Bilateral Sialadenitis as an Uncommon Initial Manifestation of Infectious Mononucleosis: A Case Report

Sialadenitis has rarely been reported in patients with infectious mononucleosis (IM). Our patient was a 22-year-old man who presented with bilateral swelling of the parotid and submandibular glands, a fever, malaise, and splenomegaly. Laboratory tests revealed an increased percentage of atypical lymphocytes in the leukocyte fraction. Serological testing for antibodies against Epstein-Barr virus (EBV) revealed an acute infection pattern. The patient was diagnosed with sialadenitis associated with IM caused by EBV infection. With symptomatic treatment, the salivary gland swelling completely resolved within a week. This case suggests that EBV-induced IM should be included in the differential diagnosis of diffuse sialadenitis with elevated atypical lymphocyte counts.

Differentiation of submandibular sialadenitis based on apparent diffusion coefficient

OBJECTIVES

This study aimed to quantify the submandibular gland in suppurative sialadenitis, primary Sjögren's syndrome (pSS) and radiation-induced sialadenitis using the apparent diffusion coefficient (ADC) for differential diagnosis.

SUBJECTS AND METHODS

This retrospective study included 16 patients with suppurative sialadenitis (n = 9), pSS (n = 3) and radiation-induced sialadenitis (n = 4) who underwent magnetic resonance imaging between June 2006 and May 2022. The ADC of the submandibular glands in each state was calculated, and the differences were analysed using a one-way analysis of variance and Tukey's post hoc test. Receiver operating characteristic curves were used to assess the ability of the ADC to distinguish each condition. Statistical significance was set at p < 0.05.

RESULTS

The mean ADC value (×10-3 mm2/s) ± standard deviation in the control (non-affected side of the suppurative sialadenitis group), suppurative sialadenitis, pSS and radiation-induced groups were 0.94 ± 0.16, 1.24 ± 0.16, 1.33 ± 0.13 and 1.5 ± 0.12, respectively (p < 0.001). The diagnostic value for distinguishing each group was ≥0.75.

CONCLUSION

ADC values are useful for quantitatively assessing and distinguishing submandibular glands in suppurative sialadenitis, primary Sjögren's syndrome and radiation-induced sialadenitis.

Expression of glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide in the rat submandibular gland is influenced by pre- and post-natal high-fat diet exposure

Background: Incretins, i.e., glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) promote insulin secretion to reduce postprandial blood sugar. Previous studies found incretins in the salivary glands. However, the role of GLP-1 and GIP in the submandibular gland (SMG) is unclear. This study investigates the effects of a high-fat diet (HFD) on the expression of GLP-1 and GIP throughout the development of rat SMG. Methods: Pregnant 11-week-old Wistar rats were divided into two groups: those fed on a standard diet (n = 5) and those fed on a HFD (n = 5). From day 7 of pregnancy and throughout the lactation period, all the rats were fed on either a chow diet or HFD. The newborns were divided into four subgroups (n = 6): standard diet males (SM), HFD males (HM), standard diet females (SF), and HFD females (HF). The SMGs of 3- and 10-week-old rats from each subgroup were collected under general anesthesia. Moreover, body weight, food intake, and fasting blood sugar were measured. The mRNA expression of GLP-1 and GIP was quantified, and the localization was observed using immunohistochemistry (p < 0.05). Results: GLP-1 mRNA expression was statistically significantly more upregulated in HM than in HF at 3 weeks. Moreover, GLP-1 mRNA expression was significantly higher in HM than in both SM and HF at 10 weeks. Although a decreasing trend was observed in GIP mRNA expression in both 3- and 10-week-old rats fed on a HFD, a significant difference between HM and SM only occurred at 3 weeks. Furthermore, the GIP mRNA expression of HM was lower than that of HF at 10 weeks. Immunohistochemical staining revealed GLP-1 and GIP expression mainly in the SMG duct system. Moreover, vacuolated cytoplasm in the duct was observed in rats fed on a HFD. Conclusion: Exposure to HFD during pre- and post-natal periods increased GLP-1 mRNA expression in the SMGs of male rats. However, GIP expression decreased following the HFD in male newborns. Furthermore, a decreasing trend of GIP mRNA expression was observed in male newborns after HFD feeding. Sex influenced incretin hormones secretion and obesity-related conditions. HFD during pre- and post-natal periods reprograms the epigenome, contributing to subsequent disease development.

Evaluation of submandibular and parotid salivary glands by ultrasonography in patients with diabetes

BACKGROUND

Microvascular complications of diabetes mellitus (DM) include oral manifestations and complications, including xerostomia, reduced salivary flow, susceptibility to infection, periodontal disease and salivary gland enlargement.

OBJECTIVE

The present study aims to evaluate B-mode ultrasonography (USG) parameters such as size, volume and echogenicity of the submandibular and parotid salivary glands on both sides, shear-wave elastography (SWE) value and colour Doppler properties in patients with DM and healthy control groups.

METHODS

In total, 160 right and left submandibular glands and 160 right and left parotid glands of 80 patients, 40 patients (20 type 1 DM, 20 type 2 DM) and 40 healthy control group, between the ages of 18-70 were examined by USG. Echogenicity, parenchyma internal structure, margin and dimensional measurements (antero-posterior length, supero-inferior length, medio-lateral length and volume) and colour Doppler with 'ML 6-15-D Matrix Array (4-15 MHz)' probe, shear-wave elastography '9L-D (2-8 MHz)' probe was investigated.

RESULT

Statistically significant difference was observed in echogenicity in the right submandibular gland, echogenicity in the right parotid gland, margin characteristics, parenchymal homogeneity and colour Doppler characteristics between the type 1 DM, type 2 DM and control groups (p < .05). It was observed that the size, volume and SWE values of both submandibular and parotid glands were higher in the DM patient group than in the control group. Higher values were observed in type 2 DM compared to type 1 DM in the patient group.

CONCLUSION

USG is an effective imaging technique in investigating the effects of diabetes on the submandibular and parotid salivary glands.

Glycyrrhizin Protects Submandibular Gland Against Radiation Damage by Enhancing Antioxidant Defense and Preserving Mitochondrial Homeostasis

Aims: Radiotherapy inevitably causes radiation damage to the salivary glands (SGs) in patients with head and neck cancers (HNCs). Excessive reactive oxygen species (ROS) levels and imbalanced mitochondrial homeostasis are serious consequences of ionizing radiation in SGs; however, there are few mitochondria-targeting therapeutic approaches. Glycyrrhizin is the main extract of licorice root and exhibits antioxidant activity to relieve mitochondrial damage in certain oxidative stress conditions. Herein, the effects of glycyrrhizin on irradiated submandibular glands (SMGs) and the related mechanisms were investigated. Results: Glycyrrhizin reduced radiation damage in rat SMGs at both the cell and tissue levels, and promoted saliva secretion in irradiated SMGs. Glycyrrhizin significantly downregulated high-mobility group box-1 protein (HMGB1) and toll-like receptor 5 (TLR5). Moreover, glycyrrhizin significantly suppressed the increases in malondialdehyde and glutathione disulfide (GSSG) levels; elevated the activity of some critical antioxidants, including superoxide dismutase, catalase, glutathione peroxidase, and glutathione (GSH); and increased the GSH/GSSG ratio in irradiated cells. Importantly, glycyrrhizin effectively enhanced thioredoxin-2 levels and scavenged mitochondrial ROS, inhibited the decline in mitochondrial membrane potential, improved adenosine triphosphate synthesis, preserved the mitochondrial ultrastructure, activated the proliferator-activated receptor-gamma coactivator-1alpha (PGC-1α)/nuclear respiratory factor 1/2 (NRF1/2)/mitochondrial transcription factor A (TFAM) signaling pathway, and inhibited mitochondria-related apoptosis in irradiated SMG cells and tissues. Innovation: Radiotherapy causes radiation sialadenitis in HNC patients. Our data suggest that glycyrrhizin could be a mitochondria-targeted antioxidant for the prevention of radiation damage in SGs. Conclusion: These findings demonstrate that glycyrrhizin protects SMGs from radiation damage by downregulating HMGB1/TLR5 signaling, maintaining intracellular redox balance, eliminating mitochondrial ROS, preserving mitochondrial homeostasis, and inhibiting apoptosis.

