Characterization of Salivary Gland Pain: A Review of the Literature / Caracterización del Dolor de Glándulas Salivales: Revisión de la Literatura

SUMMARY: The salivary glands in pathological conditions produce countless different clinical presentations, and due to their complex neuroanatomy, their pain symptoms vary widely. However, in the literature to date, few studies characterize salivary gland pain. The aim of this study was to conduct a literature review concerning the clinical characteristics of pain in various salivary gland pathologies. A literature review was done through a systematic search of scientific articles in the Web of Science (WoS), MEDLINE, Scopus, and Elton B. Stephens Company (EBSCO) databases. The free terms "salivary gland", "parotid gland", "submaxillary gland", "sublingual gland", and "pain" were used along with the Boolean operators OR and AND. The search yielded a total of 1896 articles, of which 60 fulfilled the inclusion criteria and were ultimately included in this review. It is described that pain is a nonspecific symptom of a glandular pathology and is characterized mainly by the location of the pain, which is correlated with the anatomical location of the affected salivary gland. Among the painful salivary gland pathologies, we found inflammatory disorders, including infections, obstructions, disorders secondary to hyposalivation; systemic autoimmune diseases; neoplasms, and neuropathic pain disorders. The diagnosis and management of salivary gland pain require knowledge of the causes and mechanisms of the pain, and it is to recognize the signs and symptoms of salivary gland disorders to be able to diagnose and treat them.

Las glándulas salivales en condiciones patológicas producen un sinfín de presentaciones clínicas diferentes, y debido a su compleja neuroanatomía generan variaciones en su sintomatología dolorosa. Sin embargo, en la literatura hasta ahora son escasos los estudios que caracterizan el dolor de glándulas salivales. El objetivo de este estudio fue realizar una revisión de la literatura respecto a las características clínicas del dolor en diversas patologías de glándulas salivales. Se realizó una revisión de la literatura, a través de la búsqueda sistemática de artículos científicos en las bases de datos Web of Science (WoS), MEDLINE, Scopus y Elton B. Stephens Company (EBSCO). A través de los términos libres: "salivary gland", "parotid gland", "submaxillary gland", "sublingual gland", "pain", junto con los operadores booleanos OR y AND. La búsqueda arrojó un total de 1896 artículos, de los cuales 60 cumplieron los criterios de inclusión y fueron finalmente incluidos en esta revisión. Se describe que el dolor es un síntoma poco específico para la patología glandular y está caracterizado principalmente por la localización del dolor, el cual se correlaciona con la ubicación anatómica de la glándula salival afectada. Dentro de las patologías dolorosas de glándulas salivales encontramos los trastornos inflamatorios, incluidas infecciones, obstrucciones, trastornos secundarios a hiposalivación; enfermedades sistémicas autoinmunes; neoplasias y trastornos de dolor neuropático. El diagnóstico y manejo del dolor de glándulas salivales requiere del conocimiento de las causas y mecanismos del dolor, siendo necesario reconocer los signos y síntomas de los trastornos de glándulas salivales para ser capaces de diagnosticarlos y tratarlos.

Parotidectomy and neck dissection in locally advanced and relapsed cutaneous squamous cell carcinoma of the head and neck region,,

