Salivary Gland Disease Research Articles

RESIDUAL PHENOMENA OF THE TRANSFERRED COVID-19 IN THE MAXILLOFACIAL REGION OR ITS COMPLICATIONS

Today, the issues of the incidence of the Covid-19 virus and its complications are extremely relevant. Much attention in the scientific literature is paid to possible complications such as sufferings of the lungs, heart. Along with this, it became known that the coronavirus can affect the brain, nasopharynx, eyes, blood vessels, liver, kidneys and intestines. Interesting data from clinicians and morphologists has been received. Those who have had Covid-19 note the long-term effects of scarring of the lung tissue and kidney failure, inflammation of the heart muscle, arrhythmias, liver damage, cognitive impairment, psychosis, accompanied by a sharp change in mood. Interesting observations from the Department of Systems Biology at George Mason University were seen: 70% of patients who have had Covid-19 rarely observe pathology of internal organs.
 The purpose of our work was to highlight the complications from the large salivary glands in the patients who suffered from Covid-19.
 Objects and research methods. Our observations were carried out at the Poltava Center for Salivary Gland Pathology. There were only 17 patients. Three or four weeks ago, they reliably suffered from the disease. The function of the parotid salivary glands was studied using metal catheters, which were introduced into the mouth of the gland ducts for 10 minutes. The cellular composition of the secretion of the parotid glands was investigated according to the method generally accepted in cytology. 8 patients underwent ultrasound examination of salivary glands.
 Results. The antiviral and symptomatic treatment given to the patients eliminated the leading symptoms of the disease. At the time of completion of treatment, general somatic symptoms were eliminated and they were discharged healthy. 3 patients complained of dryness in the mouth, especially at night and in the morning. 4 patients complained of dry mouth, burning sensation in the eye area. In 5 patients, along with dryness in the mouth and nose, there was a complete lack of sense food taste. 5 patients complained of disorders of appearance. The parotid-masticatory areas were enlarged, we could observe dryness of the mucous membranes of the mouth and eyes. All patients had short-term or long-term headaches. Before the viral disease, none of the patients and their relatives had diseases of the salivary glands. Physical examination in 8 patients did not reveal any facial asymmetry. Palpation revealed slightly enlarged parotid salivary glands, slightly compacted, and slightly painful. The submandibular salivary glands were of normal consistency and were painless. These patients had a moderate amount of oral fluid in the mouth. Saliva of normal viscosity was released from the ducts of the parotid and submandibular glands. With sialometry of the parotid glands, there was a slight drop in secretion to 1.5 + 0.3 ml. Cytological examination of the secretion of the parotid glands determined a small number of cells of the columnar epithelium. Some of these cells had a tendency to necrosis; single squamous epithelial cells were found in the preparation.
 Conclusions. We evaluated the results of clinical examination data of 17 patients who had a viral Covid-19 infection and they were examined by us. In 3 - 4 weeks after recovery, there were complaints: dryness of the mucous membranes of the mouth, nose, conjunctiva of the eyes, loss food taste, enlargement of the parotid and submandibular salivary glands. It is possible to reliably state that patients have clinical phenomena of sialopathy. The results of additional studies of the secretion of the parotid glands, data of the cytology of their secretion and ultrasound examination confirm the secretory process in the glands of various degrees. The presence of elements of an inflammatory nature in the secret clearly defines the sialectatic process. The presence of headaches in the examined patients determines their probable vascular disorders in the components of the brain. Such changes can indirectly affect the vascular complex of the salivary glands and be the cause of the development of duct contractures and leads to sialadenosis.
 Perspectives. In order to examine this category of patients, the study of the features of blood circulation in the vessels of the brain and salivary glands should be considered to clarify the pathogenesis of sialadenosis.

