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Finegersh A, Chang J, Lee YJ, Sirjani D. Suture Stenting After Sialendoscopy: A Novel Technique That Reduces Risk of Recurrent Parotitis. Laryngoscope 2024; 134:614-621. [PMID: 37338090 DOI: 10.1002/lary.30828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Chronic sialadenitis is associated with decreased quality of life and recurrent infections. While sialendoscopy with stenting is effective in relieving symptoms of sialadenitis, currently available stents are rigid and poorly tolerated by patients, leading to early removal and potential for adverse scarring. This study examines whether sutures can be used as a stenting material to improve patient comfort and reduce recurrence risk. METHODS This is a retrospective cohort study of a consecutive series of adult patients with chronic sialadenitis undergoing sialendoscopy with or without suture stenting. Data were collected between 2014 and 2018 with a 3-year follow-up period ending in 2021. The primary outcome measure was recurrence of sialadenitis within 3 years of surgery. Secondary outcomes were stent dislodgement and patient-reported discomfort. RESULTS We included 63 patients with parotid sialadenitis of whom 28 underwent suture stenting and 35 did not receive stenting after sialendoscopy. Stents were well tolerated, with a mean duration of 34.5 days, and only 2 of 28 stents (7.1%) accidentally dislodged within the first week. Suture stenting significantly reduced symptom recurrence after sialendoscopy (OR = 0.09, 95% CI 0.02-0.45, p = 0.003; 3-year sialadenitis recurrence rate: 7.1% vs. 45.7%, p = 0.005). Cox multivariate regression for clinicodemographic variables showed an HR of 0.04 (95% CI 0.01-0.19, p < 0.001) for the risk of symptom recurrence. CONCLUSIONS AND RELEVANCE Suture stenting after sialendoscopy is low cost, available across all institutions, well-tolerated by patients, and highly efficacious in reducing risk of recurrent sialadenitis after sialendoscopy. LEVEL OF EVIDENCE 3 Laryngoscope, 134:614-621, 2024.
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Affiliation(s)
- Andrey Finegersh
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
- Department of Otolaryngology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Julia Chang
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
- Department of Otolaryngology, Loma Linda University, Loma Linda, California, USA
| | - Yu-Jin Lee
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Davud Sirjani
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, USA
- Department of Otolaryngology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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2
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Kim JY, Kim HS, Kang SY, Moon BS, Kim BS, Yoon HJ. Value of Quantitative Salivary Gland SPECT/CT for the Detection of Saliva Leakage. Clin Nucl Med 2024; 49:e12-e13. [PMID: 37976525 DOI: 10.1097/rlu.0000000000004932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
ABSTRACT A 47-year-old woman presented to our emergency department with a 10-day history of pain, halitosis, and swelling below the left jaw. The patient was diagnosed with left sialadenitis and left submandibular abscess by tissue biopsy. An otolaryngologist performed transcervical incision and drainage of the abscess 1 day after admission. Postoperatively, the patient complained of a sensation of fluid leakage from the mouth, and a continuous purulent discharge was observed. One month postoperatively, a salivary gland scan and SPECT/CT were performed to investigate the sialorrhea and the cause of the discharge. Salivary gland SPECT/CT images localized the saliva leakage site.
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Affiliation(s)
| | - Han Su Kim
- Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University, College of Medicine, Seoul, South Korea
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3
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Chrysouli K, Karamagkiolas S. Venous malformation phleboliths mimicking submandibular sialadenitis in children. BMJ Case Rep 2023; 16:e257971. [PMID: 38087492 PMCID: PMC10728921 DOI: 10.1136/bcr-2023-257971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
To report one paediatric patient who presented with a rare venous vascular malformation as a mass in the left submandibular region with a clinical picture compatible with sialadenitis. Phleboliths are a specific feature of venous malformations due to venous stasis and may mimic sialoliths on various imaging modalities. Thus venous malformations are often misdiagnosed as sialadenitis due to sialolithiasis. Sialoliths are extremely rare in paediatric patients. In an early adolescent presenting with a submandibular mass and suspected sialadenitis arising from sialoliths, a detailed history, clinical examination and careful review of the radiological findings will allow the diagnosis of venous vascular malformation and provide the complete surgical resection. Our patient was initially referred with a presumed diagnosis of submandibular sialadenitis, and instead a venous malformation with phlebolith was diagnosed.
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Affiliation(s)
| | - Sotirios Karamagkiolas
- Department of Otorhinolaryngology, Panepistemiako Geniko Nosokomeio Attikon, Athens, Attica, Greece
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4
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Bora A. Is the neutrophil-to-lymphocyte ratio a marker for differentiating between benign and malignant submandibular gland masses? Rev Assoc Med Bras (1992) 2023; 69:e20230738. [PMID: 37909621 PMCID: PMC10610767 DOI: 10.1590/1806-9282.20230738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effect of the neutrophil-to-lymphocyte ratio on the differentiation of benign and malignant masses in the submandibular triangle. METHODS We retrospectively evaluated 48 patients who underwent surgery for submandibular gland masses between January 2013 and February 2023. The patient's age, gender, preoperative complete blood count and imaging findings, postoperative histopathological diagnosis, and hemogram data were analysed. Patients were evaluated according to their postoperative histopathological diagnoses and categorised into four main groups: sialolithiasis, sialadenitis, benign tumours, and malignant tumours. Benign submandibular gland disease formations were evaluated under group B and malignant tumour formations under group M. RESULTS A preoperative fine needle aspiration biopsy was performed on 19 patients due to sialadenitis, pleomorphic adenoma, and malignant diseases other than sialolithiasis. One patient died among the patients with malignant disease and the remaining 7 patients were compared with the benign group of 40 patients regarding preoperative and postoperative neutrophil-to-lymphocyte ratio. In the benign group, the neutrophil-to-lymphocyte ratio was 2.64 preoperatively and decreased to 2.34 in the first postoperative year. The preoperative neutrophil-to-lymphocyte ratio decreased from 4.79 to 1.77 postoperatively in the malignant group. A statistically significant difference was observed (p<0.05). CONCLUSION This is the first study to demonstrate that the neutrophil-to-lymphocyte ratio can be used as a biomarker in submandibular gland masses and has prognostic significance in malignant masses. In addition to fine needle aspiration biopsy results, neutrophil-to-lymphocyte ratio can be used as a biomarker.
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Affiliation(s)
- Adem Bora
- Cumhuriyet University, Faculty of Medicine, Department of Otorhinolaryngology – Sivas, Turkey
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5
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Cowen J, Ali M, Dave R, Woodhouse J, Anand R, Repanos C, Brennan PA, Bekker J. Radiologically-guided balloon sialoplasty for benign salivary duct obstruction: a 7-year UK service evaluation. Br J Oral Maxillofac Surg 2023; 61:547-552. [PMID: 37640606 DOI: 10.1016/j.bjoms.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
Obstructive sialadenitis is the most common cause of non-malignant salivary gland disorders, with salivary gland strictures being responsible for approximately 23% of all benign obstructive disease. Significant advances in minimally invasive techniques, including radiologically-guided balloon sialoplasty, offer the potential for successful treatment with reduced complications. At present there is a paucity of follow-up data regarding patient outcomes and repeat interventions in those undergoing the procedure. Patients with parotid or submandibular gland sialadenitis secondary to gland stricture were identified and underwent radiologically-guided balloon sialoplasty at Queen Alexandra Hospital, Portsmouth, UK between 2015 and 2022. Patient outcomes, complications and reintervention rates were recorded prospectively over the seven-year period and analysed retrospectively. A total of 44 patients underwent radiologically-guided balloon sialoplasty. Forty (89%) underwent sialoplasty for parotid gland disease, with a minority (n = 5) receiving an intervention for submandibular gland strictures. A total of 37 (84%) had their obstruction successfully treated (82% of parotid gland obstructions and 100% of submandibular gland obstructions). Five patients (11%) required a repeat intervention. Seventeen successfully treated patients (85%) who attended follow-up clinic appointments described complete resolution of their symptoms, with the remaining three (15%) describing a partial response. Radiologically-guided balloon sialoplasty for the treatment of benign obstructive sialadenitis secondary to a gland stricture is a safe and effective method of eliminating the obstruction and relieving patients' symptoms. Most patients were symptom free at short-term follow up, with a minority requiring a second sialoplastic intervention.
