Submandibular gland transfer: a new method of preventing radiation-induced xerostomia

OBJECTIVE: Radiation-induced xerostomia is a significant morbidity of radiation therapy in the management of patients with head and neck cancers. We have recently reported a method of transfer of one submandibular gland to the submental space in a small pilot series of eligible surgical patients. The submental space was shielded during postoperative radiation therapy. The transferred gland continued to function after the completion of radiation therapy and none of the patients developed xerostomia. The purpose of this article is to present the technique of submandibular gland transfer in detail and to evaluate the postoperative survival and function of the transferred submandibular glands. DESIGN: Prospective clinical trial. METHODS: The submandibular gland was transferred on eligible patients as part of their surgical intervention. The patients were followed clinically, with salivary flow and radioisotope studies. RESULTS: We performed the surgical transfer of the submandibular salivary gland in 24 of 25 patients placed on the protocol. All the glands survived transfer and functioned well postoperatively as demonstrated on the salivary flow and the radioisotope studies. The surgical transfer was relatively simple and added 45 minutes to the surgical procedure. There were no complications attributed to the submandibular gland transfer. CONCLUSIONS: We have successfully demonstrated that the submandibular gland can be surgically transferred to the submental space with its function preserved. The gland seems to continue functioning even after radiation therapy with the appropriate shielding. This surgical transfer procedure has the potential to change the way we currently manage patients with head and neck cancer.     

Angiosarcoma of the Submandibular Salivary Gland: Case Report and Review of the Literature

Objective The purpose of this report is to describe an example of angiosarcoma (AS) of the submandibular salivary gland. The clinical and immunohistopathologic features of these lesions are also reviewed.

Material and Methods A 17-year-old male high school student was admitted to our clinic with a 1-year history of a slow-growing, tender mass in the left submandibular region. Physical examination on initial presentation revealed a diffuse soft tissue mass 6 cm in diameter involving the left submandibular region. MRI analysis revealed a mass located superolateral to the submandibular salivary gland, measuring 4.0 x 2.0 cm². The mass was excised completely together with the left submandibular salivary gland. Histopathologic analysis led to a diagnosis of AS. Immunohistochemical studies were also used to determine endothelial cell differentiation. Owing to the lateralized nature of the lesion, a left functional neck dissection was performed and postoperative radiotherapy was planned.

Results AS is a malignant tumor of endothelial cell origin that may occur in any region of the body. The commonest sites include the extremities and the retroperitoneal space, with only 4% of AS tumors arising in the head and neck area. The submandibular salivary gland is an extremely rare location for this tumor. Based on a literature review, this case report represents only the second reported case of AS of the submandibular salivary gland.

Conclusion In most cases, radical surgery and postoperative radiotherapy are advocated to treat patients with AS tumors, with lymph node clearance recommended in cases of lateralized lesions In some patients, distant metastasis may occur after many years, which necessitates long-term follow-up. The prognosis is poor in most cases of AS.     

Significance of Unilateral Submandibular Gland Excision on Salivary Flow in Noncancer Patients

Objectives/Hypothesis: Normal salivary flow is important for maintaining good oral hygiene. Lack of normal flow predisposes to an increased incidence of dental caries and symptomatic xerostomia. The submandibular glands are responsible for 70% of resting salivary flow. Removal of the submandibular gland is most commonly performed for sialolithiasis, chronic sialoadenitis, or as part of a neck dissection. The effect of unilateral gland resection for benign disease on resting salivary flow has not been well examined in the literature. Study Design: Case controlled study involving patients who had undergone a unilateral submandibular gland resection matched with normal control subjects. Method: Stimulated and unstimulated salivary flow rates in surgical and control subjects were measured in a controlled setting. Results: Unstimulated salivary flow rates were 0.805 mL/min in the control group and 0.405 mL/min in the surgical group (P = .01). Stimulated salivary flow rates were not significantly different between the two groups (P > .05). Fifty-seven percent of patients in the surgical group and 14% in the control group had xerostomia (P < .05). Conclusion: Unilateral submandibular gland excision results in a decreased rate of resting salivary flow and an increase in subjective xerostomia.     

A rare malignancy of the parotid gland: oncocytic carcinoma

Oncocytic carcinomas are uncommon; they represent 11% of all oncocytic salivary gland neoplasms, 0.5% of all epithelial salivary gland malignancies and 0.18% of all epithelial salivary gland tumors. A 65-year-old woman was admitted to our ENT clinic with a history of a painless left preauricular mass. No lymph node was palpable on either side of her neck. Computed tomography demonstrated a 3×3-cm solid lesion in the left parotid gland. As oncocytes and atypical cells were seen at the cytologic examination of a fine-needle aspiration biopsy, this finding suggested a malignant epithelial tumor. Total parotidectomy by preserving the facial nerve was performed. The result of the pathologic examination was oncocytic carcinoma regarding histopathologic and immunohistochemical findings and especially the invasive growth pattern. We preferred a close follow-up to an elective neck dissection, and reserved the neck dissection for a recurrence. The prognosis of oncocytic carcinomas is not well known because of their low incidence. Further investigation of the prognosis of patients with oncocytic carcinoma of the parotid gland is warranted as more cases are reported.     