Sialendoscopy: A Four-Year Single Center Experience

Sialendoscopy is a relatively new technique designed to diagnose and treat benign obstructive salivary gland disease using a minimally invasive approach. The purpose of this study is to present our experiences regarding the use of sialendoscopy in the form of a 4-year, single center experience and to demonstrate its usefulness in oral and maxillofacial practice. We collected data on patients who underwent sialendoscopy at the Oral-Maxillofacial Surgery Department of UZ Leuven between November 2015 and August 2019, including age, gender, sex, initial clinical presentation and symptoms, gland involvement, type of diagnostic investigations, diagnosis, localization of the obstruction, therapeutic intervention, surgeon, type of anesthesia, materials used, complications, secondary treatment, duration of follow-up, and outcome. Statistical analyses were performed, chi-squared was used to compare the different variables with P < .05 being considered significant. During the 4-year timeframe, a total of 44 patients (31 female, 13 male) underwent sialendoscopy in a total of 47 procedures. The average age at time of sialendoscopy was 47.4 years. The most frequent cause of obstruction was sialolithiasis (70%). Cone-beam computed tomography (CBCT) was the most accurate preoperative investigation for the diagnosis of lithiasis (57%). Symptom improvement occurred in 57.9% of patients, with a complication rate of 11%. None of the complications were permanent. Sialendoscopy can be considered safe and effective for both the diagnosis and treatment of benign obstructive salivary gland disease, with a useful place in oral and maxillofacial surgical practice. We recommend the inclusion of CBCT and/or ultrasound in the diagnostic workup prior to endoscopy.

PRIMARY ACINIC CELL CARCINOMA IN A YOUNG FEMALE PATIENT: A CASE REPORT

<h3>Background</h3> Acinic cell carcinoma (ACC) is a rare, low-grade tumor, accounting for about 5% of all primary salivary gland malignancies. ACCs predominate in the parotid gland, are seen in the fifth and sixth decades of life, and have a female predilection. Well-differentiated and low-grade tumors are associated with a favorable prognosis. <h3>Description</h3> We report a case of a 16-year-old female patient presenting with a right parotid lump that had been slowly increasing over the past year. Clinical examination revealed a 1.5-cm right parotid nodule with no facial nerve involvement and presence of cervical lymphadenopathy. Her past medical history was unremarkable. <h3>Findings</h3> Radiological investigations revealed a well-circumscribed, lobulated lesion in the anterior right parotid gland with presence of reactive lymph nodes bilaterally. Fine-needle aspiration showed granular cells with a differential diagnosis of oncocytoma, Warthin's tumor, or acinic cell carcinoma. Histologic examination showed a multinodular appearance with some marked granular cytoplasm with oncolytic and lymphoid infiltrate. The results of immunohistochemistry were negative for S100 and positive with DOG-1. There were widespread periodic acid-Schiff diastase-resistant granules throughout the tumor cells, with a Ki67 proliferation index of approximately 5%. <h3>Outcome</h3> The tumor was completely excised, and the patient made a full recovery and was considered to have a good long-term prognosis. <h3>Conclusions</h3> This is an unusual case of ACC seen in this age group and gender, where less than 4% of cases of ACC have been reported in patients younger than 20. It is important to consider differential diagnoses of salivary gland pathology, such as ACC, in the young female patient.

WFUMB position paper. Incidental findings of the salivary glands.

A salivary incidentaloma (SI) stands for any focal salivary lesion, independent of size, discovered by any imaging method including ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), multimodal positron emis-sion tomography (PET) combined with CT or MRI, or X-ray imaging, performed for another reason, in the absence of known salivary glands' disease. The article presents a detailed analysis of salivary gland diseases with the emphasis on neoplasms. It describes frequency of SIs found on imaging, their prevalence, epidemiology and clinical significance. The probability of malignancy or malignant transformation of a SI, its imaging features, recommended treatment, management and follow-up, as well as ethical issues, psychological burden, informed decision making, economical consequences and costs are discussed. The general prevalence of SIs is low, but is dramatically increasing over time, and may rise significantly in selected groups of oncologic patients. SIs most frequently turn out to be benign primary neoplasms or pseudotumors, including intraparenchymal lymph nodes. SIs detected by other imaging methods should be subsequently assessed with US. Solid SIs demand ultrasound guided fine-needle aspiration cytology (US-FNAC). Neoplasms should undergo surgery. Post-operative US follow-up is man-datory for malignant tumors and recommended for benign neoplasms.

