Complicações pós-operatórias relacionadas a ressecção do ameloblastoma / Postoperative complications related to ameloblastoma / Complicaciones postoperatorias relacionadas con la resección de ameloblastoma

A ressecção é o tratamento de escolha para tratamento do ameloblastoma, este que é o tumor odontogênico mais comuns, excluindo os odontomas. A desregulação de diversos genes no desenvolvimento de dentes pode desempenhar papel em sua histogênese. Alguns eventos adversos podem ocorrer durante seu tratamento pós-operatório. Recidivas ocorrem porque o ameloblastoma tende a se infiltrar entre o trabeculado ósseo esponjoso intacto na periferia do tumor antes que a reabsorção óssea se torne radiograficamente evidente. Consequentemente, a margem real do tumor sempre se estende além da sua imagem radiográfica ou da margem clínica. Deiscência de sutura é uma complicação que pode ocorrer no pós-operatório imediato na qual as bordas da ferida, que estão unidas por uma sutura, acabam se abrindo, aumentando o risco de infecção e dificultando assim a cicatrização. Fratura de placa de reconstrução é um evento possível de ocorrer em tratamentos de grandes defeitos. O estresse causado pela modelagem da placa durante a conformação da placa, além da ação muscular são uns dos fatores que pode fragilizar o metal da placa. Outras complicações podem ocorrer como: assimetrias, parestesia temporária e permanente do nervo alveolar inferior e deficiência estética e funcional. As descrições destes eventos na literatura ajudam aos clínicos conhecer e tentá-lo preveni-lo e com saber tratar... (AU)

Resection is the treatment of choice for treating ameloblastoma, which is the most common odontogenic tumor, excluding odontomas. The dysregulation of several genes in the development of teeth may play a role in their histogenesis. Some adverse events may occur during your postoperative treatment. Relapses occur because ameloblastoma tends to infiltrate between intact cancellous bone trabeculae at the pe riphery of the tumor before bone resorption becomes radiographi cally evident. Consequently, the actual tumor margin always extends beyond its radiographic image or clinical margin. Suture dehiscence is a complication that can occur in the immediate postoperative period in which the edges of the wound, which are joined by a suture, end up opening, increasing the risk of infection and thus hindering healing. Reconstruction plate fracture is a possible event to occur in large de fect treatments. The stress caused by the modeling of the plate during the formation of the plate, in addition to muscle action, are one of the factors that can weaken the plate metal. Other complications may occur, such as: asymmetries, temporary and permanent paresthesia of the inferior alveolar nerve and aesthetic and functional deficiency. The descriptions of these events in the literature help clinicians to Resection is the treatment of choice for treating ameloblastoma, which is the most common odontogenic tumor, excluding odontomas. The dysregulation of several genes in the development of teeth may play a role in their histogenesis. Some adverse events may occur during your postoperative treatment. Relapses occur because ameloblastoma tends to infiltrate between intact cancellous bone trabeculae at the pe riphery of the tumor before bone resorption becomes radiographi cally evident. Consequently, the actual tumor margin always extends beyond its radiographic image or clinical margin. Suture dehiscence is a complication that can occur in the immediate postoperative period in which the edges of the wound, which are joined by a suture, end up opening, increasing the risk of infection and thus hindering healing. Reconstruction plate fracture is a possible event to occur in large de fect treatments. The stress caused by the modeling of the plate during the formation of the plate, in addition to muscle action, are one of the factors that can weaken the plate metal. Other complications may occur, such as: asymmetries, temporary and permanent paresthesia of the inferior alveolar nerve and aesthetic and functional deficiency. The descriptions of these events in the literature help clinicians to know and try to prevent them and to know how to treat them... (AU)