Salivary Duct Carcinoma Arising in the Submandibular Gland in a Patient with Neurofibromatosis Type 1

A 71-year-old man with neurofibromatosis type 1 (NF1) presented to our department with a 1-week history of a painful mass in the left submandibular area. Computed tomography (CT) and magnetic resonance imaging revealed an irregular-shaped tumor with a diameter of 2.0 cm in the left submandibular gland and a metastatic lymph node with a diameter of 1.0 cm adjacent to the tumor. Fluorodeoxyglucose-positron emission tomography/CT revealed increased uptake in the tumor. Fine-needle aspiration cytology revealed atypical cells, suggesting salivary duct carcinoma (SDC). Left neck dissection with resection of the tumor and submandibular gland was performed under general anesthesia. Histologic examination revealed ductal formation with a solid, cystic, cribriform, and papillary structure with intraductal comedonecrosis, diagnosing as SDC originating in the submandibular gland (pT3N1M0 pStage III). Mutational analysis of 160 cancer-related genes by next-generation sequencing (NGS) revealed a germline and frameshift mutation in the NF1 gene (p.R2408Kfs*14) and a somatic and frameshift mutation in the TP53 gene (p.C176Wfs*22). The patient received postoperative radiotherapy to the left neck area at 66 Gy. No evidence of recurrence or metastasis has been observed as of 10 months postoperatively. This is the first reported case of SDC in the submandibular gland in a patient with NF1. The mutational data by NGS may contribute to a better understanding of the oncogenesis of SDC in patients with NF1.

Indications for Submandibulectomy Within a 20-Year Period

Purpose: Different pathologies of the submandibular gland are an indication of submandibular gland excision-ranging from inflammatory causes and sialolithiasis to malignant tumors. The purpose of this study was to get an overview of the different indications for submandibular gland excision. Methods: The main goal of this study was to evaluate the different indications for submandibular gland excision during a 20-year period. In addition, epidemiological information and therapy concepts were investigated with a special focus on Tumor Lymph nodes Metastasis (TNM) classification and recurrence rate. Procedures during which the submandibular gland was removed while not being the primary cause for surgery (eg, neck dissection in Level Ib) were not included. Results: During the period of observation, 359 submandibular gland excisions were performed. The most common cause for submandibular gland excision was sialolithiasis (n = 129) with intraparenchymal stone localization. Up next were inflammatory causes (n = 115) in particular chronic submandibular sialadenitis followed by only a few cases of Sjögren's syndrome, sarcoidosis, and tuberculosis. In 115 cases, surgery was performed for tumors of the submandibular gland, with 88 of them being benign and 27 malignant. Malignancies were then divided into lymphomas (n = 9) and primary salivary gland malignancies (n = 18). Conclusion: This retrospective study of a large cohort of patients displays a representative overview of the indications for submandibular gland excision. Sialolithiasis was the most common underlying cause of gland excision. The malignancy rate in our cohort was lower than described in the literature.

Transcriptomic analysis of the submandibular gland under psychological stress condition

BACKGROUND

Psychological stress is associated with changes in salivary flow and composition. However, studies to show the effect of psychological stress on the transcriptome of the salivary gland are limited. This study aims to perform a transcriptomic analysis of the submandibular gland under psychological stress using a chronic restraint stress model of rats.

METHODS

Sprague-Dawley rats were divided into stress groups and control groups. Psychological stress was induced in the stress group rats by enclosing them in a plastic tube for 4 h daily over 6 weeks. RNA sequencing was performed on RNA extracted from the submandibular gland. The differentially expressed genes were identified, and the genes of interest were further validated using qRT-PCR, immunofluorescence, and western blot.

RESULTS

A comparison between control and stress groups showed 45 differentially expressed genes. The top five altered genes in RNA sequencing data showed similar gene expression in qRT-PCR validation. The most downregulated gene in the stress group, FosB, was a gene of interest and was further validated for its protein-level expression using immunofluorescence and western blot. The genesets for gene ontology cellular component, molecular function, and KEGG showed that pathways related to ribosome biosynthesis and function were downregulated in the stress group compared to the control.

CONCLUSION

Psychological stress showed transcriptomic alteration in the submandibular gland. The findings may be important in understanding stress-related oral diseases.

Photobiomodulation Recovers the Submandibular Gland in Vismodegib-Treated Rats

Objective: The submandibular gland (SMG) produces the most saliva, and factors such as aging and chemotherapy can affect its structure and function. However, there are only temporary treatments available for salivary hypofunction. This study aimed to evaluate the effects of photobiomodulation (PBM) on the function of SMG by using a rat animal model and vismodegib, an antagonist of the sonic hedgehog (SHH) pathway. Methods: Vismodegib (10 mg/kg) drug was gavaged orally for 14 days in rats to significantly decrease the SHH signaling proteins [SHH, protein patched homolog 1 (PTCH1), smoothened protein (SMO), glioma-associated oncogene homolog 1 (GLI1)], induce damage in SMG tissue, and affect salivary functional markers AQP5 and Keratin5. After that, in conjunction with vismodegib administration, PBM was performed using an 850 nm high-power light-emitting diode (LED) device treated daily for 6 days at varying total energy densities of 60, 120, and 180 J/cm2 in at least 3 rats per group. The test results were confirmed by Western blot, immunofluorescence staining, and hematoxylin and eosin staining, and the statistics were t-test or one-way analysis of variance (ANOVA) with Tukey's multiple comparisons tests. Results: Significant decreases in the expression of SHH-related proteins (PTCH1, SMO, GLI1, p < 0.05) with damage of SMG ductal cells were observed with vismodegib administration. However, a significant increase in the expression levels of SHH-related proteins (SHH, SMO, GLI1, p < 0.05) and recovery of SMG ductal cells damaged after vismodegib administration were observed for PBM-treated groups. Salivary functional marker AQP5 also showed the same increase or decrease. Conclusions: This study found that vismodegib damages SMG ductal cells and decreases SHH-related proteins and associated salivary functional markers. Also, 850 nm high-power LED recovered the damaged structure of SMG and increased SHH-related proteins and salivary functional markers. The study results suggest that PBM can restore SMG structure and function through SHH signaling.

Clinical audit of ultrasonography for detecting sialoliths in the submandibular gland in paediatric patients: A comparison to computed tomography and magnetic resonance imaging

Objectives

To compare the performance of ultrasonography with magnetic resonance imaging (MRI) and computed tomography (CT) for detecting submandibular sialoliths.

Methods

Thirteen patients with suspected submandibular sialoliths who underwent ultrasonography and CT or MRI were included. Sialoliths were diagnosed using CT (11 cases) or MRI (two cases). The submandibular duct was classified into distal and proximal ducts based on the point around the mylohyoid muscle. Sialoliths located in the proximal duct were difficult to differentiate from those located within the submandibular gland (SMG). Therefore, the location of the sialoliths was classified as follows: within the SMG/proximal duct and within the distal duct. The ultrasound results were compared with CT/MRI results.

Results

Of the 13 patients included, two had sialoliths in both the SMG/proximal duct and the distal duct, three had sialoliths in the SMG/proximal duct, and five had sialoliths in the distal duct on CT or MRI. In this small cohort, all five sialoliths in the SMG/proximal duct were detected by ultrasoonography; however, of the seven cases with sialoliths located in the distal duct, only three could be detected by ultrasonography.

Conclusions

The incidence of sialoliths in the distal duct was higher than that in the SMG/proximal duct. Ultrasonography showed a good performance compared with CT/MRI in the SMG/proximal duct but not in the distal duct.

Tlx1 regulates acinar and duct development in mouse salivary glands

Tlx1 encodes a transcription factor expressed in several craniofacial structures of developing mice. The role of Tlx1 in salivary gland development was examined using morphological and immunohistochemical analyses of Tlx1 null mice. Tlx1 is expressed in submandibular and sublingual glands but not parotid glands of neonatal and adult male and female C57Bl/6J (Tlx1+/+ ) mice. TLX1 protein was localized to the nuclei of terminal tubule cells, developing duct cells and mesenchymal cells in neonatal submandibular and sublingual glands, and to nuclei of duct cells and connective tissue cells in adult glands. Occasionally, TLX1 was observed in nuclei of epithelial cells in or adjacent to the acini. Submandibular glands were smaller and sublingual glands were larger in size in mutant mice (Tlx1-/- ) compared to wild-type mice. Differentiation of terminal tubule and proacinar cells of neonatal Tlx1-/- submandibular glands was abnormal; expression of their characteristic products, submandibular gland protein C and parotid secretory protein, respectively, was reduced. At 3 weeks postnatally, terminal tubule cells at the acinar-intercalated duct junction were poorly developed or absent in Tlx1-/- mice. Granular convoluted ducts in adult mutant mice were decreased, and epidermal growth factor and nerve growth factor expression were reduced. Along with normal acinar cell proteins, adult acinar cells of Tlx1-/- mice continued to express neonatal proteins and expressed parotid proteins not normally present in submandibular glands. Sublingual gland mucous acinar and serous demilune cell differentiation were altered. Tlx1 is necessary for proper differentiation of submandibular and sublingual gland acinar cells, and granular convoluted ducts. The mechanism(s) underlying Tlx1 regulation of salivary gland development and differentiation remains unknown.