Etiology, diagnosis, and surgical management of obstructive salivary gland disease

: Obstructive salivary gland disease (OSGD) represents a large subset of salivary gland entities that affect a significant number of patients every year. Many different pathologic processes such as sialoliths, mucous plugs, strictures, and ductal stenosis can present with nearly identical obstructive symptoms, making diagnosis and treatment challenging. Current management of OSGD revolves around resolution of acute infection, targeted imaging, and definitive surgical management of the causal obstruction. Technological advances and improved diagnostic methods over the last two decades have led to a paradigm shift in management of these disorders, with an emphasis on gland-sparing and minimally-invasive therapies. Imaging for obstructive salivary gland disorders has shifted away from traditional sialography and plain film radiography in favor of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Rehydration, gland massage, and antibiotics continue to be the mainstay of medical management. The use of sialendoscopy represents a minimally-invasive method to treat most OSGD without the morbidity associated with sialoadenectomy or other open procedures. The development of multiple adjunct treatment methods such as mechanical lithotripsy, laser lithotripsy, and extracorporeal shock wave lithotripsy have added to the overall effectiveness of minimally-invasive treatments for OSGD. This paper presents a review on the four main etiologies of salivary gland obstruction, appropriate diagnostic workup, and medical and surgical management of these disorders.

English

BACKGROUND Salivary gland diseases are rare but an important group of disorders. Following surgeries involving the parotid gland, facial nerve paresis is a common postoperative complication. The reported worldwide incidence of facial nerve paresis following parotidectomy is approximately 20 - 60 %. We need to determine the incidence of facial nerve paresis in the post-operative period following superficial, adequate, or extra-capsular parotidectomy of benign parotid tumours with the use of intraoperative facial nerve monitoring. METHODS A non-randomised interventional trial was initiated once cleared by the institutional review board. With the calculated sample size of 44, the patients underwent nervemonitoring for the identification of the branches of the facial nerve. Clinical grading of the nerve function was done using the House-Brackmann score on the postoperative days 2, 7, and 60. The findings were compared with the historical controls (HC) of 53 patients who underwent similar procedures but with no intraoperative facial nerve monitoring. All patients were recruited in continuity for over two years. RESULTS The incidence of facial nerve paresis was 30 - 40 % and 10 - 20 % in the historical control and nerve monitoring group, respectively (P = 0.07). The duration of surgery in the nerve monitoring group was 83 ± 30 minutes and 95 ± 15 minutes in the HC group. The incidence of nerve paresis was similar among the trainees and consultants suggestive of adequate training. CONCLUSIONS Intraoperative facial nerve monitoring is a useful adjunct to reduce the incidence of early postoperative facial nerve paresis. The technique would not prolong the duration of the procedure. The technique may be utilized safely on a routine basis even during surgical training. KEYWORDS Facial Nerve Monitoring, Parotidectomy, Benign Parotid Tumour, HouseBrackmann Score

Role of FNAC in diagnosis of parotid lesions

BackgroundSalivary gland masses are considered challenging for diagnosis regarding its origin and whether benign or malignant. Unique features of FNAC as a safe and easy diagnostic procedure with little discomfort to the patient made it a favorable primary diagnostic tool. Information regarding the nature of parotid lesions whether being benign or malignant is the main objective of FNAC. We have done a restrospective study for FNAC for parotid masses performed in John Hunter hospital (Newcastle, NSW, Australia) along the peroid from 2014-2018. Histopathological correlation was done in 74 cases to test the accuracy of FNAC in diagnosis of parotid lesions.ResultsOf the total 74 FNAC done for parotid lesions in which a histopathological correlation was done, we get 46 (62.2%) benign lesions (37 neoplastic and 9 non-neoplastic) while 28 (37.8%) were malignant tumor. Pleomorphic adenoma was the most common in benign tumor side (45.7%) while SCC is the most common in malignant group (53.6%). Compatibility between FNAC and histological diagnosis was found in 74% (55/74), of which 78.3% in benign lesions (36/46) and in 68% of malignant lesions (19/28). FNA cytology was true positive in 21/74 cases (28.4%) and true negative in 41/74 (55.4%) cases. We have 5 (6.8%) false-negative and 7 (9.5%) false-positive results. As a result, we get sensitivity of 81%, specificity of 85%, and accuracy of 84%.ConclusionThe role of FNAC in diagnosis of primary salivary gland pathology is considered with some debate about sensitivity/specificity; however, sometimes it should be repeated or correlated with clinical/histopathological confirmation.

