Histological effects of ductal ligation of salivary glands of the cat

Experimental Animal Model Systems for Understanding Salivary Secretory Disorders

Salivary secretory disorders are life-disrupting pathologic conditions with a high prevalence, especially in the geriatric population. Both patients and clinicians frequently feel helpless and get frustrated by the currently available therapeutic strategies, which consist mainly of palliative managements. Accordingly, to unravel the underlying mechanisms and to develop effective and curative strategies, several animal models have been developed and introduced. Experimental findings from these models have contributed to answer biological and biomedical questions. This review aims to provide various methodological considerations used for the examination of pathological fundamentals in salivary disorders using animal models and to summarize the obtained findings. The information provided in this review could provide plausible solutions for overcoming salivary disorders and also suggest purpose-specific experimental animal systems.

Enucleation or exenteration in two dogs with previous parotid duct transposition: parotid duct ligation versus reverse parotid duct transposition

Two dogs with previous parotid duct transpositions presented with unrelated ocular disease. In both cases, ophthalmic examination revealed the need for enucleation or exenteration. In case 1, systemic coccidioidomycosis was diagnosed with panuveitis and secondary glaucoma of the left eye. In this case, the parotid duct was ligated at the time of enucleation to stop salivary secretions. This dog encountered morbidity in the form of a sialocele that did not resolve for 11 months. In case 2, ultrasound and computed tomography revealed a discrete mass within the left medial orbit that was suspected to arise from the nictitating membrane. A combination of exenteration and parotid duct transposition reversal was performed to avoid morbidity associated with ligation of the parotid duct. The dog encountered no complications from this novel procedure. This case report represents the first report of re-routing a transposed parotid duct from the ventral conjunctival sac back to the mouth at the time of enucleation or exenteration in the dog.

Acinar cell response to liquid diet during rats' growth period differs in submandibular and sublingual glands from that in parotid glands

Continuously feeding a liquid diet to growing rodents strongly inhibits parotid gland growth, due to suppressed growth of acinar cells. This study investigated whether a liquid diet had a similar effect on submandibular and sublingual glands of growing rats. Rats were weaned on day 21 after birth and then fed a pellet diet in the control group and a liquid diet in the experimental group for 0, 1, 2, 4, and 8 weeks. Their submandibular and sublingual glands were excised, weighed, and examined histologically, immunohistochemically (using antibodies to 5'-bromo-2-deoxyuridine and cleaved caspase 3), and ultrastructurally. The submandibular glands did not significantly differ between the control and experimental groups at all tested points. Only at Week 8, acinar cell area and 5'-bromo-2-deoxyuridine-labeling index of acinar cells in sublingual glands were significantly lower in the experimental group than in the control group. These results show that a liquid diet during rats' growth period had no effect on acinar cells in their submandibular glands, and only a slight effect on acinar cells in their sublingual glands of growing rats, in contrast to the marked effect of a liquid diet on parotid glands.

Surgical management of parotid salivary duct rupture secondary to non-iatrogenic trauma in a dog

A 3-year-old French bulldog presented for evaluation of recurrent swelling and a fistula on the right cheek after a dog fight. A large volume of serous fluids was identified on the wound immediately after atropine drops. A diagnosis of parotid salivary duct rupture secondary to trauma was made. On surgical exploration, the thickened proximal segment of the severed duct was identified and circumferentially double ligated with 3–0 silk. No evidence of swelling and normal appearance of the parotid salivary gland were identified 4 months postoperative recheck. No further problems were noted 10 months postoperatively phone-call. To the author’s knowledge, this is the first reported case of successful proximal parotid duct ligation of parotid salivary duct rupture secondary to non-iatrogenic trauma.

What is new in management of pediatric ranula?

PURPOSE OF REVIEW

Ranula is extravasation mucocele arising from the sublingual gland, influencing the swallowing or eating; this review focuses on the most recent literature pertaining to pediatric ranulas and aims to comprehensively describe the methods of diagnosis and management approaches.

RECENT FINDINGS

Ranulas consist of intraoral ranula and plunging ranula, which are frequently misdiagnosed, so it is vital for the differential diagnosis of pediatric ranulas to depend on the clinical examination, imaging and fine-needle aspiration cytology. Pediatric patients should first be observed for 6 months before other treatments. OK-432 could activate inflammatory reaction to induce shrinkage of pediatric ranulas. Marsupialization, incision with drainage and ranula excision alone, are associated with a high rate of recurrence, even marsupialization with packing and modified micromarsupialization should be prudently applied for primary treatment of intraoral ranula. Laser excision is considered an alternative treatment for intraoral ranula of pediatric patients because of low recurrence rates and surgical complications. Recently, sublingual gland with or without ranula excision is a reasonable and suitable choice for radical treatment in pediatric patients.

