UNUSAUAL PRESENTATION OF SUBMANDIBULAR DUCT AND GLAND CALCUI: CASE REPORT

Sialolithiasis is one of the most common pathologies of the submandibular gland; sialoliths account for about 80 percent of all salivary duct calculi.The majority of sialolith occurs in the submandibular gland or its duct and is common cause of acute and chronic infection. Salivary stones larger than 15 mm are classified as giant sialoliths. They are uncommon in the practice of otolaryngology, and their management has always been a therapeutic challenge. This report presents the two unusual and rare cases of large sialolith of the submandibular duct as well as gland measuring 70x11mm and 54x25mm respectively.

Botulinum toxin therapy: functional silencing of salivary disorders.

Botulinum toxin (BTX) is a neurotoxic protein produced by Clostridium botulinum, an anaerobic bacterium. BTX therapy is a safe and effective treatment when used for functional silencing of the salivary glands in disorders such as sialoceles and salivary fistulas that may have a post-traumatic or post-operative origin. BTX injections can be considered in sialoceles and salivary fistulas after the failure of or together with conservative treatments (e.g. antibiotics, pressure dressings, or serial aspirations). BTX treatment has a promising role in chronic sialadenitis. BTX therapy is highly successful in the treatment of gustatory sweating (Frey\u2019s syndrome), and could be considered the gold standard treatment for this neurological disorder

Metastasis to parotid gland from non Head and Neck tumors

Most primary tumors spreading metastasis to the parotid gland are usually located in the head and neck region, nonetheless, rarely, parotid gland can also be the target of metastatic localization site of distant primary tumors. The purpose of this study was to describe a clinical series of metastasis to the parotid gland from distant primary tumors (non Head & Neck)

Sialendoscopic management of autoimmune sialadenitis: a review of literature

Autoimmune diseases of major salivary glands include Sjögren's syndrome and a complex of disorders classified as immunoglobulin G4-related diseases. These pathologies are characterised by an autoimmune reaction mediated by T-helper lymphocytes that targets the ducts of exocrine glands in Sjögren's syndrome and glandular parenchyma in immunoglobulin G4-related diseases. Immunoglobulin G4-related diseases represent recently introduced multi-organ diseases that also involve the salivary glands. However, the morbid conditions once known as Mikulicz's disease and Kuttner's tumour were recently considered as two variants of immunoglobulin G4-related diseases affecting the major salivary glands ( immunoglobulin G4-related sialadenitis). This review briefly summarises the pathogenesis and clinical features of autoimmune diseases of the major salivary glands, focusing on the diagnostic and therapeutic role of sialendoscopy

Branchial cleft cysts : a pictorial review

Cystic masses of the neck may represent a wide variety of pathological conditions. Among these, branchial anomalies are the commonest paediatric congenital lesions of the head and neck. This article intends to review this condition under the same headings, as well as facilitate their diagnosis with the help of appropriate radiological findings of patients diagnosed with these anomalies. In order to make an accurate diagnosis, it is imperative to have an idea about the possible differentials, and the normal embryological development of the branchial arches, as well as their anomalies, in the form of sinuses, fistulae, and cysts, with their features and subtypes. The medical history of the patient and clinical manifestations helps in suspecting branchial cleft cysts; confirmatory imaging modalities include computed tomography, magnetic resonance imaging, ultrasonography, and fine-needle aspiration. The mainstay of management is usually by surgical excision. The location, clinical picture, and radiological correlation, along with a strong degree of suspicion for the condition, facilitates the diagnosis of this relatively common embryological anomaly

Outcomes and prognostic factors in parotid gland malignancies: A 10-year single center experience.

Objectives:To describe a 10-year single center experience with parotid gland malignancies and to determine factors affecting outcomes. Study Design:Retrospective review. Methods:The institutional cancer registry was used to identify patients treated surgically for malignancies of the parotid gland between January 2005 and December 2014. Clinical and pathologic data were collected retrospectively from patient charts and analyzed for their association with overall survival (OS) and disease-free survival (DFS). Results:Two hundred patients were identified. Mean age at surgery was 57.8 years, and mean follow-up time was 52 months. One hundred two patients underwent total parotidectomy, while 77 underwent superficial parotidectomy, and 21 underwent deep lobe resection. Seventy patients (35%) required facial nerve (FN) sacrifice. Acinic cell carcinoma was the most common histologic type (22%), followed by mucoepidermoid carcinoma (21.5%) and adenoid cystic carcinoma (12.5%). Twenty-nine patients (14.5%) experienced recurrences, with mean time to recurrence of 23.6 months (range: 1-82 months). Five- and 10-year OS were 81% and 73%, respectively. Five- and 10-year DFS were 80% and 73%, respectively. In univariate analyses, age > 60, histologic type, positive margins, high grade, T-stage, node positivity, perineural invasion, and FN involvement were predictors of OS and DFS. In the multivariate analysis, histology, positive margins, node positivity, and FN involvement were independent predictors of OS and DFS. Conclusions:Our single-center experience of 200 patients suggests that histology, positive margins, node positivity, and FN involvement are independently associated with outcomes in parotid malignancies. Level of Evidence:4

Papillary cystadenoma of the parotid gland: A case report.

