Defeito ósseo de Stafne uma depressão lingual na mandíbula: revisão da literatura / Stafne's bone defect a lingual depression in the jaw: literature review

O defeito ósseo de Stafne foi considerado por muito tempo como um cisto ósseo por se apresentar radiograficamente de forma radiolúcida, circunscrita, com bordas delimitadas e em quase todos os casos unilateral. Hoje em dia já se sabe que é uma depressão e/ou cavidade óssea causada pelo alojamento da glândula submandibular ou parte dela e/ou seus tecidos adjacentes na região posterior da mandíbula, ou na região anterior em casos mais raros pelo alojamento da glândula sublingual. Sendo assim, o objetivo deste trabalho é realizar uma breve revisão da literatura acerca das características mais frequentes e suas variações desta anomalia anatômica. As buscas foram realizas em periódicos de artigos científicos publicado nas bases de dados eletrônicas: PubMed, Scielo e Google Acadêmico, contendo artigos científicos dos últimos dez anos nos idiomas inglês e português. Os dados mostram que o defeito ósseo de stafne tem predileção pelo sexo masculino, é assintomática, pois se trata de uma alteração anatômica, não requer tratamento, portanto cabe ao cirurgião dentista ter conhecimento, uma vez que este é encontrado de forma ocasional em radiografias panorâmicas para investigação de outras circunstancias, e que muitas vezes acaba levando o profissional odontólogo a realizar diagnósticos errôneos ou exames mutiladores como a biopsia que são desnecessários nesta situação pelo fato desta variação anatômica ter características muitos semelhantes aos cistos.

Stafne's bone defect was considered for a long time as a bone cyst because it presents radiographically in a radiolucent, circumscribed form, with delimited borders and, in almost all cases, unilateral. Nowadays it is known that it is a depression and / or bone cavity caused by the accommodation of the submandibular gland or part of it and / or its adjacent tissues in the posterior region of the mandible, or in the anterior region in rarer cases by the accommodation of the sublingual gland. Therefore, the objective of this work is to carry out a brief literature review of the more specific characteristics and their variations of this anatomical anomaly. Searches were performed in journals of scientific articles published in electronic databases: PubMed, Scielo and Academic Google, containing scientific articles from the last ten years in English and Portuguese. The data show that the stafne bone defect has a predilection for males, it is asymptomatic, as it is an anatomical alteration, does not require treatment, therefore it is up to the dental surgeon to be aware, once panoramic to investigate other circumstances, and that many Sometimes it ends up leading the dental professional to perform misdiagnosis or mutilating tests such as a biopsy, which are unnecessary in this situation because this anatomical variation has characteristics that are very similar to cysts.

Safety of drainless excision of the submandibular gland / Segurança na excisão da glândula submandibular sem o uso de drenos

Abstract Introduction: Percutaneous drains can be associated with several complications, including infection, fistula formation, discomfort and prolonged hospitalization. Objective: The aim of this study was to evaluate the safety of submandibular gland excision without the use of surgical drains. Methods: We analyzed the surgery time, postoperative complications such as bleeding, facial palsy, seroma, and repeat exploration of wounds and duration of the hospital stay. Excision of the submandibular gland via a transcervical approach was undertaken by two surgeons. Prior to wound closure, the skin flap and wound bed were approximated using hemostatic fibrin glue (Greenplast-Q PFS KIT®, GC Greencross, Youngin, Korea). Neither saline irrigation nor insertion of a percutaneous drain were included. Results: A total of 23 patients underwent submandibular gland excision. The study group consisted of 14 men (60.8%) and 9 women (39.2%) (mean age, 47.6 years; range, 24-70 years). There were two patients who had minor complications. One patient showed minor bleeding on the skin incision line immediately postoperatively, and one developed a seroma at 7 days postoperatively. There were no major surgical complications. Total duration of the surgery from skin incision to closure averaged 44.86 minutes. Mean duration of the hospital stay was 3.17 days. Patients were discharged on average at 1.17 days after surgery. Conclusion: The submandibular gland can be safely excised without the use of a surgical drain, therefore allowing early patient discharge.