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Affiliation(s)
- Jake Cowen
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, Portsmouth Hospitals University NHS Trust, PO6 3LY, UK.
| | - Muhammad Ali
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, Portsmouth Hospitals University NHS Trust, PO6 3LY, UK
| | - Roma Dave
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, Portsmouth Hospitals University NHS Trust, PO6 3LY, UK
| | - Joe Woodhouse
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, Portsmouth Hospitals University NHS Trust, PO6 3LY, UK
| | - Rajiv Anand
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, Portsmouth Hospitals University NHS Trust, PO6 3LY, UK
| | - Costa Repanos
- Department of Ear, Nose and Throat Surgery, Queen Alexandra Hospital, Portsmouth, Portsmouth Hospitals University NHS Trust, PO6 3LY, UK
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, Portsmouth Hospitals University NHS Trust, PO6 3LY, UK
| | - Jasper Bekker
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, Portsmouth Hospitals University NHS Trust, PO6 3LY, UK
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Sharma M, Bohara S, Manandhar S, Manandhar L, Maharjan SK. Postoperative Acute Submandibular Sialadenitis: A Case Report. JNMA J Nepal Med Assoc 2023; 61:668-670. [PMID: 38289814 PMCID: PMC10566616 DOI: 10.31729/jnma.8238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Indexed: 02/01/2024] Open
Abstract
Acute postoperative sialadenitis is a rare complication usually after surgery involving extreme head and neck rotation, such as posterior fossa surgery. It is characterized by the development of swelling in the submandibular region, usually contralateral to the surgical side, either immediately or within hours post-operatively. We report a case of a 43-year-old woman who developed sialadenitis leading to upper airway obstruction in the postoperative period. Further, she developed bilateral neck and face swelling. Dexmedetomidine used as an infusion throughout the surgery could be an additional cause. Swelling without signs of inflammation is rapidly progressive and may cause airway obstruction. Therefore, awareness and recognition are important, as a delay in airway securement can cause a complete collapse of the airway. Keywords airway obstruction; case reports; sialadenitis.
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Affiliation(s)
- Mona Sharma
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Sandeep Bohara
- Department of Neurosurgery, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Stuti Manandhar
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Lumu Manandhar
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Shyam Krishna Maharjan
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Callander JK, Plonowska-Hirschfeld K, Gulati A, Chang JL, Ryan WR. Symptom Outcomes After Sialendoscopy-Assisted Salivary Duct Surgery: A Prospective 6-Year Study. Laryngoscope 2023; 133:792-800. [PMID: 35848880 DOI: 10.1002/lary.30294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/01/2022] [Accepted: 06/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective is to evaluate the long-term impact of sialendoscopic-assisted salivary duct surgery (SASDS) on sialadenitis symptoms using the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire. METHODS The COSS questionnaire, which scores symptoms on a 0-100 scale, was administered prospectively to adult patients pre-operatively, 1-year, and 6-years post-operatively. We examined COSS scores and categories representing complete (<10), partial (10-25), and no (>25) resolution of symptoms with attention to factors significantly associated with incomplete resolution (≥10). RESULTS Approximately 6-years after SASDS, 111 patients reported scores for 128 symptomatic glands (72 with sialolithiasis, 56 without sialolithiasis). For glands with sialolithiasis, the median COSS score pre-SASDS was 27.5 (interquartile range [IQR]: 13.5-43), which was significantly reduced to 1.0 (IQR: 0-5.5) at 1-year and 1.5 (IQR 0-5) at 6-years postoperatively. Glands without sialolithiasis had a median COSS score of 40.5 (IQR: 23-52.5) preoperatively, that significantly reduced to 13.5 (IQR 5-21) at 1-year and 14 (IQR 6.5-25.5) at 6-years post-operatively. There was no significant difference in scores from 1- to 6-years. Intraoperative presence of sialolith, absence of stenosis, stenosis in the distal duct, and submandibular gland involvement were significant predictors of complete resolution of symptoms at 6-years. CONCLUSION Approximately 6-years after SASDS for sialadenitis, the majority of patients have durable symptom improvement. The sialolithiasis group had higher rates of complete resolution compared to the non-sialolithiasis group. Presence of ductal stenosis on sialendoscopy, non-distal stenoses, and parotid gland involvement were risk factors for persistent long-term sialadenitis symptoms. Laryngoscope, 133:792-800, 2023.
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Affiliation(s)
- Jacquelyn K Callander
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Karolina Plonowska-Hirschfeld
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Jolie L Chang
- Division of General Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Salivary Gland Center, University of California San Francisco, San Francisco, California, U.S.A
- Surgery Service, Department of Veterans Affairs Medical Center, San Francisco, California, U.S.A
| | - William R Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Salivary Gland Center, University of California San Francisco, San Francisco, California, U.S.A
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8
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Kc AK, Shrestha BL, Bhattarai A. Intraglandular Foreign Body - Unusual Aetiology of Submandibular Gland Sialadenitis. Kathmandu Univ Med J (KUMJ) 2023; 21:241-243. [PMID: 38628023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Obstructive sialadenitis of submandibular gland is commonly due to sialoliths and strictures in the Wharton's duct. Other endogenous pathologies include mucous plugs and polyps. Foreign bodies of Wharton's duct and submandibular gland are rare. Retrograde migration of foreign bodies via ductal orifice, traversing the ductal system to its final intraglandular location is an even rare entity. These often present with painful swelling of the gland and at times with a purulent sialitis. Diagnostic modalities include plain radiography, ultrasonography, sialography, as well as computed tomography and magnetic resonance imaging. Treatment includes antibiotics, incision and drainage of abscess, and removal of foreign body either surgically (intra-oral approach or sialadenectomy) or more recently via sialoendoscopy. This is a case report of 30 years male with accidental cannulation of Wharton's duct with grass that eventually got lodged in the deep lobe of the gland, and was managed with sialadenectomy.
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Affiliation(s)
- A K Kc
- Department of Otorhinolaryngology-Head and Neck Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - B L Shrestha
- Department of Otorhinolaryngology-Head and Neck Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - A Bhattarai
- Department of Otorhinolaryngology-Head and Neck Surgery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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Sakr AA, Magdy EA, Melek LN, Mohamed SS. Evaluation of patients' quality of life using novel "Multidisciplinary Salivary Gland Society" questionnaire in minimally invasive management of obstructive sialadenitis. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:e59-e67. [PMID: 36089488 DOI: 10.1016/j.oooo.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The introduction of minimally invasive surgical procedures has significantly reduced the rate of major salivary gland removal. This study aimed to assess these procedures in relieving patients' complaints and their impact on quality of life using the newly introduced Multidisciplinary Salivary Gland Society questionnaire. STUDY DESIGN Between January 2021 and October 2021, a case series was treated with minimally invasive surgical procedures. Data such as stone size, number and location, surgical approach, symptoms relief, and improvement of quality of life were collected and analyzed. Thirty-six patients were included (22 males and 14 females); 28 had stones in the submandibular gland and 8 in the parotid gland with largest stone diameter ranging from 0.2 to 2.8 cm. The approach was selected according to stone size and location, so 17 patients were treated with sialendoscopy (alone or using a combined approach), and 19 patients were treated without sialendoscopy using a transoral approach. RESULTS After a 6-month follow-up, the questionnaire scores showed a statistically significant difference in comparison to preoperative ones. CONCLUSIONS Minimally invasive surgical procedures present an excellent option for sialolithotomy, after which the relief of symptoms, restoration of gland function, and a significant improvement in quality of life are achieved.