BackgroundPapillary cystadenoma is a rare benign epithelial tumor of the salivary gland, which is characterized by papillary structures and oncocytic cells with rich eosinophilic cytoplasm. We found only one case of papillary cystadenoma in nearly 700 cases of salivary gland tumors. Our case was initially mistaken for a tumor of the right temporomandibular joint (TMJ) capsule rather than of parotid gland origin. Preoperative magnetic resonance imaging (MRI) and computed tomography (CT) should be carefully studied, which allows for appropriate preoperative counseling and operative planning.Case summaryHere, we report an unusual case of a 54-year-old woman with a parotid gland papillary cystadenoma (PGPC) that was misdiagnosed as a tumor of the right TMJ capsule. She was initially admitted to our hospital due to a mass anterior to her right ear inadvertently found 5 d ago. Preoperative CT and MRI revealed a well circumscribed tumor that was attached to the right TMJ capsule. The patient underwent a resection through an incision for TMJ, but evaluation of an intraoperative frozen section revealed a benign tumor of the parotid gland. Then we removed part of the parotid gland above the temporal facial trunk. The facial nerve was preserved. Postoperative histopathological findings revealed that the tumor was PGPC. No additional treatment was performed. There was no recurrence during a 20-mo follow-up period.ConclusionThe integrity of the interstitial space around the condyle in MRI or CT should be carefully evaluated for parotid gland or TMJ tumors

Role of Fine Needle Aspiration Cytology in Salivary Gland Pathology and its Histopathological Correlation: A Two Year Prospective Study in Western India.

Background and objectives: Salivary gland lesions account for 2-6.5% of all the neoplasms of the head and neck. Fine needle aspiration cytology (FNAC) is being increasingly used in the diagnosis of salivary gland lesions. The objective of this study was to evaluate the diagnostic accuracy and the sensitivity and specificity of FNAC in various salivary gland lesions in correlation with their histopathology, which helps in the appropriate therapeutic management. Methods: A total of 120 FNACs were done on salivary gland tumours from July 2010 to June 2012 in the Department of Pathology, P.D.U. Government Medical College, Rajkot (Gujarat, India). Formalin fixed (10%), surgically resected specimens were received, they were processed and slides were prepared for histopathological diagnosis. The stained cytological and histopathological slides were studied, analyzed and correlated. Results: The cytomorphological features were studied and analyzed and the following lesions were observed: Pleomorphic adenoma (88), Warthin’s tumour (2), Cystic lesion (4), Mucoepidermoid carcinoma (6), Acinic cell carcinoma (2), Primary lymphoma (2), Carcinoma EX pleomorphic adenoma(4), metastatic malignancy deposits (2), benign parotid tumour (8) and malignant tumour (unspecified)(2). A histopathological correlation was available in 78 cases. Out of these, 71 cases were true positive, 1 was false positive, 2 were false negative and 4 were true negative. Interpretation and conclusion: The overall sensitivity, specificity and the diagnostic accuracy were 97%, 80% and 92% respectively. Hence, the appropriate therapeutic management could be planned earlier. This study documents that FNAC of the salivary gland tumours is accurate, simple, rapid, inexpensive, well tolerated and harmless for the patient

Sialolithiasis. Proposal for a new minimally invasive procedure: piezoelectric surgery

Sialolithiasis is the presence of stones in the ducts of the salivary glands. Most episodes are unique, and 60-80% are located exclusively in the main excretory duct. The main clinical manifestations are swelling and pain typically before, during or after meals that decreases if the obstruction is not complete. The highest prevalence of lithiasis is in the submandibular gland -87%-, whose secretion is more viscous, followed by the parotid gland -10%- and finally the sublingual gland -3%-. The most significant consequences are caused by the prolonged blockage of the duct by a stone, which can produce a persistent ductal dilatation with a swelling that does not subside, and could lead to the complete degeneration of the parenchyma, becoming a hot spot where secondary infections may occur, leading to acute bacterial sialadenitis or glandular abscesses. Treatment options range from a single probing extraction, extraction with sialographic control using the sialoen - doscope, LASER intraductal lithotripsy, lithotripsy extracorporeal shock wave (ESWL), to the surgical techniques combining open duct with endoscopic or glandular removal. We propose, with regard to a case, the use of a simple piezoelectric device which, tunnelling through the glandular channel by the ostium, allows stone fragmentation, wi - thout damaging the surrounding soft tissue. Stone removal by this less invasive method reduces the need for more complex and expensive techniques. The postoperative course without retraction of the ostium, and the regaining of functionality is favourable