Escisión de Glándula Submandibular por Sialoadenitis Crónica Esclerosante Asociada a Sialolito en el Conducto Submandibular / Submandibular Gland Excision Due to Chronic Sclerosing Sialadenitis Associated With Sialolith in Submandibular Duct

La sialoadenitis crónica esclerosante puede extenderse desde una sialoadenitis focal hasta una cirrosis completa de la glándula. Aparece entre los 40 y 70 años de edad y afecta principalmente a la glándula submandibular. Se asocia con sialolitos y agentes infecciosos inespecíficos. La causa más frecuente de sialolitiasis es la formación de cálculos macroscópicamente visibles en una glándula salival o en su conducto excretor, de los cuales el 80 % al 90 % provienen de la glándula submandibular. Esta predilección probablemente se deba a que su conducto excretor es más largo, más ancho y tiene un ángulo casi vertical contra la gravedad, contribuyendo así a la estasis salival. Además, la secreción semimucosa de la misma es más viscosa. El sitio principal de ubicación de los litos en el conducto submandibular es la región hiliar con un 57 %. La sintomatología típica de la sialolitiasis es el cólico con tumefacción de la glándula y los dolores posprandiales. Reportamos el caso de un paciente masculino de 55 años, quien ingresa al servicio de Cirugía Oral y Maxilofacial del Hospital General Balbuena de la Ciudad de México por presentar un aumento de volumen en la región submandibular izquierda de consistencia dura y dolorosa a la palpación de 15 días de evolución, acompañada de aumento de temperatura en la zona compatible con un absceso. Los estudios de imagen reportan un sialolito en la región hiliar del conducto submandibular de 2,0 x 1,7 x 1,0 cm. Debido a su localización y tamaño, el tratamiento ideal en estos casos es la escisión de la glándula junto con el lito previo drenaje del absceso e inicio de terapia antibiótica doble.

Chronic sclerosing sialadenitis can range from focal sialadenitis to complete cirrhosis of the gland. It appears between 40 and 70 years of age and mainly affects the submandibular gland. It is associated with sialoliths and nonspecific infectious agents. The most common cause of sialolithiasis is the formation of macroscopically visible stones in a salivary gland or its excretory duct, of which 80 % to 90 % come from the submandibular gland. This predilection isprobably due to the fact that their excretory duct is longer, wider and has an almost vertical angle against gravity, thus contributing to salivary stasis. In addition, the semimucous secretion of it is more viscous. The main location of the stones in the submandibular duct is the hilar region with 57 %. The typical symptomatology of sialolithiasis is colic with swelling of the gland and postprandial pain. We report the case of a 55-year-old male patient, who was admitted to the Oral and Maxillofacial Surgery Service of the Hospital General Balbuena in Mexico City due to an increase in volumen in the left submandibular region that was hard and painful on palpation of 15 days of evolution, accompanied by increased temperature in the area compatible with an abscess. Imaging studies report a 2.0 x 1.7 x 1.0 cm sialolith in the submandibular duct hilar region. Due to its location and size, the ideal treatment in these cases is excision of the gland together with the stone previous drainage of the abscess and initiation of dual antibiotic therapy.

Tuberculosis pulmonar y lingual. Presentación de un caso / A Case Report of Pulmonary and Lingual Tuberculosis

Objetivo: presentar un caso raro de tuberculosis (TB) lingual secundaria, el cual constituye el primero reportado en el hospital y en la provincia en 50 años. Caso clínico: paciente masculino de 69 años de edad con antecedentes de dos hospitalizaciones por neumonía bacteriana adquirida en la comunidad, que es ingresado debido a que desde hace 3 semanas presenta fiebre, tos seca irritativa y síntomas constitucionales acompañados de lesiones nodulares de 0,5-1 cm en el dorso de la lengua y aftas dolorosas en la base de la misma, especialmente a la palpación, que le impedían alimentarse. El estudio BAAR del esputo reporta codificación 9 en 2 oportunidades; la prueba de tuberculina, los exámenes radiológicos y la histología confirman el diagnóstico. Se aplica terapéutica antituberculosa y a los 2 meses se aprecia desaparición de los nódulos, manteniéndose asintomático en el seguimiento en consulta externa. Conclusiones: la TB de la lengua es un hallazgo infrecuente que debe ser incluido en el diagnóstico diferencial de las patologías de la cavidad oral. Este caso demuestra la importancia de mantener la alerta sobre esta entidad en la práctica médica y odontológica.