POS0718 CLINICAL CHARACTERISTICS ASSOCIATED WITH GLANDULAR INVOLVEMENT EVALUATED BY SALIVARY GLAND ULTRASONOGRAPHY IN SJÖGREN’S SYNDROME

Background:Sjögren’s syndrome (SS) is a systemic autoimmune disease characterized by periductal lymphocytic infiltration of the salivary and lacrimal glands, which results in reduced secretory functions and oral and ocular dryness (1). In addition, patients often have extraglandular manifestations, such as interstitial pneumonia and interstitial nephritis, and the appearance of autoantibodies such as anti-Ro/SS-A and La/SS-B antibodies. Salivary gland ultrasonography (SGUS) is typically used to evaluate the findings of salivary glands; thus, we can evaluate the severity of salivary gland disorders due to SS using SGUS in real time (2).Objectives:To identify clinical indices, including disease activity, associated with glandular involvement evaluated using SGUS in patients with SS.Methods:We enrolled patients with SS (n=115) and non-SS sicca subjects (n=90) who visited Nagasaki University Hospital between 1995 and 2019. The patients’ SS classifications were based on the 2002 American–European Consensus Group (AECG) SS classification criteria (3). The non-SS sicca subjects exhibited sicca symptoms but did not fulfill the AECG SS classification criteria. SGUS and clinical indices such as age, sex, the focus score (FS), sicca symptoms, the Saxon test results, Schirmer’s test results, anti-SS-A/Ro antibody positivity, anti-SS-B/La antibody positivity, anti-centromere antibody (ACA) positivity, serum immunoglobulin G levels, and the clinical European League Against Rheumatism SS disease activity index were examined. The ultrasonography (US) score was calculated based on SGUS imaging (hypoechoic area, hyperechoic band, and irregular border) (4).Results:The US score was significantly higher in patients with SS than that in non-SS sicca subjects. In addition, we found significant correlations between the US score and FS in patients with SS. Multivariate analysis revealed the FS, Saxon test positivity, and ACA positivity as the variables independently associated with the US score in patients with SS. These results were the same in the primary SS patient group (n=96). Patients with ACA positivity had significantly higher US scores compared to those in patients with ACA negativity, whereas the FS was not significantly high. In addition, patients with ACA positivity had significantly greater positivity of hyperechoic bands than that in patients with ACA negativity.Conclusion:This study indicated that ACA positivity, which is not reflected in sialadenitis of SS, is associated with the US score in patients with SS. These results suggest that US findings of patients with ACA positivity might show specific changes in salivary glands, such as fibrosis, and not only sialadenitis (5).

Findings and feasibility of major salivary gland ultrasound in childhood-onset systemic lupus erythematosus: a pilot study

BackgroundChildhood-onset systemic lupus erythematosus (cSLE) is a complex autoimmune disorder with multi-organ manifestations and can be associated with other rheumatic diseases including Sjögren’s syndrome (SS). Salivary gland ultrasound (SGUS) represents a noninvasive tool to screen for salivary gland disease in rheumatic disease patients. The aims of this cross-sectional study were to determine feasibility of major SGUS in a clinic setting and to identify characteristics in a cohort of cSLE patients (without confirmed SS) that may be associated with salivary gland abnormalities consistent with secondary SS.MethodsPatients with SLE onset prior to age 18 were recruited. Patients completed questionnaires rating symptoms and underwent major SGUS examination. Disease and demographic differences were compared between cSLE patients with abnormal SGUS vs. cSLE patients with normal SGUS using t-tests and Fisher’s exact tests.ResultsThirty-one cSLE patients were recruited, 84% were female, 55% were Caucasian. The average disease duration among all patients was 5 years. Average time to complete the SGUS examination and scoring protocol was 7 min. 35% of SGUS scores were abnormal and significantly associated with IgG level at diagnosis, and anti-Ro and anti-La antibodies.ConclusionsThis is one of the first studies to our knowledge that assesses major SGUS in a cohort of patients with cSLE without prior diagnoses of SS. The SGUS protocol was feasible to perform by rheumatologists in a clinic setting. Although the sample size was small, SGUS abnormalities were identified in one-third of patients. IgG level at diagnosis and anti-Ro and anti-La antibodies may be associated with SGUS abnormalities.

A Rho Kinase (ROCK) Inhibitor, Y-27632, Inhibits the Dissociation-Induced Cell Death of Salivary Gland Stem Cells.