Resumo Introdução: Os drenos percutâneos apresentam várias complicações associadas, inclusive infecção, formação de fístulas, desconforto e permanência hospitalar prolongada. Objetivo: Avaliar a segurança da excisão da glândula submandibular sem o uso de drenos cirúrgicos. Método: Analisamos o tempo de cirurgia, as complicações pós-operatórias tais como sangramento, paralisia facial, seroma e necessidade de reexploração de ferida operatória, e a duração da internação hospitalar. A excisão da glândula submandibular por via transcervical foi realizada por dois cirurgiões. Antes do fechamento da incisão, o retalho cutâneo e o leito da ferida operatória foram aproximados utilizando cola hemostática de fibrina (Greenplast-Q PFS KIT®, GC Greencross, Youngin, República da Coréia). Não houve irrigação salina nem uso de dreno percutâneo. Resultados: Foram submetidos 23 pacientes à excisão da glândula submandibular. O grupo de estudo consistiu em 14 homens (60,8%) e 9 mulheres (39,2%) (média de 47,6 anos; variação de 24 a 70). Dois pacientes apresentaram complicações menores. Um paciente apresentou pequeno sangramento na incisão da pele no pós-operatório imediato e um deles teve seroma aos 7 dias de pós-operatório. Não houve complicações cirúrgicas importantes. A duração total da cirurgia, desde a incisão na pele até o fechamento, foi de 44,86 minutos. A duração média da internação hospitalar foi de 3,17 dias. Os pacientes receberam alta em média 1,17 dia após a cirurgia. Conclusão: A glândula submandibular pode ser excisada com segurança sem o uso de dreno cirúrgico, permitindo que o paciente tenha alta hospitalar mais precocemente.

Sialoadenitis por sialolito inusual de la glándula submaxilar derecha en un adulto / Sialadenitis due to uncommon sialolith of the right submaxillary gland in an adult patient

Se presenta el caso clínico de un paciente de 45 años de edad, atendido en el Departamento de Cirugía Maxilofacial del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres por presentar molestias en el suelo de la boca con 3 años de evolución. Después de un estudio minucioso se comprobó que se trataba de una sialoadenitis por sialolitiasis de la glándula submaxilar derecha. Se realizó sialolectomía canalicular intrabucal. El cálculo extraído tenía forma cónica, más ancho en su porción posterior, de 3,8 cm de largo y 4,2 cm de circunferencia externa, color amarillo-verdoso y consistencia dura friable

The case report of a 45 years patient was presented. He was assisted in the Maxillofacial Surgery Department of Saturnino Lora Torres Clinical Surgical Provincial Hospital in Santiago de Cuba due to discomfort in the floor of the mouth with a course of 3 years. After a detailed study it was confirmed that it was a sialadenitis due to sialolithiasis of the right submaxillary gland. An intraoral canalicular sialolectomy was carried out. The stone removed had a conic form, wider in its posterior portion, 3.8 cm long and 4.2 cm in the external circumference, yellow-green color and friable hard consistency

Robot-assisted submandibular gland excision via modified facelift incision / 대한악안면성형재건외과학회지

BACKGROUND: The conventional transcervical resection for submandibular gland disease has some risks and an unsatisfactory cosmetic result. Recently, robot-assisted surgery has been developed as a plausible substitute for conventional surgery which provides an excellent cosmetic outcome. CASE PRESENTATION: The authors performed robot-assisted sialadenectomy via modified facelift incision using the da Vinci Xi surgical system (Intuitive Surgical Inc., CA, USA) with two endowrist arms (monopolar curved scissors and Maryland bipolar forceps) successfully in a 44-year-old female patient who suffered from sialolith and severe atrophic submandibular gland. CONCLUSIONS: If similar studies are done in the future, this robot-assisted sialadenectomy may become established as an alternative to existing disadvantageous surgical methods.

