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Surgical management of benign tumors of the submandibular gland: a follow-up study.

PURPOSE: This retrospective study evaluated data pertaining to history, symptoms, diagnosis, and mode of therapy of patients treated for benign tumors of the submandibular gland. PATIENTS AND METHODS: The records of 38 patients were reviewed. The patients were divided into three groups: pleomorphic adenoma (first operation), pleomorphic adenoma (second operation for recurrence), and other tumors. Follow-up was done by questionnaires sent to the patient and referring doctor. RESULTS: The vast majority of patients treated (92%) had had either a first or second operation for pleomorphic adenoma. Follow-up revealed that recurrence did not develop in the group of patients with primary surgery. However, one patient undergoing surgery for recurrent pleomorphic adenoma developed two recurrences. Two patients suffered from slight weakness of the lower lip. CONCLUSION: Tumor recurrence was found only in the cases of second operation after previous surgery for pleomorphic adenoma. Therefore, the first operation should extirpate the entire gland to minimize the risk of recurrence.

Adenoma, Pleomorphic↗

Expression of transglutaminase C during the prenatal development of human submandibular glands.

The involvement of transglutaminase C (TGase C) in morphogenesis and cytodifferentiation during glandular tubule formation was addressed by immunolocalization of the protein at different stages of prenatal human submandibular gland development in 100 fetuses and 20 adult salivary glands. Immunocytochemical detection was carried out using a monospecific antibody to TGase C. The results showed TGase C reactivity in both acini and ducts early in development (from 10 to 14 weeks), followed by a marked increase in ductal activity and a decline in acinar activity up to 32 weeks. During the peak of reactivity at 25 to 32 weeks, staining was concentrated in the apical ends of the columnar cells. In the adult, staining was weakly and diffusely distributed in the striated and excretory ducts. Western blot analysis of the cellular extracts of pooled samples from various stages of salivary gland development showed a single strong band at 76 kDa early in development. This band became weaker after 32 weeks of prenatal development and in the adult. These findings of transient high expression of TGase C, which coincide with the development of tubulo-alveolar structure, suggest that TGase C may play a role in morphogenesis in human salivary gland development.

Adult↗

Electron microscopic changes in rat parotid and submandibular glands subsequent total body irradiation with fast neutrons.

Female Sprague-Dawley rats wre irradiated with fast neutrons to study the radiobiologic effect on the parotid and submandibular salivary glands. Cytologic alternations were seen in the parotid tissues as early as 3 hours after exposure and peaked in both parotid and submandibular glands by the fourth postradiation day. The injury was manifest as damaged and sequestered intracytoplasmic organelles appearing as pleomorphic inclusions. The two types of glandular tissue showed similar morphologic alterations. No injury to blood vessels or other radiosensitive cells could be found.

Animals↗

Maintenance by androgen and thyroid hormone of androgen-induced convoluted tubular cells in mouse submandibular glands.

Injection of 5 alpha-dihydrotestosterone (DHT) into castrated adult female mice stimulated the proliferation of a small proportion of the convoluted tubular cells in the submandibular glands. We investigated the effects of DHT and thyroxine (T4) on the maintenance of these proliferated convoluted tubular cells. For this, castrated adult female mice that had been treated daily with DHT for 3 days and then once with [3H]thymidine, received a first series of daily injections of DHT for various periods or T4 for 10 days, and then a second series of injections of treatment with DHT or T4, or no further treatment. The second series of treatments with DHT or T4 maintained the percentages of 3H-labeled convoluted tubular cells at similar or slightly lower levels than those at the end of the first series of treatments. In mice that did not receive the second series of treatments, the percentages of 3H-labeled convoluted tubular cells decreased markedly, becoming significantly lower than those at the end of the second series of treatment with DHT or T4. We also examined the effect of DHT on the proliferation of convoluted tubular cells of castrated adult female mice that had received 10 daily injections of DHT and then no treatment for 28 days. In these mice, the cells did not proliferate markedly on stimulation with DHT. These results suggest that androgen and thyroid hormone maintain convoluted tubular cells that have proliferated in response to androgen, and that the convoluted tubular cells may become unresponsive to androgen in terms of proliferation after their exposure to androgen.

Animals↗

Morphological and functional changes in cell junctions during secretory stimulation in the perfused rat submandibular gland.