Abstract Objective: To investigate the prognostic factors to developing parotid and neck metastasis in locally advanced and relapsed Cutaneous Squamous Cell Carcinoma (CSCC) of the head and neck region. Methods: Single-center retrospective cohort study enrolling consecutive patients with advanced CSCC from 2009 to 2019. Seventy-four cases were identified. Study variables demographic data, clinical skin tumor stage, neck stage, parotid stage (P stage), surgical treatment features, and parotid, regional, and distant metastases. Survival measures: Overall Survival (OS) and Disease-Specific Survival (DSS). Results: The study group included 72.9% men (median age, 67 years); 67.5% showed T2/T3 tumors, 90.5% comorbidities, 20.2% immunosuppressed, with median follow-up: 35.8 months. The most frequent skin primary were auricular and eyelid regions, 75% underwent primary resection with flap reconstruction. Parotid metastasis was present in 50%, 32.4% showing parotid extracapsular spread, multivariate analysis found OR = 37.6 of positive parotid metastasis evolving into positive neck metastasis, p = 0.001. Occult neck metastasis, neck metastasis, and neck extracapsular spread were observed in 13.5%, 51.3%, and 37.8%, respectively. Kaplan-Meier survival: Clinical T4 versus T1, p = 0.028, P1 stage: 30% and 5% survival at 5 and 10 years, P3 stage: 0%, p = 0.016; OS and DSS showed negative survival for the parotid metastasis group, p = 0.0283. Conclusion: Our outcomes support a surgically aggressive approach for locally advanced and relapsed CSCC, with partial parotidectomy for P0, total parotidectomy for P1-3, selective I-III neck dissection for all patients and adjuvant radiochemotherapy to appropriately treat these patients with advanced CSCC of the head and neck region. Level of evidence: II b - Retrospective Cohort Study - Oxford Centre for Evidence-Based Medicine (OCEBM).

Sialoendoscopia y abordaje mixto para el manejo dela patología obstructiva de las glándulas salivales / Sialoendoscopy and mixed approach for the management of obstructive pathology of the salivary glands

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.

Recommendations from the Brazilian society of rheumatology for the diagnosis of Sjögren's syndrome (Part I): glandular manifestations (systematic review)

Abstract Background: Primary Sjögren's syndrome (pSS) is a systemic immune-mediated disease whose main characteristic is exocrine gland inflammation and, subsequent reduction in tear and saliva production. A delayed diagnosis is common due to the nonspecific clinical manifestations of disease. The aim of the present study was to develop recommendations for the diagnosis of glandular manifestations of pSS based on evidence and expert opinion. Main body of the abstract: We conducted a systematic literature review to retrieve the best evidence available on the accuracy of diagnostic tests for pSS. We also held two in-person meetings with experts (rheumatologists, pathologists, ophthalmologists and dentists) to establish their level of agreement using the Delphi method. Ultimately, we generated 18 recommendations that aim to facilitate the diagnosis of the glandular manifestations of pSS. Conclusion: The diagnosis of glandular manifestations of pSS is complex and multidisciplinary. It requires specific knowledge in the field of ophthalmology, immunology, pathology and imaging, making it compulsory for the rheumatologist to work with professionals from these different areas in order to improve accuracy and early diagnosis. Glandular dysfunction tests, ANA, RF, Anti-Ro, protein electrophoresis, urinalysis, blood count, C-Reactive protein, complement, testing for syphilis and viruses (HCV, HIV) and SGUS should be investigated when dryness or systemic manifestation are present. Minor salivary gland biopsy is recommended for all anti-Ro negative or incomplete criteria cases.

Minor intraoral salivary gland tumors: a clinical-pathological study / Neoplasias intraorais de glândula salivar menor: estudo clínico-patológico

ABSTRACT Objective To evaluate the clinical-pathological profile of patients with minor salivary gland neoplasms. Methods A retrospective study of specific cases diagnosed as benign and malignant tumors of the minor salivary glands was performed. The data were collected from medical records of patients seen at a hospital over a period of 15 years. The sample was made up of 37 cases. For the pathological study, slides containing 5μm thick sections stained with hematoxylin and eosin were used. The data were tabulated using descriptive statistics. Results Malignant neoplasms represented 70.3% of cases. The mucoepidermoid carcinoma was the most common neoplasm (45.9%), followed by pleomorphic adenoma (24.4%). Most patients were female (70.3%), aged between 71 and 80 years. The palate (67.6%) and the retromolar region (10.8%) were the most affected sites. Conclusion Mucoepidermoid carcinoma was the most common tumor in minor salivary glands. These tumors are more common in females aged over 40 years. The palate was the most common affected site.

