Chronic sialadenitis of the submandibular gland

Summary The main etiologic factor in chronic Sialadenitis of the submandibular gland is the salivary calculus. One hundred eight extirpated submandibular glands with the clinical diagnosis of chronic Sialadenitis were histologically examined. The intensity of parenchymal destruction was related to the duration of symptoms prior to surgery. With the exception of four cases the glands showed histologically a varying degree of pathologic alterations. In almost one-third of the cases no acinar structures were found. The duration of symptoms ranged from 1 week to 55 years. No statistical evidence of correlation existed between the duration of symptoms and the degree of histological changes.Supported by grants from Torsten Söderbergs and Ragnar Söderbergs foundations, Stockholm, Sweden     

Spontaneous regression of lung lesions after excision of the submandibular gland in a patient with chronic sclerosing sialadenitis

Chronic sclerosing sialadenitis, which clinically resembles a salivary gland tumor, is considered a salivary gland lesion of the IgG4-related inflammatory disease. Corticosteroids are effective for the treatment of chronic sclerosing sialadenitis, but the natural clinical course of this disease is not fully understood. We report a 67-year-old man with chronic sclerosing sialadenitis who showed lung lesions, which spontaneously regressed without steroid therapy after excision of the submandibular gland. He presented with several weeks' history of continuous swelling in the right submandibular region. Physical examination showed a hard swelling of the right submandibular gland; the cytological finding was Papanicolaou class III. A chest X-ray demonstrated bilateral infiltration of the right middle and left lower lobes. The right submandibular gland was excised under general anesthesia for definite diagnosis, and histopathological examination revealed an IgG4-positive plasmacytic infiltration accompanied by periductal fibrosis and interlobular sclerosis, consistent with chronic sclerosing sialadenitis. Five months after operation, the lung lesions regressed spontaneously.     

Neonatal submandibular sialadenitis progressing to submandibular gland abscess

Submandibular sialadenitis is exceptionally rare in neonates. We describe a case of submandibular sialadenitis progressing to submandibular abscess in a term neonate. The aetiology, investigations and treatment for this very rare condition are discussed.     

Salivary calculi as an aetiological factor in chronic sialadenitis of the submandibular gland

During 1960–1975, 115 submandibular glands were removed for reasons other than neoplasia at the Ear, Nose and Throat department, Karolinska sjukhuset, Stockholm. The material was retrospectively analysed with regard to clinical and histopathological findings. The patients, 62 men and 52 women aged 13-77 years, exhibited in all cases but one a chronic sialadenitis. Salivary calculi were found in 82% of the patients. In one patient a mucous retention cyst was found. Microscopically some cases exhibited only a slight periductal inflammation, while others showed a complete destruction of the gland architecture. The duration of symptoms of the whole group before surgery varied from 1 week to 55 years but with a median value of almost 1 year. The conclusion of this study is that salivary calculus is the most important indication for removal of submandibular gland, for reasons other than neoplasia.     

Uncommon situation and presentation of chronic sclerosing sialadenitis

Chronic sclerosing sialadenitis of the parotid gland is a very uncommon chronic inflammatory salivary gland disease. Clinically, it presents as a slow-growing painful. Histologically, it showed a chronic inflammation and fibrosis. This case report highlights the clinical, radiological and histological aspects of this disease.We report unusual case of chronic sclerosing sialadenitis of the parotid in a 12-year-old man. CT detected a mass of tissue density in the right parotid. The evolution was marked by spontaneous fistula allowing a surgical biopsy. The mass regressed after corticosteroids. The follow-up was normal.The location, age and presentation make our case very interesting.     

Suppurative submandibular sialadenitis in a preterm infant

Submandibular sialadenitis is a rarely reported entity in neonatal period. We describe a preterm infant who developed suppurative submandibular sialadenitis. He was diagnosed clinically and confirmed by ultrasound examination. He was treated successfully with antibiotics and drainage. The etiology, diagnosis and treatment of this rare condition are discussed.     

Morphological alterations of salivary gland parenchyma in chronic sialadenitis

Ten cases of chronic nonspecific sialadenitis of the parotid and submandibular glands were studied by a combination of immunohistochemistry (to detect cytoplasmic filaments), morphometry, and electron microscopy in order to assess histological modifications that might reflect on the concepts for the induction of neoplasia in these glands. Histologically, the gradual atrophy of the glandular parenchyma results in the presence of many small ductules. Although structural alterations were apparent at all levels of the secretory/excretory glandular components, and in all types of cells, the fact that many such ductules resulted from gradual dedifferentiation of acinar cells was a major finding. The results suggest that no cell-type in salivary gland can be excluded as having a potential for neoplastic transformation and that the basis for the currently held reserve cell hypothesis is likely incorrect.     