SUMMARY

The principal goal of pediatric ranula management is radical sublingual gland excision, sealing the mucus extravasates and lowest complications.

Growth of rat parotid glands is inhibited by liquid diet feeding

This study investigated how liquid diet feeding affects the growth of parotid glands. We weaned 21-day-old rats and thereafter fed them a pellet diet (control group) or a liquid diet (experimental group) for 0, 1, 2, 4, or 8 weeks. Their parotid glands were excised, weighed, examined, and tested for 5-bromo-2'-deoxyuridine (BrdU) and cleaved caspase-3 (Casp-3) as markers of proliferation and apoptosis, respectively. Parotid gland weights were consistently smaller in experimental animals than in controls. Morphometrical analysis showed that control group acinar cells increased in area during the experiment, but experimental group acinar cells were almost unchanged. Labeling indices of BrdU in acinar cells in both groups declined during the experiment, but were consistently lower in the experimental group than in controls. Casp-3-positive acinar cells were rare in both groups, which consistently express significantly similar Casp-3 levels. Ultrastructurally, terminal portions of the experimental parotid glands consisted of a few acinar cells that were smaller than those in controls. Control acinar cells showed mitotic figures within short experimental periods, but not in experimental glands. These observations indicate that liquid diet feeding inhibits growth of parotid glands in growing rats through suppression of growth and proliferation of individual acinar cells, but not through apoptosis.

Surgical Excision of the Parotid Salivary Gland for Treatment of a Traumatic Mucocele in a Dog

A 3 yr old spayed female mixed-breed German shepherd dog was presented with a right facial swelling that developed after fighting with another dog. A parotid salivary mucocele was diagnosed via physical examination, fine-needle aspirate, and sialography of the parotid and mandibular salivary glands. Surgical excision of the right parotid salivary gland and duct was performed along with drainage of the mucocele. Neither intraoperative nor postoperative complications occurred, and follow-up examination 4 mo later revealed no evidence of recurrence. Case outcome was considered excellent. Sialography was useful for confirming the parotid gland as the source of the mucocele. Surgical excision of the parotid salivary gland is technically challenging, but an effective treatment option for traumatic mucoceles in the dog.

Modern management and pathophysiology of ranula: literature review

BACKGROUND

There is a lack of consensus about the appropriate treatment of ranula. The objective of the present investigation was to produce a scientific basis for treatment.

METHODS

A review of the relevant literature is interpreted in the light of improved knowledge about the local anatomy and the pathophysiology of the salivary glands.

RESULTS

The oral and plunging ranulas are cystic extravasation mucoceles that arise from the sublingual gland and usually from a torn duct of Rivinus. The sublingual gland is a spontaneous secretor and the salivary flow is resistant to obstruction, which is caused by fibrosis induced by the extravasation. The submandibular gland is not a spontaneous secretor, is less resistant, and does not give rise to ranulas.

CONCLUSIONS

Effective treatment is removal of the involved unit of the sublingual gland or inducing sufficient fibrosis to seal the leak through which the mucus extravasates.

Early markers of regeneration following ductal ligation in rat submandibular gland

Rat submandibular glands can recover their function and secretory protein content following ductal ligation-induced atrophy. Morphological studies have established that following ligation, deligation of the gland allows the regeneration of new salivary gland tissue. However, little is known about changes happening during early regeneration following intra-oral duct ligation, which does not damage the parasympathetic nerves. Glands that had been 2 weeks ligated or 2 weeks ligated + 3 days deligated were compared. Tissue was prepared for histological, immunohistochemical (SMG-B and Ki-67) and immunocytochemical analyses (smooth muscle actin, aquaporin 5). Haematoxylin and eosin staining of deligated glands showed that some acini regained their cytoplasmic volume; moreover, the loss of Alcian blue/periodic acid-Schiff's staining from the lumen of ducts suggested successful deligation. The deligated gland was characterized by atypical acinar-ductal branched structures, which were less frequent in the ligated gland and rarely seen in normal unoperated tissue. Myoepithelial cells were also investigated since changes in their morphology reflected changes in the acini morphology not readily detected by conventional staining. Actin staining revealed the presence of some shrunken acini in the atrophic tissue, whereas they had regained their normal morphology in the deligated gland suggesting that the acini were recovering. Some acini during deligation regained aquaporin 5 expression, which had decreased during atrophy. SMG-B protein, located in the pro-acinar cell during gland development and usually found in the intercalated duct cells in the adult, was detected in the newly formed acini of the deligated gland. This study suggests that morphological markers of regeneration appear as early as 3 days following ligation removal.