Objective: The objective of this study is to present a rare case of secondary lingual tuberculosis (TB). This was the first reported occurrence of this disease in the hospital and in the province in 50 years. Case report: A 69 year old male patient who had been hospitalized twice because of bacterial pneumonia acquired in the community was admitted to the hospital. For three weeks prior to admission the patient had suffered fever, dry irritating coughing, constitutional symptoms, 0.5 to 1.0 cm nodular lesions on the dorsum of the tongue, and canker sores at the base of the tongue. As a result the patient had been unable to eat. Two acid fast bacilli (AFB) smears both showed a rating of 9. Tuberculosis testing, x-rays and histology confirmed the diagnosis. Tuberculosis treatment was begun. After two months the nodules disappeared. The patient remained asymptomatic and continues to be monitored on an outpatient basis. Conclusions: TB of the tongue is a rare finding that should be included in the differential diagnosis of diseases of the oral cavity. This case demonstrates the importance of continued vigilance of this entity in medical and dental practice.

Primary mucosal tuberculosis of head and neck region: a clinicopathologic analysis of 47 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features, histologic diagnosis and differential diagnosis of primary mucosal tuberculosis (TB) in the head and neck region.</p><p><b>METHODS</b>Forty-seven cases of primary mucosal TB of the head and neck region were studied by hematoxylin-eosin and Ziehl-Neelsen stains. The clinical and pathologic features were analyzed with review of the literature.</p><p><b>RESULTS</b>The patients included 26 male and 21 female, with mean age 47.1 years (range 14-84 years). There were three sinonasal TB, 19 nasopharyngeal TB, two oropharyngeal TB, 18 laryngeal TB, four middle ear TB, one salivary gland TB and one laryngeal TB complicating laryngeal cancer. The initial symptoms were nasal obstruction, mucopurulent rhinorrhea, epistaxis, snoring, hoarseness, dysphagia, odynophagia, serous otitis, hearing loss, tinnitus, and otalgia. Physical examination result was variable, from an apparently normal mucosa, to an evident mass, or a mucosa with an adenotic or swollen appearance, ulcers, leukoplakic areas, and various combinations thereof. CT and MRI findings included diffuse thickening, a soft-tissue mass, calcification within the mass and bone destruction resembling malignancy. Histologic examination showed granulomas with a central necrotic focus surrounded by epithelioid histiocytes and multinucleated Langhan's giant cells. Acid-fast bacilli were difficult to demonstrate but found in 13/45 cases. Follow-up data were available in 42 patients.</p><p><b>CONCLUSIONS</b>Primary TB arising in the head and neck mucosa is rare. It may mimic or co-exist with other conditions. The characteristic histopathology is a granuloma with central caseous necrosis and Langhans'giant cells. Identification of acid-fast bacilli and bacteriologic culture confirm the diagnosis of mycobacterial disease.</p>

Disguised ulcer of lip and buccal mucosa – rare clinicalmanifestation as tuberculosis: a case report / Úlcera de mucosa labial e bucal – uma rara manifestação clínica detuberculose: relato de caso clínico

Introduction: Oral tuberculosis is a chronic granulomatous disease caused by Mycobacterium tuberculosis. According to the World Health Organization (WHO), nearly 2 billion people are infected with tuberculosis. Objective: To report a rare case of oral tuberculosis with ulcers at two different sites. Materials and methods: In order to emphasize the need to consider tuberculosis in the differential diagnosis of non-healing ulcers of oral cavity and the role of oral physician in preventing the spread of such lesions, this article presents a case of oral ulcers at two different sites, diagnosed as tuberculosis ulcer. Results: Oral cavity, which is considered to be a mirror of systemic health, rarely manifests tuberculosis. With increasing number of tuberculosis cases and unusual form of the disease in the oral cavity, the cases are likely to be misdiagnosed. Conclusion: An oral clinician should have a thorough knowledge of tuberculosis and its oral manifestations.

