Nasal endotracheal intubation under fibreoptic endoscopic control in difficult oral intubation, two pediatric cases of submandibular abscess

Securing an airway in children with trismus is challenging and dangerous. Sound clinical judgment is critical for timing and for selecting the method for airway intervention. We present two pediatric cases of Submandibular abscess with difficult oral intubation who underwent incision and drainage. Large facial [jaw] swelling, trismus-limited mouth opening, edema, protruding teeth, and altered airway anatomy makes airway management more difficult. Chances of rupture of abscess intraorally and aspiration under General Anesthesia [GA] is a major threat. Loss of airway under muscle relaxation, difficult to ventilate, difficult to intubate and unwillingness for awake intubation in the pediatric age group makes these cases most challenging. On the basis of our experience, both cases were successfully intubated in anaesthetized, spontaneously breathing children with visual-guided fibreoptic intubation

Review of indications for sialography and report of an unusual case of warthons' duct

The aim of this article was to present an unusual sialographic finding in a case of submandibular gland in which the trifurcation of warthon's duct acted somehow similar to the obstruction factors. A 36 years old male was referred to Shiraz Dental School with the symptom of obstruction of the right submandibular duct. After systemic and clinical evaluation and radiographic examination, sialography was performed. It was revealed that the trifurcation of proximal part of deep [horizontal] segment of warthon's duct was the cause of obstruction. The interesting point in this case was the absence of gland swelling and pain during meal time which in other cases it occurs due to the usual obstructive factors such as sialolithiasis [calcified or non calcified], stricture, mucocele or salivary cyst. To our knowledge and based on the literature review, this is the first reported case of warthon's duct showing this type of anatomic feature which was detected by sialography

Congenital imperforate submandibular duct in a newborn.

Varried conditions such as ranula, epidermal/dermal inclusion cyst, lymphatic cyst, thyroglossal cyst, sialolithiasis, branchial cleft cyst are known to produce swelling in the floor of mouth. Rarely imperforate or duplication anomaly of submandiblar duct may produce cystic lesion in the floor of mouth. We present a case of congenital imperforate submandibular duct with cyst formation in a newborn. We also review the literature regarding management.

Sialolitíase em glândula submandibular: relato de caso clínico / Sialolithiasis in the submandibular gland: a clinical report

Os sialolitos são formações calcificadas que ocorrem no parênquima das glândulas salivares ou em seus ductos. Dentre as glândulas salivares, as submandibulares são as mais acometidas, e isso se deve, em 80 por cento dos casos, à anatomia da glândula e de seu ducto, sendo que a presença do sialolito é mais comum no ducto. Os sialolitos maiores do que 15mm são considerados raros e poucos casos foram descritos. Essas mineralizações necessitam de remoção cirúrgica, muitas vezes por via extrabucal, sob anestesia geral. Foram relatados casos da coexistência de sialolitíase e patologias malignas; por isso, um diagnóstico precose é de extrema importância bem como a proservação, por um longo período. Este estudo apresenta um caso de sialolito maior que 15mm, supostamente situado no parênquima da glândula submandibular e que foi removido cirurgicamente por via intrabucal.

Estudio histomorfológico al microscopio fotónico y al microscopio electrónico de barrido de las glándulas submaxilares de ratón, hipertrofiadas experimentalmente / Histomorphologic studies at photonic microscopy and the electron microscopy of sweeping of the submaxillary glandular of the mouse, experimental hypertrophia

Se estudio la hipertrofia de las glándulas submaxilares (G.Sm) de ratón, provocada por amputación incisal como factor mecánico en los dientes incisivos inferiores, con el microscopio fotónico (MF) y con el microscopio electrónico de barrido (MEB). Se utilizaron veinte ratones albinos, adultos, jóvenes, manchos y hembras. Se encontró que el factor mecánico ocasiona modificaciones importantes en el parénquima glandular tales como: hipertrofia de los acinos y transformación de las células de los conductos intercalares en células acinosas excreto-secretoras. Los cambios observados con el MEB, indican que en las hembras experimentales la hipertrofia es mayor debido al elevado número de acinos y a la transformación de los conductos intercalares; en los machos también se logra a expensas de las mismas estructuras, pero es menos marcada, debido a la presencia de numerosos conductos granulares y escasos acinos

Ultrasonido en las masas cervicales altas / Ultrasound in high cervical masses

La localización superficial de las masas en la región cervical alta las hace con facilidad accesibles a la exploración mediante equipos de ultrasonido. Con ello podemos caracterizar la textura de la masa. Conocer sus dimensiones e inclusive guiar la punción biopsia para estudio histopatológico. Los patrones ecográficos resultan bastante confiables para sospechar el diagnóstico. Así las masas benignas se comportan como lesiones quísticas, de bordes nítidos, con algunos ecos finos internos de acuerdo al tipo específico de tumor. Las masas malignas son lesiones ecogénicas, con ecos irregulares en su interior y márgenes difusos. Se menciona la experiencia con 35 enfermos, entre los culaes se incluyen glándulas salivales, ganglios cervicales, quistes tiroglosos y una tumoración irregular, probable histiocitoma o neurofibroma.