A Rare Case of Submandibular Gland Squamous Cell Carcinoma: Diagnostic Challenges and Surgical Management

Squamous cell carcinoma (SCC) in salivary glands is rare, often posing diagnostic challenges. This case report presents a 75-year-old male with progressively increasing swelling and pain in the right submandibular gland, eventually diagnosed as moderately differentiated SCC. The diagnostic journey involved fine needle aspiration cytology, imaging studies, and histopathological examination. The patient underwent surgical intervention, including submandibular gland excision and selective neck dissection, which successfully achieved local control. Subsequent postoperative follow-up indicated a favorable outcome, with no significant complaints. This report contributes insights into the multidisciplinary diagnostic approach and underscores the importance of imaging modalities in managing salivary gland SCC. This rare case emphasizes the need for ongoing research to refine management strategies for salivary gland SCC. By presenting a comprehensive diagnostic and therapeutic approach, this report contributes to the limited literature on this malignancy, emphasizing its rarity and the necessity for continued exploration of long-term outcomes. In conclusion, our case provides valuable insights into the medical knowledge surrounding SCC in salivary glands, warranting attention and further investigation.

[Melatonin reverses oxidative damage in the submandibular gland of rats treated with Cyclophosphamide]

Objetive

Cyclophosphamide (Cf) produces oxidative damage in rat submandibular gland (GSM). In the present work we evaluated the antioxidant protective effect of melatonin (MLT) in GSM of rats treated with Cf.

Methods

40 adult male Wistar rats were divided into 5 groups (G): G1: control; G2: Control+Ethanol: treated with 1% ethanol for 10 consecutive days. On days 11 and 12 they received a dose of saline; G3: Cf: treated with 1% ethanol for 12 days, days 11 and 12 they received an intraperitoneal (i.p.) dose of Cf 50 mg/Kg/kg of saline. ) of Cf 50 mg/kg bw; G4: Cf + MLT: MLT (5 mg/kg bw, intraperitoneal, dissolved in 1% ethanol) was administered daily, days 11 and 12 received Cf same as G3; G5: MLT: treated 12 consecutive days with MLT (same dose as G4). After 12 hours of fasting, animals were anesthetized to obtain both submandibular glands, then they were sacrificed. Uric acid (UA), lipid peroxides (LPs), aqueous peroxides (APs) and superoxide dismutase (SOD) activity were measured in submandibular gland homogenate. Statistical analysis: we used ANOVA and Bonferroni test pos hoc, considering significant p<0.05.

Results

Cf treatment decreased AU concentration and SOD activity (AU, mg/mg prot., G1: 2.50±0.68; G2: 2.18±0.13; G3: 0.54±0.09* G4: 1.95±0.24#, G5: 2.64±0.47, *p<0.01 G3 vs G1, G2, G4; #p<0.01 G4 vs G3 and G5; SOD, U/mg prot, G1: 4.57±0.95, G2: 4.79±0.94, G3: 2.18±0.53*, G4: 5.13±1.10, G5: 5.09±0.39, *p< 0.01 G3 vs G1, G2, G4 and G5). MLT treatment prevented these effects. In addition, Cf increased PL and PA formation.

Conclusion

MLT improved the redox status in GSM of Cf-treated rats. MLT could prevent oxidative processes in GSM produced by Cf.

A Rare Case of Basal Cell Adenocarcinoma of the Right Submandibular Gland

Basal cell adenocarcinoma of the submandibular gland is an extremely rare carcinoma of the salivary gland that originates from the basal cells of the submandibular gland. Due to its rarity, there are relatively few case reports and literature on this cancer. After comprehensive clinical, imaging, and pathologic analyses, we confirmed the patient's diagnosis and documented the consultation in detail. The purpose of this article is to report the case of a patient with basal cell adenocarcinoma of the submandibular gland and to perform a review of the relevant literature to improve the understanding of this rare disease.

NUT carcinoma of the submandibular gland: A case report

BACKGROUND

NUT carcinoma (NUTc) is a rare and aggressive malignant epithelial tumor characterized by rearrangement of the NUT gene on chromosome 15q14.

METHODS

In this article, we present the fifth case worldwide of a young woman affected by a NUTc arising from a submandibular gland, presenting as a rapidly evolving mass. She underwent a right scialoadenectomy and received the initial diagnosis of high-grade mucoepidermoid carcinoma. Due to evidence of local recurrence at magnetic resonance imaging 1 month later, a subsequent right radical neck dissection was performed. The patient then sought a second opinion at our cancer center and finally received the correct diagnosis of NUT carcinoma. Given the well-known aggressive behavior of this neoplasm, as well as clinical and radiological features, she underwent adjuvant chemo-radiation (intensity-modulated radiotherapy + concurrent chemotherapy with cisplatin).

RESULTS

After a disease-free interval of 2.6 months, a widespread metastatic disease led to rapid deterioration of performance status and patient death in a few weeks after metastatic onset.

CONCLUSIONS

We presented a case of NUTc arising from salivary gland aiming to improve the knowledge of this rare malignancy. First, we pointed out that in the setting of rare tumors like salivary gland cancers, the diagnosis should be obtained by expert pathologists, and patients should be referred to tertiary cancer centers for their clinical management. Second, molecular profiling may help to identify possible druggable targets that may be exploited to treat patients suffering from this aggressive malignancy. Sharing the molecular data provided in this case will be useful for further research.

Magnetic Resonance Imaging Findings of Lymphoepithelial Carcinoma of the Submandibular Gland: A Case Report

Lymphoepithelial carcinoma (LEC) is an uncommon neoplasm strongly associated with Epstein-Barr virus (EBV). LEC of the salivary glands (LECSG) is very rare: the most commonly affected site is the parotid gland, followed by the submandibular gland. This report describes the case of a 58-year-old man who presented with a left submandibular mass that had gradually increased in size over five years. On magnetic resonance imaging (MRI), the mass showed low apparent diffusion coefficient (ADC) values, rapid initial enhancement before reaching a plateau on dynamic contrast-enhanced MRI (DCE-MRI), and internal septal-like enhancement. Histopathologically, the tumor comprised polygonal or round tumor cells with atypical or pleomorphic nuclei and numerous lymphocytes, separated by heavy fibrosis. Immunohistological findings were positive for AE/AE3, CD20, and EBV-encoded small RNA in situ hybridization (EBER-ISH), consistent with LEC. A low ADC value with rapid initial enhancement before reaching a plateau on DCE-MRI was thought to reflect abundant cellular components with tumor neoangiogenesis, whereas internal septal-like enhancement reflects separating heavy fibrosis. To the best of our knowledge, this is the first case report describing ADC value and DCE-MRI findings of LECSG, and these findings can be considered characteristic MRI findings of LECSG.

Single-Cell RNA-Seq Analysis Identifies Angiotensinogen and Galanin as Unique Molecular Markers of Acinar Cells in Murine Salivary Glands

The submandibular gland (SMG) and sublingual gland (SLG) are two of three major salivary glands in mammals and comprise serous and mucous acinar cells. The two glands share some functional properties, which are largely dependent on the types of acinar cells. In recent years, while ScRNA-seq (single-cell sequencing) with a 10 × platform has been used to explore molecular markers in salivary glands, few studies have examined the acinar heterogeneity and unique molecular markers between SMG and SLG. This study aimed to identify the molecular markers of acinar cells in the SLG and SMG. We performed ScRNA-seq analyses in 4-week-old mice and verified the screened molecular markers using reverse transcription-quantitative real-time PCR, immunohistochemistry, and immunofluorescence. Our results showed prominently heterogeneous acinar cells, although there was great similarity in the cluster composition between the two glands at 4 weeks. Furthermore, we demonstrated that Agt is a specific marker of SMG serous acinar cells, whereas Gal is a specific marker of SLG mucous acinar cells. Trajectory inference revealed that Agt and Gal represent two types of differential acinar cell clusters during late development in adults. Thus, we reveal previously unknown specific markers for salivary acinar cell diversity, which has extensive implications for their further functional research.

The effectiveness of ultrasound-guided injection of BTX-A in the management of sialorrhea in neurogenic dysphagia patients

Objective

To evaluate the effectiveness of ultrasound-guided injection of botulinum toxin type A (BTX-A) in treating sialorrhea.

Methods

We recruited 32 sialorrhea subjects and they received an ultrasound-guided injection of BTX-A. The extent of salivation was evaluated according to the Visual Analog Scale (VAS), Drooling Severity and Frequency Scale (DSFS), and Saliva Flow Rate (SFR). Laryngeal secretions were evaluated based on Fiberoptic Endoscopic Evaluation of Swallowing (FEES) rated according to the Murray Secretion Scale (MSS). We assessed the extent of salivation and laryngeal secretions before injection and at 1, 2, and 4 weeks after injection.

Results

The scores for the VAS, DSFS-S, DSFS-F, and DSFS-T decreased significantly at 1, 2, and 4 weeks after injection compared with before injection (p < .05). Based on VAS, the efficacy was substantially higher at 2 and 4 weeks after injection than at 1 week after injection (p < .05). According to DSFS-S and DSFS-T, the efficacy was significantly higher at 4 weeks than at 1 week after injection (p < .05). The SFR and MSS scores at 1 and 2 weeks after injection were superior to those before injection (p < .05). Meanwhile, the SFR score 2 weeks after injection was superior to that 1 week after injection (p < .05).