Salivary gland stem cells (SGSCs) are potential cell sources for the treatment of salivary gland diseases. The control of cell survival is an essential factor for applying stem cells to regenerative medicine or stem cell-based research. The purpose of this study was to investigate the effects of the ROCK inhibitor Y-27632 on the survival of SGSCs and its underlying mechanisms. SGSCs were isolated from mouse submandibular glands and cultured in suspension. Treatment with Y-27632 restored the viability of SGSCs that was significantly decreased during isolation and the subsequent culture. Y-27632 upregulated the expression of anti-apoptotic protein BCL-2 in SGSCs and, in the apoptosis assay, significantly reduced apoptotic and necrotic cell populations. Matrigel was used to mimic the extracellular environment of an intact salivary gland. The expression of genes regulating apoptosis and the ROCK signaling pathway was significantly reduced when SGSCs were embedded in Matrigel. SGSCs cultured in Matrigel and treated with Y-27632 showed no difference in the total numbers of spheroids and expression levels of apoptosis-regulating genes. Matrigel-embedded SGSCs treated with Y-27632 increased the number of spheroids with budding structures and the expression of acinar cell-specific marker AQP5. We demonstrate the protective effects of Y-27632 against dissociation-induced apoptosis of SGSCs during their culture in vitro.

English

BACKGROUND Neoplasms of salivary gland account for 2 - 6.5 % of all head and neck neoplasms. Fine needle aspiration cytology (FNAC) is sufficiently sensitive and relevant to the diagnosis and treatment of salivary gland pathologies for salivary gland lesions. The Milan system for reporting salivary gland cytopathology (MSRSGC) represents a stage for a structured, evidence-based international reporting system for salivary gland fine-needle aspiration (FNA). This system provides a guidance for diagnosis and management according to the risk of malignancy (ROM) in different categories. We wanted to study the various cytomorphological lesions of salivary gland and their cytological categorisation based on the MILAN system of reporting. METHODS A 2-year record-based study (January 2018 to December 2019) was conducted on FNAC of salivary gland lesions in the Department of Pathology, VSSIMSAR (Veer Surendra Sai Institute of Medical Sciences and Research), Burla, Odisha. Based on the classical system, all smears were studied and re-categorized into six groups according to the MILAN classification. Histological correlation was carried out in the available cases. RESULTS A total of 103 FNA cases were examined and 20 different categories were there in the original diagnosis. As per the categorisation based on MILAN System there were six categories, maximum cases were non-neoplastic 34 (33.0 %) followed by benign neoplasms 22 (21.35 %), malignant 14 (13.5 %), non-diagnostic 10 (9.7 %), atypia of undetermined significance 9 (8.7 %), suspicious for malignancy 8 (7.7 %) and neoplasms of uncertain malignant potential 6 (5.8 %). 43 cases (80.4 %) were found to be concordant out of 54 histopathology correlated cases. CONCLUSIONS The Milan system of reporting salivary gland cytopathology provided a uniform system of reporting salivary gland cytomorphology that may increase the effectiveness. KEYWORDS Milan System, Salivary Gland Lesions, FNAC, Risk of Malignancy (ROM)

УЛЬТРАЗВУКОВАЯ НАВИГАЦИЯ В ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ ПАЦИЕНТА СО СЛЮННОКАМЕННОЙ БОЛЕЗНЬЮ ОКОЛОУШНОЙ СЛЮННОЙ ЖЕЛЕЗЫ. КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Objectives. To analyze the possibility of using the technique of intraoperative ultrasound navigation on surgical treatment of patients with salivary stone disease of the parotid salivary gland (PSG). Material and methods. A retrospective analysis of three medical records of an in-patient treated at the department of maxillofacial surgery and operative dentistry in Gomel Regional Clinical Hospital during the period from 2019 to 2021 for salivary stone disease of PSG was made. Results. The results of clinical observation of treatment of a patient with sialolithiasis of the parenchymal part of the PSG are presented. Taking into consideration the complexity of surgical removal of sialolites of this localization, the patient was initially treated conservatively which was of no effect. Salivary stones were removed using intraoperative ultrasound navigation which made it possible to successfully perform the surgical intervention, reduce surgical trauma, create conditions for structural and functional recovery of the PSG and reduce the possibility of the disease relapse by improving intraoperative visual control. Conclusions. The use of the technique of intraoperative ultrasound navigation in the surgical treatment of patients with salivary stone disease of the parotid salivary gland allows to remove the concrement, minimizing the trauma to the tissues of the operated area and the organ itself, maintaining adequate blood flow and architectonics in it, which enables the reduction in the number of postoperative complications, relapses of the disease and positively affects the quality of patients’ life.

Diagnostic performance of Milan system for reporting salivary gland cytopathology: A prospective study.