La resección es el tratamiento de elección para tratar el ameloblastoma, que es el tumor odontogénico más común, excluyendo los odontomas. La desregulación de varios genes en el desarrollo de los dientes puede desempeñar un papel en su histogénesis. Algunos eventos adversos pueden ocurrir durante su tratamiento postoperatorio. Las recaídas ocurren porque el ameloblastoma tiende a infiltrarse entre las trabéculas del hueso esponjoso intacto en la periferia del tumor antes de que la reabsorción ósea sea evidente en las radiografías. En consecuencia, el margen tumoral real siempre se extiende más allá de su imagen radiográfica o margen clínico. La dehiscencia de sutura es una complicación que puede ocurrir en el postoperatorio inmediato en el que los bordes de la herida, que están unidos por una sutura, acaban abriéndose, aumentando el riesgo de infección y dificultando así la cicatrización. La fractura de la placa de reconstrucción es un evento posible que ocurre en los tratamientos de defectos grandes. Los esfuerzos que provoca el modelado de la placa durante la conformación de la placa, además de la acción muscular, son uno de los factores que pueden debilitar la placa metálica. Pueden presentarse otras complicaciones como: asimetrías, parestesias temporales y permanentes del nervio alveolar inferior y deficiencia estética y funcional. Las descripciones de estos eventos en la literatura ayudan a los clínicos a conocerlo y tratar de prevenirlo y saber cómo tratarlo... (AU)

Surgical Treatment of Sublingual Gland Ranulas

Abstract Introduction Ranulas are divided into oral (OR) and plunging (PR) and comprise the most common pathology of the sublingual gland. This study presents a case series of patients operated due to OR and PR within different type of modalities in a 1-year period. Objective The aim of this study is to determine the optimal surgical treatment of ranulas based on our results as well as in the literature review. Methods The medical charts of 7 patients with sublingual gland ranulas treated in 2020 were reviewed. Results The median age of the patients was 19. Three patients with OR were treated by marsupialization, micromarsupialization, and sublingual gland excision. Four patients with PR were operated via cervical approach in three cases and intraoral approach in one case. No recurrence was observed in 14 months of follow-up, on average. Conclusion Micromarsupialization should be consider as the primary treatment for OR. In case of recurrent OR and primary or recurrent PR, the best results might be obtained by radical excision of the sublingual gland, which can be performed without resection of the ranula sac with the intraoral approach.

Surgical Management of Ranula- Floor of Mouth by Marsupialization: A Case Series.

Introduction: The extravasation of saliva from the sublingual gland on the floor of the mouth results in a ranula. The most typical presenta?on is swelling under the tongue. The mylohyoid muscle may allow it to herniate, Causing a plunging ranula. Ranula can be treated in many ways, including ranula excision alone, excision of the sublingual gland with or without ranula, aspira?on of cys?c fluid, sclerotherapy, marsupializa?on, incision and drainage. Material and methods: This case study includes six pa?ents with ranula who underwent surgical treatment by marsupializa?on. The indica?ons, age and sex distribu?on, Marsupializa?on methods, pathology reports, recurrence rates, and complica?ons were seen. Results: Out of 6 pa?ents in our case series, no one pa?ent has shown to be any recurrence or complica?ons of marsupializa?on. Conclusions: Management of Ranula by Marsupializa?on is a good op?on, but if it recurs a?er marsupializa?on, Excision of the lesion and the affected gland is the best course of act?on.

Ránula cervical gigante: a propósito de un caso

La ránula es una lesión pseudoquística causada por la retención de contenido salival de la glándula sublingual en el tejido conjuntivo subyacente, siendo la patología más frecuente de esta glándula. Su localización es a nivel del suelo de la boca, pudiendo en ocasiones extenderse a través del músculo milohioideo hacia la región submaxilar o cervical (ránula plunging o cervical), presentándose clínicamente como una tumoración laterocervical de crecimiento lento. El apoyo de imágenes mediante ecografía, tomografía computarizada, o RM (resonancia magnética) es fundamental para un correcto diagnóstico. Respecto al tratamiento, el procedimiento más aceptado y con menos tasas de recurrencia es la escisión de la ránula cervical por abordaje laterocervical, asociada a la extirpación de la glándula sublingual implicada vía transoral. Aquí presentamos el caso clínico de un varón de 25 años quien presenta una masa laterocervical derecha de seis meses de evolución de crecimiento progresivo e indoloro. La ecografía y RM confirman una ránula cervical gigante de 62x45x101 mm, que se localiza en espacio submandibular derecho, alcanzando el espacio parafaríngeo en su vertiente más craneal. Debido a las características de la lesión y su anatomía se decide tratamiento quirúrgico.