Conclusion

The ultrasound-guided injection of BTX-A can effectively reduce saliva secretion in patients with neurogenic dysphagia. Furthermore, it has the advantages of early onset time and lasting curative effects, which indicates that clinical promotion and application of this technique are justified.

Level of Evidence

Level 3.

Xerostomia: An easily ignored symptom induced by induction chemotherapy in patients with nasopharyngeal carcinoma

BACKGROUND

To investigate the prevalence and predictive factors of xerostomia during induction chemotherapy (IC) in patients with nasopharyngeal carcinoma (NPC).

METHODS

We prospectively enrolled NPC patients who received IC between October 2020 and October 2021. The Visual Analogue Scale (VAS) and Xerostomia Inventory (XI) were used to evaluate the condition of xerostomia. The volume of the submandibular gland (SMG) was also calculated before and after IC.

RESULTS

Fifty-two patients were enrolled in this study. Of these patients, 32.7% (n = 17) experienced xerostomia before IC. There were 32 (61.5%) patients suffered from xerostomia after IC, including 21 (40.4%) patients with newly diagnosed xerostomia after IC and 11 (21.1%) patients complained their xerostomia aggravated in those with xerostomia before IC. The median XI scores increased from 11 (standard deviation [SD], 2.930) to 18 (SD 3.995), 16 (SD 3.605), and 17 (SD 4.331) after the first, second, and third cycles of IC, respectively. The median score of VAS also increased from 0 to 4 during the following three cycles of IC. In those with IC-related xerostomia, the SMG volume after IC was significantly decreased compared with those without IC-related xerostomia (P = 0.001). The reduction of the SMG volume after IC was the independent risk factor for xerostomia (P = 0.002).

CONCLUSION

Approximately two-thirds of NPC patients suffered from IC-related xerostomia and patients with a reduction of SMG volume after IC had a higher risk of xerostomia.

Pivotal Role of Ultrasonography and Radiology in Diagnosing a Case of Sialolith

Sialolithiasis is a condition that affects the salivary glands, which commonly occurs within the body of the submandibular gland or the Wharton duct. This condition is characterised by pain in the submandibular area after meals. Conservative therapies such as duct milking and palliative care can provide positive results for small, easily accessible calculi. This report describes the results of radiographic imaging of a 43-year-old patient with pain and swelling in the submandibular region. During the extraoral examination, a 1.5 cm wide diffuse swelling was present in the left submandibular region, and the left submandibular gland was tender and firm. In addition, a solitary, tender left submandibular lymph node was observed. Intraorally, the opening of the submandibular duct was erythematous and inflamed. The patient was advised for necessary investigations, including an orthopantomogram, cone beam CT, neck ultrasound, and left submandibular gland sialography. Ultrasonography was preferred over other imaging techniques due to its non-invasive nature and high accuracy, sensitivity, and specificity in diagnosing sialolithiasis. Timely management of sialolith is critical as delayed treatment can lead to serious consequences. A conclusive diagnosis of left submandibular sialolithiasis, accompanied by sialadenitis, was made based on clinical, radiographic, and ultrasound findings.

Human Serum and Salivary Metabolomes: Diversity and Closeness

Saliva, which contains molecular information that may reflect an individual's health status, has become a valuable tool for discovering biomarkers of oral and general diseases. Due to the high vascularization of the salivary glands, there is a molecular exchange between blood and saliva. However, the composition of saliva is complex and influenced by multiple factors. This study aimed to investigate the possible relationships between the salivary and serum metabolomes to gain a comprehensive view of the metabolic phenotype under physiological conditions. Using 1H-NMR spectroscopy, we obtained the serum metabolite profiles of 20 healthy young individuals and compared them with the metabolomes of parotid, submandibular/sublingual, and whole-saliva samples collected concurrently from the same individuals using multivariate and univariate statistical analysis. Our results show that serum is more concentrated and less variable for most of the shared metabolites than the three saliva types. While we found moderate to strong correlations between serum and saliva concentrations of specific metabolites, saliva is not simply an ultrafiltrate of blood. The intense oral metabolism prevents very strong correlations between serum and salivary concentrations. This study contributes to a better understanding of salivary metabolic composition, which is crucial for utilizing saliva in laboratory diagnostics.

Metformin Attenuates TGF-β1-Induced Fibrosis in Salivary Gland: A Preliminary Study

Fibrosis commonly arises from salivary gland injuries induced by factors such as inflammation, ductal obstruction, radiation, aging, and autoimmunity, leading to glandular atrophy and functional impairment. However, effective treatments for these injuries remain elusive. Transforming growth factor-beta 1 (TGF-β1) is fundamental in fibrosis, advancing fibroblast differentiation into myofibroblasts and enhancing the extracellular matrix in the salivary gland. The involvement of the SMAD pathway and reactive oxygen species (ROS) in this context has been postulated. Metformin, a type 2 diabetes mellitus (T2DM) medication, has been noted for its potent anti-fibrotic effects. Through human samples, primary salivary gland fibroblasts, and a rat model, this study explored metformin's anti-fibrotic properties. Elevated levels of TGF-β1 (p < 0.01) and alpha-smooth muscle actin (α-SMA) (p < 0.01) were observed in human sialadenitis samples. The analysis showed that metformin attenuates TGF-β1-induced fibrosis by inhibiting SMAD phosphorylation (p < 0.01) through adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK)-independent pathways and activating the AMPK pathway, consequently suppressing NADPH oxidase 4 (NOX4) (p < 0.01), a main ROS producer. Moreover, in rats, metformin not only reduced glandular fibrosis post-ductal ligation but also protected acinar cells from ligation-induced injuries, thereby normalizing the levels of aquaporin 5 (AQP5) (p < 0.05). Overall, this study underscores the potential of metformin as a promising therapeutic option for salivary gland fibrosis.

SHED-derived exosomes ameliorate hyposalivation caused by Sjögren's syndrome via Akt/GSK-3β/Slug-mediated ZO-1 expression

BACKGROUND

Sjögren's syndrome (SS) is an autoimmune disorder characterized by sicca syndrome and/or systemic manifestations. The treatment is still challenging. This study aimed to explore the therapeutic role and mechanism of exosomes obtained from the supernatant of stem cells derived from human exfoliated deciduous teeth (SHED-exos) in sialadenitis caused by SS.

METHODS

SHED-exos were administered to the submandibular glands (SMGs) of 14-week-old non-obese diabetic (NOD) mice, an animal model of the clinical phase of SS, by local injection or intraductal infusion. The saliva flow rate was measured after pilocarpine intraperitoneal injection in 21-week-old NOD mice. Protein expression was examined by western blot analysis. Exosomal microRNA (miRNAs) were identified by microarray analysis. Paracellular permeability was evaluated by transepithelial electrical resistance measurement.

RESULTS

SHED-exos were injected into the SMG of NOD mice and increased saliva secretion. The injected SHED-exos were taken up by glandular epithelial cells, and further increased paracellular permeability mediated by zonula occluden-1 (ZO-1). A total of 180 exosomal miRNAs were identified from SHED-exos, and Kyoto Encyclopedia of Genes and Genomes analysis suggested that the phosphatidylinositol 3 kinase (PI3K)/protein kinase B (Akt) pathway might play an important role. SHED-exos treatment down-regulated phospho-Akt (p-Akt)/Akt, phospho-glycogen synthase kinase 3β (p-GSK-3β)/GSK-3β, and Slug expressions and up-regulated ZO-1 expression in SMGs and SMG-C6 cells. Both the increased ZO-1 expression and paracellular permeability induced by SHED-exos were abolished by insulin-like growth factor 1, a PI3K agonist. Slug bound to the ZO-1 promoter and suppressed its expression. For safer and more effective clinical application, SHED-exos were intraductally infused into the SMGs of NOD mice, and saliva secretion was increased and accompanied by decreased levels of p-Akt/Akt, p-GSK-3β/GSK-3β, and Slug and increased ZO-1 expression.

CONCLUSION

Local application of SHED-exos in SMGs can ameliorate Sjögren syndrome-induced hyposalivation by increasing the paracellular permeability of glandular epithelial cells through Akt/GSK-3β/Slug pathway-mediated ZO-1 expression.

Sialolithiasis in the Left Submandibular Gland: A Case

The most common illness affecting the salivary glands is submandibular gland sialoliths. The size of the sialolith and the patient's clinical history mainly influence how this salivary system abnormality is treated. This diagnosis is suggested by a history of salivary gland pain or swelling, particularly during mastication. Palliative therapy combined with conservative therapies, such as the milking of the ducts, can effectively treat small and accessible stones. When a stone or stones are large and inaccessible, surgical therapy should be considered if conservative approaches have not proven to be effective. A case of sialolithiasis affecting the left submandibular salivary gland is described in this article. Under local anesthesia, sialolith was removed following the opening of the duct. The wound was closed with sutures, and the patient was advised to practice tongue exercises and to maintain good oral hygiene.

