Left Submandibular Gland Research Articles

Submandibular gland is a suitable site for alpha synuclein pathology in Parkinson disease

ObjectiveTo validate the role of α-synuclein (AS) pathology in submandibular gland (SMG) as a biomarker for Parkinson disease (PD). MethodsWe performed ultrasonography (USG) guided core needle biopsy of SMG in PD patients and procured SMG biopsy tissues or surgical excision specimens from non-PD patients as controls. Then, we compared AS deposition in the SMG tissues between the PD patients and the controls. We recruited 16 PD patients in this study. In each individual, two core needle biopsy tissues were obtained from the left submandibular gland under USG guidance. Fourteen sex and age-matched controls who did not have PD and dementia but received a core needle biopsy or surgical resection of the SMG due to SMG diseases were procured from the pathology archive. Biopsy tissues and surgical specimens were immuno-stained with serine 129 phosphorylated AS (pAS) antibody for microscopic examination. pAS deposition in neural structures such as ganglion cells and neurites was considered as positive. ResultsNo serious complication occurred during and after the SMG biopsy. We found glandular parenchyma and neural structures in all biopsied SMG tissues from the patients and the controls. Nine out of 16 PD patients (56.2%) were positive for pAS staining, while none of the controls were positive (0%). ConclusionsSMG core needle biopsy can reliably and safely obtain sufficient glandular parenchyma and neural structures to evaluate the α-synuclein pathology. AS pathology in SMG has high specificity and good sensitivity as a biomarker for PD.

Is volumetric modulated arc therapy with constant dose rate a valid option in radiation therapy for head and neck cancer patients?

Intensity-modulated radiotherapy (IMRT) improves dose distribution in head and neck (HN) radiation therapy. Volumetric-modulated arc therapy (VMAT), a new form of IMRT, delivers radiation in single or multiple arcs, varying dose rates (VDR-VMAT) and gantry speeds, has gained considerable attention. Constant dose rate VMAT (CDR-VMAT) associated with a fixed gantry speed does not require a dedicated linear accelerator like VDR-VMAT. The present study explored the feasibility, efficiency and delivery accuracy of CDR-VMAT, by comparing it with IMRT and VDR-VMAT in treatment planning for HN cancer. Step and shoot IMRT (SS-IMRT), CDR-VMAT and VDR-VMAT plans were created for 15 HN cancer patients and were generated by Pinnacle3 TPS (v 9.8) using 6MV photon energy. Three PTVs were defined to receive respectively prescribed doses of 66Gy, 60Gy and 54Gy, in 30 fractions. Organs at risk (OARs) included the mandible, spinal cord, brain stem, parotids, salivary glands, esophagus, larynx and thyroid. SS-IMRT plans were based on 7 co-planar beams at fixed gantry angles. CDR-VMAT and VDR-VMAT plans, generated by the SmartArc module, used a 2-arc technique: one clockwise from 182° to 178° and the other one anti-clockwise from 178° to 182°. Comparison parameters included dose distribution to PTVs (Dmean, D2%, D50%, D95%, D98% and Homogeneity Index), maximum or mean doses to OARs, specific dose-volume data, the monitor units and treatment delivery times. Compared with SS-IMRT, CDR-VMAT significantly reduced the maximum doses to PTV1 and PTV2 and significantly improved all PTV3 parameters, except D98% and D95%. It significantly spared parotid and submandibular glands and was associated with a lower Dmean to the larynx. Compared with VDR-VMAT, CDR-VMAT was linked to a significantly better Dmean, to the PTV3 but results were worse for the parotids, left submandibular gland, esophagus and mandible. Furthermore, the Dmean to the larynx was also worse. Compared with SS-IMRT and VDR-VMAT, CDR-VMAT was associated with higher average monitor unit values and significantly shorter average delivery times. CDR-VMAT appeared to be a valid option in Radiation Therapy Centers that lack a dedicated linear accelerator for volumetric arc therapy with variable dose-rates and gantry velocities, and are unwilling or unable to sanction major expenditure at present but want to adopt volumetric techniques.