Parotid Duct Sialolithiasis in a Dog

Computed tomography was used to evaluate a 7-year-old English bulldog with a history of facial swelling and to aid in the diagnosis of parotid duct sialolithiasis. Removal of the sialolith with repair of the duct was not possible because of ductal fibrosis. Histological evaluation revealed glandular atrophy and fibrosis with lymphoplasmacytic inflammation. The parotid duct was ulcerated and fibrotic, with a mixed inflammatory infiltrate. Surgical excision of the parotid duct and salivary gland was curative.

Organic secretory products, adaptive responses and innervation in the parotid gland of ferret: A histochemical study

To qualify cellular events of possible pathophysiological significance in the parotid of ferret, tissue obtained post-mortem from mature animals of either sex was examined by light microscopical histochemistry for calcium, protein, amino acids, mucosubstances and hydrolases, and by neurohistology. Calcium was localised in acinar cells replete with granules containing protein, disulphides and usually carboxylated mucosubstances. Acid phosphatase activity was basally concentrated in the acinar cells. The granular luminal region of striated ductal cells showed protein, tryptophan, disulphides, neutral mucosubstances, and E600-sensitive esterase and Naphthol AS-D chloroacetate esterase activities, whereas their basal region showed acid phosphatase activity. Strong periluminal activity of acid phosphatase and E600-resistant esterase characterised the collecting ducts. Cholinesterase activity was associated with an extensive network of nerve fibres embracing parenchyma. Catecholamine fluorescence was not seen. beta-glucuronidase reactive macrophages abounded in the interstices. The results suggest that while the acini in the parotid of ferret secrete polyionic glycoproteins, shielded by calcium, the striated ducts secrete tryptophan-rich products comprising neutral glycoproteins and showing proteolytic activity. Innervation is of the cholinergic type and parenchymal lysosomal activity, possibly related to autophagy of stored secretory products and heterophagy of luminal material, is brisk. Macrophages contribute to maintaining the glandular microenvironment, wherein secretory activity appears to be lethargic.

Feline necrotising sialometaplasia: a report of two cases

Unilateral swelling of submandibular salivary gland in two cats was diagnosed as necrotising sialometaplasia. Histological features that differentiate the disease from other salivary gland lesions, particularly neoplasia are: lobular necrosis of salivary tissue; squamous metaplasia conforming to duct and/or acinar outlines; preservation of salivary lobular morphology; and variable inflammation and granulation tissue.

Parotid duct dilation in two dogs

Two cases of parotid duct dilation are described; the clinical signs on initial examination were a tubular swelling over the lateral aspect of the face with an associated intraoral submucosal distension. Surgical exploration confirmed that the distended structure was the dilated parotid duct and intraoral marsupialisation resulted in no recurrence postsurgery.

The roles of apoptosis and mitosis in atrophy of the rat sublingual gland

The roles of apoptosis and mitosis of acinar and duct cells in the atrophy of the sublingual gland of rat induced by double duct ligation was investigated using immunohistochemistry for proliferating cell nuclear antigen (PCNA), terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-digoxigenin nick end labeling (TUNEL), and transmission electron microscopy (TEM). Many PCNA-positive duct cells were observed 3 days after duct ligation, and the numbers decreased thereafter. At 3 and 5 days, several TUNEL-positive acinar cells were observed and typical apoptotic acinar cells were identified by TEM. Necrotic acinar cells were also observed ultrastructurally. After 7 days, there were few acini but many ducts, as well as many structures representing transition from acinus to duct. These observations demonstrate that acinar cell loss by apoptosis and duct cell proliferation by mitosis occur in atrophic sublingual glands as well as in other atrophic salivary glands. In addition, it appears that the transition from acinar to duct cell and the necrosis of acinar cells play important roles in the atrophy of the sublingual gland.

Hyperplasia of myoepithelial cells expressing calponin during atrophy of the rat parotid gland induced by duct ligation

The number and location of myoepithelial cells in the rat parotid gland submitted to surgical ligation of its main excretory duct were studied through immunohistochemical labelling for calponin. These cells were labelled by the streptavidin-biotin method using anti-calponin primary antibody, and their number was determined during each step of glandular atrophy, i.e., at time zero (control) and 1, 7, 15, 21, 30 and 60 days after ligation. Morphological analysis showed a gradual decrease and fibrosis of the glandular lobules accompanied by disappearance of the acini and the occurrence of duct-like structures. The expression of calponin was observed in all specimens analysed, being restricted to myoepithelial cells. Labelling revealed the distribution of myoepithelial cells around the acini and intercalated ducts in the control group and around duct-like structures later during the course of atrophy. Quantitative analysis demonstrated significant increase in the number of myoepithelial cells up to day 7 post-ligation, followed by gradual increases which, however, were not statistically significant. These results suggest that myoepithelial cells proliferate intensely up to day 7 post-ligation, an event that coincides with a higher rate of disappearance of acinar cells. After this period, the elevatednumber of cells observed at the end of the previous period is maintained.

