RESUMEN
Los mucoceles son lesiones de extravasación salival asociados a la ruptura de los conductos que generalmente se asocian con trauma. Son azuláceos, con aspecto traslúcido, fluctuantes a la palpación, expansivos y de crecimiento rápido. Mayoritariamente se manifiestan en población joven. El sitio más común de localización es la mucosa de labio inferior, sin embargo, pueden presentarse en cualquier zona que contenga glándulas salivales menores, como vientre de lengua, donde se encuentran las glándulas Blandin-Nuhn. La frecuencia de las lesiones asociadas a éstas glándulas es del 2.25% reportándose aproximadamente 400 casos hasta la fecha. La finalidad de ésta publicación es la descripción de una patología infrecuente, así como realizar una revisión a la literatura. Se presenta el caso de una niña de tres años con historia de aumento de volumen congénito en el dorso de la lengua sin síntomas compatibles con mucocele, se realiza biopsia excisional bajo anestesia general. El resultado del estudio histopatológico reporta: fenómeno de extravasación de mucosa. Paciente evoluciona satisfactoriamente. Estas lesiones expansivas pueden repercutir en el desenvolvimiento normal de la vida de las personas causando dislalia, disfagia y disnea. El tratamiento de este tipo de lesiones en la infancia favorece a un adecuado desarrollo del habla y mejora las condiciones de alimentación.
Mucoceles are salivary extravasation lesions associated with rupture of ducts that are generally associated with trauma. They are bluish, translucent in appearance, fluctuating on palpation, expansive and fast growing. They mostly occur in young people. The most common site of location is the mucosa of the lower lip, however, they can occur in any area that contains minor salivary glands, such as the belly of the tongue, where the Blandin-Nuhn glands are located. The frequency of lesions associated with Blandin-Nuhn's glands is 2.25%, with approximately 400 cases reported to date. The purpose of this publication is the description of an uncommon pathology, as well as a review of the literature. The case of a three-year-old female with a history of congenital volume increase at the dorsum of the tongue without symptoms compatible with mucocele is reported, an excisional biopsy was performed under general anesthesia. The result of the histopathological study reports: extravasation mucus phenomenon. Patient evolves satisfactorily. These expansive lesions can affect the normal development of people's lives, causing dyslalia, dysphagia and dyspnea. Treatment of this type of injuries in childhood favors adequate speech development and improves feeding conditions.
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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.
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Humanos , Masculino , Persona de Mediana Edad , Sialadenitis/diagnóstico por imagen , Glándula Submandibular/cirugía , Tuberculosis Bucal/diagnóstico por imagen , Sialadenitis/tratamiento farmacológico , Tuberculosis Bucal/tratamiento farmacológico , Ceftriaxona/uso terapéutico , Clindamicina/uso terapéutico , Tomografía Computarizada por Rayos X/métodos , Drenaje , Antibacterianos/uso terapéuticoRESUMEN
Some situations can lead to obstruction of Wharton's duct. Obstructions are usually due to endogenous causes, such as calculi, fibromucinous plugs, stenosis, and malformations of the duct system; however, in rare situations, obstructions can also have exogenous causes, such as foreign bodies. The tortuous anatomy of Wharton's duct hinders the retrograde migration of straight-shaped foreign bodies, as well as makes their spontaneous discharge virtually impossible. Here, we report the case of a 47-year-old woman with an asymptomatic foreign body in Wharton's duct that was spontaneously discharged.
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Introducción. La sialoendoscopia es un procedimiento cuya finalidad es visualizar los conductos salivales. Se utiliza como método diagnóstico y terapéutico de procesos inflamatorios, estenosis de los conductos y procesos obstructivos. Métodos. Describir los procedimientos realizados para el tratamiento de pacientes con patología inflamatoria y obstructiva de las glándulas salivales, de forma única con sialoendoscopia o con abordajes mixtos. Resultados. Un total de 24 pacientes fueron incluidos en el estudio, con edad promedio de 42 años, en su mayoría mujeres y compromiso submaxilar en 58,3 % y de parótida en 41,7 %. Respecto a la intervención, al 29,2 % de los sujetos se le realizó extracción de cálculos, al 29,2 % sialoplastia, al 25 % dilatación de conductos y al 37,5 % lavado de conductos en el mismo momento quirúrgico. Conclusión. La sialoendoscopia y el abordaje mixto es un procedimiento que puede garantizar el manejo de patologías obstructivas y estenosis de los conductos salivales, con buen pronóstico y resultados, preservando la glándula y evitando las complicaciones de la cirugía.