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Affiliation(s)
- Aya A Sakr
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Egypt.
| | - Emad A Magdy
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Alexandria University Main Hospital, Egypt
| | - Lydia N Melek
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Egypt
| | - Sherif S Mohamed
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Egypt
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10
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de Paiva Leite S, de Oliveira MMR, Ahmad Z, Morton RP. Impact on quality of life in obstructive sialadenitis predicting outcomes after sialendoscopy. Am J Otolaryngol 2022; 43:103431. [PMID: 35460971 DOI: 10.1016/j.amjoto.2022.103431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/02/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Sialendoscopy is a minimally invasive procedure considered a paradigm shift in the treatment of obstructive sialadenitis. However, it shows an average need for revision procedure in up to 24% of operated cases. This study analyzed whether patient-related variables could predict the need for a revision during postoperative follow-up. METHODS From 2012 to 2020, this prospective comparative study analyzed demographic data as well as preoperative responses to the "Manukau Salivary Symptoms Score" (MSSS) questionnaire as predictors of the need for a revision procedure due to symptoms recurrence. RESULTS 188 sialendoscopies (39.4% for stones/60.6% for stenoses) in 112 parotid (59.6%) and 76 submandibular glands (40.4%) were included in this study. Forty patients (21.3%) required a revision procedure. The variable "Impact on quality of life" in the preoperative period of patients with sialoliths showed that the likelihood of a revision procedure increases by 33.6% with each increase in the 10-point Likert scale presented in the MSSS (p = 0.010, OR = 1336, CI = 1.071 to 1.667). This finding was not influenced by the location of the sialolith in the duct (p = 0.415), size (p = 0.058) or number of stones (P = 0.476). Other demographic variables related to the patient showed no association with the need of a revision procedure. CONCLUSION Further studies should be performed to exclude the influence of other variables on the results; however, special attention should be given to patients who report a greater pre-operative impact on quality of life due to sialolithiasis. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Sandro de Paiva Leite
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, Auckland, New Zealand; University of Auckland, New Zealand.
| | | | - Zahoor Ahmad
- Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, Auckland, New Zealand; University of Auckland, New Zealand
| | - Randall P Morton
- Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, Auckland, New Zealand; University of Auckland, New Zealand
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11
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Pereira FG, Nogueira R, Pataca I, Sampaio R. Chronic sclerosing sialadenitis (Küttner's tumour) of the submandibular gland: a neoplastic mimic. BMJ Case Rep 2022; 15:e245518. [PMID: 35022201 PMCID: PMC8756289 DOI: 10.1136/bcr-2021-245518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/03/2022] Open
Abstract
A 74-year-old man was referred for a plastic surgery consultation for two previous acute episodes of right submandibular sialadenitis. Physical examination revealed a lump in the right submandibular region, painful on palpation. The initial impression on clinical examination was of sialolithiasis. The sonography demonstrated a structural heterogeneity of the submandibular gland with a hypoechogenic and vascularised nodular formation (1.5×1.2 cm), suggestive of a mixed tumour of the right maxillary gland, requiring histological evaluation. He underwent a right submandibulectomy and an IgG4-positive chronic sclerosing sialadenitis was diagnosed. The patient's condition evolved favourably, resulting in a full recovery. The clinical features and differential diagnosis of this entity are debated in light of relevant literature.
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Affiliation(s)
- Filipa Galante Pereira
- Pathology Department, Western Lisbon Hospital Center EPE Hospital de Egas Moniz, Lisbon, Portugal
| | - Ruben Nogueira
- Plastic Surgery Department, Western Lisbon Hospital Center EPE Hospital de Egas Moniz, Lisbon, Portugal
| | - Iris Pataca
- Radiology Department, Western Lisbon Hospital Center EPE Hospital de Egas Moniz, Lisbon, Portugal
| | - Rita Sampaio
- Pathology Department, Western Lisbon Hospital Center EPE Hospital de Egas Moniz, Lisbon, Portugal
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12
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Mastrolonardo E, Stewart M, Alapati R, Campbell D, Thaler A, Zhan T, Curry JM, Luginbuhl AJ, Cognetti DM. Improved efficiency of sialendoscopy procedures at an ambulatory surgery center. Am J Otolaryngol 2021; 42:102927. [PMID: 33516124 DOI: 10.1016/j.amjoto.2021.102927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare time spent on day of surgery and post-surgical outcomes for sialendoscopy procedures at an ambulatory surgery center versus in a hospital operating room. METHODS Retrospective chart review for patients who underwent sialendoscopy for sialadenitis or sialolithiasis from March 2017 to May 2020 were included. Surgery location (ambulatory surgery center or hospital operating room) was compared. Primary outcomes included total time in hospital, operative time, total time in operating room. and recovery time. Secondary outcomes included rate of symptoms resolutions, requiring further medical management, and requiring further surgical intervention. RESULTS A total of 321 procedures were included. Sialendoscopy in an ambulatory surgery center compared to main operating room decreased median hospital time (166 min reduction, p < 0.001), operative time (18 min reduction, p < 0.001), total time in operating room (34 min reduction, p < 0.001), and recovery time (64 min reduction, p < 0.001). Sialendoscopy in an ambulatory surgery center had similar rates of post-operative resolution of symptoms and further medical or surgical intervention compared to procedures in a hospital operating room. CONCLUSION Sialendoscopy can be safely performed in an ambulatory surgery center for sialadenitis or appropriate sialolithiasis cases while decreasing hospital time, operative time, total time in operating room time, and recovery time.
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Affiliation(s)
- Eric Mastrolonardo
- Thomas Jefferson University Hospital, Department of Otolaryngology - Head and Neck Surgery, 925 Chestnut St, Philadelphia, PA 19107, United States of America.
| | - Matthew Stewart
- Thomas Jefferson University Hospital, Department of Otolaryngology - Head and Neck Surgery, 925 Chestnut St, Philadelphia, PA 19107, United States of America
| | - Rahul Alapati
- Thomas Jefferson University Hospital, Department of Otolaryngology - Head and Neck Surgery, 925 Chestnut St, Philadelphia, PA 19107, United States of America
| | - Daniel Campbell
- Thomas Jefferson University Hospital, Department of Otolaryngology - Head and Neck Surgery, 925 Chestnut St, Philadelphia, PA 19107, United States of America
| | - Adam Thaler
- Thomas Jefferson University Hospital, Department of Anesthesiology, 111 S 11th St, Philadelphia, PA 19107, United States of America
| | - Tingting Zhan
- Thomas Jefferson University, Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, 901 Walnut St, Philadelphia, PA 19107, United States of America
| | - Joseph M Curry
- Thomas Jefferson University Hospital, Department of Otolaryngology - Head and Neck Surgery, 925 Chestnut St, Philadelphia, PA 19107, United States of America
| | - Adam J Luginbuhl
- Thomas Jefferson University Hospital, Department of Otolaryngology - Head and Neck Surgery, 925 Chestnut St, Philadelphia, PA 19107, United States of America
| | - David M Cognetti
- Thomas Jefferson University Hospital, Department of Otolaryngology - Head and Neck Surgery, 925 Chestnut St, Philadelphia, PA 19107, United States of America
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13
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Abstract
Küttner tumor is an uncommon cause of salivary gland enlargement that most frequently affects the submandibular gland. More recently it has been considered a manifestation of IgG4-related disease (IgG4-RD) and synonymous with chronic sclerosing sialadenitis (CSS). We present a series of cases to emphasize this clinical entity as a disease pattern and presentation that is separate from IgG4-RD. Retrospective case series of 3 patients with unilateral salivary gland enlargement, or "Küttner tumor," histologically classified as "chronic sclerosing sialadenitis," The clinical history, radiology reports, laboratory studies, and pathology slides were reviewed for each case. Radiology showed discrete unilateral mass-like lesions in all three cases. Immunohistochemistry showed reduced tissue IgG4-positive plasma cells in two cases and increased numbers in one case, but insufficient to diagnose IgG4-RD. Storiform fibrosis was not seen in all cases and did not coincide with increased IgG4-positive plasma cells. A systemic workup, including serum IgG4 levels in two cases, was normal. A brief review of the literature on the spectrum of salivary gland involvement by IgG4-RD is presented. Küttner tumor is not necessarily the same as chronic sclerosing sialadenitis and is not always associated with IgG4-related disease. This report includes the second documented case of Küttner tumor of the sublingual gland.