The ranula is a pseudocystic lesion caused by the retention of salivary content of the sublingual gland in the underlying connective tissue, being the most frequent pathology of this gland. Its location is at the level of the floor of the mouth and can sometimes extend through the mylohyoid muscle towards the submaxillary or cervical region (plunging or cervical ranula), clinically presenting as a slow-growing laterocervical tumor. The support of images by ultrasound, computed tTomography or MRI (magnetic resonance imaging) is essential for a correct diagnosis. Regarding treatment, the most accepted procedure, and with the lowest recurrence rates is excision of the cervical ranula by the laterocervical approach, associated with the transoral removal of the involved sublingual gland. Here, we present the clinical case of a 25-year-old man who presented a six-month-old right laterocervical mass of progressive and painless growth. Ultrasound and MRI confirmed a giant cervical ranula measuring approximately 62x45x101 mm, located in the right submandibular space, reaching the parapharyngeal space in its most cranial aspect. Due to the characteristics of the injury and its anatomy, surgical treatment was decided.

Rânula mergulhante em paciente pediátrico de 5 anos de idade: relato de caso / Diving ranula in 5-year-Old pediatric patient: case report / Hundimiento de ranula en paciente pediátrico de 5 años: reporte de caso

Introdução: Rânula é um fenômeno de extravasamento de muco, também chamado cisto de retenção de muco, que ocorre especificamente no soalho bucal. A origem da mucina extravasada é usualmente da glândula sublingual, podendo, porém, se originar do ducto da glândula submandibular ou, ainda, das glândulas salivares menores presentes no soalho de boca. Rânulas de dimensões maiores usualmente originam se do corpo da glândula sublingual. Relato de caso: Este trabalho descreve um caso em uma criança de 5 anos de idade com uma rânula em região lateral esquerda de língua, e discutir questões sobre o tratamento desta patologia. Considerações finais: Há várias formas de tratamento, sendo as mais usadas a marsupialização, concomitante ou não com a excisão cirúrgica da lesão e da glândula salivar envolvida... (AU)

Introduction: Ranula is a phenomenon of mucus leakage, also called mucus retention cyst, which occurs specifically in the mouth floor. The origin of the extravasated mucin is usually from the sublingual gland, but it can originate from the duct of the submandibular gland or even from the minor salivary glands it presents on the floor of the mouth. Larger sized ranulas usually arise from the body of the sublingual gland. Case report: This work is a case in a 5-year-old child with a ranula in the left tongue region, and discuss about the treatment of this pathology. Final considerations: There are several forms of treatment, the most used being marsupialization, concomitant or not with a surgical excision of the lesion and the involved salivary gland... (AU)

Introducción: Ránula es un fenómeno de fuga de moco, también llamado quiste de retención de moco, que ocurre específicamente en el piso de la boca. El origen de la mucina extravasada suele ser de la glándula sublingual, pero puede originarse en el conducto de la glándula submandibular o incluso en las glándulas salivales menores presentes en el suelo de la boca. Las ranulas de mayor tamaño generalmente surgen del cuerpo de la glándula sublingual. Reporte de caso: Este artículo describe un caso en un niño de 5 años con una ránula en la región lateral izquierda de la lengua y analiza cuestiones sobre el tratamiento de esta patología. Consideraciones finales: Existen varias formas de tratamiento, siendo las más utilizadas la marsupialización, concomitante o no con la exéresis quirúrgica de la lesión y de la glándula salival afectada... (AU)

Prognostic factors and overall survival in a 15-year followup of patients with malignant salivary gland tumors: a retrospective analysis of 193 patients / Fatores prognósticos e sobrevida global em um seguimento de 15 anos de pacientes com tumores malignos da glândula salivar: uma análise retrospectiva de 193 pacientes

Abstract Introduction Malignant tumors of the salivary glands are uncommon pathological entities, representing less than 5% of head and neck neoplasms. The prognosis of patients with malignant tumors of the salivary glands is highly variable and certain clinical factors can significantly influence overall survival. Objective To analyze the clinicopathologic and sociodemographic characteristics that influence survival in patients with malignant tumors of the salivary glands Methods This retrospective study analyzed sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, margin status, treatment type, marital status, method of health care access and 15-year overall survival in 193 patients with malignant tumors of the salivary glands. The X², log-rank Mantel-Cox, multinomial regression and Cox logistic regression tests were used (SPSS 20.0,p < 0.05). Results The most common histological types were adenocarcinoma (32.1%), adenoid cystic carcinoma (31.1%) and mucoepidermoid carcinoma (18.7%). The 15-year overall survival rate was 67.4%, with a mean of 116 ± 6 months. The univariate analysis revealed that male sex (p = 0.026), age > 50 years (p = 0.001), referral origin from the public health system (p = 0.011), T stage (p = 0.007), M stage (p < 0.001), clinical stage (p < 0.001), compromised surgical margins (p = 0.013), and chemotherapy (p < 0.001) were associated with a poor prognosis. Multivariate analyses also showed that age > 50 years was independently associated with a poor prognosis (p = 0.016). The level of education was the only factor more prevalent in older patients (p = 0.011). Conclusion Patients with malignant tumors of the salivary glands older than 50 years have a worse prognosis and an independent association with a low education level.