Histochemical phenotypes of von Ebner's gland of ferret and their functional implications

Von Ebner's gland of ferret was examined by means of light microscopy, protein, mucosubstance and enzyme histochemistry, and neurohistology. Acinar cells were replete with granules containing neutral mucosubstances and disulphides, and showed strong diffuse acid phosphatase activity and weak granular staining for peroxidase. Staining for cytochrome oxidase, succinate dehydrogenase, and NADH and NAD(P)H dehydrogenases was also seen. Basolateral plasmalemma of acinar cells showed weak, ouabain-sensitive Na+,K+-ATPase activity. Ductal cells were of a simple appearance, contained thiols and showed variable staining for acid phosphatase, dehydrogenases and cytochrome oxidase. Variable amounts of beta-glucuronidase reaction product were localized in the glandular parenchyma, being marked in atrophic areas. Prominent stellate myoepithelial cells embracing acini and also basal ductal cells were demonstrated by alkaline phosphatase. Thiamine pyrophosphatase reaction product was concentrated in blood vessels around parenchyma, with little Golgi-like staining in acinar cells. Acetylcholinesterase activity was associated with an extensive network of nerve fibres embracing parenchyma, whereas catecholamine fluorescence was not seen. The results suggest that the acini of von Ebner's gland of ferret synthesise neutral secretory glycoproteins and peroxidase. Water mobilization is inconspicuous. Lysosomal activities feature in the parenchyma, possibly a consequence of processing secretory products in acini, absorption in ducts and/or adaptation atrophy. The gland receives a rich cholinergic-type innervation, and has extensive myoepithelial and microvascular networks.

The effects of ductal obstruction on the acinar cells of the parotid of cat

Twenty-nine parotids ligated for between 1 and 365 days were examined by light and electron microscopy. Major changes in the acini were seen at 4 days and included vacuolation, disintegration, extravasation, apoptosis, phagy and a reduction in number and size of secretory granules. There was a further reduction in secretory granules from 7 to 12 days, but acinar cells persisted even up to 365 days, some contained a luminal concentration of small secretory granules and occasionally acinar cells of a similar appearance to normal were found. These findings contrast with a reported absence of acinar cells from the obstructed parotid of rat and show that parotid acinar cells are able to persist and retain an appearance indicative of secretory activity.

Morphological and functional characteristics of acinar atrophy and recovery in the duct-ligated parotid gland of the rat

Although acinar atrophy occurs frequently in salivary diseases, the relationship between structural changes and functional decrements is not well-established, and the potential for recovery of histological and functional integrity has not been wholly quantified. We aimed, therefore, to develop further our understanding of pathological acinar atrophy. Stensen's duct was ligated for periods up to six weeks and, in separate experiments, was de-ligated after two weeks and allowed to recover for up to two weeks. Qualitative and quantitative histological analyses were carried out. Additionally, the ability of enzymatically dispersed cells from ligated and de-ligated glands to respond to neurohormonal stimuli was also measured. The results confirmed that totally obstructed glands undergo a rapid, progressive severe atrophy amounting to absolute losses of over 85% of acinar tissue by two weeks. Acinar shrinkage and cell losses through apoptosis accounted for the glandular atrophy. Remaining intralobular epithelia consisted of extremely atrophic acini and numerous duct-like structures with intermediate forms. Dispersed cells from atrophic glands exhibited agonist-induced release of chloride similar to normal. Together, these structural-functional results confirm the persistent viability of acinar-like cells in the obstructed gland and suggest that the duct-like structures are derived from surviving atrophic acini. De-ligated glands exhibited a near-normal recovery of structure by two weeks. Their enzymatically dispersed cells responded normally to agonist stimulation. The results support the view that pathological atrophy is largely similar to physiological atrophy, providing a mechanism for acinar cell survival under adverse conditions, with the possibility of eventual recovery.

Relation of preoperative sialographic findings with histopathological diagnosis in cases of obstructive sialadenitis of the parotid and submandibular glands: retrospective study

The clinical records, preoperative sialograms and histopathological slides of 33 patients who had been operated on for symptoms of obstructive salivary gland disease were reviewed. Twenty patients had had superficial parotidectomy and 13 excision of the submandibular gland. Among those who had required parotidectomy, preoperative sialograms tended to suggest more architectural damage than was actually noted on definitive histopathological examination. Patients whose symptoms had been present for longer had more severe sialographic and histopathological changes. In the submandibular group, there was a closer relation between sialographic and histopathological changes, and a positive correlation between a short history and the severity of histopathological grading. These differences may reflect the different aetiology and course of obstructive disease in the two types of gland.

