Painful parotid hypertrophy with bulimia: a report of medical management

In eating disorders, such as bulimia nervosa, body image disturbance often extends beyond the realm of weight and shape into the dermatologic spectrum. While commonly associated conditions due to binging and self-induced vomiting include cutaneous entities (e.g., Russell's sign, acne, alopecia and hypertrichosis) and oral pathologies (e.g., enamel erosion, caries and mild parotid hypertrophy), a rare but troubling manifestation is disfiguring parotid enlargement (sialoadenomegaly). This article presents a case of painful sialoadenomegaly associated with hyperamylasemia in a bulimic patient successfully managed with pilocarpine.

[Histometry of the sublingual gland in male and female mice (Mus musculus) infected with the RAL strain of the Chagas parasite, Trypanosoma cruzi]

The aim of this work was to analyze histologically and histometrically the sublingual gland of mice infected with the RAL strain of T. cruzi, according to the sex. Swiss mice (Mus musculus) were inoculated with 2 x 10(4) blood trypomastigotes of the RAL strain of T. cruzi. In the peak of the parasitemia (12th day) the mice were sacrificed, and the sublingual glands were fixed in ALFAC. HE-stained histological sections were evaluated histometrically. The parasitemia was higher in females. Histopatologically, acini of the infected animals were smaller, with scanty production of secretion, and smaller striated ducts. The nuclei of the demilunes were smaller and showed amastigote nests in the cytoplasm. Karyometrically, nuclei of the acini, demilunes and striated ducts were smaller in the infected mice. Stereologically, it was observed that relative volumes of acini and ducts were smaller and, inversely, relative volumen were greater for the conjunctive tissue in the infected males. The surface densities of acini and ducts were bigger and the diameter and thickness of the wall were smaller in this group. On the other hand, relative volume of acini was smaller and those of the ducts and conjunctive tissue were bigger in the infected females. The diameter and thickness of the wall of acini were smaller, and those of the striated ducts were bigger in this group. The RAL strain of T. cruzi caused general atrophy in the sublingual gland, with numerous nests of parasites in the glandular parenchyma.

Removal of oral cavity leiomyoma with carbon dioxide laser

Myoma is a nonmalignant neoplasm rarely found in the oral cavity and even more rarely mentioned in the world's dental or surgical literature. Not one case of oral cavity leiomyoma has been reported in Poland. This article describes a case of leiomyoma of the oral cavity in a 51-year-old patient. To remove the tumor, a carbon dioxide laser was used. Because of the method used, perioperative bleeding was avoided, which enabled better visibility of the surgical area and minimized duration of the operation. The postoperative wound did not require sutures, and healing occurred without complications.

[Diagnostic image (347). A man with a swelling underneath his tongue]

A 23-year-old man presented with a painless, growing swelling underneath his tongue due to a ranula, i.e. accumulation of saliva in the drainage canal of the sublingual salivary gland.

Incidence and clinical relevance of herniation of the mylohyoid muscle with penetration of the sublingual gland

Swelling of the submandibular region may cause problems in daily clinical diagnosis and requires further exploration. Ultrasonic examination provides a simple, non-invasive and radiation-free method. The goal of our study was to show the high incidence of herniation of the mylohyoid muscle with penetration of the sublingual glands, in some cases clinically imposing as permanent swelling. Penetration was classified into four grades (Grade 0-III). In course of routine examinations of the neck by ultrasound, the anterior part of the mylohyoid muscle was observed in 124 consecutive patients from our outpatient's clinic, presenting with unclear swelling of the neck, mostly due to lymph nodes. In resting position and during swallowing the degree of penetration of the sublingual gland through the mylohyoid muscle was staged. Almost 60% of patients showed an affection of the mylohyoid muscle at either site of varying degrees. In 40% only a thinning of the muscle could be noticed (grade I), whereas in 21 patients (17%) a significant herniation of the gland during swallowing could be observed (grade II). In two patients (2%) a constant breach of the mylohyoid muscle with permanent herniation of the gland imposing as swelling could be seen (grade III). Occasional or permanent penetration of the sublingual gland through the mylohyoid muscle is not a rare finding and can be found in almost every fifth individual using ultrasound. This may impose clinically as permanent swelling and may be of value in the differential diagnosis of swelling in the submandibular region.