Introdução: A tuberculose oral é uma doença granulomatosa crônica causada pelo Mycobacterium tuberculosis. Segundo a Organização Mundial da Saúde (OMS), cerca de 2 bilhões de pessoas estão infectadas com tuberculose. Objetivo: Relatar um caso raro de tuberculose oral com úlceras em dois locais diferentes. Materiais e métodos: Para realçar a necessidade de considerar a tuberculose sob o diagnóstico diferencial das úlceras não curadas da cavidade oral e o papel do dentista na prevenção da propagação de tais lesões, este artigo apresenta um caso de úlceras orais em dois locais diferentes, diagnosticados como úlcera de tuberculose. Resultados: A cavidade oral, considerada como um espelho da saúde sistêmica, raramente manifesta a tuberculose. Com um número cada vez maior de casos de tuberculose e a forma não usual da doença na cavidade oral, os casos são frequentemente diagnosticados erroneamente. Conclusão: O dentista clínico geral deve ter um conhecimento profundo da tuberculose e de suas manifestações orais.

Tuberculosis oral asociada al HIV: presentación de un caso clínico / HIV-related oral tuberculosis: report of a clinical case

La tuberculosis (TBC) es una enfermedad infecciosa causada principalmente por una bacteria, el Micobacterium tuberculosis. La estrecha vinculación entre TBC y VIH oermite hablar de una coepidemia dual. La localización oral de la TBC extrapulmon es rara, tanto en pacientes inmunocompetentes como VIH+. Las manifestaciones clínicas son inespecíficas, pudiendo presentarse como úlceras, fisuras, nódulos, granulomas o tumores. La falta de especificidad de las lesiones dificulta el diagnóstico. En este artículo se presenta un caso clínico de un paciente con TBC extrapulomonar en la cavidad oral asociado a HIV, atendido en el Servicio de Odontología del H.I.G.A. Gral. San Martín de la ciudad de La Plata.

Rol del odontólogo ante el avance de la tuberculosis / The dentist´s role to the advance of tuberculosis

El presente trabajo pretende concientizar a la comunidad odontológica sobre el aumento de la incidencia de tuberculosis (TB) en las últimas décadas, asociado al VIH/SIDA, a las migraciones y al desarrollo de cepas bacterianas resistentes a los fármacos que se emplean habitualmente para su tratamiento. En la actualidad, es un problema de salud en el mundo, que se ve incrementado en los países en desarrollo. El agente causal es el Mycobacterium tuberculosis que puede involucrar distintas localizaciones, aunque la mayoría es TB pulmonar. La TB bucal es poco frecuente y típicamente sigue a la TB pulmonar. La profesión odontológica desempeña unpel importante en su identificación y control, tanto por el reconocimiento temprano de las lesiones bucales primarias, como de aquellos que pueden ayudar a descubrir casos activos de TB pulmonar. Los odontólogos pueden ser los primeros profesionales de la salud en detectar a un paciente enfermo. La odontología es una profesión con elevado riesgo ocupacional, que debe respetar las normas de bioseguridad durante la atención de pacientes a fin de minimizar los riesgos de contagio.

A Case of Oral Tuberculosis Confirmed by Histopathology / 결핵및호흡기질환

Although tuberculosis is a chronic infectious disease that can occur in any section of the body, oral tuberculosis is rare. Here, we report a case of oral tuberculosis in which the patient sought treatment for a painful oral lesion. A histopathologic examination revealed the characteristics of tuberculosis and pulmonary lesions were detected on subsequent examination. The patient was treated with antituberculosis therapy, and his symptoms improved. This case emphasizes the importance of including oral tuberculosis as part of the differential diagnosis for mucosal lesions.

Primary tuberculosis of tonsil and posterior oropharyngeal wall.

Pharyngeal tuberculosis is rare and usually occurs in association with primary pulmonary disease. Primary tuberculosis involving the palatine tonsils and the posterior oropharyngeal wall is still a rare clinical entity. We report one such case of primary tuberculosis involving both the palatine tonsils and the posterior oropharyngeal wall in a 22 year-old male. The patient responded to anti-tubercular treatment with complete disappearance of lesion and no sign of recurrence on one year follow-up. The final diagnosis was based upon histopathological report.

Tuberculosis of oral cavity.