Correlation of Salivary Gland Dose to Volume Changes Noted During Adaptive Replanning of Head and Neck Radiation Therapy

Salivary gland shrinkage is known to occur with radiation therapy (RT) for head and neck cancer. Adaptive Radiation Therapy (ART) is commonly performed during the course of Intensity-Modulated Radiation Therapy (IMRT) due to weight loss and/or tumor shrinkage. Our goal was to investigate changes in parotid (PG) and submandibular gland (SMG) volumes measured on initial and replanning CT. We hypothesize that dose received by gland at the time of replan predicts for quantitative gland volume reduction. Replanning thus has the potential to reduce this effect which ultimately may reduce severity of xerostomia. We analyzed 100 patients who underwent adaptive re-planning (200 plans) between December 2014 to August 2017. Volumetric Modified Arc Therapy (VMAT) based IMRT was used in all. All patients had an initial CT simulation scan (Plan 1) used for radiation planning and a subsequent new CT simulation for adaptive replan (Plan 2). Dose-volume histograms were used to measure mean and maximum doses to right and left PG and SMG. We then correlated these doses to PG and SMG volume changes noted at the time of replan (PG1-PG2; SMG1-SMG2). Univariate and multivariate analyses were performed to identify factors contributing to gland volume changes. Tumor site included 9 oral cavity, 50 oropharynx, 14 Larynx, 7 Nasopharynx, and 20 others. Treatments were definitive chemo-RT in 67%, adjuvant chemo-RT in 20%, or adjuvant RT alone in 10%. Chemo used was Cisplatin-based 36%, Carboplatin-based 22%, or Cetuximab-based in 28%. Median total RT dose was 70 Gy (60-70 Gy in 30-35 daily fractions). Median time to performing replan was at fraction #21 (42 Gy) and around day 37 of therapy (13-66 days). Mean weight loss at time of replan was -4.3% (-21.3 to +17.5%). Analysis included 181 PG and 116 SMG. Mean dose received at time of replan with corresponding volume change: RPG = 1548 cGy, -13.6%; LPG = 1647 cGy, -14.6%; RSMG = 3359 cGy, -12.7%; LSMG = 3366 cGy, -14.4%. The correlation values of dose received and volume change: RPG r = 0.17, LPG r = -0.21, RSMG r = -0.33, and LSMG r = -0.27 (all with P<.05 except RPG, P=.13). Anatomic changes during radiation can result in increased doses to normal tissues and increased risk of toxicity. Our results show a significant change in gland volume in 3 of 4 salivary glands at the time of replanning with a direct correlation to dose received to the gland. Adaptive replan has the potential to reduce salivary gland doses.

Carcinosarcoma ex Pleomorphic Adenoma of the Submandibular Gland in a 64-Year-Old Man: A Case Report

Carcinosarcoma (CS) is a rare tumor, consisting of both carcinomatous and sarcomatous components. In this paper, we present a case of CS arising from a pleomorphic adenoma (PA) of the submandibular gland. A 64-year-old Japanese man presented with a left submandibular mass that had developed for 20 years with complaints of pain for the last 3 months. Magnetic resonance imaging showed a lesion involving the left submandibular gland. The patient underwent total dissection of the left submandibular gland and left cervical lymph nodes. Upon gross examination, the mass appeared completely covered by fibroadipose tissue measuring 46×42×45 mm; sectioning revealed a solid-white nodule with central bleeding and necrosis, invading into the surrounding adipose tissue. Microscopically, the presence of carcinomatous and sarcomatous components in the fibro-myxomatous stroma was detected, suggestive of pre-existing PA. The carcinoma component was diagnostic of salivary adenocarcinoma, not otherwise specified, whereas the sarcomatous component exhibited features of osteosarcoma characterized by formation of osteoid. As the border between the carcinomatous and sarcomatous components was not evident, CS may have occurred via transformation of the carcinoma into sarcoma. Tumor metastasis was detected in the cervical lymph nodes. Immunohistochemically, AE1/AE3 expression was noted in the carcinomatous component, but not in the osteosarcoma component. Both components were diffusely positive for vimentin. Four months after the operation, the patient developed a metastatic CS lesion in the lung, suggesting tumor aggression.