Chronic submandibular sialadenitis: ultrastructure and phosphatase histochemistry

Eleven specimens of chronic submandibular sialadenitis were examined. A reduction in secretory material in acinar cells was seen with increasing atrophy until the acini resembled intercalary ducts. Myoepithelial cells and basement membrane were sometimes more conspicuous. Striated ducts showed a reduction of the folding of the plasma membranes in the basal part, and striated and excretory ducts showed a reduction in mitochondria. This possibly represents a functional atrophy secondary to reduced salivary flow. Very atrophic parenchyma largely consisted of simple cells. Phagosomes and apoptotic bodies were occasionally seen, and appear to be involved in the atrophy. Thiamine pyrophosphatase in the Golgi apparatus and acid phosphatase in the GERL were demonstrated in moderately atrophic parenchyma. This is similar to normal and indicates continuing synthetic activity. Acid phosphatase was demonstrated in lysosomes, which appear to be involved in the atrophy by their role in phagy. Alkaline phosphatase was occasionally demonstrated at luminal surfaces, and is likely to be involved in resorption of obstructed luminal contents. The changes are similar to those seen in experimentally obstructed glands and indicate that much of the parenchyma survives by adaptation to the altered environment which forms the basis for the successful results following conservative therapy.

Intracellular calcium signalling in rat parotid acinar cells that lack secretory vesicles

Secretory vesicles from pancreatic acinar cells have recently been shown to release Ca2+ after stimulation with Ins(1,4,5)P3 [Gerasimenko, Gerasimenko, Belan and Petersen, (1996) Cell 84, 473-480]. These observations have been used in support of the hypothesis that Ca2+ release from secretory vesicles could be an important component of stimulus secretion coupling in exocrine acinar cells. In the rat, ligation of the parotid duct causes a reversible atrophy of the parotid gland. Most notably, after atrophy the acinar cells are reduced in size and no longer contain secretory vesicles [Liu, Smith, and Scott (1996) J. Dent. Res. 74, 900]. We have measured cytosolic free-Ca2+ concentration ([Ca2+]i) in single, acutely isolated, rat parotid acinar cells, and compared Ca2+ mobilization in response to acetylcholine (ACh) stimulation in cells obtained from control animals to that in cells lacking secretory vesicles obtained after atrophy of the parotid gland. Application of 50-5000 nM ACh to control cells gave rise to a typical, dose-dependent, biphasic increase in [Ca2+]i, of which the later, plateau, phase was acutely dependent on the extracellular Ca2+ concentration. An identical pattern of response was observed with cells obtained from atrophic glands. Low concentrations of ACh (10-100 nM) occasionally produced [Ca2+]i oscillations of a similar pattern in cells from both control and atrophic glands. We were able to show that Ca2+ rises first in the apical pole of the cell and the increase then spreads to the rest of the cell in cells from control glands but not in cells from atrophic glands. However, at present we are unable to determine whether this is due to the lack of secretory vesicles or whether the separation is too small to measure in the smaller acinar cells obtained from atrophic glands. We conclude therefore, that secretory vesicles make no significant contribution to overall Ca2+ mobilization in rat parotid acinar cells, nor are they required for oscillatory changes in [Ca2+]i to occur. However we are unable to eliminate completely any role for secretory vesicles in initiating Ca2+ mobilization at the apical pole of the cell.

Immunochemical analysis of laminin in duct-ligated submandibular glands of rats

Immunochemical methods have been used to study the expression of laminin during experimental atrophy of the submandibular gland of rats caused by ductal ligation. In normal submandibular glands, laminin immunoreactivity appeared as continuous linear staining around acini and ducts. In the ligated glands, it exhibited an irregular pattern and intensity. Staining was usually stronger around small ducts and acini, which were most prominent in glands ligated for 30 days. Immunoblot analysis showed that the laminin of the rat submandibular gland contains bands that correspond to the EHS alpha 1, beta 1 and gamma 1 chains, and that the composition of the laminin chains does not change during the atrophy.

The effects of obstruction and secretory stimulation on microlithiasis in salivary glands of cat: light and electron microscopy

Obstruction and increased secretory activity are considered to be important aetiological factors of salivary microlithiasis, which may itself be an aetiological factor of sialadenitis. However, there is a lack of substantial evidence for the importance of obstruction, and investigations on increased secretory activity used pathological doses of pharmacological agents. Therefore further investigation of these factors is essential. Feline parotid, submandibular and sublingual salivary glands, in which microliths occur normally as in man, were examined after ductal ligation to produce obstruction, electrical stimulation of the glandular nerves to produce increased secretory activity, or both. Microliths were detected in: 0 out of 38 untreated, 1 out of 55 ligated, 2 out of 17 stimulated and 2 out of 17 stimulated ligated submandibular glands; 6 out of 29 untreated, 7 out of 46 ligated, 3 out of 12 stimulated and 4 out of 14 stimulated ligated sublingual glands; and no parotid glands. The chi 2 test confirmed that the experimental procedures did not produce an increased occurrence of microliths. Microliths were detected in parenchymal cells, intercellularly in atrophic parenchyma, intraluminally, interstitially and in macrophages. The present investigation indicates that obstruction and increased secretory activity are not important aetiological factors of salivary microlithiasis.

