. The present article describes the diagnostic procedures, surgical management, and follow-up of a canalicular adenoma involving the palate of a 71-year-old man.

Adenocarcinoma of the minor salivary gland (MSG) is a rare neoplasm. It represents about 2% of all MSG malignant tumours. It is more common in the palate and in females. This tumour occurs in a mean age of sixty and its mean size at presentation is 1.5cm. Microscopically, the neoplasms classified as adenocarcinoma not otherwise specified (NOS) are a histologically heterogeneous group: they vary from highly anaplastic adenocarcinoma to moderate and well-differentiated lesions. This report describes a case of adenocarcinoma of MSG occurring in the buccal mucosa of a 24-year-old male. The patient underwent a sentinel node biopsy as a staging tool in association with the primary surgical treatment. In the histological examination of sentinel lymph node (SLN) there was no evidence of metastatic disease. The patient presents no evidence of recurrent disease after 4years of follow-up. We believe that the use of SLN biopsy can be indicated in similar cases considering the tumoural biology (well-differentiated) because prospective randomized studies would be very difficult to be performed due to the rarity of this neoplasm.

Salivary gland tumors usually occur as single lesions. To have more than one tumor is unusual. We report a case of an adult male who presented with a mucoepidermoid carcinoma involving the minor salivary glands of the palate at age 57 years, followed by an adenoid cystic carcinoma of the floor of mouth at age 63 years. The patient later succumbed to non-Hodgkin lymphoma at age 72 years. There are 31 acceptable cases of multiple malignant salivary gland neoplasms reported in the world literature. Multiple malignant tumors of the same histologic type are more common than those of different histologic type. Bilateral acinic cell adenocarcinoma was the most frequent combination of multiple salivary gland malignancy, accounting for 14 cases (10 synchronous and four metachronous). All involved the parotid glands bilaterally with the exception of one case that involved parotid and submandibular gland. Polymorphous low-grade adenocarcinoma accounted for three of the four cases of multiple malignant tumors involving minor salivary glands. Individuals with a history of malignancy are at risk for the development of additional malignant tumors and should receive appropriate clinical follow-up.

Anterior mandibular lingual salivary gland defects are rare. They may be evident on routine radiographic exam. Because the differential diagnosis can be exhaustive, differential interpretation and diagnosis are crucial. A case of large bilateral radiolucent lesions of the anterior mandible that was an anterior mandibular salivary gland defect is reported in a young female. This lesion was initially visualized on a panoramic radiograph. Further evaluation was undertaken with dental cone-beam computed tomography. Confirmation of bilateral anterior mandibular lingual salivary gland defects was made using magnetic resonance imaging, negating the need for surgical biopsy.

Although calcification is a common finding in inflammatory salivary gland disorders, salivary gland tumour rarely shows calcifications. A case of clear cell mucoepidermoid carcinoma (MEC) of the hard palate with extensive intratumoural calcifications visible on computed tomography (CT) scans and histologic sections is described. The calcification in the salivary gland tumour of the palate recognized by a CT scan should be considered in the differential diagnosis of a MEC. The mechanism of the intratumoural calcification in our case is speculated to be a result of a secretory function of the tumour cells.

Objectives: Surgery for tumors of the parapharyngeal space (PPS) requires adequate exposure to identify and protect vital structures. Transcervical and transcervical-transparotid approaches to the PPS may be enhanced by mandibulotomy. However, midline mandibulotomy traditionally requires lip-splitting and extensive intraoral incisions, often necessitating tracheostomy and nasogastric feeding. We describe a new technique to gain exposure to the PPS while avoiding these consequences., Study Design: Case series., Methods: Five patients with PPS tumors underwent surgery using a new technique, the subcutaneous mandibulotomy approach (SMA). Each case was retrospectively assessed for tumor size, intraoperative access to the PPS, perioperative complications, and length of hospitalization., Results: In this series, the additional exposure achieved by SMA was adequate to safely remove large PPS tumors that could not be delivered through the transcervical-transparotid approach. All patients started oral diets on postoperative day 1 and were discharged within 3 days. There were no intraoperative complications, and postoperative complications were self-limited. The pathologic entities were a venous malformation, a paraganglioma, and three large, deep-lobe pleomorphic adenomas of the parotid., Conclusions: We introduce a new technique, the SMA, which affords excellent access to the PPS without the lip-split, chin-split, and floor of mouth incisions. The SMA avoids both nasogastric feeding and a tracheostomy and offers improved cosmesis compared with a traditional midline mandibulotomy. Our current stepwise approach to achieve exposure to the PPS includes use of the SMA as an intermediate step for extensive PPS lesions, which are inaccessible through the transcervical approach yet do not require full labiomandibulotomy for safe and complete removal.