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Affiliation(s)
| | - Henry T Hoffman
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Anand Rajan Kd
- Department of Pathology, University of Iowa Hospitals and Clinics, 5239D 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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14
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Schapher M, Koch M, Weidner D, Scholz M, Wirtz S, Mahajan A, Herrmann I, Singh J, Knopf J, Leppkes M, Schauer C, Grüneboom A, Alexiou C, Schett G, Iro H, Muñoz LE, Herrmann M. Neutrophil Extracellular Traps Promote the Development and Growth of Human Salivary Stones. Cells 2020; 9:cells9092139. [PMID: 32971767 PMCID: PMC7564068 DOI: 10.3390/cells9092139] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022] Open
Abstract
Salivary gland stones, or sialoliths, are the most common cause of the obstruction of salivary glands. The mechanism behind the formation of sialoliths has been elusive. Symptomatic sialolithiasis has a prevalence of 0.45% in the general population, is characterized by recurrent painful periprandial swelling of the affected gland, and often results in sialadenitis with the need for surgical intervention. Here, we show by the use of immunohistochemistry, immunofluorescence, computed tomography (CT) scans and reconstructions, special dye techniques, bacterial genotyping, and enzyme activity analyses that neutrophil extracellular traps (NETs) initiate the formation and growth of sialoliths in humans. The deposition of neutrophil granulocyte extracellular DNA around small crystals results in the dense aggregation of the latter, and the subsequent mineralization creates alternating layers of dense mineral, which are predominantly calcium salt deposits and DNA. The further agglomeration and appositional growth of these structures promotes the development of macroscopic sialoliths that finally occlude the efferent ducts of the salivary glands, causing clinical symptoms and salivary gland dysfunction. These findings provide an entirely novel insight into the mechanism of sialolithogenesis, in which an immune system-mediated response essentially participates in the physicochemical process of concrement formation and growth.
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Affiliation(s)
- Mirco Schapher
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Otolaryngology, Head and Neck Surgery, Universitätsklinikum Erlangen, Waldstrasse 1, 91054 Erlangen, Germany; (M.S.); (M.K.); (C.A.); (H.I.)
| | - Michael Koch
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Otolaryngology, Head and Neck Surgery, Universitätsklinikum Erlangen, Waldstrasse 1, 91054 Erlangen, Germany; (M.S.); (M.K.); (C.A.); (H.I.)
| | - Daniela Weidner
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (D.W.); (A.M.); (I.H.); (J.S.); (J.K.); (C.S.); (A.G.); (G.S.); (L.E.M.)
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (S.W.); (M.L.)
| | - Michael Scholz
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Institute of Functional and Clinical Anatomy, Universitätsstrasse 19, 91054 Erlangen, Germany;
| | - Stefan Wirtz
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (S.W.); (M.L.)
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 1, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Aparna Mahajan
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (D.W.); (A.M.); (I.H.); (J.S.); (J.K.); (C.S.); (A.G.); (G.S.); (L.E.M.)
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (S.W.); (M.L.)
| | - Irmgard Herrmann
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (D.W.); (A.M.); (I.H.); (J.S.); (J.K.); (C.S.); (A.G.); (G.S.); (L.E.M.)
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (S.W.); (M.L.)
| | - Jeeshan Singh
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (D.W.); (A.M.); (I.H.); (J.S.); (J.K.); (C.S.); (A.G.); (G.S.); (L.E.M.)
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (S.W.); (M.L.)
| | - Jasmin Knopf
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (D.W.); (A.M.); (I.H.); (J.S.); (J.K.); (C.S.); (A.G.); (G.S.); (L.E.M.)
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (S.W.); (M.L.)
| | - Moritz Leppkes
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (S.W.); (M.L.)
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 1, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Christine Schauer
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (D.W.); (A.M.); (I.H.); (J.S.); (J.K.); (C.S.); (A.G.); (G.S.); (L.E.M.)
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (S.W.); (M.L.)
| | - Anika Grüneboom
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (D.W.); (A.M.); (I.H.); (J.S.); (J.K.); (C.S.); (A.G.); (G.S.); (L.E.M.)
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (S.W.); (M.L.)
| | - Christoph Alexiou
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Otolaryngology, Head and Neck Surgery, Universitätsklinikum Erlangen, Waldstrasse 1, 91054 Erlangen, Germany; (M.S.); (M.K.); (C.A.); (H.I.)
| | - Georg Schett
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (D.W.); (A.M.); (I.H.); (J.S.); (J.K.); (C.S.); (A.G.); (G.S.); (L.E.M.)
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (S.W.); (M.L.)
| | - Heinrich Iro
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Otolaryngology, Head and Neck Surgery, Universitätsklinikum Erlangen, Waldstrasse 1, 91054 Erlangen, Germany; (M.S.); (M.K.); (C.A.); (H.I.)
| | - Luis E. Muñoz
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (D.W.); (A.M.); (I.H.); (J.S.); (J.K.); (C.S.); (A.G.); (G.S.); (L.E.M.)
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (S.W.); (M.L.)
| | - Martin Herrmann
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (D.W.); (A.M.); (I.H.); (J.S.); (J.K.); (C.S.); (A.G.); (G.S.); (L.E.M.)
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (S.W.); (M.L.)
- Correspondence:
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15
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Chang M, Coughran A, Lee YJ, Collins J, Sirjani D. Retrograde parotidectomy under local anesthesia for benign, malignant, and inflammatory lesions. Am J Otolaryngol 2019; 40:152-155. [PMID: 30691973 PMCID: PMC6417876 DOI: 10.1016/j.amjoto.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To report the patient selection, surgical technique, and outcomes of parotidectomy using local anesthesia under monitored anesthesia care (MAC). METHODS A retrospective chart review was performed for patients undergoing parotidectomy under local anesthesia at an academic head and neck surgery center. RESULTS Six patients deemed high risk for general anesthesia (GA) due to medical comorbidities or with a strong preference to avoid GA underwent parotidectomy using local anesthesia and MAC. Parotidectomy was performed for several indications, including benign tumors, malignant tumors, and chronic sialadenitis. Mean age of patients was 78.0 ± 7.9 years, and all had an American Society of Anesthesia score ≥ 2 and Charlson comorbidity index ≥4. Mean operative time was 102.8 ± 38.3 min, comparable to that of parotidectomy under general anesthesia. No major complications occurred. Minor complications included three cases of temporary postoperative facial nerve weakness limited to 1-2 lower division branches. At most recent follow up (10 to 48 months), all patients were medically stable and disease free. CONCLUSION In carefully selected patients, parotidectomy under local anesthesia is a viable treatment alternative that can be offered to patients. Successful outcomes require preoperative counseling, meticulous technique, and close collaboration with anesthesia colleagues.
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Affiliation(s)
- Michael Chang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, USA 94305.
| | - Alanna Coughran
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, USA 94305.
| | - Yu-Jin Lee
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, USA 94305; Department of Health Research and Policy, Stanford University, Stanford, CA 94305, USA.
| | - Jeremy Collins
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA 94305, USA.
| | - Davud Sirjani
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, USA 94305.
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16
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Affiliation(s)
- M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 408, Memphis, TN 38163, USA.
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17
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Ebnöther E, Storck C. [CME-ORL 28/Answer: Submandibular Swelling Left]. Praxis (Bern 1994) 2018; 107:989-991. [PMID: 30131032 DOI: 10.1024/1661-8157/a003043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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18
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Kurt AB, Öztürk H, Korkmaz M, Haktanır A. Imaging findings of obstructive sialadenitis due to an intraglandular foreign body. Med Ultrason 2016; 18:406-407. [PMID: 27622423 DOI: 10.11152/mu.2013.2066.183.bek] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Ali Bekir Kurt
- Department of Radiology, Ordu University Medical School, Ordu, Turkey
| | - Hasan Öztürk
- Department of Radiology, Ordu University Medical School, Ordu, Turkey
| | - Mukadder Korkmaz
- Department of Otorhinolaryngology Head and Neck Surgery, Ordu University Medical School, Ordu, Turkey
| | - Alpay Haktanır
- Department of Radiology, Ordu University Medical School, Ordu, Turkey.