Resumo Introdução Os tumores malignos das glândulas salivares são entidades patológicas incomuns, representam menos de 5% das neoplasias de cabeça e pescoço. O prognóstico dos pacientes com tumores malignos das glândulas salivares é altamente variável e alguns fatores clínicos podem influenciar significativamente a sobrevida global. Objetivo Analisar as características clinicopatológicas e sociodemográficas que influenciam a sobrevida em pacientes com tumores malignos das glândulas salivares. Método Este estudo retrospectivo analisou sexo, idade, etnia, nível de escolaridade, localização do tumor, tamanho do tumor, envolvimento linfonodal, metástase distante, margens, tipo de tratamento, estado civil, método de acesso à assistência médica e sobrevida global em 15 anos de 193 pacientes com tumores malignos das glândulas salivares. Foram usados os testes X2, log-rank Mantel-Cox, regressão multinomial e regressão logística de Cox (SPSS 20.0, p < 0,05). Resultados Os tipos histológicos mais comuns foram adenocarcinoma (32,1%), carcinoma adenoide cístico (31,1%) e carcinoma mucoepidermoide (18,7%). A taxa de sobrevida global em 15 anos foi de 67,4%, com média de 116 ± 6 meses. A análise univariada revelou que sexo masculino (p = 0,026), idade > 50 anos (p = 0,001), origem de referência do sistema público de saúde (p = 0,011), estádio T (p = 0,007), estádio M (p < 0,001)), estágio clínico (p < 0,001), margens cirúrgicas comprometidas (p = 0,013) e quimioterapia (p < 0,001) foram associados a um prognóstico ruim. As análises multivariadas também mostraram que a idade > 50 anos foi associada independentemente a um prognóstico ruim (p = 0,016). O nível de escolaridade foi o único fator mais prevalente em pacientes idosos (p = 0,011). Conclusão Pacientes com tumores malignos das glândulas salivares acima de 50 anos apresentam pior prognóstico e associação independente com baixo nível de escolaridade.

Case report of the management of the ranula

Ranula is a mucocele caused by extravasation of the sublingual gland on the floor of the mouth. The most common presentation is a cystic mass in the floor of the mouth. A portion of the sublingual gland could herniate through the mylohyoid muscle, and its extravasated mucin can spread along this hiatus into submandibular and submental spaces and cause cervical swelling. This phenomenon is called plunging ranula. A variety of treatments for ranula has been suggested and include aspiration of cystic fluid, sclerotherapy, marsupialization, incision and drainage, ranula excision only, and excision of the sublingual gland with or without ranula. Those various treatments have shown diverse results. Most surgeons agree that removal of the sublingual gland is necessary in oral and plunging ranula. Four patients with ranula were investigated retrospectively, and treatment methods based on literature review were attempted.

Does Cimicifuga racemosa have the effects like estrogen on the sublingual gland in ovariectomized rats?