Introduction. Sialoendoscopy is a procedure which purpose is to visualise the salivary ducts. It is used as a diagnostic and therapeutic method for inflammatory and obstructive processes and duct stenosis. Methods. To describe the procedures performed for the management of patients with inflammatory and obstructive pathology of the salivary glands, only with sialoendoscopy or with mixed approaches. Results. A total of 24 patients were included in the study, with mean age of 42 years, mostly female, and 58.3% submaxillary involvement 41.7% parotid involvement. Regarding the intervention, 29.2% of the subjects underwent stone extraction, 29.2%, sialoplasty, 25% duct dilatation, and 37.5% duct lavage at the same surgical time. Conclusions. Sialoendoscopy and the mixed approach is a procedure that can guarantee the management of obstructive pathologies and stenosis of the salivary ducts with good prognosis and results, preserving the gland and avoiding the complications of surgery.
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Humanos , Enfermedades de las Glándulas Salivales , Glándulas Salivales , Procedimientos Quirúrgicos Mínimamente Invasivos , Sialadenitis , Conductos Salivales , EndoscopíaRESUMEN
BACKGROUND AND OBJECTIVES: To investigate epidemiological features of patients with sialolithiasis and to evaluate the difference in outcomes depending on its location. SUBJECTS AND METHOD: We included in the test 472 patients, or 534 cases, who were admitted to the Hallym University Sacred Heart Hospital between February 2006 and May 2017 with the diagnosis of sialolithiasis. The diagnosis of sialolithiasis was established by CT images; all of the cases were classified by the location of stones (orifice to stone/orifice to hilum: 0–0.25, type I; 0.25–0.5, type II; 0.5–0.75, type III; 0.75–1, type IV). RESULTS: The average size of stone was 7.2±4.8 mm and the mean patient age was 36.1±17.4 years old. According to the method described above, 534 cases were classified into the following: type I consisted of 188 cases (35.2%), type II consisted of 55 cases (10.2%), type III consisted of 92 cases (17.2%) and type IV consisted of 199 (37.2%). When comparing these types, stones in Type I were significantly smaller than other groups. There was a significant difference in the surgical method depending on the location of stones. Different complications such as swelling, bleeding, tongue discomfort, ranula, recurrence, etc. have been reported and, together, they statistically show meaningful differences in the distribution depending on types. CONCLUSION: The position of stone in Wharton's duct is important factor that can determine the method of surgical procedure or postoperative prognosis. We recommend 4 types classification of sialolithiasis and it can provide more specific diagnosis of disease and facilitate approach for treatment.
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Humanos , Clasificación , Diagnóstico , Corazón , Hemorragia , Métodos , Pronóstico , Ránula , Recurrencia , Estudios Retrospectivos , Conductos Salivales , Cálculos de las Glándulas Salivales , Glándula Submandibular , LenguaRESUMEN
Es poco frecuente encontrar tras los traumas penetrantes de región facial, daño a la glándula parotídea y conducto de Stenon lesionados de manera importante. Armas, contusiones, lesiones iatrogénicas secundarias a procedimientos quirúrgicos son las causas más comunes. Se presentó paciente varón de 24 años con clínica de un mes y medio de evolución aproximadamente, caracterizado por sufrir un traumatismo en el ángulo mandibular derecho con una viga, que posteriormente dañó y provocó una dilatación sacular del conducto de Stenon, que evolucionó a fístula del mismo, al que se realizó una cirugía de exploración cervical y cierre de fístula salival y resección de la dilatación sacular, obtuvo manejo quirúrgico debido a la magnitud del daño y el tiempo transcurrido, en contraste a los nuevos planteamientos conservadores en el cual se administra antisialagogos y se promueve el cierre de la herida de manera conservadora.
It's less frequent to find before penetrating trauma to the facial region injuries to the parotid gland and Stenon duct importantly. The common causes can be weapons, contusions, iatrogenic injuries secondary to surgical procedures. Was presented a 24-year-old male patient with a clinical case of one and a half months of evolution approximately, characterized by suffering a trauma in the right mandibular angle with a beam that later was subsequently damaged and caused a sacular dilation of the Stenon conduct, which evolved to fistula of the same, who has to be performed cervical exploration surgery and salivary fistula closure and resection of the sacular dilation are performed. Obtained surgical management due to the magnitude of the damage and the time elapsed, in contrast to the new conservative approaches in which antisialogogues are administered and the closing of the wound is conservatively controlled.
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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.
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Variación Anatómica , Boca , Ránula , Recurrencia , Saliva , Conductos Salivales , Escleroterapia , Glándula SublingualRESUMEN
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. .