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19
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Bhayani MK, Acharya V, Kongkiatkamon S, Farah S, Roberts DB, Sterba J, Chambers MS, Lai SY. Sialendoscopy for Patients with Radioiodine-Induced Sialadenitis and Xerostomia. Thyroid 2015; 25:834-8. [PMID: 25860842 PMCID: PMC5118964 DOI: 10.1089/thy.2014.0572] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND We examined outcomes in patients treated for radioactive iodine-induced sialadenitis (RAIS) and xerostomia with sialendoscopy. METHODS Data was prospectively collected for all patients undergoing sialendoscopy for RAIS from a single institution. Interventional details and intraoperative findings were recorded. Qualitative data were obtained through patient examination, telephone interviews, and use of a standard quality of life questionnaire, Xerostomia Questionnaire. Quantitative data were obtained from patients who underwent sialometry. RESULTS Twenty-six patients (24 women and 2 men; median age, 43 years; age range, 19-57 years) underwent interventional sialendoscopy after conservative management of symptoms proved unsuccessful. Sialadenitis was present in 25 patients and xerostomia in 22 patients. Mucus plugging in the duct of the gland was the most common finding (22 patients) followed by stenosis (18 patients), inflammation (eight patients), and erythema (eight patients). Median follow-up time was 23.4±12.1 months. Sixteen patients (64%) reported complete resolution; seven (28%), partial resolution; one (4%), no change in symptoms; and one (4%), regression in RAIS-related symptoms. Patients subjectively noted the following regarding their xerostomia symptoms: seven (31.8%) had complete resolution; 10 (45.5%), partial resolution; four (18.2%), no change; and one (4.5%), regression. Statistical analysis of the available sialometry data revealed a statistically significant difference in saliva production at 6 months following sialendoscopy for unstimulated saliva production (p=0.028). CONCLUSION Sialendoscopy is an effective treatment option for the management of RAIS and xerostomia refractory to conservative therapy and medical management. Patients in our cohort report durable improvement in symptoms after intervention.
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Affiliation(s)
- Mihir K. Bhayani
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Varun Acharya
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Suchada Kongkiatkamon
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sally Farah
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dianna B. Roberts
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer Sterba
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark S. Chambers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y. Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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20
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Wei TW, Lien CF, Hsu TY, He HL. Chronic sclerosing sialadenitis of the submandibular gland: an entity of IgG4-related sclerosing disease. Int J Clin Exp Pathol 2015; 8:8628-8631. [PMID: 26339446 PMCID: PMC4555774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/23/2015] [Indexed: 06/05/2023]
Abstract
Chronic sclerosing sialadenitis typically involves the submandibular gland. It usually occurs in the middle-aged and elderly adults with a slight male predominance. Recent evidences have suggested that it is an entity of IgG4-related sclerosing disease and has distinct histopathological features, such as a dense lymphoplasmacytic infiltrate, sclerosis and obliterative phlebitis. It is important to discriminate this entity from other diseases, trying to give effective treatment to the patients. In this report, we described a patient having chronic sclerosing sialadenitis in the submandibular gland.
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Affiliation(s)
- Tzu-Wei Wei
- Department of Otolaryngology, E-DA Hospital, I-Shou UniversityKaohsiung, Taiwan
| | - Ching-Feng Lien
- Department of Otolaryngology, E-DA Hospital, I-Shou UniversityKaohsiung, Taiwan
| | - Tun-Yen Hsu
- Department of Otolaryngology, E-DA Hospital, I-Shou UniversityKaohsiung, Taiwan
| | - Hong-Lin He
- Department of Pathology, E-DA Hospital, I-Shou UniversityKaohsiung, Taiwan
- Institute of Biomedical Science, National Sun Yat-Sen UniversityKaohsiung, Taiwan
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Wu CB, Xi H, Zhou Q, Zhang LM. Sialendoscopy-assisted treatment for radioiodine-induced sialadenitis. J Oral Maxillofac Surg 2014; 73:475-81. [PMID: 25544300 DOI: 10.1016/j.joms.2014.09.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 09/23/2014] [Accepted: 09/27/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE Chronic sialadenitis is a common complication of radioactive iodine for the treatment of thyroid disease. The aim of this study was to describe the authors' experience with interventional sialendoscopy for the management of radioiodine-induced sialadenitis. MATERIALS AND METHODS Twelve patients with radioiodine-induced sialadenitis treated with sialendoscopy from January 2013 through December 2013 at the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University were retrospectively reviewed. Age, gender, and time to development of radioiodine-induced sialadenitis were obtained from the hospital database. All patients were asked to undergo visual analog scale (VAS) and salivary gland scintigraphy (SGS) examinations before and 6 months after surgery. A paired t test was conducted, and a P value less than .05 was considered statistically significant. RESULTS Twelve patients (15 parotid glands and 4 submandibular glands) successfully underwent interventional sialendoscopy under local anesthesia. Ductal stenosis was the most common feature identified by endoscopy. Among the 12 patients, swelling occurred in 91.7%. Compared with the preoperative score of 6, the mean VAS score 6 months after sialendoscopy was 3; 15 glands (78.9%) showed improved uptake and excretion by SGS. The postoperative VAS score was significantly lower than the preoperative VAS score (P < .05), and the postoperative SGS result was significantly higher than the preoperative SGS result (P < .05). CONCLUSIONS Interventional sialendoscopy could be an effective technique for the treatment of sialadenitis caused by radioactive iodine.
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Affiliation(s)
- Chuan-Bin Wu
- Resident, Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning Province, China
| | - Hong Xi
- Resident, Department of Pediatric Dentistry, School of Stomatology, Jilin University, Changchun, Jilin Province, China
| | - Qing Zhou
- Professor, Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning Province, China.
| | - Liang-Mei Zhang
- Resident, Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning Province, China
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22
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Kaltoft B, Hainau B, Welinder JG. [Küttner tumour and IgG4-associated sialadenitis as a benign cause of swelling of the submandibular glands]. Ugeskr Laeger 2014; 176:V12130725. [PMID: 25351904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This is a case report of a 53-year-old man who had a swelling of both submandibular glands and an elevated serum immunoglobulin G (IgG) level. The histopathology examination was positive for IgG4 plasma cells with an IgG4/IgG ratio of 0.62, which is diagnostic for IgG4-associated sialadenitis. If IgG4-associated sialadenitis is suspected fine needle aspiration, serum IgG/IgG4 and examination of extra salivary disease should be performed to confirm the diagnosis.
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Affiliation(s)
- Britta Kaltoft
- Øre-næse-halskirurgisk Afdeling, Køge Sygehus, Lykkebækvej 1-3, 4600 Køge.
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Levine G, Clark M, Mandel L. Obstructive parotitis from extraorally introduced foreign body in the Stensen duct. J Oral Maxillofac Surg 2013; 71:2087-91. [PMID: 23945518 DOI: 10.1016/j.joms.2013.06.211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 06/19/2013] [Indexed: 11/15/2022]
Abstract
A rare phenomenon, the extraoral traumatic penetration of a foreign body into the lumen of the parotid duct, is described. The ensuing obstructive symptomatology and its diagnostic approach and therapy are reviewed.
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Affiliation(s)
- George Levine
- Research Assistant, Salivary Gland Center; Third-Year Student, Columbia University College of Dental Medicine, New York, NY
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Weitz-Tuoretmaa A, Laranne J, Paloneva T, Michelaki K. [Chronic sclerosing sialadenitis - Küttner tumor]. Duodecim 2013; 129:2280-2283. [PMID: 24340679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Chronic sclerosing sialadenitis i.e. Küttner tumor is a rare inflammatory disease most commonly affecting the submandibular gland, due to clinical findings easily interpreted even as a malignant tumor. Our 45-year-old patient sought medical care due to a solid lump that had appeared under the right mandibular angle. The submandibular gland and associated hard mass were excised in a surgical operation conducted after the investigations. Histologic examination proved that the seldom diagnosed reactive Küttner tumor was in question.
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Abstract
Kuttner Tumour is a chronic inflammatory disease diagnosed histologically. It is under-diagnosed due to lack of awareness of the disease. We present a case of a 40-year old female with recurrent upper lid swelling. Biopsy revealed the diagnosis of Kuttner Tumours of the lacrimal glands. Although surgical excision is a treatment option, it can be treated with a course of steroids. Our patient opted for conservative management. We describe the presentation and course of the case, with an emphasis on the histological features of the tumour.
