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.

Salivary Gland Disorders in Children and Adolescents: A 15-year Experience

Abstract Introduction Diseases of the salivary glands are rare in children and adolescents, with the exception of viral-induced infections. Objective To determine the clinical course of the disease, the diagnostic procedures, the treatment and the outcome of all children and adolescents affected with salivary gland diseases at our clinic over a period of 15 years. Methods A retrospective chart review including a long-term follow-up was conducted among 146 children and adolescents treated for salivary gland disorders from 2002 to 2016. Results Diagnosing acute sialadenitis was easily managed by all doctors regardless of their specialty. The diagnosis of sialolithiasis was rapidly made only by otorhinolar- yngologists, whereas diagnosing juvenile recurrent parotitis imposed difficulties to doctors of all specialties - resulting in a significant delay between the first occurrence of symptoms and the correct diagnosis. The severity-adjusted treatment yielded improve- ments in all cases, and a full recovery of 75% of the cases of sialolithiasis, 73% of the cases of juvenile recurrent parotitis, and 100% of the cases of acute sialadenitis. Conclusions Due to their low prevalence and the lack of pathognomonic symptoms, salivary gland diseases in children and adolescents are often misdiagnosed, resulting in an unneces- sarily long period of suffering despite a favorable outcome following the correct treatment.

Obesity, salivary glands and oral pathology / Obesidad, glándulas salivales y patología oral

Abstract Obesity has reached pandemic proportions in recent years. Not only adults suffer from the disease, but increasingly children and young people. One of the main causes of overweight and obesity is excessive food intake, in particular heavily processed carbohydrates. Obesity alters multiple organs, including the salivary glands, bringing functional alterations with it. Among researchers, the relation between obesity and tooth decay, periodontal disease and xerostomia is being debated. More and more scientific reports are drawing attention to the changes in the microflora of the oral cavity during obesity. All changes are closely related to the morphological and functional alterations of the salivary glands. This article review presents the current points of view regarding the impact of obesity on the health of the salivary glands, and how changes their functions influence other structures in the oral cavity.

Resumen La obesidad ha alcanzado proporciones pandémicas en los últimos años. No solo los adultos padecen la enfermedad, sino también cada vez más niños y jóvenes. Una de las principales causas del sobrepeso y la obesidad es la ingesta excesiva de alimentos, en particular los carbohidratos altamente procesados. La obesidad altera múltiples órganos, incluidas las glándulas salivales, y trae consigo alteraciones funcionales. Entre los investigadores, se está debatiendo la relación entre la obesidad y la caries dental, la enfermedad periodontal y la xerostomía. Cada vez más informes científicos están llamando la atención sobre los cambios en la microflora de la cavidad oral durante la obesidad. Todos los cambios están estrechamente relacionados con las alteraciones morfológicas y funcionales de las glándulas salivales. Esta revisión del artículo presenta los puntos de vista actuales sobre el impacto de la obesidad en la salud de las glándulas salivales, y cómo los cambios en sus funciones influyen en otras estructuras de la cavidad oral.

Histopathologic diagnosis of chronic graft-versus-host disease of the oral mucosa according to the National Institutes of Health Consensus / Diagnóstico histopatológico da doença do enxerto contra hospedeiro crônica da mucosa oral conforme Consenso do National Institutes of Health

Objective To validate the minimal criteria of the histopathologic diagnosis of oral chronic graft-versus-host disease, based on the histopathologic classification of the National Institutes of Health and correlate them with clinical features. Methods Forty-one specimens containing both oral mucosa and salivary glands were analyzed in slides stained with hematoxylin-eosin. The histological specimens were blindly examined by two trained pathologists using criteria recommended for the histopathologic diagnosis of chronic graft-versus-host disease proposed by the National Institutes of Health Consensus. The clinical classification of chronic graft-versus-host disease was correlated with analysis of slides. Results: Our data showed that the epithelium was involved in 39/41 specimens, presenting acanthosis (29/70.7%), exocytosis of lymphocytes (29/70.7%), thickening of basal lamina (29/70.7%), and apoptosis (15/36.6%). Connective tissue presented interstitial inflammatory infiltrate (38/92.7%). Minor salivary glands showed periductal fibrosis (38/92.7%), mixed periductal inflammatory infiltrate (32/78%), ductal ectasia (30/73.2%), lymphocytes around and into acinar units (30/73.2%), and interstitial fibrosis (29/70.7%). The most common clinical manifestations were lichenoid aspect (40/97.6%), complaints of sensitivity to oral feeding (38/92.7%), and dry mouth sensation (36/87.8%). Conclusion This study validated the National Institutes of Health Consensus of minimal histologic criteria for diagnosis of oral chronic graft-versus-host disease and has not found an association between the severity of clinical manifestation and the histopathological stage. .