RESUMO Objetivo Avaliar o perfil clínico-patológico de pacientes com neoplasias de glândula salivar menor. Métodos Foi realizado um estudo retrospectivo de casos específicos diagnosticados como neoplasias benignas ou malignas de glândula salivar menor. Os dados foram coletados dos prontuários dos pacientes atendidos em um hospital no período de 15 anos. A amostra final foi de 37 casos. Para o estudo histopatológico, foram usadas lâminas contendo secções com 5μm de espessura, coradas pela técnica de hematoxilina e eosina. Os dados foram tabulados de forma descritiva. Resultados As neoplasias malignas representaram 70,3% dos casos. O tipo histológico mais prevalente foi o carcinoma mucoepidermoide (45,9%), seguido do adenoma pleomórfico (24,4%). A maioria dos pacientes era do sexo feminino (70,3%), com idade entre 71 e 80 anos. O palato (67,6%) e a região retromolar (10,8%) foram os sítios mais acometidos. Conclusão O carcinoma mucoepidermoide foi o tumor mais comum das glândulas salivares menores. Estes tumores foram mais comuns em mulheres com mais de 40 anos. O palato foi o sítio mais acometido.

Salivary gland endoscopy in children: A systematic review / Endoscopia de glândulas salivares em crianças: revisão sistemática

Summary Objective: To review studies on sialendoscopy (SE) of the salivary glands in children focusing mainly on the indications, endoscopic findings, and effectiveness of the procedure. Method: The electronic databases searched were Pubmed, Scielo, and Cochrane. The search was conducted by two researchers independently, following inclusion and exclusion criteria. A third author analyzed sources of conflict. In the first stage they were discarded by reading the articles title that had no relation to the purpose of the study and then evaluated the abstracts of each study. In these two initial phases 37 articles were excluded. Articles not excluded by the selection criteria have been retrieved and assessed in full. Seven articles had their data extracted and were compared. Results: The literature search parameters listed allowed the recovery of 44 articles. After applying the exclusion criteria, seven studies were included in this review representing 207 patients undergoing with ages ranging from 1 to 16 years. All studies except one underwent SE under general anesthesia. The juvenile recurrent parotitis was the main clinical diagnosis related with SE procedures (N=152). The number of inflammatory attacks per patient per year was the parameter for indication of SE. The efficacy of the procedure was considered high by all authors ranging between 83 and 93% in larger series evaluated. Conclusion: Sialendoscopy is a safe and effective procedure for the diagnosis and treatment of recurrent inflammatory diseases of salivary glands in children.

Resumo Objetivo: revisar os estudos sobre endoscopia das glândulas salivares em crianças tendo como foco principal as indicações, os achados endoscópicos e a eficácia do procedimento. Método: foram avaliadas as bases de dados eletrônicas Pubmed, Scielo e Cochrane. A busca foi realizada por dois pesquisadores de forma independente, seguindo critérios de inclusão e exclusão. Um terceiro autor analisou pontos de conflito. Em uma primeira etapa, foram descartados pela leitura do título artigos que não tivessem relação com o objetivo do estudo e a seguir foram avaliados os resumos de cada estudo. Nessas duas fases iniciais, foram excluídos 37 artigos. Os artigos não excluídos pelos critérios de seleção foram levantados e avaliados integralmente. Sete artigos tiveram os dados extraídos e comparados. Resultados: a busca na literatura de acordo com os parâmetros elencados permitiu a recuperação de 44 artigos. Após a aplicação dos critérios de exclusão, sete estudos foram incluídos na revisão, representando um N de 207 pacientes submetidos à sialoendoscopia (SE) com idades variando de 1 a 16 anos. Todos os estudos, exceto um, realizaram a SE sob anestesia geral. A parotidite recorrente da infância foi a hipótese diagnóstica clínica que levou à indicação de SE no maior número de pacientes, um total de 152 procedimentos. O critério de indicação dos procedimentos foi o número de crises inflamatórias por paciente por ano. A eficácia do procedimento foi considerada alta por todos os autores, variando entre 83 e 93% nas maiores séries avaliadas. Conclusão: a sialoendoscopia é um procedimento eficaz e seguro para diagnóstico e tratamento de afecções inflamatórias recorrentes de glândulas salivares em crianças.