Submandibular gland excision / Ressecção da glândula submandibular

OBJECTIVE: To analyze the value of fine needle aspiration and the rates of postoperative complications in patients undergoing resection of the submandibular gland. METHODS: we analyzed the records of patients treated with resection of the gland from January 1995 to December 2008. The data collected included age, gender, findings on clinical history, surgical procedure, results of fine needle aspiration (FNA), pathological diagnosis and complications. RESULTS: 117 patients were studied, aged 12-89 years (mean 48), 70 women and 47 men. Thirty-nine patients (33.3%) were affected by inflammatory diseases (28 patients with lithiasis), 70 had benign tumors, and malignant tumors, eight. Regarding FNA, the sensitivity and specificity were 85.7% and 100%, respectively. Nine patients (7.7%) had temporary paralysis of the marginal mandibular nerve and one had permanent paralysis. CONCLUSION: resection of the submandibular gland is a safe procedure, with low complication rates.

OBJETIVO: Analisar o valor da punção aspirativa por agulha fina e os índices de complicações pós-operatórias em pacientes submetidos à ressecção da glândula submandibular. MÉTODOS: foram analisados os prontuários de pacientes tratados com a ressecção da glândula, de janeiro de 1995 a dezembro de 2008. Os dados coletados foram: idade, sexo, achados na história clínica, procedimento cirúrgico, resultados da punção por aspiração com agulha fina (PAAF), diagnóstico anatomopatológico e complicações. RESULTADOS: foram estudados 117 pacientes, com idade variando de 12 a 89 anos (média, 48 anos), sendo 70 mulheres e 47 homens. Trinta e nove pacientes (33,3%) foram acometidos por doenças inflamatórias (28 pacientes com litíase), 70 tiveram tumores benignos e oito tumores malignos. A respeito da PAAF, a sensibilidade e especificidade foram de 85,7% e 100%, respectivamente. Nove pacientes (7,7%) tiveram paralisia temporária do nervo mandibular marginal e um apresentou paralisia definitiva. CONCLUSÃO: a ressecção da glândula submandibular é um procedimento seguro, com baixa taxa de complicações.

Bone marrow-derived mesenchymal stem cells migrate to healthy and damaged salivary glands following stem cell infusion / 国际口腔科学杂志·英文版

Xerostomia is a severe side effect of radiation therapy in head and neck cancer patients. To date, no satisfactory treatment option has been established. Because mesenchymal stem cells (MSCs) have been identified as a potential treatment modality, we aimed to evaluate stem cell distribution following intravenous and intraglandular injections using a surgical model of salivary gland damage and to analyse the effects of MSC injections on the recruitment of immune cells. The submandibular gland ducts of rats were surgically ligated. Syngeneic adult MSCs were isolated, immortalised by simian virus 40 (SV40) large T antigen and characterized by flow cytometry. MSCs were injected intravenously and intraglandularly. After 1, 3 and 7 days, the organs of interest were analysed for stem cell recruitment. Inflammation was analysed by immunohistochemical staining. We were able to demonstrate that, after intravenous injection, MSCs were recruited to normal and damaged submandibular glands on days 1, 3 and 7. Unexpectedly, stem cells were recruited to ligated and non-ligated glands in a comparable manner. After intraglandular injection of MSCs into ligated glands, the presence of MSCs, leucocytes and macrophages was enhanced, compared to intravenous injection of stem cells. Our data suggest that injected MSCs were retained within the inflamed glands, could become activated and subsequently recruited leucocytes to the sites of tissue damage.

meta-analysis of the efficacy and safety of managing parotid and submandibular sialoliths using sialendoscopy assisted surgery

To review the available techniques and procedures for management of parotid and submandibular sialoliths with special emphasis on the efficacy and safety of the most commonly used combination of techniques; namely, sialendoscopy with conservative surgical removal of the stone. A systematic search of the English literature using MEDLINE, EMBASE, and the Cochrane library databases were conducted at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. Articles between the years 2004 and 2013 were selected on the basis of preset inclusion criteria. Then, they were reviewed against a checklist to assess the evidence of efficacy of therapy or prevention and analyzed for pertinent data. Eleven articles met the inclusion criteria and were reviewed and analyzed. The success rate of sialendoscopy combined with minor surgical removal of parotid and submandibular sialoliths ranges from 69-100%. Sialendoscopy combined with a minor surgical extraction of parotid and submandibular sialoliths is safe and efficacious

Unusual Involvement of IgG4-Related Sclerosing Disease in Lacrimal and Submandibular Glands and Extraocular Muscles