Fine-needle aspiration (FNA) is a well-established modality for diagnosing salivary gland pathologies. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a standardized uniform framework leading to an evidence-based risk of malignancy (ROM). Based on the current literature, ROM in the 6-tier MSRSGC ranges from <5% for neoplasm-benign to >90% for the malignant category. Here, we report our institutional experience adopting MSRSGC. The cytopathology group at our institution implemented MSRSGC at the end of 2018. Through a query of our laboratory information system, we identified all salivary gland FNA cases from 27 November 2018 to 26 October 2020. The pertinent surgical pathology follow-up was also extracted. After manual curation, data was analyzed in Rv4.0.2. Our cohort comprised of 315 patients undergoing 343 salivary gland FNA biopsies, predominantly on the parotid (90%), 162 with a surgical pathology follow-up. The risk of malignancy ranged from 3.2% in neoplasm-benign (IVA) to 100% in suspicious for malignancy (V) and malignant (VI) categories. ROM in the other categories was: 12.5% for non-diagnostic, 0 for non-neoplastic, 33.3% for atypia of undetermined significance, and 41.9% for salivary gland neoplasm of uncertain malignant potential (SUMP). Most SUMP cases had a basaloid or oncocytoid cytomorphology with similar ROM. In distinguishing benign and malignant salivary gland lesions, FNA had adequacy of 93.6%, a diagnostic yield of 62.2%, a sensitivity of 93.1% and a specificity of 100%. MSRSGC was successfully adopted by our cytology group and clinicians, with overall diagnostic performance similar to previous studies.

“ROLE OF FNAC IN THE DIAGNOSIS OF SALIVARY GLAND LESION”

Background: Fine needle aspiration cytology (FNAC) has been used for diagnosis of salivary gland lesions for many years. Various studies in the existing literature have shown a wide range of sensitivity and diagnostic accuracy of cytologic diagnosis. FNAC is a safe, simple, cost effective, 1-4 accurate and minimal invasive procedure for the evaluation of salivary gland lesions. FNAC is not only useful in planning denitive preoperative 2,5-6 diagnosis but also can prevent unnecessary surgical intervention. Salivary gland swelling occur more commonly in 3rd decade of life with equal sex incidence. Parotid is one of the most commonly involved glands in the head &amp; neck region swellings. FNAC appears to be highly sensitive for benign tumours and highly specic for malignant tumors and it should be the rst line of investigation in evaluating the salivary gland pathologies. 7 Early diagnosis and appropriate management carries good prognosis. Methods: Patients with suspected salivary gland enlargements, referred for FNAC, were included in this study. FNAC was performed by using the standard procedure. Cytologic diagnosis was compared with histopathologic diagnosis wherever it was available. Results: In the present study conducted in the department of pathology, Shyam Shah Medical College Rewa MP, over a period of 5 years, 152 Patients with suspected salivary gland enlargements were retrospectively appraised. The benign lesions of salivary gland were 133 (87.5%), out of which Pleomorphic adenoma was diagnosed in 75 (56.39%) cases, clinical correlation was found in 58 (77.33%) cases. 29 cases were subsequently correlated with histopathological examination 26 correctly correlated and the diagnostic accuracy of FNAC was found to be 89.65%. Inammatory lesions were proved correct in 08 out of 10 cases after histopathology. Therefore, accuracy of FNAC was 80.0%. Malignant lesions of salivary gland were found in 19 cases, out of which 15 (78.94%) cases correlated with clinical diagnosis. 13 cases were subjected to histopathology 10 correctly correlated and the diagnostic accuracy of FNAC was found to be 76.92%. Overall diagnostic accuracy of FNAC was 84.61%. Conclusion:In conclusions it can be established that FNAC is an efcient and accurate procedure with high sensitivity index, and its usefulness is enhanced due to it being a relatively easy procedure which can be carried out even on outdoor patients.