Salivary gland duct obstruction after radioiodine therapy: a case report

Background: Radioiodine therapy has long been used in the treatment of hyperthyroid patients. Salivary complications secondary to radioactive iodine (RAI) treatment are well documented, there is little in the literature addressing salivary gland duct obstruction. We present a rare case of salivary gland duct obstruction developed 2 months after RAI treatment. Case Presentation: We describe a 50-year-old male, treated with RAI for hyperthyroidism. He developed pain and swelling in the left submandibular region, 2 months after receiving RAI treatment (25 mCi). His salivary gland scintigraphy was done after injecting 370 MBq (15 mCi) of Tc99m pertechnetate in supine position. It revealed retention of radiotracer in the left submandibular gland with no drainage through the duct system, even on giving lemon stimulus, favoring submandibular gland duct obstruction. Conclusion: We report this rare complication of submandibular gland duct injury occurring after RAI therapy. The occurrence of this complication even after low dose of radioiodine administration may be listed in gamut. All necessary measures must be taken to reduce such potential complications.

Salivary gland duct obstruction after radioiodine therapy: a case report

Background: Radioiodine therapy has long been used in the treatment of hyperthyroid patients. Salivary complications secondary to radioactive iodine (RAI) treatment are well documented, there is little in the literature addressing salivary gland duct obstruction. We present a rare case of salivary gland duct obstruction developed 2 months after RAI treatment. Case Presentation: We describe a 50-year-old male, treated with RAI for hyperthyroidism. He developed pain and swelling in the left submandibular region, 2 months after receiving RAI treatment (25 mCi). His salivary gland scintigraphy was done after injecting 370 MBq (15 mCi) of Tc99m pertechnetate in supine position. It revealed retention of radiotracer in the left submandibular gland with no drainage through the duct system, even on giving lemon stimulus, favoring submandibular gland duct obstruction. Conclusion: We report this rare complication of submandibular gland duct injury occurring after RAI therapy. The occurrence of this complication even after low dose of radioiodine administration may be listed in gamut. All necessary measures must be taken to reduce such potential complications.

A Giant Sialolith in the Submandibular Salivary Gland Parechyma - A Rare Entity

Sialolith is a calcified organic matter that is formed within the secretory system of the salivary glands. Sialolithiasis affects around .01-1.0% of the world population. Salivary calculi are usually seen in the ducts of the glands and in the hilus of the gland. Sialoliths on the parenchyma occur in 9-17% of the cases. Giant sialoliths are a rare finding there sizes vary from approximately 1.5 cm to 7 cm and their weight varies in the literature. Here we report an interesting case of a large sized sialolith in the parenchyma of the left submandibular gland.

Mucoepidermoid carcinoma mimicking a mucocele (ranula) in the floor of the mouth

Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy. The submandibular gland is rarely involved, about less than 10% of all other major salivary glands. We report a case of a 49-year-old female who presented with a mass on the left side of the floor of the mouth. She was complaining of neck pain for the last 2-3 days and had noticed the mass growing in size and becoming tender to palpation. There was no exacerbation of pain during eating, drinking, or opening of mouth. A multidetector CT scan was made. The radiographic examination revealed a mostly well-defined hypodense area suggestive of mucocele (ranula), which was thought to be corroborated by the clinical findings. The treatment of choice was the complete excision of the mucocele and the left submandibular salivary gland. The histopathological examination surprisingly revealed a low-grade MEC. No further treatment was recommended; however, a follow up was scheduled in 4 months. This atypical location of MEC in the floor of the mouth simulated the clinical and radiographic features of a mucocele. This case highlights the value and importance of using all the available diagnostic tools and modalities for optimal patient management, as the histopathological analysis played an important role to confirm the diagnosis.