Ultrastructural localization of microliths in salivary glands of cat

Although microliths occur in normal human salivary glands and may be an aetiological factor of sialadenitis, little is known of their natural history. In an attempt to remedy this, we investigated a large archival collection of normal and experimental feline parotid, submandibular and sublingual salivary glands. In submandibular and sublingual glands, microliths were detected ultrastructurally in: all types of acinar secretory cells; myoepithelial cells; ductal cells; lumina; intercellular spaces; basement membrane; stroma; macrophages; multinuclear giant cells; and neutrophils. Microliths were not detected ultrastructurally in parotid glands. Microliths appear to form in acinar cells during autophagy and in stagnant secretory material in lumina. Microliths appear to be removed by secretion in the saliva, discharge from cells laterally and basally, and engulfment by macrophages. There appears to be a turnover of microliths, which possibly is upset by secretory inactivity with a resulting accumulation that leads to localized obstruction and sialadenitis.

Microliths in normal salivary glands of cat investigated by light and electron microscopy

This investigation concerns the natural history of microlith in the salivary glands of cat. Microliths were detected in more sublingual than submandibular glands and were almost absent in the parotid. They were found intraparenchymally, intraluminally and interstitially, and ultrastructurally in phagosomes of acinar, ductal and myoepithelial cells, intermixed with the cytoplasm of degenerate acinar cells, and in intraparenchymal macrophages and a multinuclear giant cell. They appear to form in healthy acinar cells during autophagocytosis, and possibly to be discharged luminally, laterally or basally, and to form in the debris of degenerate cells intraparenchymally and intraluminally. They appear to be removed by expulsion in the saliva, scavenging macrophages, and possible eventual degradation in the parenchymal phagosomes. The greater occurrence of microliths in the sublingual gland may relate to a low level of secretory activity, and the near absence of microliths in the parotid to a low level of calcium. The feline salivary glands were found to be an outstanding model for the investigation of microlithiasis.

Analytical ultrastructural investigation of microliths in salivary glands of cat

Microliths in Araldite-embedded pieces of submandibular and sublingual glands of cat were stained in semithin sections by Methylene Blue and Azure II followed by Basic Fuchsin, and were examined in ultrathin sections by electron-microscopical X-ray microanalysis. Calcium and phosphorus were detected in substantial aggregates of crystals that were stained by Basic Fuchsin and appeared to be hydroxyapatite, but were not detected in granular material that was stained by Methylene Blue and Azure II and appeared to be organic. The polychromatic stain thus appears to be a useful indicator of calcified material. The majority of microliths in acini contained substantial aggregates of crystals, whereas the majority of those in ducts did not. This corresponds to the distribution of the glandular calcium, and suggests that microliths are variously enriched with calcium according to its local level.

Marsupialization for treatment of oral ranula: a second look at the procedure

Simple marsupialization to manage oral ranula has fallen into disfavor because of excessive failures and the high incidence of iatrogenically caused cervical ranula that may follow this procedure. With the simple addition of packing the entire pseudocystic cavity with gauze after its unroofing, the rate of recurrence is minimized. It is recommended that oral ranula be treated initially by marsupialization with packing and, if recurrence occurs, then the offending sublingual gland should be excised.

Plunging ranula: a case report and a literature review

The plunging ranula is a mucous extravasation cyst of the sublingual gland. It is slightly more common in females, shows no side preference, and is more prevalent in the second and third decades of life. It typically manifests as a painless, nonmobile swelling in the neck and in four of five cases is associated with an intraoral ranula or swelling. If there is no history of an oral ranula the clinical diagnosis is difficult, and it may be left to the reporting pathologist to give the correct diagnosis. The histologic appearance is characteristically of a cyst, devoid of epithelium or endothelium, with a vascular fibro-connective tissue wall containing some chronic inflammatory cells and macrophages stuffed with mucin. The correct diagnosis is essential for the most effective treatment, which is excision of the sublingual gland.

Immunohistochemical and electronmicroscopic studies of obstructive lesions in submandibular glands

Obstructive sialoadenitis was examined by immunohistochemical techniques for keratin (MoAb KL1, PKK1 and K8.12) and actin. Electronmicroscopy (EMS) was used to identify ultrastructural changes in myoepithelial cells and ductal basal cells. With immunohistochemistry, actin staining was used as a marker of myoepithelium, MoAbs KL1 and PKK1 for ductal luminal cells, and MoAb K8.12 for ductal basal cells. Histologic features of the lesion usually showed degenerative changes of acinar and duct cells with cell infiltration and fibrous replacement. Immunohistochemical findings indicated that actin staining in the changed myoepithelial cells was irregularly positive or negative, and also keratin staining in luminal and ductal basal cells was reduced or disappeared. Ultra-structural features of the changed myoepithelial cells indicated that these cells appeared less altered than adjacent acinar and ductal cells and showed increased amounts of lipid droplets and lipofuscin granules, and also wrinkled processes filled the prominent myofilament material.