BACKGROUND: Cimicifuga racemosa is one of the herbs used for the treatment of climacteric syndrome, and it has been cited as an alternative therapy to estrogen. Apart from hectic fevers, dyspareunia and so on, dry mouth also increase significantly after menopause. It has not yet been reported whether C. racemosa has any impact on the sublingual gland, which may relate to dry mouth. In an attempt to determine this, we have compared the effects of estrogen and C. racemosa on the sublingual gland of ovariectomized rats. RESULTS: HE staining showed that the acinar cell area had contracted and that the intercellular spaces were broadened in the OVX (ovariectomized rats) group, while treatment with estradiol (E2) and iCR (isopropanolic extract of C. racemosa) improved these lesions. Transmission electron microscopy showed that rough endoplasmic reticulum expansion in mucous and serous acinar epithelial cells and apoptotic cells was more commonly seen in the OVX group than in the SHAM (sham-operated rats) group. Mitochondria and plasma membrane infolding lesions in the striated ducts were also observed. These lesions were alleviated by both treatments. It is of note that, in the OVX + iCR group, the volume of mitochondria in the striated duct was larger than in other groups. Immunohistochemical staining showed that the ratio of caspase-3 positive cells was significantly increased in the acinar cells of the OVX group compared with the SHAM group (p < 0.05); and the MA (mean absorbance) of caspase-3 in the striated ducts also increased (p < 0.05). Estradiol decreased the ratio of caspase-3 positive cells and the MA of caspase-3 in striated ducts significantly (p < 0.05). ICR also reduced the ratio of caspase-3 positive cells and the MA in the striated ducts (p < 0.05), but the reduction of the MA in striated ducts was inferior to that of the OVX + E2 group (p < 0.05). CONCLUSION: Both estradiol and iCR can inhibit subcellular structural damage, and down-regulate the expression of caspase-3 caused by ovariectomy, but their effects were not identical, suggesting that both drugs confer a protective effect on the sublingual gland of ovariectomized rats, but that the specific location and mechanism of action producing these effects were different.

Significance of Sublingual Gland Excision in Surgical Treatment of Ranula / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ranulas, pseudo cysts found on the floor of mouth, develop from the retention or extravasation of saliva from the sublingual gland. The main treatment of ranula is surgical excision but the extent of surgery is controversial. The aim of this study was to evaluate the significance of sublingual gland excision in the surgical treatment of ranula. SUBJECTS AND METHOD: We retrospectively reviewed 112 patients with ranula who had undergone surgical excision from January 2004 to April 2016. Those who underwent any previous treatment such as sclerotherapy, marsupialization, or excision of cyst were excluded in the study. Surgical outcomes including complications and recurrence were compared between the group that went through simple cyst excision and the group that went through cyst and sublingual gland excision. RESULTS: Of 112 patients, 94 were simple ranula and 18 were plunging ranula. Thirty-seven (33%) were male and 75 (67%) were female. Of the 94 simple ranula patients, 23 underwent excision of cyst only; the remaining 71 patients and all other patients with plunging ranula underwent excision of cyst and sublingual gland together. The recurrence rate was significantly lower for the cyst and sublingual gland excision group than for the simple cyst excision group (2.2% vs. 17.4%, p=0.004). The complication rate did not differ between the two groups (4.3% vs. 1.1%, p=0.298). CONCLUSION: The excision of sublingual glands as well as cysts is an important option to reduce recurrence in the surgical treatment of ranula.

A Large Superficial Dissecting Sublingual Ranula Crossing the Midline: Our Experience.

Ranula is a cystic lesion arising in the oral cavity in relation to the sublingual gland. Typically ranulas are unilateral although there has been a report of superficial dissecting ranula crossing the midline thus presenting as a bilateral lesion. This article is about our experience with a similar large right sided sublingual ranula crossing the midline in a 17 year old female who underwent a complete excision of the lesion along with removal of ipsilateral sublingual gland which is the accepted treatment at present.

Pathophysiology and Management of the Ranula / 대한이비인후과학회지

Ranulas are pseudocysts on the floor of the mouth resulting from the retention or extravasation of saliva from the sublingual gland (SLG). The etiology of ranulas is unknown, but they have been associated with local trauma or previous surgery. The anatomic variation of the ductal system of the SLG such as Bartholin's duct might be a possible cause of ranulas. Treatment modalities range from conservative to various surgical techniques, including sclerotherapy, marsupialization, excision of the ranulas with or without excision of the SLG and botox injection. Recently, less invasive treatment modality such as micro-marsupialization has been introduced. It was able to easily and safely treat the ranulas. But it also has the possibility of recurrence, especially in cases having anatomic variation of the ductal system of the SLG. A definitive and reliable treatment choice is surgical resection of the SLG with or without marsupialization than other, more conservative treatments.