Scoring hypoechogenic areas in one parotid and one submandibular gland increases feasibility of ultrasound in primary Sjögren’s syndrome

ObjectiveTo assess whether ultrasonographic scoring of (i) both parotid and submandibular salivary glands and (ii) all individual components of the Hocevar scoring system, is needed for classifying patients as primary...

Anatomical Variation Of The Submandibular Gland Duct. A Unreported Anomaly

Background: The submandibular gland is the second largest major salivary gland and weighs 7–16 gr. The gland is located in both sides of the face, at the same level of the body of the jaw, in the submandibular triangle, The submandibular duct or Wharton’s duct exits anteriorly, coursing deep to the lingual nerve and medial to the sublingual gland, the main excretory duct of the submandibular gland, whose diameter is of 2 to 3mm and approximately 4–5 cm long. It empties lateral to the lingual frenulum through a papilla in the floor of the mouth behind the lower incisor tooth. The purpose of this study is determine the morphologic features and describe an unusual anatomical variation of the path of the submandibular duct.&#x0D; Methods and Findings: A total of 17 cadavers were used for this study in the Morphology Laboratory at the University of Pamplona. In a cadaver were findings: The excretory duct of the left submandibular gland had an external location that ascends and crosses vertically off the body of the mandible, in its termination it is divided in four ducts that had separate openings into the oral cavity upon a small papillas independent, opposites to the first and second lower molar Crown.&#x0D; Conclusions: Awareness of potential variations of the excretory ducts of the salivary glands can aid in the accurate diagnosis and treatment of patients with salivary conditions as well as help surgeons avoid further complications or duct lacerations during surgical procedures.

Radioprotective effect of vitamin E on salivary glands after radioiodine therapy for differentiated thyroid cancer: a randomized-controlled trial.

This study aimed to examine the radioprotective effect of vitamin E on salivary glands after radioactive iodine (I) therapy in patients with differentiated thyroid cancer. Eighty-two patients with differentiated thyroid cancer were enrolled in this study. They were divided randomly into four groups (control group: 22 cases, group A: 23 cases, group B: 22 cases, and group C: 15 cases) before postsurgical ablation therapy with 100 mCi I. The patients in groups A, B, and C received vitamin E 100, 200, and 300 mg/day orally, respectively, for a duration of 1 week before to 4 weeks after I therapy. Salivary gland function was assessed using salivary gland scintigraphy immediately before and 6 months after I therapy. Uptake fraction (UF), uptake index (UI), excretion fraction (EF), and excretion ratio (ER) of each salivary gland were measured and compared. On comparison between before and after I therapy in the control group, there was a significant decrease in UF of both right and left parotid glands (all P<0.01). In group A, a significant increase in EF of the right parotid gland (P<0.01) and UI of the right submandibular gland (P<0.05) was found. In group B, there was a significant increase in UI of the right parotid gland and both submandibular glands (all P<0.01). In group C, there was a significant increase in UF of the left parotid gland (P<0.05) and the right submandibular gland (P<0.01). Also, there was a statistical increase in UI in both submandibular glands (all P<0.01). However, on comparing the changes in the post-I therapy salivary scintigraphy parameters among the four groups, there was a significant difference in ΔUI of the right parotid gland (P<0.05) and both submandibular glands (all P<0.01), as well as ΔER of the left parotid gland (P<0.05) and ΔUF of the left submandibular gland (P<0.05). Vitamin E exerts significant protective effects on the parotid and submandibular glands after I therapy.