Pleomorphic Adenoma of the Submandibular Gland in a 10-Year-Old Child: A Case Report

We report the case of a 10-year-old girl with a painless slowly growing mass that had developed over the course of 2 years in the left submandibular area. Physical examination revealed a firm painless submandibular mass with no other associated signs. Ultrasound graphics were in favor of a sebaceous cyst. Fine-needle aspiration and magnetic resonance images (MRI) concluded to a pleomorphic adenoma of the submandibular gland. The patient underwent left submandibulectomy. Histopathological examination confirmed the diagnosis of pleomorphic adenoma arising from the submandibular gland. The postoperative course was uneventful. Pleomorphic adenoma of the submandibular gland represents a diagnostic and therapeutic dilemma in children. Preoperative evaluation, including MRI and fine-needle aspiration, is recommended. Total submandibulectomy is also recommended to minimize recurrences and to avoid malignant transformation.

Safety considerations for treating the parotid and submandibular glands with neuromodulators for facial slimming

BACKGROUND

Neuromodulators have predominantly been used for the treatment of upper facial lines, but their use has expanded to include lower face and neck treatments. However, the injection sites for these treatments are based on skin surface landmarks, which may pose risks to nearby structures and result in undesired outcomes.

OBJECTIVE

To investigate the spatial relationship between the FDA-approved skin surface landmarks for neuromodulator injections in the parotid and submandibular glands and the topographical anatomy of critical facial structures such as the facial artery, facial vein, external carotid artery, and retromandibular vein.

MATERIALS AND METHODS

A cross-sectional retrospective analysis was conducted on contrast-enhanced cranial CT scans. The scans were analyzed for the morphology and location of the parotid and submandibular glands. Measurements were taken for gland volume, craniocaudal extent, anterior-posterior extent, and distances between the skin surface and gland capsule or nearby structures such as arteries.

RESULTS

The study sample consisted of 53 subjects, including 7 males and 46 females, with a mean age of 36.91 years and a mean BMI of 23.28 kg/m2 . The mean volume of the parotid gland was 31.9 ± 3.0 cc in males and 28.5 ± 3.6 cc in females with p < 0.001, while the mean volume of the submandibular gland was 18.2 ± 2.0 cc in males and 14.5 ± 3.4 cc in females with p < 0.001. The mean distances between skin surface and the gland capsule were 5.98 ± 2.2 and 8.84 ± 4.0 mm for the parotid and submandibular gland, respectively. This distance increased with higher age and higher BMI values in a statistically significant manner with p < 0.001.

CONCLUSION

The distances between FDA-approved skin surface landmarks and the parotid and submandibular glands varied significantly depending on gender, age, and BMI. Optimal injection depth and location for neuromodulator treatments cannot be generalized based on these landmarks alone, emphasizing the need for real-time ultrasound imaging guidance.

Gadolinium as a contrast agent for infusion sialograms in patients with iodine allergy

Objectives

To assess the adequacy of gadolinium in sialography as an alternative contrast agent for patients with iodine allergies. To directly compare images taken with gadolinium versus iodine-based contrast agents using the Iowa Sialography Classification System.

Methods

Retrospective chart review was performed on patients undergoing sialography between February 2008 and July 2022. Patients with sialograms obtained with gadolinium were identified and matched to similar sialograms obtained with iodine-based contrast agent. Patients were matched based on duct location, duct side, and initial radiology findings. Blinded reevaluation of sialograms was performed first independently and then by consensus by two head and neck radiologists to evaluate overall image adequacy and grade using the Iowa Sialography Classification System.

Results

Four patients with six sialograms (one bilateral parotid and one parotid + submandibular) obtained with gadolinium were identified and reevaluated. Five patients with six sialograms (one bilateral parotid) obtained with iodine-based were matched to the gadolinium sialograms. The overall adequacy of images for gadolinium sialograms was graded at an average of 4.25 (4 = good and 5 = excellent); whereas, the overall adequacy of iodine-based sialograms was graded at an average of 5. Inter-observer variability was observed in three sialograms obtained with gadolinium (50%), while no interobserver variability was observed in sialograms obtained with iodine-based contrast agent.

Conclusion

Gadolinium is an adequate alternative to use in sialography for patients with iodine allergies undergoing contemporary digital infusion sialography. Adverse reactions to iodine contrast agents are rare in sialography; however, the precautionary use of gadolinium is acceptable for the diagnostic and therapeutic benefits in sialography.Level of Evidence: IV.

Value of High-Frequency Ultrasonography in the Qualitative and Semi-Quantitative Assessment of Immunoglobulin G4-Related Submandibular Sialadenitis

OBJECTIVE

To assess the value of high-frequency ultrasonography in the evaluation of immunoglobulin G4-related submandibular sialadenitis (IgG4-SS).

METHODS

Thirty-four submandibular glands in 17 patients with IgG4-SS were retrospectively enrolled, as well as 34 submandibular glands in 17 healthy control subjects. Qualitative ultrasonic features including submandibular gland size, border, echogenicity, and vascularity were reviewed. Two different scoring systems (0-16 and 0-48, respectively) were used for semi-quantitative analysis of imaging features. Comparison of both qualitative and semi-quantitative ultrasonic analysis were made between patients with IgG4-SS and healthy controls. Spearman correlation was used to explore relationships between variables.

RESULTS

The submandibular glands with IgG4-SS presented with enlarged size, rough border, increased vascularity, and abnormal echogenicity (All P < .05). The most common echogenicity pattern for IgG-SS was diffuse hypoechoic foci pattern (44.1%), followed by superficial hypoechoic pattern (20.6%), tumor-like pattern (14.7%), and diffuse hypoechogenicity pattern (11.8%). Most IgG4-SS glands presented linear hyperechogenicity in parenchyma (91.2%). Based on both scoring system, scores of IgG4-SS were significantly higher than those of the controls (All P < .05). Association analysis of both scoring systems showed positive correlation of scores with vascularity in the gland parenchyma (All P < .05).

CONCLUSION

The ultrasonic features of IgG4-SS comprise enlarged gland, rough border, increased vascularity, and abnormal echogenicity, which correlate with its pathological characteristics. The most common echogenicity pattern for IgG4-SS was diffuse hypoechoic foci pattern. Semi-quantitative analysis systems could be useful in the assessment of IgG4-SS. Ultrasound is a potential, valuable, and non-invasive tool for the diagnosis and evaluation of IgG4-SS.

d-Serine Increases Release of Acetylcholine in Rat Submandibular Glands

d-serine has been observed in submandibular gland tissue in rats, but its functions remain to be clarified. Oral administration of d-serine, but not l-serine, increased its concentrations in the submandibular gland and pilocarpine-induced salivary secretion. In vivo microdialysis was used to collect the d- and l-enantiomers of amino acids from local interstitial fluid in the rat submandibular gland. The proportion of the d-form of serine in interstitial fluid was higher than that in plasma or saliva. Perfusion of the rat submandibular gland with d-serine and l-glutamic acid via the submandibular gland artery resulted in a significant increase in salivary secretion after stimulation of muscarinic receptors with carbachol. In vivo microdialysis applied to the submandibular glands of rats showed that infusion of d-serine along with l-glutamate through the microdialysis probe significantly elevated acetylcholine levels in local interstitial fluids in the submandibular glands of anesthetized rats as compared to that with l-glutamate alone in an N-methyl-d-aspartate receptor glycine site antagonist-sensitive manner. These results indicate that d-serine augments salivary secretion by increasing acetylcholine release in the salivary glands.

The sublingual branch of the lingual nerve: Anatomical study and suggestion for a new terminology

The lingual nerve carries somatosensory fibers from the anterior two-thirds of tongue. The parasympathetic preganglionic fibers arising from the chorda tympani also travel with the lingual nerve in the infratemporal fossa to synapse in the submandibular ganglion to innervate the sublingual gland. However, only a few studies have investigated the specific nerve that innervates the sublingual gland and surrounding tissue i.e., the so-called sublingual nerve. Therefore, this study aimed to clarify the anatomy and definition of the sublingual nerves. Thirty sides from formalin fixed cadaveric hemiheads underwent microsurgical dissection of the sublingual nerves. The sublingual nerves were found on all sides and categorized into three branches, i.e., branches to the sublingual gland, branches to the mucosa of the floor of the mouth, and gingival branches. Additionally, branches to the sublingual gland were subcategorized into types I and II based on the origin of the sublingual nerve. We suggest that the lingual nerve branches should be categorized into five branches, i.e., branches to the isthmus of the fauces, sublingual nerves, lingual branches, posterior branch to the submandibular ganglion, and branches to the sublingual ganglion.