The learning progression of diagnostic sialendoscopy / Progressão do aprendizado da sialoendoscopia diagnóstica

ABSTRACT INTRODUCTION: Sialendoscopy is becoming the gold standard procedure for diagnosis and treatment of Salivary Gland Inflammatory Diseases. OBJECTIVE: To evaluate the learning progression of a single surgeon to implement and perform diagnostic sialendoscopy: to estimate how many procedures were necessary to achieve better results; if it was higher rate of complications in the beginning. METHODS: Retrospective analysis involving 113 consecutive sialendoscopies performed from 2010 to 2013. According to a descriptive analysis of the factors related to surgeon's experience, the casuistic was divided into two groups: group (A) comprising the first 50 exams, and group (B) the last 63. Groups were then compared concerning demographic and peri-operative aspects. RESULTS: In Group A, failure to catheterize papilla were 22% versus 3% in B (p = 0.001). Failure to complete examination was 30% in group A versus 6% in B (p = 0.001), and necessity to repeat exams was 22% in group A versus 10% in B (p = 0.058). The complication rates were 18% in group A, and 10% in B (p = 0.149). Operative time was slightly shorter in group B (56 versus 41 min, p = 0.045). CONCLUSION: We found better outcomes after the first 50 diagnostic sialendoscopies. Complication rates were statistically the same between early and late groups of experience with sialendoscopy.

RESUMO INTRODUÇÃO: A sialoendoscopia vem se tornando o procedimento de referência para o diagnóstico e o tratamento das doenças inflamatórias da glândula salivar. OBJETIVO: Avaliar a progressão de aprendizado de um mesmo cirurgião para implementação e realização da sialoendoscopia diagnóstica: verificar quantos procedimentos foram necessários para a obtenção de resultados melhores e se houve ocorrência de maior taxa de complicações no início do aprendizado. MÉTODO: Análise retrospectiva envolvendo 113 sialoendoscopias consecutivas realizadas de 2010 a 2013. De acordo com uma análise descritiva dos fatores relacionados à experiência do cirurgião, a casuística foi dividida em dois grupos: grupo (A), compreendendo os primeiros 50 exames; e grupo (B), os últimos 63. Em seguida, os grupos foram comparados, levando em consideração os aspectos demográficos e perioperatórios. RESULTADOS: No grupo A, a não realização do cateterismo papilar foi de 22% vs. 3% em B (p = 0,001). A não realização de um exame completo foi de 30% no grupo A vs. 6% em B (p = 0,001), e a necessidade de repetir o exame foi de 22% no grupo A vs. 10% em B (p = 0,058). Os percentuais de complicações foram 18% no grupo A e 10% em B (p = 0,149). O tempo operatório foi ligeiramente menor no grupo B (56 vs. 41 minutos, p = 0,045). CONCLUSÃO: Verificamos melhores desfechos após as 50 primeiras sialoendoscopias diagnósticas. Os percentuais de complicações foram estatisticamente semelhantes entre os grupos inicial e avançado de experiência com a sialoendoscopia.

Tratamiento quirúrgico de los tumores de parótida: experiencia de 10 años / Surgical treatment of parotid neoplasms: a 10 years experience

Background: Parotid neoplasms correspond to 3 percent of head and neck tumors. Most are benign, treatment is parotidectomy. Aims: To analyze the results of treatment, histology, complications and recurrence. Patients and Methods: Retrospective analysis of patients with parotid tumors treated in our center among 2001-2010. Results: The series consisted of 82 patients, 52 (63 percent) women. Average age: 46 years (range, 17-77), 73 (89 percent) had benign tumors, 7 (8.5 percent) were malignant and 2 (2.4 percent) had chronic inflammatory disease. The most common benign tumors were pleomorphic adenoma (55 percent) and Warthin's tumor (20 percent). The most common malignant tumors were mucoepidermoid carcinoma (5 percent) and acinar cell carcinoma (4 percent). The technique was total parotidectomy in 10 patients (12 percent), total suprafacial 53 (64.6 percent) and partial in 19 (23 percent). The most common complication was transient facial nerve dysfunction in the immediate postoperative period in 38 cases (46.3 percent), 14 (17 percent) had surgical bed depression, 15 (18.3 percent), dysesthesia periauricular, 2 (2.4 percent) permanent paralysis of the facial nerve (tumor) and 6 (7.3 percent) Frey Syndrome. No patient had a disagreement with his scar and pain periauricular, there were no recurrences. There was lesser transient facial nerve paralysis with partial suprafacial parotidectomy than with total suprafacial parotidectomy (21 percent and 53 percent), RR 0.4 IC 95 percent (0.16-0.99). Discussion: The application of less invasive surgical techniques such as partial parotidectomy suprafacial allow comparable results in benign conditions, with low morbidity without increasing recurrence.