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Lee JW, Yoon YH. Gustatory sweating after submandibular gland excision. Otolaryngol Head Neck Surg 2010; 143:845-6. [PMID: 21109089 DOI: 10.1016/j.otohns.2010.06.920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 06/16/2010] [Accepted: 06/29/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Jin Woo Lee
- Department of Otolaryngology–Head and Neck Surgery, Chungnam National University, School of Medicine, Daejeon, Republic of Korea
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Agale SV, Momin YA, Agale VG. Kuttner tumor: a report of an underdiagnosed entity. J Assoc Physicians India 2010; 58:694-695. [PMID: 21510464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Kuttner tumor (KT) is a benign tumor-like lesion predominantly involving the submandibular gland of middle aged individuals. Although described more than a century ago, this clinical entity which masquerades as carcinoma is underdiagnosed by many surgeons. KT is usually diagnosed by histopathologist when the lesion is surgically biopsied to confirm clinical diagnosis of malignancy.
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McCluney N, Shakeel M, Rai B, Ah-See K, Brewis C. Postoperative facial paralysis on the side contralateral to head and neck surgery. J Otolaryngol Head Neck Surg 2010; 39:E35-E36. [PMID: 20828498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- Neil McCluney
- Department of Otolaryngology-Head and Neck Surgery, University of Aberdeen, Foresterhill, Aberdeen, Scotland, UK
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Witt RL. Sialendoscopy in Delaware. Del Med J 2009; 81:227-229. [PMID: 19772078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Robert L Witt
- Helen F. Graham Cancer Center, Christiana Care Health System, Newark, Del., USA
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Korotkikh NG, Morozov AN. [Sialoendoscopy possibilities in diagnostics and comprehensive treatment of chronic sialoadenitis]. Stomatologiia (Mosk) 2009; 88:45-49. [PMID: 20081781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Checkup and treatment of 187 patients with different forms of chronic sialoadenitis was done, 38 from them parotid gland sialoendoscopy was performed. Sialoendoscopic criteria of chronic sialoadenitis forms and clinical results of the fulfilled sialoendoscopic procedures in the immediate postoperation period were described. The direct visual assessment of parotid duct system let with high degree of exactness to determine the sialoadenitis form and simultaneously to make surgical intervention that made sialoendoscopy the choosing method in diagnostic and treatment of chronic inflammatory pathology of major salivary glands.
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Chow TL, Chan TTF, Choi CY, Lam SH. Kuttner's tumour (chronic sclerosing sialadenitis) of the submandibular gland: a clinical perspective. Hong Kong Med J 2008; 14:46-49. [PMID: 18239243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE To study clinical perspectives pertaining to chronic sclerosing sialadenitis, which is also known as Kuttner's tumour. DESIGN Retrospective medical chart review. SETTING Regional hospital, Hong Kong. PATIENTS From February 2005 to February 2007, nine cases with Kuttner's tumour were identified from our hospital electronic database. INTERVENTIONS They underwent submandibular sialadenectomy under either local (n=6) or general (n=3) anaesthesia. MAIN OUTCOME MEASURES The results of preoperative ultrasonography, fine-needle aspiration cytology, and intra-operative frozen section examination were correlated with the final diagnosis. Operative morbidity was also evaluated. RESULTS The mean age of the patients at diagnosis was 61 years; three were females. Three had bilateral submandibular swellings. Following preoperative ultrasonography in six of the patients, tumours were suspected in two, an enlarged lymph node in one, and diffuse enlargement was visualised in the other three. Six patients had preoperative fine-needle aspiration cytology; five yielded scanty acini with normal-looking ductal cells, variable degrees of infiltration by chronic inflammatory cells without granuloma admixing fibrosis. In the sixth patient, only bland-looking epithelial cells, indicative of ductal differentiation suspicious of neoplasm were noted. Intra-operative frozen section examination was conducted in three patients: chronic inflammation without evidence of carcinoma was visualised in each. Operations performed under local anaesthesia were well tolerated; only one patient endured a transient, marginal facial nerve palsy. CONCLUSIONS Kuttner's tumour is by no means rare. When supported by ultrasonography and fine-needle aspiration cytology, an accurate diagnosis can be made preoperatively and surgery can be reserved for symptomatic cases. Submandibular sialadenectomy is a safe and effective means of treating Kuttner's tumour, and can be accomplished under local anaesthesia.
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Affiliation(s)
- T L Chow
- Division of Head and Neck Surgery, Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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Abstract
UNLABELLED We aimed to describe the effect of our surgical and sialoendoscopic technique for diagnosis and treatment of chronic obstructive submandibular sialadenitis. METHODS Between January 2004 and June 2006, 68 patients presented with obstructive symptoms and were diagnosed and treated by interventional sialoendoscopy or excision. The patients all had radiographs and then, if the sialolith could not be found, diagnostic sialoendoscopy. The obstruction was treated by operation or interventional sialoendoscopy depending on the size, shape, site, and quality of the sialolith. RESULTS Forty-nine patients had sialoliths shown radiographically, and the features of 19 were found endoscopically and were of three types: radiolucent (n=6), in the branch (n=3), mucus plug (n=3), and stenotic (n=7). Twenty-seven obstructions were successfully removed surgically, giving a success rate of 27/31 (87%). Twenty-seven patients were treated by interventional sialoendoscopy, and in 22 cases the sialoliths were removed directly by sialoendoscopy (22/27, 81%). Obstructive symptoms were relieved in 9 of 10 cases without stones. CONCLUSION Operation or sialoendoscopy can be used to treat the obstruction in the submandibular gland.
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Affiliation(s)
- C-Q Yu
- Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao-tong University Medical College, 639 Zhi-zao-ju Road, Shanghai 200011, PR China.
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Dumić M, Janjanin N, Markov-Glavas D, Prgomet D, Putarek NR. Sialolithiasis with concurrent sialadenitis in an 18-year-old boy with triple A syndrome. J Otolaryngol 2007; 36:E98-E99. [PMID: 18076839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Miroslav Dumić
- Department of Pediatrics, Zagreb University Hospital Center, Kispatićeva, Zagreb, Croatia.
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Abstract
BACKGROUND In 5-10% of all cases with an obstructive disease of the major salivary glands, a diagnosis cannot be established by conventional radiological imaging or ultrasound. Using sialendoscopes, intraductal pathology can made visible to the surgeon, aiding in diagnosis and adequate treatment. MATERIAL AND METHODS Between 2001 and 2005, 369 sialoscopies were performed on 318 patients in the ENT department of the University of Erlangen-Nuremberg. Semi-rigid sialoscopes with an external diameter of between 0.7 and 1.7 mm were used. RESULTS In 34.9% of cases conservative treatment was necessary. In 65.1%, based on the sialoscopic findings, further therapeutic procedures such as extracorporeal shock wave lithotripsy, interventional sialoscopy or duct slitting were required and planned. Of 133 performed interventional sialoscopies, 83.5% were successful. CONCLUSIONS Sialoscopy is a useful diagnostic and therapeutic tool in obstructive salivary gland disease. Interventional sialoscopy has been performed with high success rates and has proven to be an important part in our concept of a gland preserving therapeutic regime.
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Affiliation(s)
- M Koch
- Hals- Nasen-, Ohrenklinik, Kopf- und Hals-Chirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen.
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Preuss SF, Klussmann JP, Wittekindt C, Drebber U, Beutner D, Guntinas-Lichius O. Submandibular Gland Excision: 15 Years of Experience. J Oral Maxillofac Surg 2007; 65:953-7. [PMID: 17448847 DOI: 10.1016/j.joms.2006.02.036] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2005] [Revised: 01/09/2006] [Accepted: 02/22/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE The surgical management of submandibular gland diseases has always been a challenge because it carries a considerable risk of nerve injury. The aim of this study was to review a single institution's experience of a nonselected case series of submandibular gland excision over 15 years. MATERIALS AND METHODS We retrospectively analyzed 258 unselected submandibular excisions of a tertiary university center for the histopathologic diagnosis and postoperative morbidity; 119 patients (46%) with sialolithiasis, 88 patients (34%) with sialadenitis, and 51 patients (20%) with submandibular tumors were operated. RESULTS We found a high rate of malignant tumors (42%) in the group of submandibular gland tumors. A low rate of transient palsies of the mandibular branch of the facial nerve (9%) and lingual nerve (2%) was observed. One patient developed a permanent paresis of the mandibular branch (<1%). CONCLUSION Our large series has shown that standardized submandibular sialadenectomy is a safe operation with a low rate of complications. Malignant disease is frequent in tumors of the submandibular gland.
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Affiliation(s)
- Simon Florian Preuss
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany.