[Rare case of supernumerary submandibular gland lobes forming a complex with the sublingual gland]

In the sublingual/submandibular gland complex (L/M complex hereafter), the submandibular gland process adjoins the sublingual gland. Therefore, it is speculated that the L/M complex in the fused state is due to excessive development of the submandibular gland process. However, we encountered a case of the L/M complex formed due to supernumerary glandular lobes (lobes A, B, and C) developing in the posterior 1/3 portion of the submandibular duct. Lobes A, B, and C showed the following macroscopic morphologies, constitutions, ducts, and histological morphologies. Lobe A was disc-shaped, and this lobe together with the major sublingual gland was wrapped with the minor sublingual gland. Lobe B was attached to lobe C, forming a cingulate lobe. Lobe B had an irregular shape and was attached to the superior area of lobe A, while lobe C was rod-shaped and attached to the posterior area of lobe B. The posterior area of lobe C was attached to the submandibular gland at the base of the submandibular duct. The excretory ducts of lobes A, B, and C joined, forming one duct, which joined the posterior 1/3 portion of the submandibular duct. The histological morphologies of lobes A, B, and C showed a predominance of serous cells over mucous cells, which was the same as the morphology of the submandibular gland. In this case, the L/M complex may have formed by the following mechanism. Supernumerary lobes A, B, and C of the submandibular gland formed in the posterior 1/3 portion of the submandibular duct, and lobe A together with the major sublingual gland was wrapped with the minor sublingual gland. Lobes B and C formed a cingulate lobe, and its posterior portion (posterior portion of lobe C) attached to the submandibular gland, resulting in a fused state.

[Congenital ranula in a newborn]

Ranulas are cystic lesions in the floor of the mouth. They are either retention cysts of the excretory duct of the sublingual gland or pseudocysts formed by excretory duct rupture followed by extravasation and accumulation of mucus in the surrounding tissue. We report the case of a premature newborn with a congenital ranula in the floor of mouth. The ranula caused no discomfort or complications, so that immediate intervention was not necessary. The cyst resolved completely by the age of 4 months. Complications in newborns especially include airway obstruction and feeding difficulties. Surgical treatment options are needle aspiration, excision of the ranula, marsupialization, cryosurgery, and--in addition to excision of the cyst--removal of the ipsilateral sublingual gland. Sclerotherapy has shown good results as well. As many congenital cysts resolve or rupture spontaneously, they should be observed for potential resolution for several months in uncomplicated cases.

Idiopathic hyperplasia of the sublingual glands in totally or partially edentulous individuals

OBJECTIVE

To determine the possible etiologic factors associated with the development of idiopathic hyperplasia of the sublingual gland (IHSG).

STUDY DESIGN

Fifty partially or totally edentulous patients were divided into 2 groups, each with 25 subjects, matched by sex. Group 1 was made up of patients with IHSG, whereas group 2 consisted of patients without IHSG. Patients of both groups were investigated with respect to the use of prostheses, systemic medication, systemic diseases, smoking habits, alcohol consumption, and xerostomia. In addition, patients of group 1 were examined by occlusal radiography, and in 6 of them, a biopsy of the sublingual gland swelling was taken for histopathologic investigation. The Fisher exact test was used, with significance set for P < or = .05.

RESULTS

The comparative analysis revealed no statistical difference between the 2 groups concerning all factors investigated (P > .05). Radiographic examination did not detect any presence of salivary calculi; the histopathologic findings revealed either chronic sialadenitis (4 cases) or normal glandular tissue (2 cases).

CONCLUSION

Our clinical and histopathologic analyses confirm that IHSG is a harmless condition for which no surgical treatment is required. The etiologic investigation did not find any local or systemic factors significantly associated with the development of IHSG. The absence of posterior teeth remains as the only known predisposing factor to be strongly linked to this condition.