Case Report: Absent Left Submandibular Gland Secondary to Gland Obstruction Due to a Sialolith and a Review of the Literature Surrounding This

Case Report: Absent Left Submandibular Gland Secondary to Gland Obstruction Due to a Sialolith and a Review of the Literature Surrounding This

Hydatid cyst submandibular gland, an unusal presentation: A case report

This is a case report of a sixteen years old female presented in the Otolaryngology and Head &amp; Neck Surgery with left submandibular region which did not recovered by medical treatment. She underwent excision of left submandibular gland and hispathological examination confirmed the diagnosis as hydatid cyst of left submandibular gland.Health Renaissance 2015;13(3): 188-190

Sclerosing Mucoepidermoid Carcinoma of the Submandibular Gland Presenting as Chronic Sialadenitis: A Case Report and Review of Literature

Sclerosing mucoepidermoid carcinoma of the salivary gland (SMEC) is a rare subtype of mucoepidermoid carcinoma (MEC), first described in 1987 by Chan and Saw. As far as we are aware, only 30 cases have been published since then. Most cases were located in the parotid gland with some cases described in the submandibular and minor salivary glands. SMEC typically presents as a long-standing mass, with a non-specific enhancing appearance on imaging and is often non-diagnostic on fine needle aspiration, making pre-operative diagnosis very difficult. It is characterised by dense sclerosis within an otherwise typical MEC, frequently with lymphoid proliferation and eosinophils at the periphery. The histological diagnosis of SMEC can be challenging, as the sclerosis may obscure the other morphological features, which can lead to misdiagnosis. Grading can also be difficult, and the prognostic value of grading for SMEC remains unclear. Herein is described a new case of SMEC, presenting clinically as chronic sialadenitis in the left submandibular gland of a 41year old male. A brief literature review and the issues surrounding diagnosis and grading are also discussed.

Effect of selenium supplementation for protection of salivary glands from iodine-131 radiation damage in patients with differentiated thyroid cancer.

In the current study, we examined whether selenium supplementation during iodine-131 (131I) treatment had a radio-protective effect on salivary glands. Sixteen patients with differentiated thyroid cancer were prospectively enrolled in the study. Patients after total thyroidectomy, before 131I treatment, were divided into two groups; 8 patients in the selenium group and 8 patients in the control group. Patients in the selenium group received 300νg of selenium orally for 10 days, from 3 days before to 6 days after 131I treatment. The control group received a placebo over the same period. To assess salivary gland function, salivary gland scintigraphy was performed before and 6 months after 131I treatment. Serum amylase and whole blood selenium levels were measured before and 2 days and 6 months after 131I treatment. Using salivary gland scintigraphy, maximum uptake ratio (MUR), maximum secretion percentage (MSP), and ejection fraction (EF) of each salivary gland were calculated. Baseline clinical characteristics, baseline amylase and selenium levels, and parameters of baseline salivary gland scintigraphy were not significantly different between selenium and control groups (P>0.05). On a blood test performed 2 days after 131I treatment, the selenium group showed a significantly higher whole blood selenium level (P=0.008) and significantly lower serum amylase level (P=0.009) than the control group. On follow-up salivary gland scintigraphy, the control group showed significantly decreased, MUR of the bilateral parotid and left submandibular glands, MSP of the bilateral parotid and submandibular glands, and EF of the left submandibular glands (P<0.05), while the selenium group only had a significant decrease in MSP of the right submandibular gland and EF of the left submandibular gland (P<0.05). Selenium supplementation during 131I treatment was effective to reduce salivary glands damage by 131I radiation in patients with differentiated thyroid cancer.

A case report of absence of the left submandibular gland, secondary to gland obstruction due to a sialolith and a review of the literature

A case report of absence of the left submandibular gland, secondary to gland obstruction due to a sialolith and a review of the literature

A spontaneous high-grade undifferentiated mammary carcinoma in a seven-week-old female rat

The present work describes a rare case of a spontaneous high-grade carcinoma in a seven-week-old Sprague-Dawley female rat that had been included in the control group of an assay of mammary carcinogenesis. The mass was detected at 50days of age, it grown quickly and the animal was humanely sacrificed eight days later. The tumor was located in the left cervical region, in the vicinity of the left submandibular and sublingual glands. It was soft and reddish and had several dens with a bloody content. The tumor was PAS negative and exhibited immunostaining for ER-α. The histopathologic and immunohistochemical data are suggestive of a high-grade carcinoma from mammary gland. It was the first report of a spontaneous mammary tumor in such a young rat.