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Proliferación Celular/fisiología , Fenotipo , Conductos Salivales/citología , Glándula Sublingual/citología , Células Acinares/fisiología , Factores de Edad , Biomarcadores/análisis , Cadáver , Recuento de Células , Inmunohistoquímica , /análisis , Valores de Referencia , /análisis , Coloración y Etiquetado , Estadísticas no ParamétricasRESUMEN
PURPOSE: We reviewed treatment outcomes and prognostic factors for patients with salivary ductal carcinoma (SDC) treated with surgery and postoperative radiotherapy from 2005 to 2012. MATERIALS AND METHODS: A total of 16 patients were identified and 15 eligible patients were included in analysis. Median age was 61 years (range, 40 to 71 years) and 12 patients (80%) were men. Twelve patients (80%) had a tumor in the parotid gland, 9 (60%) had T3 or T4 disease, and 9 (60%) had positive nodal disease. All patients underwent surgery and postoperative radiotherapy. Postoperative radiotherapy was delivered using 3-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Locoregional failure-free survival (LRFFS), distant failure-free survival (DFFS), progression-free survival (PFS), and overall survival (OS) were calculated using the Kaplan-Meier method. Differences in survival based on risk factors were tested using a log-rank test. RESULTS: Median total radiotherapy dose was 60 Gy (range, 52.5 to 63.6 Gy). Four patients received concurrent weekly chemotherapy with cisplatin. Among 10 patients who underwent surgery with neck dissection, 7 received modified radical neck dissection. With a median follow-up time of 38 months (range, 24 to 105 months), 4-year rates were 86% for LRFFS, 51% for DFFS, 46% for PFS, and 93% for OS. Local failure was observed in 2 patients (13%), and distant failure was observed in 7 (47%). The lung was the most common involved site of distant metastasis. CONCLUSION: Surgery and postoperative radiotherapy in SDC patients resulted in good local control, but high distant metastasis remained a major challenge.
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Humanos , Masculino , Cisplatino , Supervivencia sin Enfermedad , Quimioterapia , Estudios de Seguimiento , Pulmón , Disección del Cuello , Metástasis de la Neoplasia , Glándula Parótida , Radioterapia , Radioterapia Conformacional , Radioterapia de Intensidad Modulada , Factores de Riesgo , Conductos SalivalesRESUMEN
Objective To evaluate the CT and MR imaging findings of salivary duct carcinoma (SDC) in order to enhance the understanding of this rare disease.Methods A retrospective analysis of CT and MRI images was performed in 20 patients (14 males and 6 females,median age 56 years old) with pathologically proved SDC.CT and MR images were evaluated with respect to the following feature factors:location,size,morphology,margin,CT density/ MR signal intensity and enhancement pattern.Results Thirteen lesions were located in parotid gland,4 lesions in submandibular gland,1 lesion in sublingual gland and 2 lesions in the buccal spaces.The maximum diameter of SDC ranged from 1.5 to 7.0 cm,mean (3.5 ±0.9) cm.Five cases demonstrated round or oval round masses with well-defined margin,15 cases demonstrated irregular masses with ill-defined edge.Among them,the peritumoral fat tissues were infiltrated in 7 cases,the preauricular skin were invaded in 3 cases,the jaw muscles were invaded in 2 cases and the parapharyngeal space,pterygoid muscle,retromandibular vein was invaded in 1 case respectively.Lesions were homogeneous in 4 cases and heterogeneous in 16 cases.Seven lesions showed varied calcifications.Lesions were homogeneous iso-intense in 1 case and heterogeneous iso-intense in 2 cases on T1WI,heterogeneous hyperintense in all cases on T2WI.On post contrast images,lesions demonstrated remarkable enhancement in 17 cases,moderate enhancement in 3 cases.Enlarged cervical lymph nodes were found in 12 cases.Conclusions SDC has nonspecific imaging characteristics.CT and MR examinations can accurately demonstrate the extent of tumor involvement and are helpful to provide more comprehensive information for SDC management.