Objetivo Validar os critérios mínimos de diagnóstico histopatológico da doença do enxerto contra hospedeiro crônica oral, com base em critérios de classificação do National Institutes of Health, e correlacioná-los com as características clínicas. Métodos Quarenta e um espécimes contendo mucosa oral e glândulas salivares foram analisados em lâminas coradas por hematoxilina-eosina. Os espécimes histológicos foram avaliados de forma cega, por dois patologistas calibrados, utilizando os critérios recomendados para diagnóstico histopatológico de doença do enxerto contra hospedeiro crônica propostos pelo Consenso do National Institutes of Health. A classificação clínica da doença do enxerto contra hospedeiro crônica foi correlacionada após a análise das lâminas. Resultados Nossos resultados mostraram que o epitélio estava comprometido em 39/41 espécimes, apresentando acantose (29/70,7%), exocitose de linfócitos (29/70,7%), espessamento da lâmina basal (29/70,7%) e apoptose (15/36,6%). O tecido conjuntivo apresentou infiltrado inflamatório intersticial em 38 (92,7%) casos. Nas glândulas salivares menores, observaram-se fibrose periductal (38/92,7%), infiltrado inflamatório periductal misto (32/78%), ectasia ductal (30/73,2%), linfócitos em torno e migrando para dentro dos ácinos (30/73,2%), e fibrose intersticial (29/70,7%). As manifestações clínicas mais comuns foram mucosa de aspecto liquenoide (40/97,6%), queixa de sensibilidade bucal ao se alimentar (38/92,7%), e sensação de boca seca (36/87,8%). Conclusão Os critérios mínimos para o diagnóstico histopatológico da doença do enxerto contra hospedeiro crônica oral, com base no Consenso do National Institutes of Health, foram ...

Análisis de Biomarcadores para pronóstico de neoplasias de Glándulas Salivales / Analysis of Biomarkers for prognosis of Salivary Gland Neoplasms

Introducción y objetivos: La probabilidad de recurrencia del adenoma pleomorfo y la agresividad de algunas variedades de neoplasias malignas de glándulas salivales requieren de un recurso de fácil aplicación que contribuya a establecer un pronóstico. El objetivo de este trabajo fue analizar biomarcadores en tejido tumoral obtenido por escisión quirúrgica a fin de determinar su implicancia en el pronóstico de tumores malignos y benignos potencialmente recidivantes de glándulas salivales. Materiales y métodos: Este estudio, de tipo descriptivo transversal, fue realizado sobre una selección de treinta y seis pacientes con diagnóstico de tumores benignos y malignos de glándulas salivales con y sin recidiva. Ellos fueron seleccionados en los Servicios de Cirugía de Cabeza y Cuello de los hospitales Córdoba y Privado de la ciudad de Córdoba. El protocolo de trabajo y el consentimiento informado que firmaron los participantes fueron previamente aprobados por los Comités Institucionales de Ética de Investigación en Salud (CIEIS) de los hospitales mencionados. Los pacientes fueron distribuidos en cuatro grupos de estudio según el comportamiento biológico y la presencia o no de recidiva: TBSR (tumor benigno sin recidiva), BCR (tumor benigno con recidiva), TMSR (tumor maligno sin recidiva), TMCR (tumor maligno con recidiva). Se confeccionó una ficha individual y se obtuvieron muestras de tejido tumoral, las cuales fueron fijadas para luego aplicar las técnicas de inmunohistoquímica. Dos observadores independientes realizaron el análisis mediante microscopía óptica. Resultados: MUC1, Ki-67 y p53 presentan un alto porcentaje de marcación (91, 91 y 86%, respectivamente), en tanto que c-erbB-2 sólo se expresó en un 20% de los casos. Este último marcó solamente en un 10% de los tumores benignos y Ki-67 fue el único se expresó que en el 100% de los tumores malignos.

SUMMARY: Introduction and objective: the probability of recurrence of pleomorphic adenoma and the aggressiveness of home malignant salivary gland neoplasms require an easily applicable method to help in establishing a prognosis. The aim of this study was to analyze the expression of biomarkers in tumor tissue obtained by surgical excision in order to determine its implication in predicting malignant and potentially recurrent benign salivary gland tumors. Materials and methods: a descriptive cross study was carry out on thirty-six patients with diagnosis of benign and malignant salivary gland tumors both with and without recurrence. They were selected from the Head and Neck Surgery Departments of the Córdoba and Privado hospitals, in Córdoba, Argentina. The study protocol and the informed consent which were signed by the participants were reviously approved by the Institutional Committee for Ethics in Health Research (CIEIS) of the involved hospitals. Patients were distributed in four study groups according to tumor biological behavior and presence or absence of recurrence: BTwR (benign tumor without recurrence), BTR (benign tumor with (recurrence), MTwR (malignant tumor without recurrence) and MTR (malignant tumor with recurrence). An individual record was produced and tumor tissue samples were obtained and fixed for immunohistochemistry procedures. A light microscopy analysis was performed by two independent observers. Results: MUC1, p53 and Ki-67 have marked in a high percentage (91, 91 and 86%, respectively) whereas c-erbB-2 was expressed only in 20% of cases