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36
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Abstract
The submandibular glands are subject to several pathologies that require excision. The most common problem that affects these salivary glands is sialadenitis combined with sialolithiasis. This problem occurs in the submandibular gland 10 times more frequently than it does in the parotid gland. Other illnesses frequently involving the submandibular glands are represented by sialadenosis and benign, malign, and intermediate neoplasms. Diagnosis of any disturbance in the submandibular gland involves both a clinical and instrumental (echography, traditional radiography [ortopantomography] and eventually computed tomography (CT) or magnetic resonance imaging) assessment. Surgery is the usual method of treatment of both chronic sialadenitis and neoplasms in the submandibular gland. A submandibular gland surgical approach can be cervical, intraoral, or endoscopic. The authors present their clinical experience with a total of 40 patients with illnesses involving the submandibular gland treated with submandibular gland excision by a transcervical approach. Their experience suggests that this approach entails a relatively simple procedure, involves low risks for the nerve structure around the gland, permits wide resection margins for neoplasms, and incurs little aesthetic damage.
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Affiliation(s)
- Andrea A Torroni
- Department of Maxillo Facial Surgery, University of Rome La Sapienza, Rome, Italy
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Abstract
OBJECTIVE To analyze the clinical outcome of patients treated surgically for chronic parotid sialadenitis. STUDY DESIGN A retrospective cohort study of patients whose clinicopathologic information had been collected prospectively onto a dedicated head and neck database. METHODS Between 1987 and 2006, a total of 75 patients had 78 parotidectomies, 17 superficial and 61 near-total, to treat chronic parotid sialadenitis. The clinicopathologic data including treatment morbidity and outcome were analyzed. RESULTS Temporary postoperative facial weakness occurred in 26 (33%) patients, and this was permanent, although partial, in one (1%) patient. There was no significant difference (P > .05) in the incidence of temporary facial nerve neuropraxia in the superficial (35%) and near-total parotidectomy (33%) groups. Recurrence of symptoms was noted in two patients who had undergone near-total parotidectomy and none of the patients who had undergone superficial parotidectomy. Chronic parotid sialadenitis was effectively treated in 97% of patients undergoing parotidectomy. CONCLUSION Near-total parotidectomy is a safe and efficacious surgical treatment in the management of patients with debilitating severe chronic parotid sialadenitis.
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Affiliation(s)
- Rajan S Patel
- Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital and University of Sydney, New South Wales, Australia.
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38
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Titiz A, Unal A, Ozlugedik S, Yilmaz YF. An unrecognized foreign body in the parotid gland after trauma. B-ENT 2007; 3:31-3. [PMID: 17451124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE Foreign bodies within the parotid gland retained after trauma are rarely observed, due in part to ease of detection. Few, however, particularly wooden foreign bodies, may not be identified clinically and radiologically. CASE A 44-year-old male was admitted complaining of recurrent swelling and pain in the left parotid gland with recent history of penetrating parotid trauma and foreign body removal. Ultrasonography revealed a high degree of parenchymal heterogeneity and an 18 x 5.7 mm linear mass shadow. Following superficial parotidectomy, an approximately 1 x 2 cm wooden fragment that was buried in the masseter muscle and surrounded by granulation tissue was palpated and extracted. CONCLUSION Any suspicion of a residual foreign body after penetrating parotid gland trauma can be clarified with a detailed radiological examination, which may provide further guidance for treatment. The treatment modality of parotid foreign bodies is early surgical exploration, and in delayed cases, superficial parotidectomy may be needed.
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Affiliation(s)
- A Titiz
- First ENT Clinic, Ankara Numune Training and Research Hospital, Turkey.
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39
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Baurmash HD. Sialectasis of Stensen’s Duct With an Extraoral Swelling: A Case Report With Surgical Management. J Oral Maxillofac Surg 2007; 65:140-3. [PMID: 17174780 DOI: 10.1016/j.joms.2005.12.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Revised: 11/02/2005] [Accepted: 12/22/2005] [Indexed: 11/20/2022]
Affiliation(s)
- Harold D Baurmash
- Columbia University, School of Dental and Oral Surgery, NY, New York, USA.
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40
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Nouraei SAR, Ismail Y, McLean NR, Thomson PJ, Milner RH, Welch AR. Surgical treatment of chronic parotid sialadenitis. J Laryngol Otol 2006; 121:880-4. [PMID: 17166325 DOI: 10.1017/s0022215106005445] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2006] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To review the results of surgical management of chronic parotid sialadenitis refractory to medical therapy, with particular respect to long-term symptom resolution and development of post-operative complications. METHODS A retrospective review of parotidectomies performed for chronic intractable parotid sialadenitis. Information was collected about presentation, pre-operative investigations, surgical treatment, post-operative complications and outcome. RESULTS 36 parotidectomies were performed for chronic sialadenitis between 1991 and 2002. Age at presentation was 56+/-9.6 years, with median symptom duration of 2.3 years. For patients with non-specific presentations, magnetic resonance imaging (MRI) was the most useful pre-operative investigation. Superficial parotidectomy with duct preservation was the main treatment with a 94 per cent success rate, and near-total parotidectomy was reserved for patients with extensive deep-lobe involvement. Duct ligation significantly increased the risk of transient facial palsy. There was a 56 per cent and 22 per cent incidence of temporary facial paresis and Frey's syndrome, respectively. CONCLUSIONS Controversies exist regarding the optimal pre-operative investigation and surgical treatment of chronic parotid sialadenitis. We advocate magnetic resonance image (MRI) scanning for patients with non-specific symptoms of sialadenitis, and sialography in the presence of reasonable clinical suspicion. We propose superficial parotidectomy without parotid duct ligation as the standard of care, with near-total parotidectomy reserved for extensive deep-lobe disease.
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Affiliation(s)
- S A R Nouraei
- Department of Otolaryngology, Charing Cross Hospital, London, UK.
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41
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Suresh L, Aguirre A. Subacute necrotizing sialadenitis: a clinicopathological study. ACTA ACUST UNITED AC 2006; 104:385-90. [PMID: 17142073 DOI: 10.1016/j.tripleo.2006.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 08/09/2006] [Accepted: 08/15/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To report cases of extra-palatal subacute necrotizing sialadenitis (SANS), an uncommon condition that usually affects palatal minor salivary glands, and to characterize the etiopathogenesis, clinical features, and histology of this lesion. STUDY DESIGN Retrospective reviews of records for patients with SANS diagnosed between 1999 and 2005; only cases with complete clinical history and histology were included in the study. RESULTS Five cases (3 women, 2 men) were identified. The majority of patients presented with painful 1.0 to 1.5 cm swellings, with sudden and rapid increase in size. Two cases occurred in the buccal mucosa, 2 on the ventral surface of tongue, and 1 on the upper lip. Histology showed acinar necrosis surrounded by a dense polymorphous inflammatory infiltrate with focal exuberant tissue eosinophilia. Ductal atrophy was seen with minimal squamous metaplasia. In all the cases, healing occurred without any further treatment in 3 weeks. No recurrence was observed. CONCLUSION SANS is an uncommon, inflammatory condition of unknown etiology affecting minor salivary glands. SANS appears to be a self-limiting process that has distinct characteristic clinical and histologic features. Nevertheless, SANS shares some of the histologic features of early necrotizing sialometaplasia (NS), suggesting a possible relationship between the 2 conditions. Additional reporting of SANS would be helpful in better defining the condition and its delineation from NS.
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Affiliation(s)
- Lakshmanan Suresh
- Advanced Oral and Maxillofacial Pathology Program, School of Dental Medicine, State University of New York at Buffalo, NY 14214, USA
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42
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Abstract
BACKGROUND During the last 13 years, there has been a growing interest in and use of minimally invasive treatment techniques. Salivary gland endoscopes provide an accurate means of diagnosing and providing minimally invasive surgical treatment for salivary gland diseases. METHODS The authors review the relevant literature and provide the history of sialoendoscopy. They also report on the treatment methods they use, including instruments and techniques, and their experiences. RESULTS The authors' overall success rate for parotid endoscopic sialolithotomy is 86 percent, and their overall success rate for submandibular endoscopic sialolithotomy is 89 percent. Their success rate for treating strictures is 81 percent. CLINICAL IMPLICATIONS The endoscopic technique opens new horizons in the field of salivary gland diseases. Salivary gland stones and sialadenitis no longer are absolute indications for sialadenectomy. Owing to growing experience and surgical skills, new endoscopic techniques are in clinical use, and there is constant improvement in endoscopic treatment success rates. CONCLUSIONS Sialoendoscopy is a promising new method for use in the diagnosis, treatment and postoperative management of sialadenitis, sialolithiasis and other obstructive salivary gland diseases.