Developments and trends of endoscopic salivary gland resection: from endoscope-assisted to full endoscopic

More than 30 years of rapid development of endoscopic surgery has led to the mainstreaming of this procedure in many surgical departments in China. Since the first report on endoscopy, it has been used in salivary gland resection for more than 20 years. The overall development of endoscopic surgery indicates that its use in oral and maxillofacial surgery is still in the early exploration stage; it has not yet been maturely developed or applied. Owing to the advancement of other disciplines and corresponding widening experiences in those fields, the development of endoscopic technology in oral and maxillofacial surgery will likely achieve a leapfrogging. Learning from the general development pattern of endoscopy, this research explores the application history, current situation, and future direction of the application of endoscopy in salivary gland surgery.

Vasculitis mimicking immunoglobulin-G4-related disease with involvement of the submandibular and lacrimal glands and periaortitis: A case report

INTRODUCTION

Vasculitis does not usually induce glandular tissue lesions. Herein, we present a case of vasculitis with a distribution similar to that of immunoglobulin-G4-related disease (IgG4-RD), including that of the submandibular and lacrimal glands, and periaortitis.

CASE REPORT

A 70-year-old man presented with shortness of breath. Laboratory findings revealed an IgG4 level of 191 mg/dL, negative antineutrophil cytoplasmic antibody test, and C-reactive protein level of 8.33 mg/dL. Magnetic resonance imaging of the head and computed tomography of the neck revealed bilaterally enlarged submandibular and lacrimal glands. Neck-to-pelvis computed tomography revealed bilateral infiltrative shadows in the lower lobes of both lungs, mass shadows in both lungs, and periaortitis of the abdominal aorta extending to the common iliac artery. Thus, the patient was diagnosed with IgG4-related respiratory disease and periaortitis/periarteritis. Prednisolone was administered at a dose of 35 mg (0.6 mg/kg daily). The dose was gradually tapered while observing the effects of the treatment. Imaging findings indicated an improvement and the C-reactive protein and IgG4 levels decreased, indicating a successful treatment course. However, after reexamination of the pathological findings, the diagnosis changed from IgG4-RD to vasculitis. One year after treatment initiation, the patient symptoms have stabilized.

CONCLUSION

Vasculitis can present with lesions and pathological findings similar to those of IgG4-RD.

Granulomatosis with polyangiitis with salivary glands involvement: Presenting a case and describing its clinical, pathophysiological, and therapeutic aspects

Granulomatosis with polyangiitis (GPA), a rare form of small vessel vasculitis, may be manifested by multisystem involvement misleading its definitive diagnosis. The involvement of salivary glands is a very rare characteristic of GPA. Herein, we described a case of GPA with submandibular salivary gland involvement followed by reviewing the literature on similar cases. The case was a 31-year-old man, a known case of seronegative peripheral arthritis that referred recently with bilateral enlargement of the parotid and submandibular glands. Pulmonary nodules were also evident in the patient's CT scan. Fine-needle aspiration under ultrasound guidance indicated the presence of degenerated squamoid cells, giant cells, and inflammatory cells with a priority of neutrophils in the submandibular gland, as well as the presence of a cyst containing fluid without the evidence of malignancy in the parotid gland. The positivity for the Anti-neutrophil Cytoplasmic Antibody (C-ANCA) marker was also revealed. The patient was treated with methotrexate, prednisolone, and rituximab which led to a gradual reduction in the size of the glands and the improvement of the patient's clinical symptoms within 1 month after the treatment. Enlargement of salivary glands in the context of inflammatory disorders can raise doubts about the existence of GPA, and therefore imaging evaluation and histopathological assessment with an ANCA test will be necessary to confirm or rule out it.

Pancreatic Islet Transplantation into the Submandibular Gland: Our Experimental Experience and a Review of the Relevant Literature

Pancreatic islet transplantation is a promising therapy for type 1 diabetes. Islet transplantation is clinically performed through intra-portal infusion, which is associated with several drawbacks, including poor engraftment. The histological resemblance between the submandibular gland and the pancreas renders it an attractive alternative site for islet transplantation. In this study, we refined the technique of islet transplantation into the submandibular gland to achieve good morphological features. Then, we transplanted 2600 islet equivalents into the submandibular glands of diabetic Lewis rats. Intra-portal islet transplantation was performed in diabetic rats as a control. Blood glucose levels were followed for 31 days, and an intravenous glucose tolerance test was performed. Immunohistochemistry was used to demonstrate the morphology of transplanted islets. Follow-up after transplantation showed that diabetes was cured in 2/12 rats in the submandibular group in comparison to 4/6 in the control group. The intravenous glucose tolerance test results of the submandibular and intra-portal groups were comparable. Immunohistochemistry showed large islet masses in the submandibular gland in all examined specimens with positive insulin staining. Our results show that submandibular gland tissue can support the islet function and engraftment but with considerable variability. Good morphological features were achieved using our refined technique. However, islet transplantation into rat submandibular glands did not demonstrate a clear advantage over conventional intra-portal transplantation.

Mucocele Arising from the Submandibular Gland Presenting as Neck Swelling: A Rare Case Report

Mucoceles rarely involve major salivary glands. Very few cases involving the submandibular gland have been reported to date. A young male child presented with diffuse, soft, and painless swelling of the left submandibular region. Investigations suggested mucocele of the submandibular salivary gland. The mucocele was excised along with the left submandibular gland. Recovery was uneventful.

Assessment of Dimensional Changes in Submandibular Glands in Head-Neck Radiotherapy Patients by Ultrasonography

OBJECTIVES

The present study investigated the dimensional changes in the submandibular glands following radiotherapy using ultrasonography.

METHODS

Twenty-three patients planned to receive head-neck radiotherapy were included in this study. The anteroposterior, superoinferior, mediolateral length, and volumes of 46 submandibular glands were measured by ultrasonography at 3 different time periods (before radiotherapy and in the second and sixth months after the radiotherapy onset) and evaluated in terms of dimensional changes and the effect of the radiation dose on these changes. The data were statistically analyzed using repeated measures analysis of variance (ANOVA) and 2-factor repeated measures ANOVA.

RESULTS

Before radiotherapy and in the second and sixth months after the radiotherapy onset, mean anteroposterior length of the submandibular glands was 32.39 ± 4.55, 30.38 ± 4.80, and 31.50 ± 3.68 mm, respectively; mean superoinferior length was 9.96 ± 1.54, 8.76 ± 1.26, and 9.08 ± 1.01 mm, respectively; mean mediolateral length was 24.66 ± 3.77, 22.03 ± 3.73, and 21.76 ± 4.01 mm, respectively; and mean volume was 4.21 ± 1.01, 3.08 ± 0.77, and 3.32 ± 0.63 cm³ , respectively. Moreover, there were significant differences in the anteroposterior (P < .01), superoinferior (P < .001), and mediolateral lengths (P < .001), as well as the volumes (P < .001) of the submandibular glands measured at the 3 different time periods.

CONCLUSION

In the second and sixth months after the radiotherapy onset, the sizes of the submandibular glands were markedly reduced, but it partially recovered to normal as more time elapsed after radiotherapy.

The histologic comparison of submandibular gland between yak and yellow cattle

The purpose of this study was to compare between the histochemical characteristics and the expression of epidermal growth factor (EGF) and it's receptor (EGFR) in the submandibular gland (SMG) of adult yaks and yellow cattle. The SMG tissues of yaks and yellow cattles were collected for histochemical, immunohistochemical (IHC), immunofluorescence (F-IHC)，real-time quantitative polymerasechain reaction (RT-qPCR) and Western blotting methods. The results showed that the striated ducts of SMG were highly developed and connected to the intercalated ducts, which were shorter and directly connected to the acini. Compared with yellow cattle, yak SMG contains more mucous acini. Immunofluorescence showed significant expression of EGF and its receptor in both striated and intercalated ducts of these two species of cattle. Statistical analysis divulged that the distribution density of EGF and EGFR in the SMG of the yak was both significantly higher than that in yellow cattle (p < 0.05). Furthermore, the mRNA expression of EGF and EGFR in yak SMG was also higher than that in yellow cattle. The above results indicated that the intercalated ducts and striated ducts are the main expression sites of EGF and EGFR, the acidic mucin and EGF secreted from SMG of yak were more than that from yellow cattle. The results of this study provide powerful data for the study of physiological functions of submaxillary gland in ruminants and also provide important clues for the study of adaptive physiological mechanisms in plateau organisms.

Oxidative-antioxidant imbalance in chronic sialadenitis of submandibular gland in human and rat

OBJECTIVES

This study aimed to evaluate the level of oxidative stress (OS) in human and rat chronic sialadenitis (CS) of the submandibular gland (SMG).

METHOD

We collected human SMG tissues and established a rat CS model using Wharton's duct partial ligation (PL). Morphological changes in the SMG were evaluated by HE, Sirius Red, AB/PAS, TUNEL and immunohistochemical (IHC) staining. Oxidative damage and antioxidant capacity were detected by ELISA, commercial assay kits and IHC staining to evaluate their expression levels and locations in the SMG.

