Symptomatic unilateral submandibular gland aplasia associated with ipsilateral sublingual gland hypertrophy

Rare condition of unilateral submandibular gland aplasia and its diagnostic significance in oral cavity carcinoma

Background

The unilateral submandibular gland aplasia (agenesis) is a rare, asymptomatic condition usually discovered incidentally on imaging. This is associated commonly with either compensatory hypertrophy of contralateral submandibular gland or sublingual glands.

Case presentation

We report the case of a 34-year-old male with incidentally detected unilateral submandibular gland aplasia associated with hypertrophy of ipsilateral sublingual gland, demonstrated by imaging modalities, where we have highlighted the diagnostic significance of such rare findings in oncology, particularly in oral cavity carcinoma cases with metastatic submandibular lymph nodes (level IB) mimicking as submandibular gland. Hence, lymphadenopathy can be missed preoperatively which is an important part of staging and treatment planning.

Conclusions

Aim of the present report is to create awareness about such rare entity in both clinicians/radiologists and highlight the imaging features for correct identification and to avoid any diagnostic dilemmas.

Unilateral Submandibular Gland Aplasia with Ipsilateral Sublingual Ranula - A Case Report

Background:

Congenital aplasia of major salivary glands is a very rare entity, especially if it concerns an ipsilateral aplasia in a nonsyndromic patient.

Key points from the case:

The aim of this report is to present a case of an aplasia of the left submandibular gland, which was incidentally diagnosed during presurgical imaging for an ipsilateral sublingual ranula. Histopathological evidence of the lack of sublingual gland tissue in the excised specimen of the ranula is discussed.

Main lessons to be learned from this case report:

Unilateral submandibular aplasia has unknown etiology. Clinicians should be aware of this condition mainly to be able to differentially diagnose a hypertrophy/dysplasia of the contralateral or other major salivary glands, or when xerostomia is the main patient's symptom.

Unilateral sublingual salivary gland hypertrophy with herniation through a boutonniére defect and contralateral sublingual gland hypoplasia

A 74-year-old male attended our ear, nose and throat clinic with left-sided otalgia. MRI highlighted an area of abnormal signal in the region of the right mylohyoid muscle in the floor of the oral cavity. The patient was called back for a post-contrast MRI scan for clarification. Post-contrast MRI demonstrated a left-sided hypoplastic sublingual salivary gland and a hypertrophied right-sided sublingual salivary gland. The left sublingual gland hypoplasia had resulted in compensatory hypertrophy of the contralateral (right) sublingual salivary gland, extending through the mylohyoid gap or "boutonnière defect". This is a common incidental variant often encountered in radiological imaging. This is the only report of a case of contralateral compensatory hypertrophy of sublingual salivary gland, as all the others have reported ipsilateral hypertrophy of either submandibular salivary glands.

Agenesis of submandibular glands: a report of two cases with review of literature

Background. Congenital absence of the submandibular gland (SMG) is a rare condition. Although complaints such as dry mouth, dental problems, or difficulty in swallowing may be seen, the subjects may also be asymptomatic. The absence of the SMG may be associated with hypertrophy of the contralateral SMG. Case Report. We report the case of a 44-year-old woman with incidentally detected left SMG aplasia, with contralateral SMG hypertrophy mimicking a mass, and the case of a 46-year-old woman with incidentally detected bilateral SMG aplasia, demonstrated by computerized tomography (CT) and magnetic resonance imaging (MRI). Conclusion. It is important for the clinician to know that this very rare abnormality may exist. When such a case is encountered, symptoms and findings should be reevaluated and, if necessary, conservative therapy should be initiated. The possibility of observing additional deformities should be kept in mind and an evaluation should be done for other cases in the family.

Dynamic sonography and CT findings of unilateral submandibular gland agenesis associated with herniated hypertrophic sublingual gland

Congenital agenesis of the submandibular gland is uncommon. We report dynamic sonography and CT findings of the unilateral submandibular gland agenesis associated with herniated hypertrophic sublingual gland tissue through the mylohyoid gap. The dynamic sonography examination applied at rest and during the modified Valsalva maneuver demonstrated hypertrophied sublingual gland prolapsing to the anterior part through the mylohyoid gap. This may be the first reported case describing dynamic sonography findings of this entity. CT confirmed the agenesis of the left submandibular gland and compensatory hypertrophy of the ipsilateral sublingual gland.

Isolated unilateral aplasia of submandibular gland: a rare anomaly detected incidentally on computerized tomography

Aplasia of the major salivary glands is a very uncommon anomaly, with isolated aplasia of only 1 submandibular gland being even rarer. We report a case of a 60-year-old woman in whom unilateral aplasia of the left submandibular gland was detected incidentally on computerized tomography with no other associated congenital abnormalities.