[Transcutaneous excision of the submandibular and sublingual glands: notes on anatomy and surgical technique]

Removal of the submandibular and sublingual glands requires in-depth knowledge of the anatomy and scrupulous technique for the purposes of limiting the functional and aesthetic damage, which is unjustifiable above all in the treatment of benign lesions (sialodenitis, lithiasis). After presenting the main aspects of the surgical anatomy of the submandibular space, the operative technique for its dissection with removal of the submandibular gland and excision of the sublingual gland is described. The complexity of the anatomical structures that may be involved in submandibular and sublingual gland lesions is the cause of unsatisfactory functional and aesthetic outcomes in some cases. The most feared complications are lesions to nerve formations, due both to the resulting deficits and the possible legal implications.

Apparent diffusion coefficient mapping of salivary gland tumors: prediction of the benignancy and malignancy

BACKGROUND AND PURPOSE

Preoperative prediction of tumor malignancy is clinically very important, because this information strongly influences the surgical plan. We evaluate the preoperative apparent diffusion coefficient (ADC) maps of benign and malignant salivary gland tumors.

MATERIALS AND METHODS

High-resolution MR imaging was performed on 31 patients with benign or malignant salivary gland tumors; ADC maps of the tumors were also obtained. Surface coils of 47 or 110 mm diameter were used to improve the image resolution. The ADCs were compared with histologic features of the excised tumors.

RESULTS

The ADC maps effectively depicted the histologic features of the salivary gland tumors, such as presence of cancer cells, myxomatous tissues, fibrosis, necrosis, cyst formation, and lymphoid tissues. The ADC maps showed that more frequent areas with high ADCs (> or = 1.8 x 10(-3) mm(2)/s) were significantly greater in benign tumors than in malignant tumors. The sensitivity and specificity for high ADC occupying fewer than 5% of the area of a tumor was 89% and 100%, respectively, resulting in 97% accuracy, 100% positive predictive value, and 96% negative predictive value.

CONCLUSION

The ADC may provide preoperative tissue characterization of the salivary gland tumors.

Quantitative age-related differences in human sublingual gland

OBJECTIVE

To quantify morphological age- and gender-related differences in human sublingual glands (SLG).

DESIGN

Ninety right human SLG from necropsies were distributed by gender and age groups. Individuals with ages ranging from 7 months to 92 years were divided into Groups I (0-30 years), II (31-60 years) and III (61-92 years). The glandular volume of each SLG was calculated. The morphometric quantifications of the volume density and total volume of acini, ducts, stroma, adipose tissue and septa were realized under light microscopy using a Zeiss II integration grid with 100 points symmetrically distributed.

RESULTS

The glandular volume decreased, on average, 33.78% across the groups. The volume density (V(V)) of acini reduced 60.54% and of septa 34.82%, being replaced partly by an increase of 58.82%, 551.22% and 2,783.33% in the volume density of ducts, stroma and adipose tissue, respectively. In absolute terms, with aging, the total volume (V(T)) of the acini decreased by 54.04% and by 34.84% in the septa. In contrast, the total volume of ducts, stroma and adipose tissue showed increases of 62.53%, 363.25% and 2,308.64%, respectively. Both the V(V) and the V(T) of acini, ducts, stroma and adipose tissue and the V(V) of septa were statistically different with age. No significant difference was observed between genders.

CONCLUSION

The decrease of parenchyma accompanied by an increase of stroma observed here in SLG is a common feature of aging in human salivary glands.

Unilateral submandibular gland aplasia associated with ipsilateral sublingual gland hypertrophy

Congenital absence of the major salivary glands is an infrequent disorder. Clinically, patients may be asymptomatic or may present with dryness of the mouth, difficulty in chewing and swallowing, and dental caries. The absence of the submandibular gland may be associated with hypertrophy of the contralateral submandibular gland. We report a case of ipsilateral sublingual hypertrophy associated with unilateral submandibular aplasia.

