Benign Submandibular Gland Tumours Research Articles

Extracapsular dissection versus total excision for benign submandibular gland tumors

IntroductionBenign submandibular gland tumors pose challenges in balancing treatment effectiveness and preserving gland function. This study aimed to compare gland-preserving surgery, extracapsular dissection (ECD), with total excision in managing these tumors, focusing on function preservation and recurrence rate. MethodsFifty consecutive patients with treatment-naïve benign submandibular gland tumors were alternatively allocated to receive ECD (n = 25) or total excision (n = 25) without randomization procedures. Intraoperative findings, postsurgical complications, subjective satisfaction, and gland function were assessed. Follow-up data were collected for a median duration of 55 months (24–80 months) to monitor recurrences. ResultsECD demonstrated significant advantages, including shorter operation time, reduced bleeding, and preservation of the facial artery and vein (P < 0.05). Both groups exhibited acceptable postsurgical pain and taste sensations. Complications were minimal and similar between the two groups. ECD resulted in superior facial contour satisfaction (P = 0.030) and preserved gland function, as evidenced by salivary scintigraphy. No recurrences were observed in either group during the follow-up period. ConclusionsECD is a practical approach for benign submandibular gland tumors, offering favorable functional outcomes, reduced surgical morbidity, shorter operation times, and improved cosmetic results.

Benign submandibular gland tumours: outcomes of gland-preserving excision by endoscopic or conventional approach

Endoscope-assisted surgery is becoming a preferred technique in salivary gland surgery. However, this technique has not yet been applied in submandibular gland (SMG) preservation surgery. This retrospective study was performed to evaluate the outcomes of endoscope-assisted gland-preserving surgery through a hairline incision in patients with benign SMG tumours. The study included 38 patients with benign SMG tumours who underwent tumour excision with gland preservation: 19 who underwent local excision of the tumour through an endoscope-assisted hairline approach and 19 who received the conventional cervical approach. The feasibility of the surgical procedure, perioperative patient variables, and postoperative appearance and functional outcomes were evaluated. Patients in both groups had their tumours removed successfully with tumour-free margins. The intraoperative blood loss, postoperative amount of drainage, mean length of the incision, and unstimulated saliva flow rate did not differ between the two groups. There was no difference in the stimulated saliva flow rate between the preserved gland and unaffected SMG. The aesthetic result was better in the endoscope-assisted hairline incision group. No tumour recurrence occurred during follow-up (range 12–52 months). Thus, gland-preserving tumour dissection appears to be a safe method for benign SMG tumours, with good functional results. Furthermore, the endoscope-assisted hairline incision is a feasible method with excellent cosmetic results.

PLEOMORPHIC ADENOMA OF THE SUBMANDIBULAR GLAND TREATED WITH PARTIAL SIALOADENECTOMY: A CASE REPORT

Pleomorphic adenomas of the submandibular glands are rare, and their treatment usually involves excision of the whole gland along with the tumor. A 24-year-old male patient presented with the main complaint of an extensive slow-growing painless swelling in the submandibular region. Physical examination showed a palpable, rounded, and mobile mass. Computed tomography showed a well-circumscribed lesion in the topography of submandibular gland. Fine needle aspiration was suggestive of pleomorphic adenoma. Partial sialoadenectomy of the submandibular gland with safety margins was performed through submandibular transcutaneous access. The postoperative period was uneventful and no facial or hypoglossal nerve damage or salivary flow alterations were observed. Histopathologic examination revealed a fragment of encapsulated benign neoplasm of glandular origin, composed of rounded myoepithelial cells in the middle of a predominantly chondromyxoid stroma, confirming the diagnosis of pleomorphic adenoma. Partial sialoadenectomy represents a safe and more conservative approach to benign submandibular gland tumors.