Mucocele de las glándulas Blandin-Nuhn, aspectos patológicos y terapéuticos, a propósito de dos casos clínicos / Mucocele of the glands of Blandin-Nuhn

Las glándulas de Blandin-Nuhn son un grupo de pequeñas glándulas salivales mucoserosas, ubicadas en el espesor de los haces musculares de la zona anterior de la cara ventral de la lengua. Los mucoceles de las glándulas de Blandin-Nuhn son poco frecuentes. Se revisa la literatura y se presentan dos casos de mucocele de las glándulas de Blandin-Nuhn, ambos casos eran lesiones exofíticas, indoloras, una de ellas asociada a trauma. Los mucoceles de las glándulas salivales linguales anteriores deben ser resecados hasta el plano muscular para evitar la recidiva. Como esta lesión puede ser confundida con otras patologías, se recomienda su estudio histopatológico para evitar diagnósticos errados.

The Blandin-Nuhn glands are a small group of mucous serous salivary glands, located in the thickness of the muscle bundles of the anterior ventral side of the tongue. Mucocele of the glands of Blandin-Nuhn has been reported as unusual. We review the literature and present two cases of mucocele of the glands of Blandin-Nuhn, both cases were exophytic lesions, painless, one associated with trauma. Mucoceles of the salivary glands should be resected up to the muscular plane to avoid recurrence. Because this lesion may be confused with other diseases, it is recommended an histopathological exam to avoid misdiagnosis.

Fine needle aspiration cytology [FNAC] and neck swellings in the surgical outpatient

Fine Needle Aspiration Cytology [FNAC] is a simple, quick and inexpensive method that is used to sample superficial masses like those found in the neck and is usually performed in the outpatient clinic. It causes minimal trauma to the patient and carries virtually no risk of complications. Masses located within the region of the head and neck, including salivary gland and thyroid gland lesions can be readily diagnosed using this technique. The objective of this descriptive study was to see the frequency of various pathological conditions detected on FNAC in patients presenting with neck swellings coming to Surgical Outpatient Department of Postgraduate Medical Institute, Lady Reading Hospital Peshawar. This study included patients with neck swellings presenting to the Surgical Outpatient Department of Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January 2007 to December 2007. Patients below 18 years of age were excluded. Patients' data were recorded. Samples of FNAC were sent to the cytologist and results recorded. Frequency of various pathologies was determined. The study included 50 patients with neck swellings. There were 16 male and 34 female patients with an age range of 15-55 years. Tuberculous lymphadenitis was the commonest diagnosis [36%] followed by reactive/non-specific lymphadenitis [18%]. Other pathologies were malignant neoplasms [14%], cysts [10%], benign neoplasms [8%] and sialadenitis [6%]. FNAC was inconclusive in 8% of cases. Carcinomas metastatic to lymph nodes were the most common type of malignancy followed by lymphoma and thyroid gland carcinoma [Papillary Carcinoma]. It is concluded that tuberculous lymphadenitis is still the commonest condition in patients presenting with neck swellings followed by non-specific lymphadenitis and malignant neoplasms especially metastatic carcinoma. FNAC is an easy and suitable tool for the assessment of patients with neck swellings in the outpatient clinics. Although its diagnostic accuracy is limited as compared to tissue biopsy but it is a good test for both screening and follow-up

Mucocele of the glands of Blandin-Nuhn: report of 2 cases

This report describes two cases of mucocele of the glands of Blandin-Nuhn [the anterior lingual salivary glands]. Both patients were males, aged 19 and 24 years, respectively. There was no history of trauma in either case as possible initiating cause. In one patient, there was interference with speech, mastication and deglutition. In the other case, the patient had a previous surgery for removal of the sublingual gland the but the swelling recurred. Treatment of the two mucoceles was by excision of the involved glands. Histologically, one case was an extravasation mucocele and the other was a retention mucocele

Inflamación de glándulas salivales, revisión bibliográfica / Salivary glands inflammation: a review of the literature

Las glándulas salivales son estructuras pares, simétricas y localizadas junto a la rama y el cuerpo de la mandíbula, involucran glándulas parótida (saliva serosa), submaxilar (predominantemente serosa) y sublingual (predominantemente mucosa). Además existen numerosas glándulas salivales menores en la superficie de la mucosa bucal, yugal, palatina y sublingual de la cavidad bucal (300-400 aproximadamente) que producen saliva mucosa. El objetivo de esta revisión bibliográfica es hacer una reseña sobre los diversos proceos infecciosos que afectan las glándulas salivales, los diferentes enfoques diagnósticos y pautas de tratamiento. Los trastornos infecciosos de las glándulas salivares entran en el área de responsabilidad de la odontología, todo facultativo debe estar familiarizado con estos tratornos, las técnicas de diagnóstico aplicables y estar en capacidad de referir aquellos casos que son competencia de los especialistas.