Production of microliths and sialadenitis in rats by a short combined course of isoprenaline and calcium gluconate

The relationship between microliths and sialadenitis in man is unclear, so an attempt was made to investigate it experimentally in rats with the use of isoprenaline and calcium gluconate either alone or combined. The acini of the submandibular and parotid glands of rats that were given isoprenaline were enlarged, and degenerate acinar cells were seen, with extravasated secretions in the submandibular gland. Similar changes were seen in the submandibular and parotid glands of rats that were given isoprenaline combined with calcium gluconate; in addition, ductal microliths with regions of atrophic sialadenitis were observed. The results suggest that there is temporary obstruction to the salivary flow after isoprenaline is injected, and in the rats that were also given calcium gluconate some of the stagnant saliva calcified to form microliths, which produced a lasting obstruction and obstructive sialadenitis. This supports the possibility that microliths, which are present in normal salivary glands of man, are a primary etiologic factor in sialadenitis.

Plunging ranula: a bilateral presentation

A patient is described with bilateral plunging ranulae which arose asynchronously and solely as cervical swellings. The diagnostic difficulties caused by the clinical presentation and the different treatment modalities are discussed.

The presence of microcalculi in normal human submandibular and parotid salivary glands

A search for microcalculi in 10 submandibular and 10 parotid glands obtained from autopsies revealed them in 8 submandibular glands in all decades from the third to the seventh, and in one parotid gland in the fourth decade. They were found in serous acinar cells, striated ductal cells, lumina and interstitium. They may form in autophagosomes in parenchymal cells and usually pass into lumina to be expelled in the saliva.

Effects of prolonged duct ligation of the rat salivary glands on the activity of trypsin-like protease

The effects of ligation on body weight, protease activity and hair kynurenine content were observed. The body weights of parotid gland(PT)-ligated and of combined submandibular (SM)-, sublingual (SL)- and PT-ligated rats were much less than those of sham-operated controls. However, the weights of SM,SL-ligated rats were similar to those of controls. The activity of trypsin-like protease in the duct-ligated submandibular gland was significantly reduced to 0.3-0.7 per cent of that in controls. Protein concentration also decreased in the duct-ligated submandibular gland. Kynurenine content in the hair of duct-ligated rats was higher than that in controls.

Chronic sialadenitis. An immunocytochemical study in humans

The cellular changes in salivary gland parenchyma with chronic inflammation were studied immunocytochemically with a panel of antibodies. Myoepithelial cells were labelled with antimyosin, duct cells with a polyclonal anti-callus prekeratin, a monoclonal anti-keratin CAM 5.2 and a monoclonal anti-keratin 7 (RPN 1162), and a subpopulation of basal duct cells with a monoclonal anti-keratin 16a. The wide range of changes observed were similar to those described following experimental duct ligation. One of the most striking features was the survival of myoepithelial cells surrounding persisting acini and ductal structures. Most of these ductal structures appeared to be either surviving intercalated ducts or were altered acinar cells. There was no evidence of myoepithelial or ductal hyperplasia. The 16a positive basally located duct cells which are conspicuous in normal glands, pleomorphic adenomas and in the epithelial islands in lymphoepithelial lesions (Palmer et al. 1985; 1986) were virtually absent, except in one specimen with mild inflammatory changes. If this cell type represents a reserve cell, then loss of it may preclude recovery of the remaining parenchyma following resolution of inflammation.

Ultrastructural and histochemical observations on intracellular and luminal microcalculi in the feline sublingual salivary gland

As the genesis of salivary calculi in man has not been established, the fortuitous observation of microcalculi in sublingual glands of cats prompted this study. Microcalculi were seen occasionally within acinar cells and lumina and macrophages, and rarely interstitially. Microcalculi were stained with the periodic-acid/Schiff technique, and acid-phosphatase activity was associated with intracellular microcalculi. Intracellular microcalculi were seen ultrastructurally in acinar cells in membrane-bound vacuoles that also contained debris and sometimes what appeared to be secretory material. X-ray microanalysis showed the microcalculi to consist of crystals containing calcium and phosphorus. The observations suggest that the microcalculi form within autophagosomes in acinar cells by a precipitation of calcium and phosphorus present in degenerate material, and that the microcalculi eventually enter lumina, where they may be discharged in the saliva or retained and enlarge.