Clinical Outcomes of Salivary Gland Tumor Surgery: A 10-year-chart View

ABSTRACT Background Salivary gland tumors constitute about 3% of all head and neck tumors. We present a series of 104 cases of various salivary gland pathologies and the various modalities of surgeries done between January 2007 and July 2017. Materials and methods Total 104 patients with salivary gland tumors were included in this study, of which 76 patients had parotid tumors and 28 were submandibular gland tumors. The presence or absence of coexisting salivary gland stones, involvement or noninvolvement of ducts were all considered. Preoperatively, patients underwent fine needle aspiration cytology (FNAC) and imaging studies along with routine blood investigations. Results All patients underwent surgery and subsequent histopathological examination (HPE). The preoperative FNAC and postoperative HPE were not correlating in 6.5% of parotid tumors and in 3.5% of submandibular gland tumor. Anomalies in the fasciovenous planes were seen in 3% of the patients, which caused intraoperative difficulties. Postoperatively, five patients had salivary leak and three patients had neuropraxia, which was managed conservatively and the patients recovered subsequently between 3 months and 6 months postoperatively. Conclusion Surgery for salivary gland tumors has its own threats due to the close proximity of nerve, vessels, and ducts. Postoperative complications like nerve palsy is seen more common in malignant tumors in both parotid and submandibular gland tumors. A proper methodical assessment and awareness of the various anatomical anomalies intraoperatively may give good surgical outcomes in surgeries of salivary gland tumors. In our study, various anomalies were encountered and dealt appropriately. How to cite this article Vemuru T, Mohanty S, Manimaran V, et al. Clinical Outcomes of Salivary Gland Tumor Surgery: A 10-year-chart View. Int J Head Neck Surg 2021;12(1):11–14.

Pathology of salivary gland dysfunction and restoration of function.

In this review, the author shows that simultaneous multiple disorders caused by reactivation of Epstein-Barr virus can lead to salivary gland disorders as part of Sjogren's syndrome (SS). Therefore, clinicians must differentiate SS from other diseases when diagnosing and treating salivary gland disorders. In particular, the author explains how microbial infection in SS overcomes immunological tolerance, leading to pathological changes, and how cytokine overexpression and endocrine disrupters contribute to glandular tissue injury. Also, the author suggests that involvement of reactive oxygen species is a common pathogenesis of salivary gland disorders and SS, so regulation of oxidative stress is an effective treatment for both. The results of clinical studies on restoring salivary gland function and regenerating salivary glands with tissue stem cells may provide clues on elucidating the cause of SS.

Mucocele in Lower Lip as a Result of Trauma

Mucocele is a common salivary gland disorder that can appear on the dorsal surface of the tongue, lacrimal sac, paranasal sinuses, and oral cavity. Mucocele results in alteration of the minor salivary glands due to a mucous accumulation causing limited swelling. Two histological types of mucoceles exist, namely extravasation and retention. Lower lip is the most common site of occurrence of these lesions in the oral cavity and the most probable cause is trauma or habits of lip biting. This report presented a 6½-year-old female child patient having mucocele on the inner side of her lower lip due to fall while playing, which resulted difficulty in mastication and speech. Treatment performed was conventional surgical excision followed by removal of the minor salivary glands.

Significance of the Overexpression of Substance P and Its Receptor NK-1R in Head and Neck Carcinogenesis: A Systematic Review and Meta-Analysis.

Simple SummaryHead and neck cancer is the sixth most frequent type of cancer, with more than 600,000 new cases/year, and it is responsible for around 300,000 deaths/year. Substance P (SP) is a peptide of the tachykinin family whose functions are related to a large number of physiological mechanisms in humans. The implications of SP in human carcinogenesis have recently been reported through the stimulation of its receptor NK-1R, or directly through the effects derived from the constitutive activation of NK-1R. With this background, we have shown, through a systematic review and meta-analysis, evidence that the upregulation of SP and NK-1R are oncogenic events involved in head and neck carcinogenesis, probably acting in the early stages of malignization. Our findings also highlight translational opportunities for SP/NK-1R as potential therapeutic targets in head and neck cancer.The objective of our study has been, through a systematic review and meta-analysis, to increase the scientific evidence on the implications of SP and its receptor NK-1R in head and neck carcinogenesis. We searched studies published before May-2020 without date and publication language restrictions (PubMed, Embase, Web of Science, Scopus). We evaluated the quality of the studies included (QUIPS tool). We performed heterogeneity, sensitivity, small-study effects, and subgroup analyses. A total 16 studies and 1308 cases met inclusion criteria. Qualitative evaluation demonstrated that not all studies were performed with the same scientific rigor, finding the greatest risk of bias in the study confounding and prognostic factors measurement domains. Quantitative evaluation showed a greater SP/NK-1R overexpression in malignant head and neck lesions compared to benign lesions (p = 0.02), and that expression was observed in malignant salivary gland pathology. Likewise, we found a higher overexpression of NK-1R compared to SP (p = 0.02). In conclusion, the results of this systematic review and meta-analysis show evidence that the upregulation of SP and NK-1R are oncogenic events involved in head and neck carcinogenesis, probably acting in the early stages of malignization. In addition, there is evidence of a greater relevance of the upregulation of the NK-1R receptor compared to SP, which highlights the interest in deepening the development of targeted therapies on the receptor. Future studies assessing the relationships between SP/NK-1R among subjects with head and neck tumors could consider the recommendations given in this systematic review and meta-analysis to improve and standardize future research.