Chronic sclerosing sialadenitis, also known as Kuttner tumor, is a chronic inflammatory disease of the salivary glands that is reported in a few cases in medical literature. Recent reports suggest that certain aspects of sclerosing diseases, including chronic sclerosing sialadenitis or dacryoadenitis, should be classified under immunoglobulin G4 (IgG4)-related sclerosing disease based on immunohistochemical studies. This study reports an unusual case of IgG4-related sclerosing disease appearing simultaneously in the lacrimal glands, submandibular glands, and extraocular muscles. A 56-year-old male presented with complaints of bilateral eyelid swelling and proptosis that began two years ago. Computed tomography confirmed that bilateral submandibular enlargements also existed five years ago in the subject. Orbital computed tomography and magnetic resonance imaging revealed bilateral lacrimal gland enlargement and thickening of extraocular muscles. Typical findings of chronic sclerosing dacryoadenitis were revealed upon pathologic exam of the right lacrimal gland. Immunostaining revealed numerous IgG4-positive plasma cells. Through these clinical features, we make a diagnosis of IgG4-relataed sclerosing disease in the subject.

Preliminary experience with endoscope-assisted transoral excision of the submandibular gland / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the indications, risks and benefits of endoscope-assisted transoral approach to excise the submandibular gland.</p><p><b>METHODS</b>A retrospective review of a series of 12 patients treated by endoscope-assisted transoral submandibular gland excision was carried out. Of the 12 patients, 8 were chronic sialoadenitis (2 cases with sialolith), 3 were pleomorphic adenoma, and 1 was cyst of submandibular gland. Preoperatively, all patients were diagnosed as benign diseases by Ultrasonography, CT or MRI. Pathologic diagnosis of 8 cases were identified by fine needle aspiration cytology (FNAC) or fine needle aspiration biopsy (FNAB).</p><p><b>RESULTS</b>Temporary lingual sensory paresis and temporary limitation of tongue movement were found in two patients. However, these signs soon resolved spontaneously within 1 - 3 months. There were no other complications. Postoperatively, mean satisfaction score with cosmetic results was 10. All patients were satisfied with the cosmetic results. No recurrences were found in patients with pleomorphic adenoma with a follow-up period ranged from 12 months to 48 months (median follow-up period: 36 months).</p><p><b>CONCLUSIONS</b>Endoscope-assisted transoral excision of the submandibular gland is a feasible and safe approach for the benign diseases of the submandibular gland. The major advantages of this approach are no external scar and no injury to the marginal mandibular nerve.</p>

Salivary gland diseases: analysis of patients attended at dow lab Karachi

The aim of this study is to describe demographic characteristic of 103 cases of major and minor salivary glands diagnosed at DDRRL [Dow lab Diagnostic reference and research laboratory] OJHA campus, DUHS Karachi. Observational Study. This study was conducted at Dow University of Health Sciences Ojha Campus, Karachi from January 2009 to April 2011. Salivary gland diseases are uncommon and include diseases which affect both major and minor salivary gland. They consist of a group of heterogeneous lesions with complex clinicopathological characteristics and distinct biologic behavior. Epidemiological data of these diseases in the various parts of the world can be helpful for a better understanding of its biology and clinical characteristics. Clinical and histopathological data of all patients with salivary gland diseases are retrospectively analyzed and described. In this study, 103 cases of salivary gland diseases be analyzed, out of all cases 31 were infections, 50 were benign neoplasms, and 22 were malignant neoplasms. Majority of the cases occurred in parotid gland followed by submandibular and minor salivary glands. Infections are common between the ages between 10-35 years and peak incidence in 30 years. Benign tumors are common between 20-25 years and 40-50 years and with a peak incidence in 40 years. Tumor affected more commonly the adult patients with peak incidence between 35065 years and peak incidence in 50 years with slight predominance in females. Pleomorphic adenoma is the most frequent finding followed by sialadenitis and squamous cell carcinoma. patients with salivary gland diseases were mainly adults with marginally more female patients. Most commonly found infections are sialadenitis involving sub mandibular gland in majority of cases. Benign tumors are more frequent then malignant ones. Pleomorphic adenoma is the commonest benign tumor and squamous cell carcinoma is the commonest malignant neoplasm. Both benign and malignant tumors involve parotid gland commonly