A Case of Mucosa-Associated Lymphoid Tissue Lymphoma in Sublingual Glands without Autoimmune Disease / 대한이비인후과학회지

Mucosa-associated lymphoid tissue (MALT) lymphomas are low-grade extranodal B-cell lymphomas that may involve various sites in the head and neck including the thyroid, salivary, and lacrimal glands. In particular, primary salivary gland MALT lymphoma is rare, with sublingual gland tumors especially rarer and frequently malignant. In Korea, there has been no reported case of MALT lymphoma in sublingual glands. Here we report a case of a MALT lymphoma in the sublingual gland.

Neurilemmoma in the floor of the mouth: a case report

Neurilemmomas are well-encapsulated, benign, slow-growing tumors originating from Schwann cells of the nerve sheath surrounding cranial, peripheral, or autonomic nerves. Intraoral neurilemmomas are relatively rare and have a wide variety of morphologic and radiologic features. This makes differential diagnosis difficult, and only histopathological features can lead to a definitive neurilemmoma diagnosis. In this report, we present the case of a 30-year-old woman whose chief complaint was a solitary, nodular mass on the right floor of the mouth. After computed tomography and magnetic resonance imaging, we performed an incisional biopsy that showed the typical characteristics of a neurilemmoma. The mass was removed completely through an intraoral surgical approach. Despite losing a portion of the lingual nerve, the patient did not complain of any specific discomfort. Wound healing was uneventful and there were no signs or symptoms of recurrence.

Cryosurgery for the treatment of pediatric plunging ranula: a conservative management / Criocirurgia para tratamento de rânula mergulhante em criança: uma abordagem conservadora

Several methods of treatment for plunging ranulas have been described in the literature, such as: surgical treatment including the excision of the sublingual gland followed by transoral drainage of the pluging ranula, needle aspiration, excision of the ranula, cryosurgery and CO(2) laser excision. Marsupialization and micro-marsupialisation can be also recommended primarily to treat oral ranulas. The aim of this paper is to present the treatment of pediatric ranula with liquid nitrogen cryosurgery performed in a 8 year, 6-month-old male, without local anesthesia. We have outlined the current protocol of cryosurgery recommended in the management of ranulas, both clinical advantages and disadvantages, with emphasis on the clinical outcomes and also pediatric patients' safety. At the 1year follow-up visit, the lesion had disappeared completely. There was no recurrent lesion. Liquid nitrogen cryosurgery for management of ranulas may become a primary treatment modality prior to surgery in children.

Muitas modalidades de tratamento têm sido propostas para o tratamento da rânula mergulhante, dentre elas: tratamento cirúrgico incluindo a excisão da glândula sublingual seguida da drenagem transoral da rânula mergulhante, aspiração, e criocirurgia e excisão com laser de CO2. Além dessas modalidades, a marsupialização e micro-marsupialização também podem ser recomendadas para o tratamento de rânulas intraorais. O objetivo deste trabalho será apresentar um caso clínico de rânula mergulhante em um paciente infantil de 8 anos e 6 meses de idade. A lesão foi tratada por meio do uso da criocirurgia, realizada com nitrogênio líquido e sem a aplicação de anestesia local. Serão destacados o protocolo de utilização, vantagens e desvantagens, resultados alcançados e a segurança para o paciente durante o tratamento. Após um ano de acompanhamento, observou-se que a lesão desapareceu completamente e não houve recidiva. Pode-se concluir que o uso da crioterapia com nitrogênio líquido pode ser o tratamento de escolha em relação à cirurgia convencional em pacientes pediátricos.

Localization of cannabinoid receptor 1 (CB1) in submandibular and sublingual salivary glands of mice throughout postnatal development / Localización de los receptores cannabinoides 1 (CB1) en glándulas salivales submandibulares y sublinguales de ratones durante el desarrollo postnatal

In view of the fact that human marijuana users often show dry mouth symptom, the present study was attempted to examine the localization of CB1, which was originally identified in brain, in the submandibular and sublingual salivary glands of postnatal developing male mice by immunohistochemistry. In submandibular gland, CB1-immunoreactivity was positive in a majority of acinar cells in forms of granular appearance in their apical cytoplasm, while it was negative in the ducts at newborn stage. The immunoreactivity decreased in the acinar cells at P1W and no immunoreactivity was detected in the acinar cells at P3W and thereafter. The immunoreactivity was positive in ductal cells at P3W and it remained positive thereafter until P8W stage. The immunoreaction was distinct on the apical plasmalemma of the intercalated ductal cells, while it was distinct on the basal plasmalemma of the granular convoluted ductal cells. The enhanced immunostaining on the lateral plasmalemma of the granular ductal cells was discerned only on P6W. In sublingual gland, CB1-immunoreactivity was detected in the demilune acinar cells and ductal cells only on P4W. Furthermore, CB1-immunoreactivity was shown to occur in the salivary ganglionic neurons, suggesting the CB1-inhibitory action in the saliva secretion through the parasympathetic nervous transmission.