Tuberculous involvement of oral cavity is very rare. A 34-year-old male presented with non-healing ulcer at upper lip mucosa. Biopsy from ulcer revealed tuberculous lesion. He also had asymptomatic pulmonary tuberculosis diagnosed during work up for primary site of the disease.

[Tuberculosis of the upper aerodigestive tract]

Tuberculosis of upper aerodigestive tract is rare. Was to report our experience in the diagnosis and the management of this disease with a review of the literature. We carried a retrospective study between 1990 and 2005, about 10 cases. Diagnosis of tuberculosis was confirmed by histopathological examination. All patients were treated with antituberculous chemotherapy. Follow-up was based on clinical, biological and endoscopic examinations with a mean duration of 24 months. Mean age was 29 years. Nine patients were male. Clinical examination and panendoscopy showed nasal, pharyngeal and laryngeal lesions respectively in 1, 6 and 3 cases. Sputum examinations were negative in all cases. After confirming diagnosis by biopsy and anatomopathological examination, all patients received antituberculous treatment for 8 to 9 months. Nine patients were followed regularly. They had all recovered from their symptoms, and lesions had completely disappeared. Tuberculosis of upper aerodigestive tract must be suspected in front of unusual evolution of any nasal or laryngo-pharyngeal symptom. Early and well-conduced medical treatment achieves a good outcome

Primary isolated gingival tuberculosis

Tuberculosis of the oral cavity is a rare event and when present is usually secondary to pulmonary tuberculosis. We present a case of a 33-year-old male patient who presented with symptoms of gingivitis. Local examination revealed multiple ulcers and a few nodules over the gingiva. A nodule biopsy was consistent with the diagnosis of gingival tuberculosis. The patient had no evidence of tuberculosis any where else in the body. Medical treatment was curative. As this condition is very rare, it is often over looked as it is never thought as a common clinical diagnosis. A biopsy is mandatory to establish diagnosis. The relevant literature is reviewed.

Tuberculous ulcer of tongue with oral complications of oral antituberculosis therapy.

Tuberculosis (TB) is an infectious disease affecting humans of all ages in all parts of the world. The dentist plays an important role in the identification and control of this condition by early recognition of oral lesions that may precede the detection of the pulmonary form. Occurrence of increased incidence of mycobacterial infections as a part of the spectrum of AIDS only emphasizes the importance of early diagnosis. A case of a tuberculous ulcer on the tongue along with oral ulcerations, which occurred as a consequence of oral antituberculosis therapy (ATT), is presented. Such complications have rarely been reported in the literature and the management of these is described herein. The tuberculous ulcer healed uneventfully in five weeks after institution of ATT and the other ATT-induced ulcers healed after a week of topical anesthetic application. The clinical presentations, differential diagnoses to be considered, and management of such oral manifestations is discussed. The occupational risk posed by TB to the dentist and appropriate precautions to be observed have been highlighted.

Primary oral tuberculosis: report of two cases.

Oral lesions of tuberculosis though uncommon, are seen in both the primary and secondary stages of the disease. In secondary tuberculosis, the oral manifestations may be accompanied by lesions in the lungs, lymph nodes, or in any other part of the body and can be detected by a systemic examination. Primary oral tuberculosis may present as a diagnostic challenge for the clinician. Here we report two patients with primary tuberculosis in the oral cavity who presented to the dental department, were diagnosed and referred for medical management.

Oral tuberculosis : a case report.

Tuberculosis can affect any part of the body and oral cavity remains no exception. The oral lesions of tuberculosis, though not common, are seen in various forms. The purpose of this article is to emphasize the importance of early diagnosis of primary tuberculosis of the mouth, which may be misdiagnosed when the oral lesions are the sole manifestation of the disease.

Tuberculosis of the parotid gland.

Tuberculosis of the parotid gland is a rare entity. Only about a hundred cases have been reported till date, mostly from parotidectomy specimens. The present case was diagnosed by fine needle aspiration and treated successfully by short-course antitubercular chemotherapy. An early diagnosis can avoid parotidectomy, which can be a hazardous procedure in a medically treatable condition.

Primary tuberculosis of soft palate.

Primary tuberculosis of upper respiratory tract including oral cavity is a rare disease. One such unusual case is reported.