The aim of this study was to provide an appropriate experimental model to study functional changes in salivary glands using scintigraphy. Although the rabbit was frequently used for laboratory experiments, there are only a few studies that describe the exact position of its different salivary glands on the sialoscintigram. Twenty rabbits were used for the study; ten of them were anatomically dissected to provide the required topographic anatomy on the different salivary and lacrimal glands. The remaining ten animals underwent a static scintigraphy after extirpation of a particular salivary gland. Changes in the pattern of tracer uptake indicated the exact position of every gland allowing its evaluation. The results show that the 99mTcO4- uptake can only be selectively evaluated in two salivary glands, the superficial mandibular gland and the parotid gland. The superficial mandibular gland was proved to be a particularly useful model to evaluate functional changes of salivary gland parenchyma due to its well defined and high enhanced structure which allows a precise detection and measurement of the tracer uptake. Additionally, the good surgical accessibility of this gland and the existence of a well defined capsule facilitate associated histological studies of its parenchyma.

Background: Submandibular masses are mostly secondary to sialolithiasis. Salivary gland tumors should be considered in the differential diagnosis. In this case report, an unusual cause of Warthin's duct obstruction caused by an accessory salivary gland tissue is presented., Methods: Sialography revealed the submandibular accessory salivary gland., Results: Submandibular gland excision was performed and histopathologic investigation showed the accessory salivary tissue, which was narrowing the Warthin's duct., Conclusions: In cases of a symptomatic submandibular accessory gland, excision extirpation of the submandibular gland and accessory salivary tissue should be undertaken., (Copyright 2000 John Wiley & Sons, Inc.)

We report a case of minor salivary gland sialolithiasis presenting as acute, painful swelling of the upper lip. Conventional, unguided, incision and drainage removed three of the sialoliths. Diagnostic ultrasound identified two further sialoliths which were successfully removed with real-time, ultrasound-guided, needle localization. This technique of sialolith retrieval has not been previously reported.

Tumors of minor nasal salivary glands are relatively sparse. The case reported is a monomorph adenoma of benign character, which first clinical diagnosis mimicked a naso-sinusal polyposis. Examination of the removed piece by functional endoscopic surgery firstly was considered as an adenocarcinoma of low malignity degree but afterwards resulted as a mucinous cysto-adenoma of minor salivary glands with favorable clinical behaviour.

Objective: The purpose of this study was to evaluate the usefulness of ultrasonography for the preoperative evaluation of palatal salivary gland tumors., Study Design: Eleven surgically treated patients with salivary gland tumors of the palate were examined retrospectively. Intraoral ultrasonic scanning examinations were performed with a 10-MHz transducer., Results: The ultrasonographically well-delimited tumors had a complete capsule histologically, whereas the poorly delimited tumors had no capsule or only an incomplete capsule. The tumors that had a reinforced posterior wall echo were associated with pressure bone absorption, and the tumors that had a reinforced posterior echo were associated with bone destruction. Echograms of the tumors were classified into 4 types on the basis of the internal echoes., Conclusions: Intraoral ultrasonography of palatal tumors can be used to determine the localization and condition of the tumors by close analysis of the echogram. The internal echo pattern on the ultrasonogram of a palatal tumor was found to reflect the pathologic structure of the tumor. Ultrasonography can therefore be a quite useful technique for the preoperative evaluation of palatal salivary gland tumors.

The epithelial-myoepithelial carcinoma of salivary glands is rarely presented and it's considered as an intermediate grade tumor. Usually are located in the parotid gland, however sometimes occur on minor salivary glands. An epithelial-myoepithelial carcinoma sitting on a palatine minor salivary gland of long course is reported.

Lipomatosis has not previously been reported in minor salivary glands. Its occurrence in the parotid gland is well recognized. We present the first reported case of lipomatosis of the minor salivary glands in the nasal cavity. We also review the tumours of the minor salivary glands, lipomas and lipomatosis of the parotid, and the few reported cases of lipomas of the sinonasal tract.

The case of a 41-year-old female is described wherein a minor salivary gland pleomorphic adenoma originating in the right retromolar area had extended into the infratemporal fossa and enlarged to 5 x 6 x 12 cm. The patient first became conscious of the mass as a slight swelling of the buccal mucosa when she was about 30 years of age, and the swelling since then had gradually gained in prominence. Preoperative computed tomography scan demonstrated a well-circumscribed mass occupying the right infratemporal fossa and medially displacing the pterygoid laminas. The mass was easily removed without much bleeding and no recurrence has been detected for 4 years. The incidence of pleomorphic adenoma originating in the retromolar area, the size of minor salivary gland pleomorphic adenomas at the time of diagnosis, and the treatment of choice are discussed.

Objective: To define the CT criteria for differentiating malignant from benign tumours of the minor salivary glands of the palate and to evaluate their accuracy., Patients and Methods: CT findings of 63 patients with histopathologically proven minor salivary gland tumours of the palate (23 malignant, 40 benign) were retrospectively evaluated., Results: Aggressive bone destruction was a specific finding of malignant tumours, but was seen in only 57% (13/23) of this series. Extension into the pterygopalatine fossa was observed in seven malignant and one benign tumour. Calcifications within a tumour were observed in four cases, all of which were malignant. These three CT findings were significantly more frequent in malignant tumours. Using any one of these as the criterion for the malignancy, the sensitivity was 78% (18/23), specificity 98% (39/40) and accuracy 90% (57/63)., Conclusion: Malignant tumours of the minor salivary glands of the palate are very likely to show any or all of aggressive bone destruction, extension into the pterygopalatine fossa and calcification, whereas benign tumours can almost always be correctly diagnosed by their absence.