Effectiveness of Levodropropizine on Post-Operative Sore Throat After Endotracheal Intubation for Head and Neck Surgery: A Double-Blind Randomized Controlled Trial

ABSTRACT&#x0D; Objective: To determine the effectiveness of levodropropizine in reducing the incidence of post-operative sore throat (POST) among ear, nose, throat, head and neck (ENT-HNS) patients undergoing general endotracheal anesthesia.&#x0D; Methods:Design: Double-Blind, Randomized, Placebo Controlled TrialSetting: Tertiary Government Training Hospital Participants: Sixty (60) ENT-HNS patients aged between 19 to 60 years old admitted to the Southern Philippines Medical Center from January to March 2019 for surgeries on benign thyroid tumors, benign submandibular gland tumors and tonsils requiring orotracheal intubation were randomized into control and treatment groups of 30 patients each.&#x0D; Results: There was a statistically significant difference (p=.0016) in the incidence of POST 6 hours after surgery between control (25/30; 83%) and treatment (16/30; 53.33%) groups. However, confounders such as length and type of surgery (more females and tonsillectomy cases in the control group) were not fully eliminated by randomization.&#x0D; Conclusion: Perioperative levodropropizine significantly decreases the incidence of moderate (as well as mild) postoperative sore throat. It was not shown to decrease the incidence of severe sore throat. A larger cohort (adjusted for other confounders) may better describe the benefit of this treatment.

Large Pleomorphic Adenoma of the Submandibular Gland Causing Internal Jugular Vein Compression: Case Report

Pleomorphic adenoma is the most common benign tumor of the major salivary glands. It is generally asymptomatic; however, it may adversely affect surrounding structures when it becomes enlarged. In the submandibular gland in particular, the cervical blood vessels may be compressed or displaced by the tumor, and surgery to remove the tumor is associated with a higher risk. The purpose of this report is to describe how an enlarged pleomorphic adenoma in the submandibular gland may compress or displace cervical blood vessels, demonstrating that 3-D computed tomography angiography could be valuable for preoperative evaluation. This article describes a rare case of a 46-year-old man who had an internal jugular vein compression as a result of leaving untreated a large pleomorphic adenoma in the submandibular gland. Considering the anatomical location, salivary gland tumors arising in the submandibular gland may adversely affect the surrounding structures such as the trachea or cervical blood vessels when they grow larger. Preoperative evaluation of the positional relationship between the tumor and the surrounding structures is essential. 3-D computed tomography angiography was valuable for preoperative evaluation of the positional relationship between the tumor and the surrounding blood vessels. By confirming the compressed and displaced blood vessels with 3-D computed tomography angiography, the skin incision line can be designed to allow for successful separation of the tumor. This report suggests that 3-D computed tomography angiography could ensure a safe surgical approach for removal of large benign submandibular gland tumors, including pleomorphic adenomas.

Conservative and functional surgery in the treatment of salivary gland tumours

The principle of modern oncological surgery is to conserve the functional organs or tissues as much as possible based on eradication of the tumour. For salivary gland tumours, conservative and functional salivary surgery, including partial sialoadenectomy as well as anatomical and functional preservation of the facial nerve, great auricular nerve, superficial musculo-aponeurotic system (SMAS), and Stensen’s duct, has become increasingly popular. In the present review, we discuss the following aspects of conservative and functional surgery in the treatment of salivary gland tumours: (i) partial superficial parotidectomy (PP) to treat benign parotid gland tumours, (ii) modification of surgical incisions to improve cosmetic results, (iii) modification of the surgical approach to decrease complications, (iv) extracardial dissection to treat benign superficial parotid tumours, (v) partial sialoadenectomy to treat benign submandibular gland tumours, and (vi) 125I brachytherapy to preserve facial nerves. The majority of the operated parotid or submandibular glands are preserved, and surgical complications are also decreased. Conservative and functional surgery plays a significant role in maintaining normal salivary gland function and in improving patients’ quality of life during the treatment of salivary gland tumours and thus should be further promoted.