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Affiliation(s)
- Oded Nahlieli
- Oral and Maxillofacial Surgery Department, Barzilai Medical Center, Ashkelon, Israel 78404.
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43
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Abstract
PURPOSE To describe an endoscopic technique for submandibular sialoadenectomy in humans, as well as the equipment, instrumentation, and pertinent anatomy. MATERIALS AND METHODS Six submandibular sialoadenectomies were carried out in 5 patients (3 women, 2 men; mean age, 26.6 years; range, 16 to 42 years) via a 15 to 20 mm neck incision for insertion of the endoscopic camera and surgical instruments. RESULTS All operations were successful without conversion to an open surgery. Operative time was 20 to 120 minutes (mean, 65 minutes). All patients were discharged the day after surgery. There were no postoperative complications (hematoma, nerve injury, infection). All patients experienced a mild degree of edema, which had resolved totally at the 6-month follow-up visit. All patients were satisfied with the outcome and especially the cosmetic result. CONCLUSIONS Absence of extensive scars, nontraumatic dissection, and magnification of anatomic structures are the most obvious advantages of this innovative technique.
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Affiliation(s)
- Jean-Paul Meningaud
- Department of Maxillofacial Surgery, Pitié-Salpêtrière Hospital, Paris, France.
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44
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Huang HZ, Huang ZQ, Zhao XP, Zhang B. [Intraoral submandibular gland excision and how to deal with external maxillary artery]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2006; 41:514-6. [PMID: 17007375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To investigate the feasibility and safety of intraoral submandibular gland excision. METHODS Analyze the relationship between the external maxillary artery and submandibular gland, and offer a reliable anatomical base for 10 cases of intraoral submandibular gland excision, including 8 cases of chronic sialadenitis, 1 case of pleomorphic adenoma and 1 case of cyst of submandibular gland. RESULTS The external maxillary artery went across the surface of gland submandibular, and its branches provided nutrition for the gland in most cases. The results of 10 cases intraoral submandibular gland excision were effective and satisfied, without major complications. The average time of operation was 50 minutes and the average hemorrhage of operation was 60 ml. CONCLUSION Intraoral submandibular gland excision is safe and feasible for chronic sialadenitis and cyst of submandibular gland and some of benign tumor submandibular gland as long as indications strictly controlled and the external maxillary artery well coped with.
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Affiliation(s)
- Hong-Zhang Huang
- Centre of Oral and Craniomallofacial Surgery, Second Hospital of Sun Yat-Sen University, Guangzhou 510120, China
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Kessler P, Bloch-Birkholz A, Birkholz T, Neukam FW. Feasibility of an endoscopic approach to the submandibular neck region—Experimental and clinical results. Br J Oral Maxillofac Surg 2006; 44:103-6. [PMID: 15951073 DOI: 10.1016/j.bjoms.2005.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Accepted: 03/01/2005] [Indexed: 12/29/2022]
Abstract
We have investigated the feasibility of an exclusively endoscopic approach to the submandibular region in four pigs, four cadavers and two women. We inflated the subplatysmal space with carbon dioxide at low pressure. The submandibular gland and the jugulodigastric region were easy to identify once the correct anatomical space had been dissected and inflated. Four endoscopic resections of the submandibular gland were done successfully.
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Affiliation(s)
- P Kessler
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen-Nuremberg, Glückstrasse 11, D-91054 Erlangen, Germany.
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Abstract
This report presents an unusual case of spontaneous salivary otorrhoea in which advanced imaging was used to identify a developmental defect in the anterior wall of the bony external auditory meatus. This defect, the so-called foramen of Huschke, was subsequently found to be the source of the fistula. A review of the literature highlights the diagnostic dilemmas that such cases pose for the clinician.
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Affiliation(s)
- V E Rushton
- School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK.
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47
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Unal M, Karabacak T. Küttner's tumour of the submandibular gland. B-ENT 2006; 2:197-9. [PMID: 17256409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Küttner's tumour (chronic sclerosing sialadenitis) is a chronic inflammatory disease of the salivary glands that produces a firm and relatively painful swelling of the glands. Although Küttner's tumour is a common submandibular disease, many clinicians and pathologists have under-recognized this entity because of its superficial resemblance to neoplasia and the presence of only a few reports in the English literature. We report a case of Küttner's tumour in a 41-year-old male who presented with a painless submandibular mass, and discuss its histological and clinical characteristics.
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Affiliation(s)
- M Unal
- Department of Otorhinolaryngology, University of Mersin, Mersin, Turkey.
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48
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Kaba S, Kojima M, Matsuda H, Sugihara S, Masawa N, Kobayashi TK, Fukuda T. Küttner's tumor of the submandibular glands: Report of five cases with fine-needle aspiration cytology. Diagn Cytopathol 2006; 34:631-5. [PMID: 16900478 DOI: 10.1002/dc.20505] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Küttner's tumor (KT) is a benign tumor-like lesion of the salivary gland that mimics neoplasm clinically because of presentation as a hard mass. Recently, the histomorphological and immunohistochemical findings of this lesion have been analyzed, and differential diagnostic problems relating to salivary gland lymphoma have been discussed. However, currently there is little information on the cytological findings of those lesions. We present cytological findings from five such cases using fine-needle aspiration cytology (FNAC). FNAC of this lesion may present a diagnostic challenge to the cytologist as lesions share some cytologic features with inflammatory process containing numerous lymphoid cells. Smears obtained from two cases contained moderate to large numbers of lymphoid cells without definite cytological atypia, scattered ductal structures, and acinar cell clusters. The remaining three cases showed low cellularity probably attributable to fibrosis that made it difficult to aspirate the cellular element. FNAC findings of scattered ductal structures surrounded by collagens and infiltrated by a mixed population of lymphoid cells, not specific for KT, are highly suggestive of the diagnosis with the appropriate clinical findings. However, a portion of cytological specimens of KT containing relatively large numbers of lymphoid cells should be differentiated from malignant lymphoma arising from the submandibular gland.
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Affiliation(s)
- Sadayuki Kaba
- Department of Laboratory Science, School of Health Sciences, Faculty of Medicine, Gunma University, Shouwa-machi, Maebashi, Gunma, Japan.
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49
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Düker J. Sialadenitis of the left submandibular gland/sialolith. Quintessence Int 2005; 36:747-8. [PMID: 16163878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Jürgen Düker
- University Dental Clinic, Department of Radiology, Hugstetter Stratsse 55, 79106 Freiburg, Germany
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50
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Mauz PS, Mörike K, Kaiserling E, Brosch S. Valproic acid-associated sialadenosis of the parotid and submandibular glands: diagnostic and therapeutic aspects. Acta Otolaryngol 2005; 125:386-91. [PMID: 15823809 DOI: 10.1080/00016480410024460] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Sialadenosis has been defined as a non-inflammatory, parenchymatous salivary gland disease causing recurrent, bilateral swelling of the salivary glands. As an adverse drug reaction of valproic acid, sialadenosis is very rare. To our knowledge, it has been reported only once in the world literature to date. We present herein the case of a patient with valproic acid-associated sialadenosis of both the parotid and submandibular glands. This appears to be the first published case of a patient who received surgical treatment. On light and electron microscopy of all the affected salivary glands, granular sialadenosis with predominantly moderate electron-dense secretory cytoplasmatic granules was observed. No relevant degenerative alterations were seen. There was no histological evidence of peripheral neuropathy of the nerve supply, leading to disordered activity of acinar cells by loss of neurosecretory granules. Lateral parotidectomy, performed under neuromonitoring control for safety reasons, is the treatment of choice for chronic recurrent parotitis that does not respond to conservative therapy, particularly if the cosmetic deformity is unacceptable to the patient. If the submandibular glands are involved, partial removal is recommended.
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Affiliation(s)
- P S Mauz
- Department of ENT, University Hospital Tübingen, Tübingen, Germany.
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