The surgical management of submandibular gland disease.
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One of the most common causes of submandibular gland enlargement is benign inflammatory disease. The usual cause is ductal outflow obstruction due to either a calculus or stenosis allowing stasis and retrograde movement of the saliva into the acinar structures leading to an inflammatory response and gland enlargement. Faced with a submandibular mass, a work-up that will rule out neoplastic causes of submandibular enlargement is instituted. This includes clinical assessment, probing of the gland, radiocontrast sialography, and CT scanning. The treatment should reflect the obstructive nature of the disease. Plastic reconstruction of the duct allows the removal of calculi, shortening of the duct, and enlargement of the outflow opening preventing recurrence and allowing healing of the gland. The procedure is performed intraorally as an outpatient, does not disrupt oral functioning, or subject the patient to the risks of gland removal or loss of that organ's function. Our experience with 27 patients over a 7-year period is presented with a detailed description of the technique and an analysis of the results. The procedure was successful in 22 of the 27 patients.
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OBJECTIVE: To study the normal glandular function of the submandibular gland as a background for evaluation of changes in submandibular gland diseases. METHODS: The backgrounds of both submandibular area and temporal area were analyzed comparatively with Emission Computerized Tomography in eleven pairs of normal submandibular gland. RESULTS: About 2.18 times of the temporal background equals to submandibular area background; the Concentrate Index of normal submandibular gland was 1.42 +/- 0.89; the Secretory Index was (109.4 +/- 39.8)%, the Secretory Index Ratio and the Concentrate Index Ratio were (77.2 +/- 17.2)% and 71.0 +/- 15.2% respectively; and the Function Index was (89.9 +/- 7.4)%. CONCLUSION: The use of submandibular area background and functional index to represent submandibular gland function is more accurate and more sensitive. Normal functional index can provide the basis for researching submandibular gland disease.
We encountered an unusual case of a mucocele arising from the submandibular gland. Among the limited number of cystic salivary gland neoplasms reported in the literature, there have been no reports, to our knowledge, of a similar cystic lesion. The unique characteristics of this mass permitted definitive diagnosis by computed tomographic scanning.
A case of cat scratch disease, initially considered a malignant disease or an aggressive inflammatory lesion, is reported. The lesion was excised and the characteristic disease pattern was established for this patient. The paper discusses the natural history of the disease and presents an extensive listing of swellings in the lateral part of the neck.
In a 29 year old Japanese woman with SLE, a bilateral submandibular mass was detected. Computed tomographic (CT) scan suggested inflammatory changes around the submandibular glands. Histological findings of the deep skin biopsy showed typical changes of lupus erythematosus profundus (LEP). LEP should be considered in the differential diagnosis of an unexplained submandibular mass in a subject with SLE.
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Chagas' disease induces acinar enlargement in the submandibular salivary gland of rats inoculated with the Y strain of Trypanosoma cruzi at the age of 27-28 days and killed 18 days after inoculation (acute phase). Propranolol, a beta-adrenoceptor blocker, prevents the acinar enlargement induced by T. cruzi infection. Phenoxybenzamine, an alpha-adrenoceptor blocker, enhances this enlargement. These results suggest that catecholamines are involved in the genesis of the acinar hypertrophy induced by Chagas' disease.
Swellings of the submaxillary region are very frequent in otorhinolaryngology clinical practice. The authors of this study analyzed 106 cases of submaxillary gland excision under their observation, emphasizing their epidemiological, clinical and anatomopathological aspects which could be useful during the diagnostic and therapeutic phase of the submaxillary gland affections. They also made a comparison with the data already published on the same subject.
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We recorded 45 sialograms on digital screens and discuss the use of a digital recording, processing and screening system for the diagnosis of inflammation, tumours and stones of the major salivary glands. Thirty-three investigations of a total of 33 parotid sialograms and 12 submandibular sialograms were analysed. A ductal examination with small volumes of soluble contrast media, permitting painless examination, was possible in all cases due to excellent homogeneous optical density, satisfactory detail and good contrast.
Digital subtraction sialography offers a new technique for the diagnosis of salivary gland disease. The basis of this technique is the removal of superimposed bony structures. Ninety-one patients (4-77 years old) with acute and chronic inflammatory disorders, chronic sialectasis, chronic sialolithiasis and tumours of various types underwent sialography using the digital subtraction technique. In addition, conventional sialography using a 100 mm camera and high resolution ultrasonography was performed. The results were compared with the histopathology and intraoperative findings. The digital subtraction technique is superior in recognition of inflammatory changes and chronic sialolithiasis, whereas ultrasonography is more sensitive in diagnosis and localization of tumours.
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