Solitary fibrous tumor with pseudo-lipoblasts involving the sublingual gland: report of a case and review of the literature

Solitary fibrous tumors (SFTs) are mesenchymal neoplasms uncommonly occurring in the salivary glands. In rare instances, SFTs can contain mature fat, atrophic fat, or vacuolated cells previously termed 'pseudo-lipoblasts', which may be misinterpreted as a feature of malignancy. We report an unusual tumor with pseudo-lipoblasts occurring in the sublingual gland. The tumor exhibited a prominent hemangiopericytic pattern, bland cytology, and immunohistochemical and morphologic features consistent with that of an SFT. A review of 15 cases of SFTs of the salivary glands is presented. Emphasis is laid upon the histologic differential diagnosis and the clinical features of these tumors.

Das Speichelgangkarzinom der Glandula Sublingualis

RATIONALE

Pleomorphic adenoma is the most common neoplasm of major and minor salivary gland origin, followed by infectious reasons and sialolithiasis. Less common are adenocarcinomas presented. The salivary duct carcinoma represents a rare variant of the group of adenocarcinomas originated from the salivary glands, especially extremely rare from minor salivary gland origin.

CASE REPORT

We report about a 52 year old male patient presenting with painless, non-ulcerating tumor at the floor of the mouth. Since 2 weeks ingestion was painful. Further ENT-investigations including endoscopy and scans (MRT, ultrasound) showed no pathology. In particular, growth of cervical lymph nodes and distant metastases were not revealed. A biopsy showed a rare salivary duct carcinoma of comedo-type originated from the left sublingual salivary gland. The patient underwent an operation: the tumor was extirpated in toto, and, as the pathohistological investigation confirmed, in sano. Additionally a neck dissection at the left side was performed, followed by the radiation of the tumor region and the lymphatic neck regions, after sufficient reconvalescence. The tumor-classification was pT3, pN0. Since 3 years no recurrence of the tumor was confirmed.

DISCUSSION

Salivary duct carcinoma is a rare, high-grade malignant epithelial neoplasm, which occurs almost exclusively in the parotid. As presented, it can also occur in minor salivary glands. Histologically it is composed of structures that resemble expanded salivary glands. Comedonecrosis of these structures is a frequent feature. There is some histologic similarity to intraductal carcinoma of the breast. Differential diagnosis comprises adenoid cystic carcinoma, metastases of other adenocarcinomas, such as the carcinoma of the thyroid gland and the comedocarcinoma of the breast. Because of its poor prognosis a rapid and radical therapy is recommended.

CONCLUSION

A rare case of a salivary duct carcinoma of sublingual salivary gland origin is presented. Usually the prognosis is poor. The adequate therapy is the complete surgical extirpation including the surgery of the regional lymphatic nodes and the additional radiotherapy.

Sialolithiasis in the sublingual gland

Sialolithiasis is a major cause of salivary gland dysfunction. The submandibular gland is the most common site followed by the parotid gland. The sublingual gland and minor glands are very rare sites for stone formation. This paper describes a case of multiple sialoliths arising in the sublingual gland. They presented on the right floor of the mouth. The sublingual gland and sialoliths were completely removed with careful preservation of the lingual nerve and Wharton’s duct. This was an uncommon sialolithiasis of the sublingual gland in a 14-year-old female.

Accessory or sublingual salivary gland biopsy to assess systemic disease: a comparative retrospective study