A comparison between endoscopic-assisted submandibular gland resection via retroauricular hairline incision and conventional submandibular gland resection / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the feasibility, the risks and the advantages of endoscope-assisted submandibular gland resection using a retroauricular hairline incision (RAHI) by comparing it with the conventional submandibular gland resection.</p><p><b>METHODS</b>Twenty eight patients with benign lesions of the submandibular gland were included in the prospective clinically controlled study. Thirteen patients had endoscope-assisted resection using the RAHI approach and 15 cases had conventional transcervical approach resection. The size, location and adjacency of all lesions were evaluated by CT or MRI before surgery. The pathologic diagnoses of all cases were identified as benign diseases using fine needle aspiration biopsy. The two groups were compared for incision length, operation time, bleeding, incision cosmetic result, and complications.</p><p><b>RESULTS</b>All 28 operations were successfully performed. Incision length in the endoscopic group was significantly longer than that in the transcervical group (Z = -4.516, P < 0.01), and the surgical time was longer in the endoscopic group (Z = -3.263, P < 0.01). After three months the mean subjective satisfaction score for the incision scar in the endoscopic group was significantly higher than that in the transcervical group (Z = -4.472, P < 0.01). In the endoscopic group, 2 cases (15.4%) with temporary numbness of the earlobe and 1 case (7.7%) with a temporary marginal mandibular nerve paralysis were found postoperatively. However, they recovered within 1 month. All 28 patients were disease free with a follow-up of 10 to 24 months (median of 18 months).</p><p><b>CONCLUSIONS</b>Endoscope-assisted submandibular gland resection via RAHI is feasible and safe for the treatment of benign submandibular gland lesions. In comparison with the transcervical approach, this method can provide better cosmetic results without significant complications.</p>

unusual large submandibular gland calculus: a case report

Salivary gland stones [Sialothiasis] most commonly occur in the Submandibular duct. This report describes the case of a patient who had an unusual large Submandibular gland sialolith [calculus] that was completely obstructing the Submandibular gland duct and the use of the computed tomography [CT] as a diagnostic aid and a surgical guide. Patients with sialolithiasis require definitive surgical treatment in most cases, which results in an excellent prognosis

Submandibular mass excision in an Asian population: a 10-year review

<p><b>OBJECTIVES</b>The objectives of this study were to compare the prevalence of submandibular gland neoplasia in an Asian population with a Western population and to evaluate the accuracy of fi ne needle aspiration cytology (FNAC) and computed tomography (CT) scan in the study of submandibular gland pathologies.</p><p><b>MATERIALS AND METHODS</b>We conducted a 10-year retrospective review of 101 submandibular mass excisions. Data on the demographic profi le of patients, clinical features, correlation of fi ne needle aspiration cytology, CT scans and histology and morbidities related to surgery were collected.</p><p><b>RESULTS</b>The prevalence of submandibular gland neoplasia was 27.1%. Most (78.9%) of these were benign. FNAC and CT scans were accurate for benign neoplasia. However, the accuracy of FNAC and CT scans for sialadenitis without sialolithiasis was low.</p><p><b>CONCLUSION</b>The prevalence of submandibular gland malignancy was lower in the Asian population. FNAC and CT scans were accurate for benign neoplasia of the submandibular gland.</p>

Sialography: Report of 3 cases.

Salivary gland examination is an important part of oral examination, especially because of it's involvement in most of the systemic diseases. Patients most commonly seek medical attention when the major salivary glands like parotid and submandibular gland become enlarged or painful. The various imaging modalities practiced to check the salivary gland disorders include conventional radiography, sialography, ultrasonography, computerized tomography, radionuclide imaging and magnetic resonance imaging. Sialography is one of the oldest imaging procedures and still most commonly practiced, as it is a chair side procedure, simple to perform, and cost effective. We report the role of sialography as an adjuvant in the diagnosis of bacterial sialadenitis and sialadenosis and as a diagnostic and therapeutic aid in a case of juvenile recurrent parotitis.