En vista de que los usuarios humanos de la marihuana a menudo presentan síntomas de sequedad oral, en el presente estudio se intentó examinar la localización de CB1, que se identificó originalmente en el cerebro, en las glándulas salivales submandibulares y sublinguales durante el desarrollo postnatal en ratones machos. En la glándula submandibular, la inmunoreactividad CB1 fue positiva en la mayoría de las células acinares de apariencia granular en su citoplasma apical, mientras que fue negativa en los conductos en la etapa de recién nacidos. La inmunorreactividad disminuyó en las células acinares en P1W y no se detectó inmunoreactividad en las células acinares en P3W. La inmunoreactividad fue positiva en las células ductales en P3W y se mantuvo positiva hasta la etapa P8W. La inmunorreacción se observó en el plasmalema apical de las células ductales intercaladas, mientras que fue distinta en el plasmalema basal de las células ductales contorneadas granulares. La inmunotinción mejorada en el plasmalema lateral de las células ductales granulares fue distingible sólo en P6W. En la glándula sublingual, se detectó inmunoreactividad CB1 en las células acinares y se observaron células ductales solamente en P4W. Además, se demostró que la inmunoreactividad CB1 se produce en las neuronas ganglionares salivales, lo que sugiere la acción CB1 inhibitoria en la secreción de saliva a través de la transmisión parasimpática nerviosa.

Rânula Mergulhante Recidivante: relato de caso / Recurrent Plunging Ranula: case report

Rânula é uma patologia não hereditária, indolor, caracterizada por formação de uma bolsa preenchida geralmente por líquido mucinoide, frequentemente resultante de trauma ou obstrução da glândula associada. Geralmente, essas lesões são facilmente identificáveis a partir de um exame clínico minucioso, apesar de existirem outras entidades clínicas com aspectos semelhantes. A variante mergulhante disseca o músculo milohióideo, podendo causar tumefação na região cervical correspondente. Existem várias formas de tratamento, sendo as mais usadas a marsupialização concomitante ou não à excisão cirúrgica da lesão e da glândula salivar envolvida. A proposta deste relato de caso é mostrar ao colega cirurgião-dentista uma visão de plano de tratamento para esse tipo de alteração e as prováveis condutas de acordo com a apresentação e mudanças que, porventura, podem ocorrer, além da importância da proservação e acompanhamentos posteriores a partir de uma experiência do nosso serviço... (AU)

Ranula is a non-hereditary disease, painless, characterized by forming a generally liquid-filled mucina, often resulting from trauma or obstruction associated gland. Generally, these lesions are easily identifiable from a thorough clinical examination, although there are others clinical entities with similar aspects. The variant plunging mylohioideo dissects the muscle, causing swelling in the neck accordingly. There are several forms of treatment, of which the most used are the marsupialization or without concomitant surgical excision of the lesion and the salivary gland involved. The purpose of this case report is to show the dentist colleague of vision treatment plan for this type of change and the likely behavior according to the presentation and changes that may occur, and the importance of proactive observation and subsequent follow from experience of our service... (AU)

Phenotype and cell proliferation activity of duct-like structures in human sublingual glands: a histological and immunohistochemical study

There are several age-related microscopic changes in the salivary glands, including the increase in the number of duct-like structures (DLS). However, the true origin and the phenotype of the DLS are not known. Objective To evaluate the phenotype and the cell proliferation index of the DLS of human sublingual glands. Material and Methods Sixty sublingual glands obtained from human cadavers were divided into two groups - 0-30 and 61-90 years old. The phenotype was estimated by immunostaining for cytokeratin 19 (CK 19) and the S-100 protein as well as by the presence of mucin and glycogen. The cell proliferation index was determined by the Ki-67 antibody. The histochemical techniques used periodic acid-Schiff (PAS) and Alcian Blue. In each captured microscopic field, the DLS were counted to establish a percentage for the staining profile. The statistical analysis was accomplished using Student's t-test, the Mann-Whitney test and Pearson's correlation coefficient (p<0.05). Results Comparing both groups, only CK 19 showed a statistically significant difference (p=0.033), with the strongest expression in the elderly group. There was no significant difference between PAS and Alcian Blue (p=0.270). In both groups, the immunostaining for CK 19 was stronger than that for S-100 (p=0.004;p<0.001), but there was no correlation between the two immunomarkers (ρ=-0.163; p=0.315). There was no immunostaining for Ki-67. Conclusions DLS demonstrate a ductal phenotypic profile and do not present cell proliferation activity. DLS may represent a regressive process arising from acini or represent the result of metaplasia. .