Gland-preserving robotic surgery for benign submandibular gland tumours: a comparison between robotic and open techniques

Benign tumours of the submandibular gland are usually treated surgically. Gland-preserving techniques, which can be used to completely remove the tumour, preserve the function of the gland and reduce complications, but conventional open operations result in obvious scars on the neck. We aimed to investigate the feasibility and efficacy of gland-preserving robotic surgery using a hairline approach. We compared robotic with open techniques for gland-preserving operations to remove benign tumours of the submandibular gland. Patients were matched for age and sex (4 in each group). All patients in the robotic surgery group had their tumours removed successfully through hairline approaches. No patient had operative complications or postoperative functional nerve deficit, and an aesthetically pleasing outcome was achieved by concealing the scars within the hairline. Robotic operations took longer than open operations. No recurrence was noted during follow-up. Gland-preserving robotic surgery is a feasible alternative to conventional techniques and has potential advantages for safety and aesthetic outcome.

Conventional MRI findings for predicting submandibular pleomorphic adenoma

Although pleomorphic adenomas account for over 90% of all benign submandibular gland tumors, the imaging features of submandibular pleomorphic adenomas have not been reported in a large number of cases. To assess the conventional magnetic resonance imaging (MRI) findings for predicting the submandibular pleomorphic adenoma. MR studies of 42 pleomorphic adenomas and 28 other types of tumor were reviewed. MR images were assessed for the presence of hyperintense areas on T2-weighted images (first sign), a well-defined margin (second sign), and presence of crescent-shaped compression of the ipsilateral normal submandibular gland (third sign). For identifying submandibular pleomorphic adenoma, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 97.6%, 50.0%, 74.5%, 93.3%, and 78.6% for the first sign, 95.2%, 46.4% 72.7%, 86.7%, and 75.7% for the second sign, and 23.8%, 100%, 86.7%, 46.7%, and 54.3% for the third sign, respectively. Combining the first and second findings achieved to 85.7% specificity and 90.9% accuracy. Although non-specific, submandibular pleomorphic adenomas usually have hyperintense areas on T2-weighted images and well-defined margins. In addition, crescent-shaped compression of the ipsilateral normal gland seems to represent a highly specific sign.

Gland-preserving surgery can effectively preserve gland function without increased recurrence in treatment of benign submandibular gland tumour

The most widely accepted treatment for neoplasms of the submandibular gland usually involves excision of the entire gland. Our aim was to establish a gland-preserving operation for benign tumours of the submandibular gland and evaluate its efficacy. We treated 40 patients from January 2007 to December 2008 with benign submandibular gland tumours who were listed to have an operation that either preserved the gland or sacrificed it. Duration of operation, extent of injury to the nerve, postoperative function of the gland, aesthetic appearance, and recurrence were assessed. We found no significant difference in baseline characteristics among the 20 patients in each group (19 men; 21 women, mean (SD) age of 34 (33.8±5.72) years. The extent of injury to the lingual nerve and submandibular branch, together with deformities of the facial contour, were significantly less in the group in which the gland was preserved. Postoperative salivary production and overall patients’ satisfaction were also better in that group. There was no recurrence in either group during the follow up period of 38 months–5 years. The gland-preserving procedure has advantages over the typical approach in which the gland is sacrificed. There is less risk of injury to the nerve, less deformity of the facial contour, better preservation of function, and patients are more satisfied. The gland-preserving technique should therefore be the first choice for management of benign submandibular tumours.

Feasibility of robot‐assisted submandibular gland resection via retroauricular approach: Preliminary results

To present the surgical technique and feasibility of robot-assisted submandibular gland (SMG) resection via retroauricular approach. Feasibility study of case series. We performed robot-assisted SMG resection on five patients with benign SMG tumors. The surgical complications, operation time, amount of bleeding, amount and duration of drainage, and duration of hospital stay were reviewed. The surgery was successful in all patients without any significant complications. The mean operation time was 62.4 ± 6.3 minutes, amount of bleeding was 10.4 ± 3.2 mL, amount of drainage was 149.8 ± 114.7 mL (3.2 ± 1.6 days), and duration of hospital stay was 4.2 ± 1.8 days. All patients showed excellent cosmetic satisfaction because the postoperative scar was hidden by the auricle and hair. Robot-assisted SMG resection was feasible without any significant complications and satisfactory cosmetic results. The safety and oncologic outcome of the procedure should be verified with larger number of patients and longer follow up period.