颌下支气管源性囊肿一例

正1病例资料患者女,41岁,2017年8月21日因颌下肿胀2个月就诊,收入山东省枣庄矿业集团枣庄医院耳鼻咽喉头颈外科。问诊知其2个月前无意中发现颌下局部肿胀,略疼痛,无其他不适,应用抗生素静滴、中药口服(具体不详)等方法治疗,肿痛加重,后应用青霉素静滴,渐好转,但未完全消退。入院体检示,无声音嘶哑,无体温升高,无吞咽困难;口腔黏膜无出血点、无溃疡;颌下、喉结上方扪及肿物,约2.0 cm     

内镜辅助经口入路颌下腺切除的初步经验

目的 探讨内镜辅助经口入路颌下腺切除术的指征和利弊.方法 同顾性分析12例内镜辅助经口入路颌下腺切除术患者的临床资料.术前诊断慢性颌下腺炎8例(2例含涎石),多形性腺瘤3例,颌下腺囊肿1例.所有病例术前经影像学评估,其中8例经细针穿刺细胞学或细针穿刺组织学活检确诊.结果 术后2例出现暂时性的舌体麻木和舌体运动障碍,1～3个月后完全缓解;无其他并发症.术后1个月未损害面容满意度采用视觉模拟量表评分均为10分,所有患者都满意.多形性腺瘤患者随访时间12～48个月(中位数36个月),未见复发.结论 内镜辅助经口入路良性颌下腺病损切除术安全、可行,优点是无颈部瘢痕和面神经下颌缘支损伤的风险.

Abstract：

Objective To discuss the indications, risks and benefits of endoscope-assisted transoral approach to excise the submandibular gland. Methods A retrospective review of a series of 12 patients treated by endoscope-assisted transoral submandibular gland excision was carried out. Of the 12 patients, 8were chronic sialoadenitis (2 cases with sialolith), 3 were pleomorphic adenoma, and 1 was cyst of submandibular gland. Preoperatively, all patients were diagnosed as benign diseases by Ultrasonography, CT or MRI. Pathologic diagnosis of 8 cases were identified by fineneedleaspiration cytology (FNAC) or fineneedle aspiration biopsy (FNAB). Results Temporary lingual sensory paresis and temporary limitation of tongue movement were found in two patients. However, these signs soon resolved spontaneously within 1-3 months. There were no other complications. Postoperatively, mean satisfaction score with cosmetic results was 10. All patients were satisfied with the cosmetic results. No recurrences were found in patients with pleomorphic adenoma with a follow-up period ranged from 12 months to 48 months(median follow-up period:36 months). Conclusions Endoscope-assisted transoral excision of the submandibular gland is a feasible and safe approach for the benign diseases of the submandibular gland . The major advantages of this approach are no external scar and no injury to the marginal mandibular nerve.     

Submandibular approach for excision of a large schwannoma in the base of the tongue

A 24-year-old Turkish woman is described, who gradually developed progressive swallowing problems over 6 months due to a tumor in the base of the tongue. Magnetic resonance imaging showed a large well-circumscribed solid mass. Histopathological examination of an incisional biopsy showed a schwannoma. The tumor was completely removed through a submandibular approach. The postoperative course was uneventful and her complaints disappeared. The submandibular approach used gave an excellent exposure of the base of tongue with a less obvious scar than a lip-splitting incision. Received: 16 June 1999 / Accepted: 22 July 1999     

Stony whartons’s duct

Sialolithiasis is a major cause of salivary gland dysfunction. Chronic sialadenitis promotes stone formation. Conversely the presence of calculi causes chronic sialadenitis. It is clear that the genesis of calculi lies in relative stagnation of a calcium rich saliva. The submandibular gland is a more common site than the parotid, sublingual and other minor salivary glands for calculi formation. This case is presented here because of its unusual size of the wharton’s duct stone for its clinical interest.     

Oncocytic carcinoma of the salivary glands: A Danish national study

Objectives

To present a Danish national series of oncocytic carcinoma (OC) patients, including data on treatment, recurrence and survival.

