Presentation and diagnosis of unilateral maxillary swelling in children

Pediatric Salivary Gland Disease

Salivary gland disease in the pediatric population is rare, yet it encompasses a wide spectrum of disease. It is estimated that 4.3% of salivary gland disease occurs in the pediatric population, with most classified as nonneoplastic. Further extrapolation reveals that 5% of salivary gland neoplastic diseases occur in patients younger than 20 years. Moreover, salivary gland tumors represent 1% of all head and neck tumors across all ages. Regardless, clinicians across all fields should be familiar with the workup of various pediatric salivary gland diseases and appropriate referral to a pediatric otolaryngologist.

Imaging of parotid anomalies in infants and children

A wide spectrum of disorders involves the parotid glands, in infancy and childhood. Acute or chronic inflammatory/infectious diseases are predominant. The first branchial cleft anomalies are congenital lesions that typically manifest during childhood. Tumor lesions are more likely to be benign, with infantile hemangioma the most common in infancy and pleomorphic adenoma the most frequent in childhood. Malignant tumors are uncommon, with mucoepidermoid carcinoma the least rare. Infiltrative parotid diseases are rare and have some pediatric clinical specificities. These common and uncommon disorders of parotid glands during childhood and their imaging characteristics are reviewed.

Disorders and tumors of the salivary glands in children

Salivary gland neoplasms are rare in children. In infants most tumors are benign hemangiomas, with some notable exceptions, such as sialoblastomas. An asymptomatic swelling in the periauricular region is the most common presenting complaint in older children. Approximately 50% of these lesions are malignant, which dictates a thorough diagnostic evaluation by a head and neck surgeon. Surgical excision is the primary treatment modality. Prognosis is primarily determined by histopathologic findings. This review discusses neoplastic lesions of the salivary glands in children, and malignant epithelial tumors in particular.

High-frequency ultrasound in parotid gland disease

Parotid gland is involved in many inflammatory and neoplastic conditions. Many a times, it is difficult to ascertain the type of swelling by clinical examination. The anatomy and various abnormalities of the glands are very easily visualized by high-frequency ultrasound. Ultrasound can confirm the presence of the mass with sensitivity up to 100%. It can demonstrate whether a lesion is located in the parotid gland or outside. It can help in differentiating benign from malignant neoplasms and local staging of the mass in malignant lesions. In addition, ultrasound can identify those entities that may not need surgical intervention. The glands appear enlarged and show altered echopattern in acute inflammation and may be normal or reduce in size in chronic inflammation. Other pathologies that involve salivary glands are sialolithiasis and various benign and malignant neoplasms. Ultrasound many times suggests final diagnosis or supplies important differential diagnosis. In this article, the use of high-frequency ultrasound in parotid disease is discussed, and sonographic features of different parotid pathologies are reviewed with examples illustrated. High-frequency ultrasound is the first and many a times the only imaging investigation done for evaluation of parotid glands.

Unilateral maxillary swelling: a retrospective study

Unilateral maxillary swelling is a rare condition, however we being in tertiary care centre did see a large number of these cases. All patients presenting with unilateral maxillary seen during the last 3 years were included in this retrospective study and evaluated concerning histories, diagnostic and therapeutic approaches and achieved outcomes. A total of 31 patients were seen during this period. 27 of these were benign lesions and were subdivided as follows: odontogenic cystic lesions (11/27), fibro-osseous lesions (8/27), secondary to extensive allergic fungal sinusitis (5/27) and mucocele (2/27). The remaining five were malignant lesions, two each were squamous cell cancer and adenocarcinoma of the maxillary sinus, and one was rhabdomyosacroma. All patients received treatment with due merit of the underlying etiology. Understanding and recognizing key diagnostic features helps in appropriate management and reducing morbidity.

Pediatric salivary gland imaging

A variety of lesions occur in the pediatric salivary glands. With modern imaging techniques such as Doppler sonography, helical CT, and MRI, identification of a specific etiology is often possible. Knowledge of clinical information, normal anatomy, and imaging characteristics of salivary gland pathology are essential for appropriate radiologic evaluation. This review illustrates the various congenital, neoplastic, and inflammatory entities that can occur within the parotid, submandibular, and sublingual spaces.

Swelling at the angle of the mandible: imaging of the pediatric parotid gland and periparotid region

The pediatric parotid gland and periparotid region are subject to a variety of lesions and are most often evaluated with ultrasonography (US), contrast material-enhanced computed tomography (CT), and magnetic resonance (MR) imaging. US may be used to assess the size of the parotid gland, distinguish diffuse from focal disease, assess vascularity and adjacent vascular structures, distinguish cystic from solid lesions, and guide fine-needle aspiration. However, further evaluation with CT or MR imaging may be needed to better define the nature and extent of disease. CT is the imaging modality of choice for most pediatric parotid disease (including acute inflammation, abscess, calculi, and major salivary duct obstruction) and most solid masses and may obviate sedation. However, a mass associated with facial nerve symptoms should be evaluated with MR imaging because it is the only modality that can consistently demonstrate the facial nerve. Findings at US, CT, and MR imaging allow localization of parotid lesions and may suggest a specific cause. Clinical information, familiarity with normal parotid anatomy at various stages of its development, and knowledge of the imaging characteristics of parotid and periparotid lesions are essential for appropriate radiologic evaluation. This information can be used to guide therapy and plan a surgical approach.

Factors in the pathogenesis of tumors of the sphenoid and maxillary sinuses: a comparative study

OBJECTIVES/HYPOTHESIS

To explain the processes that lead to the development of tumors in the maxillary and sphenoid sinuses.

STUDY DESIGN

A 32-year review of the world's literature on neoplasms of these two sinuses and a randomized case-controlled study comparing the normal mucosal architecture of the maxillary to the sphenoid sinus.

METHODS

Analysis of a 32-year world literature review reporting series of cases of maxillary and sphenoid sinus tumors. Tumors were classified by histological type and separated into subgroups if an individual incidence rate was reported. Histomorphometry of normal maxillary and sphenoid sinus mucosa was performed in 14 randomly selected patients (10 sphenoid and 4 maxillary specimens). Specimens were fixed in 10% formalin, embedded in paraffin, and stained with periodic acid-Schiff (PAS) and hematoxylin. Histomorphometric analysis was performed with a Zeiss Axioscope light microscope (Carl Zeiss Inc., Thornwood, NY) mounted with a Hamamatsu (Hamamatsu Photonics, Tokyo, Japan) color-chilled 3 charge coupled device digital camera. The images were captured on a 17-inch Sony (Sony Corp., Tokyo, Japan) multiscan monitor and analyzed with a Samba 4000 Image Analysis Program (Samba Corp., Los Angeles, CA). Five random areas were selected from strips of epithelium removed from each sinus, and goblet and basal cell measurements were made at magnifications x 100 and x 400.

RESULTS

The literature review revealed that the number and variety of tumors in the maxillary sinus are much greater than those in the sphenoid. The incidence of metastatic lesions to each sinus is approximately equal. No recognized pattern of spread from any particular organ system could be determined. On histomorphometric study there were no statistically significant differences between the sinuses in the concentration of goblet cells, basal cells, or seromucinous glands.

CONCLUSIONS

Factors involved in the pathogenesis of tumors of the maxillary and sphenoid sinuses include differences in nasal physiology, embryology, morphology, and topography. There are no significant histological differences in the epithelium and submucous glands between the two sinuses to explain the dissimilar formation of neoplasms.