Cytodiagnosis of submandibular sialadenitis with crystalloids mimicking metastasis

Sialomrgaly of suhmandibultir gland, whether inflammatory or neoplastic can be clinically mistaken for lymphoid metastasis especially when encountered in an elderly patient. Other than the neoptastic lesions and usual inflammatory lesions rarely amylase crystalloids can evoke a granulomatous response and can result in sialomegaly. We report an interesting case which presented as a submandibular swelling and was clinically diagnosed as metastasis where the diagnosis of granulomatous response to crystalloids was made at FNAC. The aim of this report is to bring an awareness of the existence of such lesions and to highlight the role of FNAC in diagnosis of such lesions in order to avoid unnecessary surgeries.     

Tumors of the submandibular gland

Primary neoplasms of the submandibular gland do not hold a statistically impressive position when compared to other tumors in the head and neck. Due in part to their relative rarity, incorrect preoperative diagnosis is not uncommon, but perhaps of more significance is the lack of an adequately prepared management program of these lesions. This presentation reviews tumors of the submandibular gland at the Charity Hospital in New Orleans, La., for the 24-year period 1948-1971.     

Endoscope-assisted submandibular sialadenectomy: a new minimally invasive approach to the submandibular gland

PURPOSE: Although submandibular sialadenectomy with a minimal incision improves overall cosmetic outcomes, visualization of the surgical field exposure is relatively limited as compared with that in the conventional procedure. To overcome this limitation, we applied the endoscope system to submandibular sialadenectomy. The aim of this study was to evaluate the technical feasibility and potential role of our endoscope-assisted submandibular sialadenectomy (EASS). MATERIALS AND METHODS: We performed EASS on 5 patients, 3 of whom had intraparenchymal sialolithiasis and 2 of whom had pleomorphic adenomas. The dissection was carried out by bipolar dissection with a 4-mm nasal endoscope system. RESULTS: The procedure achieved successful results for all 5 patients except for 1 who had severe adhesion to the adjacent tissues; this patient suffered from postoperative lingual nerve paresthesia. All the patients achieved good cosmetic outcomes. CONCLUSIONS: An EASS with bipolar dissection is technically feasible and secures a better surgical view through a minimal incision. However, for patients with severe adhesion to the adjacent tissues, conversion to the wide-open procedure would be safer.     

Removal of the submandibular gland by a retroauricular approach

OBJECTIVE: To evaluate the benefit of a retroauricular approach by comparing it with a conventional transcervical approach for removal of the submandibular gland. DESIGN: Prospective clinical study. SETTING: Academic center. PATIENTS: Thirty patients with benign submandibular gland disorders. INTERVENTIONS: Patients were divided into 2 surgical groups to undergo retroauricular (n = 15) and conventional (n = 15) procedures matched by age, sex, marital status, and pathologic condition. The retroauricular approach used an incision along the postauricular sulcus and hairline and subcutaneous tunneling to the gland; the conventional approach used an incision along a natural skin crease overlying the gland. MAIN OUTCOME MEASURES: The operation time, complications, hospital stay, and subjective satisfaction of incision scar checked by visual analog scale were compared between groups. RESULTS: The submandibular gland disorders were comparable between groups: pleomorphic adenoma (n = 15), chronic sialadenitis with sialolithiasis in the gland (n = 5) or hilum (n = 8), and Küttner (n = 1) or Kimura (n = 1) disease. Mean +/- SD operation times were 49 +/- 17 minutes in the retroauricular group and 38 +/- 15 minutes in the controls (P = .08). Mean +/- SD hospital stay and complication rates were comparable between groups. The mean +/- SD score of patient satisfaction was 8.9 +/- 0.9 in the retroauricular group and 4.2 +/- 2.9 in the conventional group (P<.001). The incision scar was commonly less visible in the retroauricular group because of hiding by the auricle and natural hair when comparing with the control group. CONCLUSION: The retroauricular approach can provide better cosmetic outcome than the conventional transcervical approach and without significant complications.