A Novel Experimental Approach for In Vivo Analyses of the Salivary Gland Microvasculature.

Microvascular dysfunction plays a fundamental role in the pathogenesis of salivary gland disorders. Restoring and preserving microvascular integrity might therefore represent a promising strategy for the treatment of these pathologies. The mechanisms underlying microvascular dysfunction in salivary glands, however, are still obscure, partly due to the unavailability of adequate in vivo models. Here, we present a novel experimental approach that allows comprehensive in vivo analyses of the salivary gland microvasculature in mice. For this purpose, we employed different microscopy techniques including multi-photon in vivo microscopy to quantitatively analyze interactions of distinct immune cell subsets in the submandibular gland microvasculature required for their infiltration into the surrounding parenchyma and their effects on microvascular function. Confocal microscopy and multi-channel flow cytometry in tissue sections/homogenates complemented these real-time analyses by determining the molecular phenotype of the participating cells. To this end, we identified key adhesion and signaling molecules that regulate the subset- and tissue-specific trafficking of leukocytes into inflamed glands and control the associated microvascular leakage. Hence, we established an experimental approach that allows in vivo analyses of microvascular processes in healthy and diseased salivary glands. This enables us to delineate distinct pathogenetic factors as novel therapeutic targets in salivary gland diseases.

MORPHOMETRIC STUDY OF ARTERIES OF THE LOWER JAW REORGANIZATION ASPECTS IN THE SIMULATED POST-RESECTION ARTERIAL PULMONARY HYPERTENSION

Summary. The salivary glands are a special group of secretory organs that play a significant role in dental health of the population, as well as one of the vital functions of the whole human body. With the development of modern medical science, clinicians have often diagnosed salivary gland pathology. One of the most important problems of these pathologies is the study of direct and reverse effects of organs on each other, the principles of their correlations and methods of morphological expression. In recent decades, there has also been an increase of pulmonary lesions, which are accompanied by hypertension in the small circulation and lead to the development of pulmonary heart disease and its decompensation. There are isolated studies on the features of the involvement of the mandibular gland in the pathological process, and only some works reflect the structural changes of the submandibular gland in hemodynamic disorders.&#x0D; The aim of the work – to study morphometric aspects of mandibular arteries reorganization in simulated post-resection arterial pulmonary hypertension.&#x0D; Material and Methods. The arteries of medium (51–125) μm and small (26–50) μm calibers [16] of the mandibular salivary gland of 27 Vietnamese pigs, which were divided into 3 groups, were studied by a complex of histological and morphometric methods. Group 1 included 9 intact animals aged 6.5–7 months, group 2 – 12 pigs of the same age with post-resection pulmonary hypertension and compensated pulmonary heart, group 3 – 6 animals 6.5–7 months with pulmonary hypertension and decompensated pulmonary heart.&#x0D; Results and Discussion. Hypertension (one-month term) in the small circle of blood circulation, which occurred after right-sided pulmonectomy led to the development of pulmonary heart and venous stasis in the organs of the large circle of blood circulation, including in the mandibular gland. At arterial hypertension in a small circle of blood circulation essential structural reorganization of arteries of a mandibular gland is revealed. Although morphological changes were found in the arteries of small caliber of the studied organ and in the decompensation of the pulmonary heart.&#x0D; Conclusions. Our morphological study provided comprehensive information on the features of remodeling of the mandibular arteries in postresection arterial pulmonary hypertension. Prolonged pulmonary hypertension leads to structural rearrangement of the arteries of the middle and small caliber of the mandible, which is characterized by thickening of the membrane, narrowing their lumen and endothelial cells damage, impaired blood supply and hypoxia in the body. The biggest changes are in the arteries of the small caliber of the mandibular gland and in the decompensation of the pulmonary heart in 6.5–7 month old male pigs of the Vietnamese breed.