Salivary Gland Ducts Research Articles

Delayed Management of Parotid Sialocele: Role for Two-week Intraoral Drainage.

Iatrogenic injury or trauma to the salivary gland duct is one of the most common causes of parotid sialoceles, which are usually superficial, soft, and filled with saliva. The enrolled 7 patients with parotid sialocele were divided into two groups: trauma group (4 cases) and iatrogenic group (3 cases). No evidence of recurrence or cranial nerve injuries were observed. With persisted parotid sialocele, intraoral drainage for two weeks as a safe and inexpensive method is recommended.

A Mathematical Model of Salivary Gland Duct Cells

Saliva is produced in two stages in the salivary glands: the secretion of primary saliva by the acinus and the modification of saliva composition to final saliva by the intercalated and striated ducts. In order to understand the saliva modification process, we develop a mathematical model for the salivary gland duct. The model utilises the realistic 3D structure of the duct reconstructed from an image stack of gland tissue. Immunostaining results show that TMEM16A and aquaporin are expressed in the intercalated duct cells and that ENaC is not. Based on this, the model predicts that the intercalated duct does not absorb Na^+ and Cl^- like the striated duct but secretes a small amount of water instead. The input to the duct model is the time-dependent primary saliva generated by an acinar cell model. Our duct model produces final saliva output that agrees with the experimental measurements at various stimulation levels. It also shows realistic biological features such as duct cell volume, cellular concentrations and membrane potentials. Simplification of the model by omission of all detailed 3D structures of the duct makes a negligible difference to the final saliva output. This shows that saliva production is not sensitive to structural variation of the duct.

Histopathological evaluation of minor salivary gland aberrations in oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is one of the most established oral cancers in India, with high morbidity and mortality. The most common etiological agent associated with it is tobacco (in any form), which releases chemical carcinogens that affect not only the oral epithelial lining but also deep stromal structures such as minor salivary glands. They may cause changes in ductal or acinar part of gland depending on tumor grade, thus providing a fertile soil for tumor growth and recurrence. To observe the frequency of minor salivary gland changes associated with tobacco as well as to measure the length and depth of ductal involvement in routine tissue sections of OED and OSCC. A total of 94 hematoxylin and eosinstained archival slides which included cases of well, moderate, and poorly differentiated OSCC and oral epithelial dysplasia were histopathologically evaluated to observe changes in different components of minor salivary gland. Ductal hyperplasia, ductal metaplasia, mucous pooling within duct, acinar degeneration, pattern of malignant cell invasion (single/clusters), inflammatory infiltrate, eosinophilic cuffing around the gland, and glandular/vascular involvement were evaluated in each slide and correlated with different grades of OSCC. Ductal hyperplasia, inflammatory cell infiltrate, mucous pooling, and pattern of malignant cell infiltration came out to be statistically significant with the highest percentage of changes being observed in poorly differentiated squamous cell carcinoma > moderately differentiated squamous cell carcinoma> well differentiated squamous cell carcinoma>oral epithelial dysplasia. Further, the results of this study suggest that extension of dysplasia or squamous cell carcinoma from overlying oral epithelium along salivary gland ducts is an uncommon finding. Conclusion: Hence, histopathological interpretation for OED and OSCC should also include changes related to associated minor salivary gland tissue as detection and eradication of the putative precursors are the best way of decreasing the overall morbidity caused by tumors.

Experience in using a minimally invasive method for removing salivary gland duct calculus under sonography control

Background. Removal of calculi in salivary stone disease is one of the urgent problems of maxillofacial surgery and surgical dentistry due to the complexity of the manipulation, the trauma of the technique and the frequent development of complications.
 Aim. Improvement of the treatment results of patients with salivary stone disease by using our developed method of minimally invasive removal of calculi located in any part of the excretory duct of the submandibular and/or parotid salivary glands, under constant ultrasound visualization of the intervention.
 Material and methods. The study included patients diagnosed with salivary stone disease (10 people: 9 male and 1 female aged 1850 years, mean age 44.21.25 years). The methodology was as follows. An ultrasonic sensor was brought in from the side of the skin, and the location of the calculus in the gland duct was determined. Next, a needle with a diameter of 0.3 cm with a mandrin was inserted percutaneously through a puncture into the duct of the salivary gland to the distal surface of the calculus, and it was advanced with the help of a needle as far as possible towards the mouth of the excretory duct. Then the needle was removed, leaving a mandrel in the duct, with which the calculus was fixed in a new position. After bougienage of the excretory duct, Dormias basket was introduced into it, and the calculus was captured and removed. The manipulations were performed under constant ultrasound imaging.
 Results. The use of the technique developed by us for minimally invasive removal of a calculus with a diameter of up to 5 mm, located in any part of the excretory duct of the submandibular and/or parotid salivary glands, under constant ultrasound visualization of the intervention course, made it possible to achieve a positive result in all 10 patients included in clinical observations.
 Conclusion. The minimally invasive technique for removing calculi from the excretory ducts of the salivary glands under constant ultrasound imaging developed by us makes it possible to facilitate manipulation, its visibility and accuracy, as well as atraumaticity and prevention of complications.