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BACKGROUND AND OBJECTIVES: Obstructive lesion of salivary glands by salivary duct calculi and stenosis is the main inflammatory disease of major salivary glands. Recently, the sialendoscopy has been introduced for the diagnosis and intervention of salivary ductal disease. The purpose of this study is to assess the efficacy of the sialendoscopy for the treatment of inflammatory salivary gland diseases. SUBJECTS AND METHOD: Diagnostic and interventional sialendoscopy were performed in 19 patients (7 parotid glands, 12 submandibular glands), who had salivary duct calculi or recurrent sialadenitis without calculi from 2003 Sep. to 2004 Jun. Diagnostic sialendoscopy was performed for obstructive lesions and evaluation of ductal status. Interventional sialendoscopy was performed for the removal of salivary duct calculi and dilatation of duct stenosis in cases with calculi and stenosis. RESULTS: Diagnostic sialendoscopy was performed in all cases successfully. Sixteen glands had obstructive lesions and 3 glands had sialadenitis with no evidence of obstruction. Only one case with salivary duct calculi was failed. The remaining 10 calculi were removed with microforceps and basket with or without laser fragmentation. The average size of sialoliths was 5.2 mm and multiple stones were found in 2 cases. Five cases with stenosis of parotid and submandibular gland duct were dilated with balloon catheter or endoscopy sheath successfully. In the remaining 3 glands with no obstruction, the finding of ductal inflammation was identified. No major complications were noted. CONCLUSIONS: Diagnostic sialendoscopy is a new and minimal invasive technique for complete exploration of ductal system and evaluating salivary duct disease. Interventional sialendoscopy allows the extraction of salivary duct calculi in most cases and the dilatation of stenotic duct. This technique might be useful in preventing open gland surgery in well indicated cases.
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Humanos , Cálculos , Catéteres , Constricción Patológica , Diagnóstico , Dilatación , Endoscopía , Inflamación , Glándula Parótida , Cálculos del Conducto Salival , Conductos Salivales , Cálculos de las Glándulas Salivales , Enfermedades de las Glándulas Salivales , Glándulas Salivales , Sialadenitis , Sialografía , Glándula SubmandibularRESUMEN
BACKGROUND AND OBJECTIVES: Sialendoscopy was introduced with favorable results in the management of salivary duct stones. We recently attempted this new procedure to diagnose and remove sialoliths for the first time in Korea. In this paper, we aimed to find out the clinical efficacy and limitations of sialendoscopy. SUBJECTS AND METHOD: Nine patients, 2 males and 7 females with the average age of 27, who consented to the trial of a new procedure were enrolled in this study beginning in April 2003. Diagnostic sialendoscopy was performed first, and then intervention was attempted after sialoliths were identified. A retrospective analysis was conducted on the characteristics of sialoliths, preoperative work-up, postoperative complications and outcomes. RESULTS: All but one case had sialoliths in the duct of the submandibular gland. In view of diagnostic sialendoscopy, the success rate was 100%, that is, we could detect sialoliths in all cases. In interventional sialendoscopy, however, the success rate was 44% (4 of 9 cases). In 3 cases, the basket broke down or got caught with the stone. Other complications such as salivary duct perforation, bleeding and nerve injury did not occur. CONCLUSION: Sialendocopy is a new, less invasive procedure to visualize the entire salivary ductal system for the diagnosis of salivary duct stone. However, interventional sialendoscopy for the removal of sialolith is a delicate and technically challenging procedure, requiring strict size criteria of the sialolith and much experience of the operator.
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Femenino , Humanos , Masculino , Diagnóstico , Endoscopios , Hemorragia , Corea (Geográfico) , Complicaciones Posoperatorias , Estudios Retrospectivos , Cálculos Salivales , Cálculos del Conducto Salival , Conductos Salivales , Cálculos de las Glándulas Salivales , Glándula SubmandibularRESUMEN
BACKGROUND AND OBJECTIVES: Salivary duct carcinoma (SDC) is a rare but highly malignant tumor of the salivary glands. Authors aimed to assess the current treatment outcome and to estimate the prognostic factors in the patients with SDC. MATERIALS AND METHODS: We reviewed the medical records of 11 patients with SDC, who were treated between Jan. 1995 and Jun. 2002 at the Department of Otolaryngology, Samsung Medical Center. Follow-up duration ranged from 10 to 76 months with a mean of 29.6. RESULTS: The parotid glands were more frequently involved (9 patients) than the submandibular glands (2 patients). Most patients were diagnosed to have an advanced stage of the disease. Curative surgical resections and/or postoperative radiation were the mainstay of the treatment. The adjusted 3-year survival rate was 64.9% and the disease-free 3-year survival rate was 34.1%. Four patients died of the disease at a mean interval of 22 months after the initial diagnosis. Presentation with the facial nerve paralysis, positive surgical resection margins and pathological vascular invasion had a tendency to result in poor survivals. Treatment failures due to distant metastasis were common (54.5%). CONCLUSION: We reconfirmed the aggressive clinical natures of SDC: frequent distant metastasis and poor survival rates. These findings strongly suggest that additional treatment modalities such as an adjunctive systemic treatment need to be considered in the patients with SDC especially when they have high risk factors or an advanced disease, which need further investigation.