Evolução clínica agressiva de carcinoma adenóide cístico sólido / Aggressive clinical course of adenoid cystic carcinoma

O carcinoma adenóide cístico (CAC) de glândula salivar é uma neoplasia maligna de crescimento lento caracterizada por grande potencial de invasão dos tecidos adjacentes além de grande propensão a recidivas e metástases. Dentre os três subtipos histológicos, o padrão sólido é reconhecidamente o de pior prognóstico. No presente trabalho, relata-se um caso de CAC do tipo sólido em paciente jovem, sexo feminino, que apresentou uma extensa lesão localizada na hemi-maxila esquerda. Através da evolução deste caso clínico, constata-se, mais uma vez, o prognóstico reservado usualmente associado ao carcinoma adenóide cístico de glândula salivar

A ultra-sonografia no diagnóstico das doenças das glândulas salivares / Ultrasonography in diagnosis of the salivary glands diseases

A literatura é revisada sobre o uso da ultra-sonografia no diagnóstico das doenças das glândulas salivares, abordando os principais aspectos ultra-sonográficos destas doenças, bem como as indicaçöes do médico. Três casos clínicos säo relatados usando a ultra-sonografia como exame complementar, mostrando ser este um método de alta sensibilidade para o diagnóstico das doenças salivares

Biopsia por aspiración con aguja fina de glándula salival. Experiencia en el Instituto Nacional de Cancerología de México / Fine needle aspiration of salivary gland. experience at he Instituto nacional de Cancerologia de Mexico

La biopsia por aspiración con aguja final de glándula saliva es un procedimiento fácil, seguro y económico que en muchas circunstancias permite un diagnóstico rápido con molestias mínimas para el paciente y con sensibilidad de 81-100 por ciento y especificidad de 94-100 por ciento. En este trabajo revisamos 237 biopsias por aspiración con aguja fina de glándula salival realizadas en un periodo de ocho años en el Instituto Nacional de Cancerología (INCan), México. En 185 pacientes se obtuvieron aspirados satisfactorios y en 144 casos de efectuó correlación con diagnóstico de histopatología. Se encontraron 65 (45 por ciento) verdaderos positivos, 62 (43 por ciento) verdaderos negativos, 11 (8 por ciento falsos negativos, seis (4 por ciento) falsos positivos. La sensibilidad fue de 85.52 por ciento, la especificidad de 91.17 por ciento, el valor predictivo positivo de 91.54 por ciento, el valor predictivo negativo de 84.93 por ciento y la eficiencia de 88.19 por ciento (p< 0.001). Nuestros resultados fueron similares a los obtenidos en 14 series publicadas previamente de biopsia por aspiración con aguja fina de glándula salival

Aspiration cytology of salivary gland lesions advantages and pitfalls.

FNAC of the major salivary glands was performed on 72 patients during a period of two and a half years. In 64 patients samples were satisfactory. The cytologic diagnosis was correlated with histology available in 36 cases. 21 out of 22 benign lesions and 12 out 4 malignant lesions were correctly identified rendering a diagnostic accuracy of 91 percent. The pitfalls of FNAC of salivary gland lesions are reflected by the overall false positive rate of 5.5 percent of false negative rate of 2.7 percent. Diagnostic pitfalls are due to variability of tumor morphology which makes sampling & interpretation difficult. Multiple sampling and increasing experience help to minimize errors.

Diagnostic approach in parotid swellings

This work is based on the analysis of data obtained from 30 patients with unilateral parotid swellings in the period between January, 1987 and December, 1990 in the Ain Shams University Hospital. The advantages of ultrasonography, CT scanning and fine needle aspiration cytology [FNAC] over clinical diagnosis have been evaluated. The patients were subjected to superficial conservative or total parotidectomy according to the site and nature of the lesion. Ultrasonography served in the detection of cystic lesions not evident in clinical examination in two patients, while it failed to localize the lesion in relation to parotid gland. CT scanning detected involvement of the deep lobe in four patients and localized the lesions precisely in all other patients. Fine needle aspiration cytology gave a correct pathological diagnosis in 24 patients. The results obtained from the work encourages the use of these investigatory tools more oftenly