Lectin histochemistry of submandibular glands following duct-ligation in mice and rats

Lectin binding patterns of Con A, PNA, SBA, DBA, WGA, RCA-1 and UEA-1 were carried out in duct-ligated submandibular glands (SMGs) of rats that displayed acute degenerating changes. Lectin staining was also related to histologic changes. Proliferating epithelial cells which were probably derived from intercalated duct cells showed a strong SBA and WGA staining on the 3rd day. Duct-like and cystic structures appeared on the 7th day and staining by PNA, SBA, WGA, RCA-1 and Con A was described. In mice, lectin binding after duct ligation appeared similar to the rat. In the long-term observation of mice SMGs, acinar cell regeneration occurred between the 21st and 42nd days and they stained strongly for DBA.

Immunohistochemical observation of EGF and NGF in submandibular glands after duct ligation with or without testosterone administration

Immunohistochemical detection of epidermal growth factor (EGF) and nerve growth factor (NGF) was carried out in duct-ligated submandibular glands (SMG) of mice with or without testosterone treatment. High levels of EGF and NGF were limited to granular convoluted tubule (GCT) cells in normal adult male mice, and reduced levels were evident in the female. After duct ligation, EGF and NGF stainings began to decrease on the 2nd or 3rd day, and by the 10th day, no staining was detectable. Decreasing levels of EGF and NGF following duct ligation, were more pronounced in the male SMG than in the female. Testosterone administration before ligation resulted in decreased EGF and NGF levels of staining; however, staining of sections on the 1st and 3rd day was a little stronger than comparable stained sections of untreated mice. In contrast, testosterone administration after duct ligation showed GCT cells of normal size with some degranulation at 10 days and irregular staining of growth factors with varying degrees of degranulation at 14 days. Histochemical staining for EGF and NGF in this group was marked, as in the normal, until the 10th day with decreasing reactions by the 14th day.

Conservative management of post-traumatic parotid fistulae and sialoceles: a prospective study

A prospective study of 14 consecutive patients with parotid injuries treated over a 4-month period, is presented. Three patients underwent emergency duct repair and 11 patients, presenting with delayed fistulae or subcutaneous collections of saliva (sialoceles), were treated conservatively with uniform success. Glandular injury closed within an average of 5 days of treatment and ductal leaks within approximately 14 days.

Progressive secretory dysfunction in the rat submandibular gland after excretory duct ligation

Unilateral ligation of the main excretory duct of the rat submandibular gland caused a progressive deterioration of secretory function characterized by: (1) the secretion of progressively smaller volumes of saliva in response to a standard maximal intraperitoneal (i.p.) dose of pilocarpine. Saliva volume was reduced 69.4, 88.8 and 95.9 per cent, respectively, 1, 3 and 7 days after duct ligation. By 2 weeks, the contralateral, non-ligated gland had an enhanced response to pilocarpine and the ligated gland a 96.8 per cent reduction in the volume of saliva secreted; (2) a progressive reduction in the maximum flow rates attained upon stimulation with pilocarpine, which were 23.4, 10.1 and 5.1 per cent of those attained in the contralateral gland at, respectively, 1, 3 and 7 days after ligation; (3) a progressive increase in the sodium concentrations of saliva, which became plasma-like 2 weeks after ligation; (4) a significantly reduced secretory response to standard doses of isoproterenol, phenylephrine, methoxamine and substance P 2 weeks after ligation. In addition, both cholinergic and adrenergic receptors were significantly reduced in number 2 weeks after ligation. Administration of daily injections of pilocarpine (10 mg, i.p.) after duct ligation reduced the gland atrophy observed 3 days (by 17 per cent) and 1 week (by 9 per cent) later, but did not prevent the reduction in volume or flow rats observed after duct ligation alone. Thus ligation of the main excretory duct causes a progressive dysfunction in acinar and duct cells in the rat submandibular gland and alters their responsiveness to physiological regulators of secretion. The alterations in glandular secretory function and in the composition of saliva which occur in diseases causing partial or complete obstruction to the flow of saliva are likely to be similar to the changes described.

A fluorescent histochemical investigation of the rat submandibular gland after ligation of the excretory duct and isoproterenol treatment

Fluorescent histochemical investigations were carried out on the adrenergic terminal plexus in the salivary gland of the rat 24 hours, 72 hours, and 14 days after ligation of the main excretory duct and the concomitant administration of isoproterenol (IPR, 60 mg/kg body weight subcutaneously). The atrophy of the salivary gland occurring after ligation was also present after the concomitant administration of IPR which induces amylase secretion and DNA synthesis in intact salivary glands. The adrenergic fibres in the atrophic gland exhibited an intensive fluorescence of the adrenergic terminal plexus after IPR treatment. Thus the presynaptic elements remain intact, although the acini are atrophic, and the reason for the absence of the stimulus response probably lies in the effector cells.