RESULTS

Histopathological damage were observed in the human and rat CS. In rat PL group, the oxidative damage products (8-OHdG, AOPP, 8-iso-PGF2α and H₂ O₂ ) were significantly increased. For antioxidants, the PL group had markedly decreased T-AOC and CAT activity, but markedly increased SOD activity. 3-NT, 4-HNE and MDA expression changed during the process of CS, and antioxidant enzymes (CAT, SOD1, SOD2, GPX1 and GPX4) were mainly expressed in ducts.

CONCLUSIONS

The oxidative-antioxidant imbalance of CS in human and rats was revealed, the different expression of oxidative damage during the process of CS was detected, and the different antioxidant reaction in acinar and ductal cells was demonstrated.

Sebaceous Carcinoma of the Submandibular Gland a Case Report and Review of the Literature

Objective

Sebaceous carcinoma (SC) of the submandibular gland is extremely rare. Owing to the low morbidity and nonspecific clinical manifestations, diagnosis is commonly delayed, which increases metastasis and mortality. To date, there have been five reported cases of SC of the submandibular gland. Here, we present a new case and review the relevant literature.

Methods and Results

A 36-year-old woman presented with an enlarged left submandibular gland. Clinical features included a non-tender solitary nodular mass with normal overlying skin. There were no special findings on computed tomography or ultrasound examination except for a swollen mass in the left submandibular gland. The patient underwent surgical resection. Pathological examination confirmed the diagnosis of SC with nerve infiltration. Immunohistochemical examination of this case showed positive staining for P63, P40, CK7, CK8/18, MLH1, MSH2, MSH6, and PMS2. The specimen was negative for androgen receptor, CEA, S-100, CK5/6, SOX-10, SOX-11, SMA, and GCDFP-15. The KI-67 labeling index was determined to be 15%. PAS and anti-epithelial membrane antigen were positive in partial area. The patient is still undergoing follow-up, and no metastasis or recurrence has been observed for 2 months.

Conclusion

This case highlighted the fact that despite its rarity, SC should be considered as a differential diagnosis for masses located in the head and face. Early and accurate diagnosis, followed by wide surgical excision, has a favorable prognosis. Therefore, clinicians should be familiar with the clinical and pathological features of this disease.

Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review

OBJECTIVE

Botulinum toxin A is known to be effective and safe in managing sialorrhea in pediatric patients; however, there is no consensus on a protocol for optimal injection sites and appropriate dosing for injection.

METHODS

This review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. PubMed, EMBASE, and other databases were queried to identify articles that evaluated botulinum toxin type A for the treatment of sialorrhea in the pediatric population. A total of 405 studies were identified. After applying inclusion and exclusion criteria, 31 articles were included for review.

RESULTS

A total of 14 studies evaluated 2-gland injections, and 17 studies evaluated 4-gland injections. Of the 31 studies included, one study assessed incobotulinumtoxinA (Xeomin®) the remaining all used onabotulinumtoxinA (Botox®). For 2-gland injection studies, a combined total of 899 participants were reviewed, where 602 participants received 50 units into their submandibular glands, while 262 participants received 30 to 50 units. Among 4-gland injection studies, there was a combined total of 388 participants, with the most prevalent dosage utilized being 60 to 100 units in 230 participants, followed by 100 units total in 77 participants. The most common adverse event was dysphagia which resolved in nearly all cases. Three studies aimed to examine 2-gland versus 4-gland injections, with 2 of the studies concluding 4-gland injection was superior.

CONCLUSIONS

The strength of evidence suggests that the dosing of 50 units total of onabotulinumtoxinA to the submandibular glands is safe and effective in the pediatric population. For 4-gland injections, bilateral submandibular and parotid gland injections of 60 to 100 units total is the safe and effective dosage. There is no substantial evidence comparing 4-gland injections to 2-gland injections, but research thus far suggests 4-gland injections to be superior. Future study is needed to evaluate incobotulinumtoxinA and abobotulinumtoxinA dosages in the pediatric population.

Correlations of MR Sialographic Gradings with the Clinical Measures of Sjögren's Syndrome

OBJECTIVES

Sjögren syndrome (SS) features salivary gland architectural changes such as ductal deformities and fat deposition secondary to inflammatory cell infiltrates; however, the anatomical and pathophysiological correlations of SS remain to be determined. This study aimed to determine the correlations of imaging findings based on the magnetic resonance (MR) sialography with the clinical and laboratory aspects of SS patients.

METHODS

We evaluated the MR sialographic findings of two pairs of parotid glands (PGs) and submandibular glands (SMGs) from 41 SS patients. The distinct MR sialographic features were then compared with the clinical symptoms, biological (anti-SSA/Ro antibody positivity), histological (labial gland focus score), and functional (salivary flow and scintigraphy) data.

RESULTS

Ductal deformities such as sialectasis in the PG ducts were exclusively observed in SS, and fat replacement in SMGs was more distinct in patients with SS than in non-SS sicca patients. Of the 82 PGs and SMGs from 41 SS patients, the grade of sialectasis in PGs on MR sialographic images and fat stage in SMGs showed strong correlations with anti-SSA/Ro-positivity. PG sialectasis was found more frequently in patients with dry mouth and decreased salivary gland function. A significant correlation was found between fat deposition in PGs and SMGs and decreased salivary gland function.

CONCLUSION

These results suggest that MR sialography is a reliable, adjunctive anatomical and functional study to assess SS. Detail aspects of sialectasis and fat accumulation encountered on MR sialography in SS patients can help physicians assume the disease status in SS.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:307-316, 2023.

[Narrative review of imaging studies of calcifications of the submandibular gland]

Sialolithiasis is one of the most common pathologies of the major salivary glands and occurs more frequently in the submandibular glands. Between 80 and 95% of sialoliths develop in the submandibular glands, between 5 and 20% in the parotid gland, and only 1% in the sublingual gland. Sialoliths form within the parenchyma and associated duct systems. In Wharton's duct (80-90%) and only 15% in the gland. Sialolithiasis is the cause of pain and inflammation of the salivary gland by obstructing the duct and preventing salivary secretion, before, during and after food.The objective of this article was to review the different diagnostic imaging methods used for the study of calcifications of the submandibular gland, based on different studies reported in contemporary scientific literature, in order to establish the correct diagnosis. A search of the literature was carried out in the main information sources including Medline (via PubMed), SEVIER, SCIELO, and LILACS, using the search terms with a date limitation of the last 5 years on average. The selected articles included information regarding the calcifications of the salivary glands. Imaging studies of salivary gland calcifications can be obtained with conventional radiographs, Sialography, Ultrasonography (US), Computed Tomography (CT) and Magnetic Resonance Imaging (MR).

Adamantinoma-like Ewing sarcoma of the salivary glands: a case report and systematic literature review

Adamantinoma-like Ewing sarcoma (ALES) of the salivary glands is an exceedingly rare malignancy defined by the t(11,22) EWSR1::FLI1 fusion, with complex epithelial differentiation. To identify features that can allow for better recognition of this disease entity, we reviewed all published reports of molecularly confirmed ALES of the salivary glands and explored epidemiological, clinical, radiological, pathological, and therapeutic characteristics of a population of 21 patients including a single newly reported patient from our group. We searched the English-language literature indexed in PubMed, Medline, Scopus, and Web of Science using the keyword 'Adamantinoma-like Ewing sarcoma' published up to June 2022. The median age at diagnosis was 46 years, and a slight female sex predilection was observed. Most tumors originated in the parotid gland (86%) and presented as a painless palpable mass with a median diameter of 3.6 cm. Metastatic dissemination was reported only in one patient (5%), and after a median follow-up of 13 months the 1-year overall survival rate was 92%. Salivary gland ALES were frequently misdiagnosed at presentation (62% of cases) and were pathologically characterized by the presence of highly monomorphic small round blue cells with infiltrative pattern and positive immunostaining for CD99 and high- and low-molecular weight cytokeratins. Epidemiological and clinical features of salivary gland ALES raise questions on the incorporation of this malignancy in the Ewing sarcoma family tumor group.

The Role of Endothelial Barrier Function in the Fibrosis of Salivary Gland

In the salivary glands, fibrosis occurs in many pathological conditions. Endothelial tight junction (TJ)-based barrier function plays a vital role in maintaining the homeostasis of the salivary glands. However, whether endothelial barrier function is changed and involved in the pathogenesis of glandular fibrosis is unknown. Here, by using a mouse model in which the main excretory duct of the submandibular gland (SMG) was ligated to induce inflammation and fibrosis, endothelial barrier function and TJ protein expression and distribution were examined. Both 4-kDa and 70-kDa fluorescence-labeled dextrans permeated more in the 1-, 3-, and 7-d ligated SMGs. Meanwhile, the mRNA level of claudin-5 was increased with an obvious redistribution from apicolateral membranes to lateral membranes and cytoplasm in the fibrotic glands. Notably, the TJ sealer AT1001 significantly attenuated the disrupted endothelial barrier function and thereby ameliorated the glandular fibrosis. Cytokine array detection showed that monocyte chemoattractant protein-1 (MCP-1) was highly enriched in the 3-d ligated SMGs, and MCP-1 directly impaired barrier function, increased claudin-5 expression, induced the relocalization of claudin-5, and activated p-ERK1/2 in cultured human endothelial cells. Furthermore, the upregulation and disorganization of claudin-5 as well as the elevation of MCP-1 and p-ERK1/2 signaling were also confirmed in fibrotic SMGs from patients with chronic sialadenitis and immunoglobulin G4-related sialadenitis. Altogether, our findings revealed that disrupted endothelial barrier function contributed to the progression of glandular fibrosis, and targeting endothelial TJs might be a promising approach to alleviate salivary gland fibrosis-related diseases.