MRI of chronic sclerosing sialoadenitis

The purpose of our study was to describe the MR appearance of Kuttner's tumours and to interpret their differences in appearance from other submandibular gland tumours. MR studies of 7 Kuttner's, 8 malignant and 12 benign submandibular gland tumours were reviewed. MR sequences obtained included T(1) weighted, short inversion time inversion recovery (STIR), T(2) weighted, diffusion-weighted (DW) and dynamic contrast-enhanced MR (dynamic MR) images. In all cases of Kuttner's tumour, the affected submandibular glands were swollen with slightly higher intensity on T(2) weighted, STIR and DW images, but the tumour margin could not be defined. Conversely, the margins of the other tumours could be detected. On T(2) weighted, STIR and DW images, the mean signal intensity ratios and the mean apparent diffusion coefficient (ADC) values for Kuttner's tumours and malignant tumours were significantly lower than those of benign tumours, but there were no significant differences between those of Kuttner's tumours and those of malignant tumours. All benign tumours showed late enhancement, with peak enhancement later than 120 s on dynamic MR images. Kuttner's tumours and malignant tumours showed variable enhancement patterns. In conclusion, signal intensity ratios for T(2) weighted and STIR images, ADC values and patterns of enhancement may help distinguish Kuttner's tumours from benign submandibular gland tumours, but not from malignant tumours. Although the intensities, ADC values and enhanced patterns of Kuttner's tumours were similar to those of malignant tumours, there were some morphological differences.

Tumors of the submandibular gland: Clinicopathologic analysis of 23 patients

Tumors of the submandibular gland are rare, comprising less than 2% of head and neck neoplasia. Both benign and malignant lesions show a mild symptomatology, resulting in late presentation and in advanced stage of disease. The purpose of this article was to report our experience in treating submandibular gland neoplasia during the last 10 years. The medical records of all patients with histologically confirmed epithelial tumors of the submandibular gland were retrospectively reviewed. This review found 23 patients with 9 benign and 14 malignant tumors. The collection of data included demographic data, diagnostic procedures, operative and pathology reports, complications, additional treatment, and follow-up. There were 10 men and 13 women with a mean age of 60 years. Pleomorphic adenoma was the most frequently encountered benign tumor; adenocarcinoma and adenoid cystic carcinoma had an equal presentation in the malignant group of patients. Eleven of the 14 patients with malignant tumors presented in advanced stages of disease (stage III and IV). Surgery was the sole treatment for the benign tumors. There were no recurrences. In the majority of cases, patients with malignant tumors were treated with surgery and postoperative radiotherapy. Eight patients died during the follow-up period, giving a mortality rate of 61.5%. Benign submandibular gland tumors manifest a mild course of disease, and local excision along with the gland is a safe and effective method of treatment. Malignant tumors have a poor symptomatology that results in late diagnosis. Radical surgery and postoperative radiotherapy is the treatment of choice. Prognosis depends on the histopathology and biologic behavior of the specific type of malignant tumor.

Computed tomography and ultrasonography in submandibular tumours

The value of computed tomography (CT) and ultrasound (US) for assessing submandibular tumours has been assessed. Thirty-five patients with 23 benign submandibular gland tumours and 12 malignant tumours have been investigated. In 33/35 patients, 18 plain CT (PCT), 19 CT sialography (CTS), and eight intravenous contrast-enhanced CT (CECT) procedures were performed. PCT did not allow clear delineation of 78% of the lesions, due to the similar density of the tumour and normal submandibular gland parenchyma. The tumours were easily recognized as low-echogenic or low-density masses by US, CTS and CECT. Benign lesions were usually sharply demarcated and had smooth borders on US, CTS and CECT. In addition, lobulation was often recognized in pleomorphic adenomas. Malignant tumours were poorly defined with irregular borders in 11/12 cases on US, CTS and CECT. CECT was superior to PCT and CTS in providing images of the tumour and its involvement of adjacent structures. It was concluded that US is the most useful primary examination method for submandibular tumours, while CECT provides the best evaluation of extension to the surrounding structures and/or adjacent lymph nodes. CTS seems to be unnecessary, if a submandibular tumour can be visualized by US and CECT.