A Case of Acinic Cell Carcinoma Associated with Ranula in Sublingual Gland / 대한이비인후과학회지

Acinic cell carcinoma (ACC) is a low-grade malignancy of salivary gland that constitutes approximately 17% of primary salivary gland malignancies. ACC predominantly occurs in the parotid gland. The higher incidence in the parotid gland seems to be related with the serous acinar cells of the glands, while the sublingual gland is a mixed gland, predominantly mucinous. Therefore, ACCs which originated in the sublingual gland are very rare and till now only 8 cases have been reported in the literature. Recently, we experienced a case of ACC which was found incidentally in the surgical specimen of a ranula arising in the sublingual gland. The finding of this case suggests that the early pathological diagnosis is needed to clarify the reasons for the recurrence of a ranula.

Study of dose distribution of sublingual gland carcinoma treating with 125I radioactive seeds / 中华放射医学与防护杂志

Objective To measure and calculate the dose distribution (tissue absorbed dose) of mouth floor area while using 125I to treat sublingual gland carcinoma.Methods Phantom of head and neck was used to place the 125I radioactive seeds to simulate the sublingual gland carcinoma treatment.125I radioactive seeds of 29.6 and 25.9 MBq per seed were used as two groups,with 31 seeds in each group,and prescribed dose (peripheral matched dose) was 120 Gy.Thermoluminescence dosimetry (TLD) was used to measure the absorbed dose value in the simulated target and adjacent area.Gafchromic Eriochrome Black T (EBT) film was used to draw the dose distribution curve.Results Dose absorbed in the target area,target area center and the adjacent area one centimeter away from target reached 160 Gy,390-500 Gy,and 90-170 Gy,respectively.Dose of the skin ranged from 25 to 81 Gy,dose of mandible ranged from 7.9 to 67 Gy.No radiation cold spot was found.Conclusions 125I seeds could achieve an effective therapeutic dose distribution of the target area for sublingual gland carcinoma.Dose absorbed in the adjacent tissue is under safety limit.The radiation dose at mandible is lower,reducing the possibility of radiation damage to the bone.

Innervation of submandibular and sublingual glands in elderly donated cadavers: a preliminary histological study of differences in nerve morphology between mucous and serous acini / 대한해부학회지

We examined morphological differences between the sublingual and submandibular glands with special reference to their innervation. The sublingual gland contained abundant periodic acid Schiff-positive mucous acini: some lobules were composed of purely mucous acini, while others were purely serous or mixed. However, in the submandibular gland, the area of mucous acini was very limited. Notably, in the sublingual gland, immunohistochemistry for neuron-specific enolase demonstrated that the serous acini carried a higher density of nerve elements than the mucous acini. However, no such difference was evident in the submandibular gland, possibly due to the small areas of the mucous acini. In both types of gland, neuronal nitric oxide synthase-positive parasympathetic nerves as well as tyrosine hydroxylase-positive sympathetic nerves were observed in the interlobular tissue, but we were unable to trace these thin fibers to the acini. Myoepithelial cells expressed smooth muscle actin, but were negative for S100B protein, glial fibrillary acidic protein and neuron-specific enolase. However, antibody against S100A stained some of the myoepithelial cells and ductal cells in the sublingual gland. Cells positive for peripheral myelin protein 22 were seen in some of the ductal cells in the submandibular gland, but not in the sublingual gland. Therefore, with regard to the neurogenic features of the gland cells, S100B reactivity might disappear first in postnatal life, whereas S100A reactivity is likely to remain as aging progresses. The sublingual gland in elderly individuals seems to provide a good model for comparison of the nerve supply between mucous and serous acini.