Decellularized rat submandibular gland as an alternative scaffold for dental pulp regeneration

Introduction: Decellularized extracellular matrix has been recognized as an optimal scaffold for dental pulp regeneration. However, the limited amount of native dental pulp tissue restricts its clinical applications. The submandibular gland shares some basic extracellular matrix components and characteristics with dental pulp. However, whether decellularized submandibular gland extracellular matrix (DSMG) can be used as an alternative scaffold for dental pulp regenerative medicine is unclear. Methods: Thus, we successfully decellularized the whole rat submandibular gland and human dental pulp, and then conducted in vitro and in vivo studies to compare the properties of these two scaffolds for dental pulp regeneration. Results: Our results showed that extracellular matrix of the submandibular gland had great similarities in structure and composition with that of dental pulp. Furthermore, it was confirmed that the DSMG could support adhesion and proliferation of dental pulp stem cells in vitro. In vivo findings revealed that implanted cell-seeded DSMG formed a vascularized dental pulp-like tissue and expressed markers involved in dentinogenesis and angiogenesis. Discussion: In summary, we introduced a novel accessible biological scaffold and validated its effectiveness as an extracellular matrix-based tissue engineering scaffold for dental pulp regenerative therapy.

Congenital second branchial cleft anomalies in children: A report of 52 surgical cases, with emphasis on characteristic CT findings

Objective

The objectives of this study was to review the clinical features and surgical treatment outcomes of congenital second branchial cleft anomalies (CSBCAs) and to investigate the characteristic computed tomography (CT) findings of CSBCAs.

Methods

We conducted a retrospective study of 52 children who were referred to Shanghai Children's Hospital from October 2014 to December 2021 diagnosed as CSBCAs.

Results

There were 36 males and 16 females. Of them, 35 patients were presented as having a skin pit at birth or discharge from the skin opening on the lateral neck, and 17 patients presented with an asymptomatic or painful mass. The typical CT features of CSBCAs included isolated and homogeneously hypodense cystic lesions surrounded by a uniformly thin, smooth wall. CSBCAs were generally located at the anteromedial border of the sternocleidomastoid muscle, posterior to the submandibular gland, and lateral to the carotid sheath. All patients were treated surgically and only one case underwent ipsilateral tonsillectomy. After a median follow-up of 30 (range 4-90) months, no recurrence or complications were observed.

Conclusions

The CSBCAs show some characteristic CT findings, which can help clinicians diagnose and plan surgical strategies. High ligation of the lesions is sufficient for complete excision of CSBCAs.

Diagnostic Challenges in a Rare Submandibular Epidermoid Cyst Transforming into Squamous Cell Carcinoma - A Case Report

Rationale

Submandibular gland epidermoid cyst is extremely rare and malignant transformation into squamous cell carcinoma (SCC) is even rarer. No such case report is published.

Patient Concerns

A 49-year-old female reported with a large, slowly growing left-sided neck swelling present for two years. Her primary concern was large swelling.

Diagnosis

Clinical finding, cytology and imaging were suggestive of 'Epidermoid Cyst of Submandibular Gland'. Intraoperative frozen section and post-operative definitive histopathological examination (HPE) revealed malignant transformation into SCC.

Treatment

In toto surgical excision was performed. Once the frozen section HPE confirmed transformation into SCC, clearance of 4-6 mm margin and modified supraomohyoid neck dissection was completed.

Outcome

No sign of recurrence on 1-year postoperative follow-up.

Take-Away Lesson

This case is unique of its kind without any previous literature report. In case of large and rapidly growing submandibular gland lesion, possibility of malignant transformation should not be overruled.

Adenoid cystic carcinoma of submandibular gland: Emphasis on locoregional metastasis and prognosis

OBJECTIVES

To analyze the clinicopathological features, locoregional or distant metastasis, and prognosis of adenoid cystic carcinoma of submandibular gland (SMG-AdCC).

METHODS

The clinicopathological data of 80 patients with SMG-AdCC from January 2005 to December 2017 were analyzed retrospectively, and the relationships between different parameters of SMG-AdCC and its locoregional or distant metastasis or prognosis were analyzed.

RESULTS

As of December 2019, 41 patients (51.25%) were tumor-free, while 20 patients were found to be living with tumors. The locoregional metastasis rate of grade II-III SMG-AdCC were found to be significantly higher than that of grade I. The five-year DFS and OS rates were 70.8% and 87.1%, respectively. Univariate analysis showed that clinical size, extraglandular extension, pathological grade, pathological node (pN) status, and perineural invasion were correlated with DFS. Multivariate Cox regression analysis showed that pathological grade and extraglandular extension were independent prognostic factors for DFS; pN status and extraglandular extension were independent prognostic factors impacting OS.

CONCLUSION

The pathological grade is a risk factor for locoregional metastasis of SMG-AdCC. Pathological grade, pN status, and status of extraglandular extension are independent prognostic factors for DFS/OS in SMG-AdCC patients.

High-risk subtype: Clinical manifestations and molecular characteristics of submandibular gland adenoid cystic carcinoma

Objective

Adenoid cystic carcinoma of the head and neck mainly occurs in the major salivary glands, of which the parotid gland and submandibular gland are the most common. The purpose of this study was to clarify the site-specific differences in prognosis and molecular expression characteristics of the patients and to achieve stratified risk management of the clinical prognosis.

Materials

By performing a single-centre retrospective analysis combined with analyses of the Surveillance, Epidemiology, and End Results (SEER) database, cBioPortal and GEO databases, the clinical prognostic characteristics and the differences in molecular expression patterns of ACC in the submandibular gland and parotid gland were analysed. Cox regression analysis, the chi-square test, Fisher's test and the log-rank test were used to compare the significance of differences.

Results

Compared with patients with parotid gland ACC, the submandibular gland ACC is more likely to have metastases in the cervical lymph node (21.7% vs. 3.3%) and shows a higher rate of distant metastasis within 1 year after the primary site diagnosis (47.8% vs. 23.3%), a worse overall prognosis, more frequent mutations of MYB/MYBL1 (50% vs. 25%) and abnormal upregulation of the phosphatidylinositol-3 kinase (PI3K) pathway.

Conclusions

Submandibular gland ACC is associated with site-specific early cervical lymph node metastasis and hidden distant metastasis, along with rapid progression and a poor prognosis. A high MYB/MYBL1 mutation rate and abnormal upregulation of the PI3K pathway with MYB involvement were identified.

Transoral submandibulotomy plus duct marsupialization; an appropriate approach for the treatment of proximal submandibular sialolithiasis; a long-term follow-up study

BACKGROUND

Sialolithiasis is the most common salivary gland-related disease worldwide, leading to sialadenitis. Although there is no serious problem with surgical removal of stones at the middle and distal parts of the Wharton's duct, the approach for treating proximal stones located near to hilum and its adjacent parenchyma is a challenge. The current study has aimed to evaluate the outcome of transoral submandibulotomy for submandibular gland stone treatment.

METHODS

This study was conducted on 63 patients with proximal (or deep hilar) submandibular sialolithiasis treated with transoral submandibulotomy and duct marsupialization from January 2011 to April 2019 in Pars hospital. Complications of the old fashion surgery (transcervical submandibulectomy) were assessed in this method (number and size of the stone(s), relapse of sialolithiasis-related obstructive symptoms, partial or complete removal of the stone(s), sialolithiasis recurrence, postoperative surgical or nonsurgical intervention, foreign body sensation, and taste sensation quality).

RESULTS

The stone(s) was located at the proximal of the duct in 68% of the cases, while 32% of the stones were located at the deep hilar region. The mean size of the stones was 1.28±0.51 cm. Postoperative inflammation, postoperative pain, sialolithiasis recurrence, obstructive symptoms, postoperative nonsurgical intervention, postoperative surgical intervention, reduced taste sensation, and foreign body sensation were presented in 24%, 29%, 29%, 44%, 14%, 6%, 11%, and 10% respectively. Eighty-nine percent of recurrences were healed spontaneously.

CONCLUSION

Considering the cosmetic advantage due to the lack of cervical surgery scar (which is mandatory in old fashion transcervical method), long-term follow-up of transoral submandibulotomy showed successful outcomes regarding neurological impairment, postoperative pain and inflammation and incredibly complete stone removal that was found in all of the patients. In addition, submandibular duct marsupialization is recommended based on our study.