Application of 3D FIESTA sequence in magnetic resonance sialography for obstructive salivary diseases / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the value of 3D FIESTA sequence in magnetic resonance sialography (MRS) in the diagnosis of obstructive salivary diseases.</p><p><b>METHODS</b>Eleven patients with obstructive salivary diseases underwent MRS, and three-dimensional (3D) reconstruction and virtual endoscopic images of the salivary gland ducts were obtained after MRS data post-processing for comparison with those of sialoendoscopy.</p><p><b>RESULTS</b>The diagnostic accuracy of MRS was 72.7% for obstructive salivary diseases. The virtual endoscopy provided a visual field highly consistent with that by sialoendoscopy.</p><p><b>CONCLUSION</b>MRS is capable of visualizing the tracts of salivary glands. MR virtual endoscopy can provide sufficient morphological and pathological data for preoperative assessment of salivary operations with sialoendoscopy.</p>

[Septic Thrombophelebitis on intracranial venous sinuses following submadibular abscess, a case report]

Septic intracranial vanous thrombosis is a rare vascular disease of the brain with no specific sign or symptom. While urgent treatment will result in complete recovery, delays may cause permanent complications or even death. The patient was a 23-year-old woman who had suffered visual loss, Hallucination, and confusion two weeks after undergoing submandibular abscess removal surgery. In neurological examinations, she had difficulty speaking, was febrile [T: 38.5] and showed signs of meningeal irritations. Bilateral pupil edema and sixth nerve palsy were also observed. MRI and MRV showed cerebral venous thrombosis with right occipital lobe infraction. The patient went under treatment with antibiotics. The symptoms improved gradually. Septic intracranial thrombosis may lead to death, when diagnosis and treatment is delayed. Therefore detection of predisposing factors that cause development of infection to cerebral venous sinuses such as facial infection and cervical abscesses is considered vital. It is important that appropriate antibiotic is administered before removal of such abscesses

Endoscopic management of sialolithiasis (a practical experience in 52 cases) / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the value of endoscopy in the diagnosis and treatment of sialolithiasis.</p><p><b>METHODS</b>Diagnostic and interventional sialoendoscopic procedures were performed in 52 patients with sialolithiasis (43 submandibular glands and 9 parotid glands).</p><p><b>RESULTS</b>Of the 34 sialoliths in the anterior and/or posterior part of the Wharton's duct, 24 were removed with basket retrieval; 2 removed with open surgery and basket retrieval, and 8 removed with open surgery under the guidance of endoscopy. Eight sialoliths in the hilum of the Wharton's duct were treated with open surgery. Of the 9 stone cases in the Stensen's duct, 3 was removed with basket retrieval, 3 was removed after opening-up of the ostium, 1 was treated with basket capturing and open surgery. The obstructive symptoms were improved in these cases during 1-24 months' follow-up.</p><p><b>CONCLUSIONS</b>Sialoendoscopy is a minimal invasive and efficacious technique for the diagnosis and treatment of sialolithiasis.</p>

Sialoadenite esclerosante crônica (tumor de Kuttner): relato de caso clínico / Chronic sclerosing sialadenitis (Kuttner tumour): clinical case report

A sialoadenite esclerosante (tumor de Kuttner) representa um processo inflamatório crônico incomum de glândula salivar, que acomete com maior freqüência a glândula submandibular. O objetivo deste trabalho é relatar o caso clínico de um paciente que apresentou sialoadenite esclerosante crônica associada a quadro de sialolitíase. Essa entidade patológica é pouco freqüente, clinicamente pode ser confundida com uma neoplasia e, embora seja resolvida com a exérese da lesão, causa transtornos importantes ao paciente, como dor intensa, disfonia e disfagia.

Chronic sclerosing sialadenitis (Kuttner tumour) is an unusual chronic inflammatory process of the salivary gland that affects principally the submandibular gland. The aim of this work is to report a case of chronic sclerosing sialadenits associated with sialolithiasis. Kuttner tumour is an uncommon entity that clinically may not be distinguished from neoplasia and though it can be resolved by surgical excision of the lesion, it causes important upset for the patient, as intense pain, dysphonia and dysphagia.