Epithelioid hemangioendothelioma of the submandibular gland

Epithelioid hemangioendothelioma (EH) is a seldom tumor of vascular origin, which occurs at sites such as liver, lung or soft tissues, and has a highly unpredictable malignant potential and clinical course. We submitted a case with epithelioid hemangioendothelioma of submandibular gland. The patient was a 44-year-old woman who presented with left submandibular painly mass. Fine needle aspiration showed a mixed lymphoid population. Contrast enhanced Computerize Tomography (CT) scan revealed that to be a well-circumscribed and including microcalcification in centre 2.5 cm x 2.0 cm mass in diameter without evidence of bony invasion. Submandibular gland was excised. The pathological result was interpretated as epithelioid hemangioendothelioma of the submandibular gland. The patient was seen regularly for recurrence.     

Fistula of submandibular gland-a rare presentation

Salivary fistulas commonly affect parotid gland. Sabmandibular fistulas are very rare. Most of them are congenital in origin and may be associated with abnormalities of the branchial apparatus. Traumatic submandibular fistulas on the other hand are very rare entities with only few cases reported till date.     

Large cell neuroendocrine carcinoma of the submandibular gland: Case report and literature review

Large cell neuroendocrine carcinoma (LCNEC) of the salivary gland is extremely rare. We report on a case of LCNEC in the submandibular gland. A 58-year-old male had a four-month history of an enlarging mass in his left submandibular region. He underwent lymph node resection and metastasis of LCNEC was suspected. Magnetic resonance imaging of the neck showed a solid submandibular gland tumor with marginal blurring. Positron-emission tomography and upper gastrointestinal endoscopy showed no evidence of malignancy other than in the left submandibular gland. He underwent left submandibular gland resection and left upper neck dissection. The final diagnosis was LCNEC of the submandibular gland; surgical margin was negative. Fourteen months later he is free of tumors. This is the first report of LCNEC of the submandibular gland. LCNEC of the salivary gland shows high-grade malignancy like that of the lung. According to past reports, two of four patients died despite multidisciplinary treatments. There are no standard treatments for LCNEC of the salivary glands. More studies are needed to define prognostic factors and establish therapeutic methods.     

The effect of submandibular gland preservation during level 1B neck dissection on postoperative xerostomia

Objective

Compare the presence and degree of postoperative xerostomia following preservation or excision of the submandibular gland (SMG) during level IB neck dissection (ND) without adjuvant radiation.

Histopathological and radiological investigations of the influence of botulinum toxin on the submandibular gland of the rat

The aim of the study was to correlate the sonographic features of Botox A injection in rat submandibular gland with the histopathological changes. Fifteen Wistar albino rats were randomly assigned to 2 groups. Group 1 (control group) consisted of 5 animals not given any substance. Group 2 was divided as “a” and “b” each consisting of 5 animals. A median cervical incision has been performed to the rats in group 2 and 2.5 U Botulinum toxin A reconstituted 0.1 ml physiologic saline was injected into the right gland. Sonograms were obtained before the application, at the first day of the Botox A application, in addition to group 2a on the 14th day, and on 28th day to group 2b. Gland size was lower in group 2a and 2b comparing to control group. The gland size of group 2b was lower than group 2a. There was no change in vascularization. There was no other histopathological change except lymphocytic infiltration in group 2. It was observed that Botox A injection does not have a direct effect on the cells in submandibular gland but it causes a homogenic shrinking in gland size without atrophy.     

Arteriovenous hemangioma involving submandibular salivary gland

We present a case of an arteriovenous hemangioma involving the submandibular salivary gland in a 20 year old girl. Hemangiomas in this region are rare. Out of the reported cases most have been cavernous hemangiomas. The rarity of an arteriovenous malformation in the submandibular salivary gland prompted us to report this case.     

Large-cell undifferentiated carcinoma of the submandibular gland

Large-cell undifferentiated carcinoma (LCUC) arising in the submandibular gland is so rare that there have been only a few reported cases. We encountered a 65-year-old Japanese male, whose left submandibular gland was enlarged due to LCUC. Exenteration of the left submandibular gland together with selective neck dissection was performed, followed by postoperative radiotherapy. Current literature concerning the histopathological and clinical features of this neoplasm was reviewed.     

Submandibular approach to anterior C2-C4 disc space in the management of an aneurysmal bone cyst

We report a case of a ten-year-old girl with a large posterior neck mass, an aneurysmal bone cyst involving the upper cervical spine.Patient underwent tumor resection through a posterior approach and required subsequent anterior fusion and instrumentation of C2-C4 for stability. We describe a challenging transcervical submandibular approach that allowed anterior cervical discectomy with placement of interdisc spacer using pre-contoured allograft and plating to achieve anterior fusion. We demonstrated that this approach is safe and effective in children, and provides excellent visualization for direct access with a surprisingly large operative field for instrumentation.