Minor salivary gland biopsies are commonly performed as part of the diagnosis of Sjögren's syndrome or other systemic diseases. Until now, a lip biopsy taken from inside the inferior lip has been the most often performed method to assess the accessory salivary glands. Because of the risk of damaging the inferior alveolar nerve and of harvesting non-contributive biopsies, for the past several years we have chosen the sublingual biopsy described by Adam. The aim of this study was to describe the indication and diagnosis and to evaluate work incapacity, pain and the complication rate among our salivary gland biopsies. In this retrospective study, we evaluated 79 biopsies (lip, n=24, and sublingual, n=55) taken at the Department of Oral and Maxillofacial Surgery of the University Hospital St-Luc, Brussels, by multiple junior trainees and senior surgeons (n=17). Data were collected from record study and from telephonic patient questionnaires. The three major indications were: sicca syndrome (24%), suspicion of Sjögren's syndrome (32%) or exclusion of other systemic diseases (44%). The histology results of the lip and sublingual biopsies, respectively, were: normal tissue (29%, 24%), chronic inflammation (29%, 41%), compatible, but not characteristic for Sjögren (8%, 7%), Sjögren's syndrome (13%, 24%), salivary gland atrophy (13%, 0%) or non-contributive (8%, 0%). The procedures were both almost painless (time during which painkillers had to be taken: 0.33 vs. 0.69 days, NS) and work incapacity was not encountered in any group. After one lip biopsy we had to deal with a permanent anesthesia of the lower lip (6.6%), and after one sublingual biopsy a swelling of the floor of the mouth had to be incised under local anesthesia (2.7%). Thus, sublingual biopsy is an easy procedure with low morbidity and excellent reliability in comparison to lip biopsy. No salivary gland atrophy and no non-contributive biopsies were encountered; no important bleeding or nerve lesion was recorded after sublingual biopsies.

A Stafne's cavity with unusual location in the mandibular anterior area

The typical Stafne's cavity, located on the posterior portion of the mandible, is a relatively uncommon entity. However, when the defect is located in the anterior region of the mandible, it is quite rare, having thus far been described in only 36 cases in the scientific literature. Most of these defects appear in the fifth and sixth decades of life, are localized to the area of the canines and premolars, and have a predilection for males. The inferior dental canal, one of the anatomical-radiographic landmarks that aid in the diagnosis of Stafne's cavity in the posterior region, is rarely present anterior the mental foramen. For this reason, because of its more variable radiographic appearance compared to the posterior defect, its tendency to be superimposed over the apices of the teeth, and the rarity of its localisation to the anterior mandible, it is much more difficult to establish a definitive diagnosis of a Stafne's cavity in this location. It is therefore more likely that a diagnostic error can occur, especially early on. We present a new case in a 68-year-old male in which the diagnosis was serendipitous, and we review in particular the aetiology and pathogenesis, clinical aspects, and differential diagnoses for this condition.

[Diagnostic image (229). A neonate with a sublingual swelling]

A male neonate presented with a right-sided swelling in the floor of the mouth, a congenital ranula, which disappeared spontaneously.

Mylohyoid herniation of the sublingual gland diagnosed by magnetic resonance imaging

Mylohyoid herniation of the sublingual gland has been a frequent finding at dissection of adult human cadavers and at retrospective studies of computed tomography (CT) and magnetic resonance imaging (MRI) of the floor of the mouth. Even so, very few clinical reports exist. The present report describes an adolescent boy with a suspected submental tumour, which at MRI was shown to be caused by a mylohyoid hernia of part of an enlarged, but otherwise normal sublingual gland.

[A new method of sublingual salivary gland cyst treatment by silicone membrane]

It is suggested to use silicone membrane in operations of plastic cystotomy in cases of ranula. 1-2-year follow-up results are good, no recurrence was observed.

Functional MR imaging of submandibular herniation of sublingual tissues through a gap of the mylohyoid muscle in two cases of submandibular “masses”

Except for neoplasms, in symptomatic patients with submandibular swellings, gaps of the mylohyoid muscle may be the cause of herniations of sublingual tissues, such as fat and/or the sublingual gland. In two patients with a submandibular swelling, MRI with standard sequences including contrast enhancement was performed to exclude a neoplastic lesion. In addition, we performed a trueFISP sequence during modified Valsalva's maneuver. In both patients, a neoplasm was excluded. Instead, the trueFISP sequence during the modified Valsalva's maneuver showed submandibular herniation of sublingual tissues. If MRI of the floor of the mouth does not show a neoplasm, an additional functional MR investigation should be performed. Gaps of the mylohyoid muscle can be the cause of herniating sublingual tissues (similar to plunging ranulas). During the modified Valsalva's maneuver, sublingual fat and/or gland can herniate and cause a symptomatic submandibular swelling. A coronal trueFISP sequence is particularly suited to demonstrate this.