OP - CONGENITAL LIPOMATOSIS OF THE FACE: A RARE DISEASE

Facial congenital infiltrating lipomatosis is a rare subtype of hemifacial hyperplasia. Abnormal growth of one side of the face occurs in all tissues of the affected area, particularly adipose tissue. Diagnosis is by exclusion, as the etiology of this condition is unknown. However, some factors associated with it include heredity, chromosomal and neural abnormalities, atypical twinning forms, altered intrauterine environment, endocrine and anatomical dysfunction, functional abnormalities of the vascular and lymphatic systems, and central nervous system disorders. Herein, we report a 15-year-old girl who sought treatment in the Hospital Heliópolis of São Paulo for congenital facial swelling that partially regressed over time. Extraoral examination revealed facial asymmetry with normal color, soft consistency, and non-pulsatile swelling in the left mandibular region. Intraoral examination showed a slight erythematous tongue and soft palate on the left side. Magnetic resonance imaging showed thickening and signal heterogeneity in the fat planes of the left perimandibular and perimaxillary regions, with thread-like vascular structures in between. Magnetic resonance angiography revealed an increase in the left submandibular and parotid glands. Based on her medical history, physical examination results, and imaging studies, the patient was diagnosed with congenital lipomatosis of the face.

OP - SOLITARY FIBROUS TUMOR IN THE FLOOR OF THE MOUTH IN A PATIENT PREVIOUSLY AFFECTED BY A PLEOMORPHIC ADENOMA

A solitary fibrous tumor (SFT) is a benign neoplasm derived from pluripotential mesenchymal cells. Although described as a pleural tumor, SFTs affecting extrapleural locations have been reported, but involvement of the oral cavity is rare. A 37-year-old woman was referred for evaluation of a painful swelling in the mouth. Her medical history revealed surgical removal of a pleomorphic adenoma on the left submandibular gland 12 years earlier. Intraoral examination showed a firm, tender to palpation, submucosal swelling on the left side of the floor of the mouth. The provisional diagnosis was a recurrent pleomorphic adenoma and an incisional biopsy was performed. Histological examination showed a storiform spindle cell proliferation arranged in cellularized areas interspersed by a dense fibrous tissue with fewer cellularized areas. The neoplastic spindle cells were immunopositive for CD34, bcl-2, and CD99, leading to the diagnosis of SFT. The patient was submitted to a conservative surgical removal of the lesion and analysis of the surgical specimen confirmed the SFT. The patient remains in clinical follow-up for one year with no signs of local recurrence. An SFT is a rare benign mesenchymal tumor that should be considered in the differential diagnosis of oral submucosal swellings.

Ectopic undescended left parathyroid adenoma: Diagnosed on ultrasound

We report here a case of left ectopic undescended parathyroid nodule located high in the neck, at the angle of jaw which was diagnosed primarily on high-resolution color Doppler ultrasound imaging at our institution, followed by Sestamibi and computed tomography-single photon emission computed tomography (CT-SPECT) and surgery. A 41-year-old female having endometrial hyperplasia and planned for TAH + BSO. Her routine preoperative investigations showed serum calcium to be 13.0 mg/dL. Serum parathyroid hormone (PTH) was 914.6 pg/mL and 25–OH Vitamin D 8.0 g/mL. Ultrasound neck with color Doppler localized an ectopic undescended left parathyroid adenoma located high in the neck just adjacent to the left submandibular gland. Sestamibi was suggestive of the left ectopic undescended parathyroid adenoma (below the pole of the left submandibular gland), confirmed further on CT-SPECT. The patient was operated and a 30 mm × 23 mm × 10 mm sized parathyroid adenoma was removed and confirmed on histopathology. A dedicated high-resolution color Doppler ultrasound has a great potential to localize the parathyroid nodules in all cases of raised serum PTH and must be utilized in all cases along with other imaging modalities.