To examine the influence of cholinergic and beta-adrenergic agents on paracellular transport, we applied confocal microscopy and freeze-fracture to the isolated, perfused submandibular gland of the rat. By confocal microscopy, perfusion of lucifer yellow through an arterial catheter, revealed a bright fluorescence in the basolateral spaces of acini, but not in the intercellular canaliculi. However, addition of isoproterenol on carbachol stimulation, induced lucifer yellow fluorescence in intercellular canaliculi. This finding indicates that isoproterenol is capable of opening the paracellular route. The tight junction strands surrounding intercellular canaliculi were visualized using freeze replicas. Fixation was carried out both by vascular perfusion with Karnovsky's solution and by metal contact rapid freezing with liquid helium. In the chemically-fixed specimens, the strand particles of tight junctions formed 2-5 lines at the P-face along most of the apical portion at rest. With carbachol/isoproterenol stimulation, the strand particles rearranged with free ends and terminal loops. In the rapidly frozen specimens, the strand particles were arranged more irregularly even in the resting state. The meshwork of strands became more disheveled and interrupted during carbachol/ isoproterenol stimulation. The present findings led us to conclude that: 1) the beta-adrenergic agent, isoproterenol, can open the paracellular transport. 2) in the rapidly frozen specimen, the tight junction strand particles are arranged roughly and become disheveled and interrupted during stimulation by carbachol/isoproterenol. These findings may be related to rearrangement of subcellular structures, especially of the actin filament network.

Adrenergic beta-Agonists↗

Progestin and estrogen receptors: characterization and localization in rat submandibular glands, with special reference to epidermal growth factor.

By using progestin (P) and estrogen (E), the localization and characterization of both steroid receptors were examined in the submandibular gland (SMG) of 6-week-old immature castrated rats, with special reference to localization of epidermal growth factor (EGF). In the castrated male and female rats, both 3H-estradiol-17 beta (3H-E2 beta) and 3H-promegestone (3H-R5020) bound to SMG cytosol with high affinity and low capacity. These values were similar to those reported for other tissues. However, E-treatment after castration inhibited the specific binding. In sucrose density gradient ultracentrifugation, it was found that P receptors in both castrated males and females had a sedimentation coefficient of 7S, whereas E receptors had sedimentation coefficients of 4S and 7S. A histochemical study of the SMG of castrated male and female rats showed that the E-peroxidase complex (EPC)- and P-peroxidase complex (PPC)-stained cells were predominantly located in the epithelium of the duct system including the excretory duct and the granular convoluted tubules. Few cells were located in the intercalated duct, and none were found in the acinus. EGF-immunoreactive cells were also located in the epithelium of the same tissue region as in PPC- and EPC-stained sections. Moreover, E-treatment after castration inhibited the intensity of staining and immunoreactivity. These results clearly suggest that rat SMG contains specific P and E receptors which are mainly located in the epithelial cells of the duct system in which EGF-containing cells are identified. We discussed the possibility that P and E might affect EGF immunoreactivity, which reflects EGF production, through their receptors in the epithelium of the duct system.

Animals↗

Microvascular submandibular gland transfer for severe keratoconjunctivitis sicca: operation key points, prevention and management of complications.

OBJECTIVE: To summarize operation key points, prevention and management of complications in vascularized autotransplantation of submandibular gland for treatment of severe keratoconjunctivitis sicca. METHODS: 23 patients with severe keratoconjunctivitis sicca were treated by this procedure. Postoperative (99m)Tc images, follow-up studies, and management of complications were performed. RESULTS: The transplantations were successful in 19 cases, whose symptoms of xerophthalmia disappeared. The patients could stop applying artificial tears. In 4 patients the transplanted glands did not survive. Epiphora occurred in 5 cases. They were successfully treated by reducing the size of the graft. Obstruction of the Wharton's duct took place in one case and was treated by reconstructing the duct. When the superficial temporal vein was too small, venous bridging was applied. To select a relevant vein for anastomosis, blood oozing from the three veins was carefully inspected prior cutting off the gland when the external maxillary artery was preserved and was infused with heparin after the gland had been freed. CONCLUSIONS: If every point has been properly managed, the successful rate of operation could be warranted.

Adolescent↗

Effects of cholinergic and alpha-adrenergic agonists on the monovalent ion content of rat submandibular gland acinar cells studied by X-ray microanalysis.

The effects of cholinergic and alpha-adrenergic stimulation (in vivo and in vitro) on the monovalent ion content of rat submandibular gland acinar cells were evaluated at the subcellular level by X-ray microanalysis. Fragments of glands or enzymatically dispersed acini were slam-frozen and cut into ultrathin cryosections. Spectra were collected from secretory granules, nucleus, the basal cytoplasm containing endoplasmic reticulum and the apical cytoplasm identified between secretory granules. No significant changes in Na and Cl content were observed after the isolation of acini, but the K concentration decreased compared with cells from in situ glands. The Cl and K content in all four compartments studied decreased significantly after cholinergic stimulation both in vivo and in vitro but in a more restricted fashion after alpha-adrenergic stimulation. Our findings indicate that: (1) the physiological mechanisms regulating the monovalent ion composition of submandibular cells are relatively well preserved in isolated acinar cells; (2) the results from in vivo experiments are in good agreement with those from in vitro experiments; and (3) the effects of cholinergic and alpha-adrenergic stimulation on the K+ and Cl- efflux at the subcellular level are similar but the response is generally less with alpha-adrenergic stimulation.