Introducción: Las neoplasias parotídeas corresponden al 3 por ciento de los tumores de cabeza y cuello. La mayoría son benignas, el tratamiento es la parotidectomía. Objetivo: Analizar los resultados del tratamiento, histología, complicaciones y recurrencia. Pacientes y Métodos: Análisis retrospectivo de los pacientes con tumores parotídeas intervenidos en nuestro centro entre 2001-2010. Resultados: La serie estuvo compuesta por 82 pacientes, 52 (63 por ciento) mujeres. La edad promedio: 46 años (rango, 17-77); 73 (89 por ciento) tuvieron tumores benignos, 7 (8,5 por ciento) malignos y 2 (2,4 por ciento) presentaron enfermedad inflamatoria crónica. Los tumores benignos más frecuentes fueron el adenoma pleomorfo (55 por ciento) y el tumor de Warthin (20 por ciento). Los tumores malignos más frecuentes fueron el carcinoma mucoepidermoide (5 por ciento) y el carcinoma de células acinares (4 por ciento). La técnica fue parotidectomía total en 10 pacientes (12 por ciento), suprafacial total en 53 (64,6 por ciento) y parcial en 19 (23 por ciento). La complicación más frecuente fue la disfunción transitoria del nervio facial en el postoperatorio inmediato en 38 casos (46,3 por ciento); 14 (17 por ciento) presentaron depresión del lecho operatorio, 15 (18,3 por ciento) disestesia periauricular, 2 (2,4 por ciento) parálisis permanente del nervio facial (tumor maligno) y 6 (7,3 por ciento) Síndrome de Frey. Ningún paciente presentó disconformidad con su cicatriz ni dolor periauricular; no hubo recidivas. Se observó menos parálisis transitoria del nervio facial con la parotidectomía suprafacial parcial que con la parotidectomía suprafacial total (21 por ciento y 53 por ciento, respectivamente), RR 0,4 IC 95 por ciento (0,16-0,99). Discusión: La aplicación de técnicas quirúrgicas menos agresivas como la parotidectomía suprafacial parcial permite obtener resultados comparables en patologías benignas, con bajas tasas de morbilidad, sin aumentar la recurrencia.

The study of the expression of E-cadherin and Snail in the labial glands of the patients with primary Sj(o)gren's syndrome / 中华风湿病学杂志

Objective To study the expression of E-cadherin protein and Snail protein in the labial glands of patients with primary Sj(o)gren's syndrome(pSS) and to analyze their roles in the pathogenesis of pSS.Methods The expression of E-cadherin protein and Snail protein were detected by immunohistochemical method.The labial glands were obtained from 50 patients with pSS and 30 healthy controls.The data was analyzed by Chi-Square test,Fisher's exact probability and Spearman's rank correlation analysis.Results The expression rate of E-cadherin in the labials gland of the patients with pSS were lower than that in normal salivary tissues (x2=14.651,P＜0.01).The positive rates of Snail in the labial glands of the patients with PSS were 40％ and it's expression rates were significantly higher than those in normal salivary tissues (x2=28.800,P＜0.01).There was a negative correlation between lymphocyte focus score and the expression of E-cadherin (P＜0.01) and a positive correlation between lymphocyte focus score and the expression of Snail in pSS group (P＜0.01).There was a negative correlation between the expression of E-cadherin and Snail (rs=-0.484,P＜0.01).Conclusion The interaction of E-cadherin and Snail may have played an important role in the pathogenesis of PSS.