Adrenergic alpha-Agonists↗

Human submandibular gland statherin and basic histidine-rich peptide are encoded by highly abundant mRNA's derived from a common ancestral sequence.

The molecular cloning of sequences encoding human submandibular gland (SMG) statherin and a basic histidine-rich peptide is described. The corresponding mRNA's were highly abundant in the human and the Rhesus monkey (Macaca mulatta) SMG, but no homologous message was detectable in the murine SMG. Sequence analysis revealed strong homology between the statherin and basic histidine-rich mRNA's, suggesting their evolution from a common ancestral sequence.

Animals↗

A morphologic study of the recovery of the rat submandibular gland after retrograde infusion. II. Lipid-soluble radiographic contrast medium.

Lipid-soluble radiographic contrast medium was infused retrogradely through the main excretory duct of the rat submandibular gland until ductal and slight parenchymal filling or heavy parenchymal filling was achieved, as determined by the developing intraglandular pressure. The glandular tissue was fixed by vascular perfusion at different times following infusion, and examined by light and electron microscopy. Dilation of the intralobular ducts and scalloping of the luminal border were pronounced after both degrees of filling. Widening of the acinar lumina and intercellular canaliculi occurred early. Masses of fused secretory granules were commonly seen in the cytoplasm of the acinar cells and formation of vacuoles occurred frequently. In some acinar cells, densely packed granules filled the major part of the cytoplasm. Large lysosomes and autophagic vacuoles, frequently present in the various parenchymal cells, often contained apparent contrast medium. In addition, widening of the intercellular spaces between parenchymal cells was seen, particularly in the acini and intercalated ducts. An inflammatory cell-infiltrate, primarily comprised of polymorphonuclear leukocytes, was particularly prominent at 20 h and 30 h after infusion. The changes were generally more pronounced and persisted for a longer time in glands subject to heavy parenchymal filling. Large cyst-like spaces surrounded by inflammatory cells were seen in the lobules and in the interlobular connective tissue of these glands. At later times, areas containing apparent contrast medium surrounded by macrophages, were frequently observed in the connective-tissue stroma. Atrophy of the parenchymal cells was seen later, after heavy parenchymal filling, and a proliferation of the connective tissue had occurred. The changes were most probably caused by the elevated intraglandular pressure induced during infusion, and the subsequent cell damage and inflammatory reaction. A foreign body reaction, induced by the retained lipid-soluble contrast medium, was probably partly responsible for the morphological alterations observed, following infusion.

Animals↗

Effects of cyclic nucleotide derivatives on the Na+ pump activity and the release of sialic acid in dog submandibular glands.

The effects of dibutyryl cyclic AMP (DBcAMP) and cyclic GMP (DBcGMP) on the Na+,K+-ATPase activity and the release of sialic acid were investigated in dog submandibular gland pieces. The Na+,K+-ATPase activity and the release of sialic acid were significantly stimulated in the presence of 100 microM DBcAMP or in the combination of 3 mM NaF and 50 microM 1-methyl-3-isobutylxanthin but were not by DBcGMP. When the pieces were incubated in the Ca2+-free medium, the DBcAMP-induced Na+,K+-ATPase activity slightly decreased but the sialic acid release was unaffected. The corresponding results were also observed in the Ca2+-free medium supplemented with 2 mM EGTA. These results suggest that the cytosolic cyclic AMP modifies the Na+ pump activity.

Animals↗

Experimental calcification in rat submandibular gland.

The present study describes the phenomenon of calciphylaxis, rapid calcification due to treatment with sensitizer dihydrotachysterol (DHT) and challenging agent 5-hydroxytryptamine (5-HT) in the rat submandibular gland (SMG) in terms of light and electron microscopy, and histochemistry. For biophysical analysis of the calcified bodies, X-ray microanalysis (XMA) and X-ray powdered diffraction methods were used. The calcified lesions in the salivary glands were histologically divided into 3 types: type 1, calcification of basal membranes in duct-like structures; type 2, granular calcified materials with remarkable necrotic changes in cell, containing 3 kinds of small vesicular structures observed in electron microscopy; and type 3, von Kossa's positive structures containing needle-like crystalline and electron-dense amorphous materials. Con A and UEA-1 lectin staining reactions were strong in the type 1 and 2 lesions. These findings suggest that the calcification matrix may contain mannose, fucose and glucose. The X-ray microanalysis of calcified materials revealed the magnesium whitelockite pattern, the type 3 displayed high quantities of Ca, P, and Mg ions comparing with the type 1 and 2, and the X-ray diffraction showed the hydroxyapatite pattern. We suggest that the above changes may be categorized as dystrophic calcification due to necrotic alterations brought about by the hypercalcaemic condition.

Animals↗

An outwardly rectifying chloride channel in a human submandibular gland duct cell line (HSG).

We have used the single channel patch-clamp technique to study the ion channels in the plasma membrane of the HSG human submandibular gland duct cell line. When the pipette contained an isotonic KCl-rich solution and the bath an isotonic NaCl-rich solution, the predominant channel type seen in excised inside-out patches was a Cl- channel with an outwardly rectifying I-V relation that had a conductance of 12 pS at positive pipette potentials and 43 pS at negative pipette potentials. The channel was only seen in excised patches and its open probability was not significantly increased by membrane depolarization. The channel selectivity sequence (relative to Cl-) was estimated from reversal potential measurements to be SCN- > NO3- > I- approximately Cl- approximately Br- > acetate. In inside-out patches the channel was blocked by addition of 5-nitro-2-(3-phenylpropylamino)benzoate (NPPB) (100 mumol/l) to the bath but not by 9-anthracene carboxylic acid (9-AC) (100 mumol/l). The channel was not activated by increases in the free Ca2+ concentration on the cytosolic surface.

Calcium↗

Polarized distribution of key membrane transport proteins in the rat submandibular gland.

Immunofluorescence labelling and confocal microscopy were employed to examine the polarized distribution of several membrane transport proteins believed to be essential for salivary secretion in the rat submandibular gland. The Na+/K+-ATPase, Na+/H+ exchanger isoform 1 (NHE1), and the secretory Na+/K+/2Cl- cotransporter isoform were all found in the basolateral membranes of acinar and intralobular duct cells. Anion exchanger isoform 2 (AE2) was found only in the basolateral membranes of acinar cells, while AE1 was absent from glandular epithelial cells. Aquaporin 5 was detected in the apical membranes of acinar cells, while the cystic fibrosis transmembrane conductance regulator was found only in apical membranes of intralobular duct cells. NHEs 2 and 3 were found in the apical membranes of both acinar and intralobular duct cells. Our results are generally consistent with the expected distribution of most transporters based on previous physiological and pharmacological experiments. However, the apical localization of NHEs 2 and 3, and the presence of the secretory isoform of the Na+/K+/2Cl- cotransporter in intralobular duct cells were not predicted.

Animals↗

Carbachol potentiates isoprenaline-induced mucin secretion by rat submandibular gland.

We studied the effects of carbachol on isoprenaline-induced secretion of 3[H]glucosamine-labeled high molecular weight protein from in vitro fragments of rat submandibular gland. The concentration-response curve for isoprenaline was determined alone and in the presence of one of two concentrations of carbachol. Isobolic interaction indices were calculated from the resulting curves. The role of extracellular calcium on this interaction was assessed by examining the effect of increasing concentrations of [Ca2+]e on secretion induced by a fixed concentration of isoprenaline alone and in the presence of carbachol. Carbachol alone caused a small, but statistically significant, protein secretion. Carbachol markedly shifted the isoprenaline concentration-response curve to the left in a dose-dependent manner. In the absence of extracellular calcium, carbachol did not increase isoprenaline-induced secretion, but secretion increased as the [Ca2+]e was increased. The carbachol-induced increase in secretion reached a maximal level at approximately 2.0 mM [Ca2+]e. We conclude that carbachol's increase of isoprenaline-induced secretion of 3[H]glucosamine-labeled high molecular weight protein is not additive, but is true potentiation. This potentiation requires extracellular calcium, and may be maximal at physiological [Ca2+]e.

Animals↗

Immunohistochemical observation of EGF and NGF in submandibular glands after duct ligation with or without testosterone administration.

Immunohistochemical detection of epidermal growth factor (EGF) and nerve growth factor (NGF) was carried out in duct-ligated submandibular glands (SMG) of mice with or without testosterone treatment. High levels of EGF and NGF were limited to granular convoluted tubule (GCT) cells in normal adult male mice, and reduced levels were evident in the female. After duct ligation, EGF and NGF stainings began to decrease on the 2nd or 3rd day, and by the 10th day, no staining was detectable. Decreasing levels of EGF and NGF following duct ligation, were more pronounced in the male SMG than in the female. Testosterone administration before ligation resulted in decreased EGF and NGF levels of staining; however, staining of sections on the 1st and 3rd day was a little stronger than comparable stained sections of untreated mice. In contrast, testosterone administration after duct ligation showed GCT cells of normal size with some degranulation at 10 days and irregular staining of growth factors with varying degrees of degranulation at 14 days. Histochemical staining for EGF and NGF in this group was marked, as in the normal, until the 10th day with decreasing reactions by the 14th day.

Animals↗