STRUCTURE OF THE EXCRETORY DUCT OF THE PAROTID SALIVARY GLAND: HISTOLOGICAL AND IMMUNOHISTOCHEMICAL FEATURES

There are a number of reasons that lead to inadequate salivation or complete cessation of salivation. Among others, one of the main can be systemic diseases like Sjögren’s syndrome, and the use of medication, dysbiotic changes in oral cavity and stress. Most often, patients with xerostomia disturbed itching and burning in the mouth, taste disturbance, difficulty in speaking and swallowing food (especially dry), and difficulty wearing dentures. Hypofunction of salivary glands can lead to different outcomes in the mouth. The most common are, first of all, the loss of gloss of the oral mucosa, it atrophic changes, the appearance of fissures and lobes on the back of the tongue, the development of angular cheilitis, dysbiotic change, and the development of multiple caries. If xerostomia oral mucosa requires compliance with the rules of oral hygiene and constant daily moisturizing. The best method of relief of patients is to stimulate the secretion and the mandatory use of wetting agents to the oral mucosa. A thorough intra-oral and extra-oral clinical examination is important for diagnosis. Treatment may include the use of salivary substitutes (Biotene), salivary stimulants such as pilocarpine, ongoing dental care, caries prevention, a review of the current prescription drug regimen and possible elimination of drugs having anticholinergic effects. The article presents the results of histological and immunohistochemical features of the structure of the main excretory duct of the parotid salivary gland for the presence of muscle structures in it and clarifying the possibility of their influence on the development of xerostomia.

Salivation in some diseases of the digestive system

In a healthy person, there is constant salivation, the magnitude of which varies from person to person, but is almost constant in this individual. Attachment of the Krasnogorsky Leshley capsule to the excretory duct of the parotid salivary gland allows you to observe continuous saliva secretion, which some call rest secretion, others background salivation.

Mucocele of lower lip – Case reports

Mucoceles are cavities filled with mucus and are one of the most common benign soft tissue masses that occur in the oral cavity. They are traumatic in origin and are formed when the main duct of a minor salivary gland is traumatized with subsequent extravasation of the mucus into the fibrous connective tissue forming a cyst like cavity. Mucoceles can appear by an extravasation or a retention mechanism. They appear as discrete, small, translucent, soft, painless swelling of the mucosa ranging from normal pink to deep blue in color and are most commonly found on the lower lip, lateral to the midline and may occur at any age, but they are more frequently seen in the second and third decade of life. The lesion has no sex predilection and occurs more frequently in children, adolescents. Generally managed by conservative surgical excision.

Gaint Sialolith of The Wharton S Duct of Salivary Gland – A Case Report

Gaint Sialolith of The Wharton S Duct of Salivary Gland – A Case Report

Effectiveness of Thuja occidentalis in the treatment of solitary nodular lesion of tongue: A case report

Background: Solitary, nodular lesions of the oral mucosa present a clinical dilemma with their similar presentation to the physician. The lesions that appear on the ventral surface of the tongue, a soft muscular organ are distinct and even rarer with varied manifestations. It may occur in different locations in the oral mucosa due to trauma or obstruction of minor salivary gland ducts with the lower lip as the predominant site, often overlooked during screening procedures because of their asymptomatic nature.Case Summary: Here, we report an interesting case of solitary nodular lesion on the anterior ventral surface of the tongue in 4 year old female child based on the clinical diagnosis. Moreover, these cystic nodular lesions should be considered as one of the differential diagnosis while evaluating a growth involving the ventral surface of the tongue in young female children. Diagnosis: Mucocele of the Tongue.

Impact of photobiomodulation therapy on the morphological aspects of submandibular gland submitted to excretory duct ligation and hypothyroidism: an animal study.

The aim of this study was to evaluate the impact of photobiomodulation therapy (PBMT) on histomorphological aspects of submandibular gland (SMG) submitted to salivary gland duct obstruction in hypothyroid rats. Fifty-six male Wistar rats (250 to 300g) were divided into 4 groups (n = 14): euthyroid (EU), EU + PBMT, hypothyroid (HYPO), and HYPO + PBMT. Duct obstruction of the left submandibular gland (LSMG) was performed in all animals by a ligature procedure. For the induction of hypothyroidism, total thyroidectomy was performed. PBMT groups received irradiation with AlGaInP diode laser (808nm, 0.04W, 0.04cm2 spot size, 60s, 2.4J per point, 60J/cm2, 1W/cm2). Irradiation was performed immediately, 24h, and 48h after the obstruction of the salivary gland duct, in one point, extra oral and perpendicular to the gland. Animals were sacrificed after 24h and 72h after duct ligature. Our results indicated that salivary duct obstruction and hypothyroidism caused negative modifications on the salivary glands' histomorphology, especially acinar atrophy, after 24h and 72h. HYPO + PBMT showed a significant reduction of the inflammatory infiltrate, congested blood vessels, and acinar atrophy in the SMG submandibular salivary gland in 72h compared to 24h (p < 0.05). In conclusion, obstruction of the salivary gland excretory duct and hypothyroidism causes severe sialoadenitis with expressive atrophy of the glandular parenchyma. However, PBMT was able to modulate the inflammatory process and delaying acinar atrophy. This study provided insights to better understand the role of the PBMT on the altered salivary gland by duct ligation and associate hypothyroidism.

Functional Parotid Sparing: Does Sparing the Parotid Ducts Yield Improvements in Patient Reported Xerostomia?

Literature suggests that salivary gland stem cells, capable of regenerating salivary tissue, may preferentially reside in the large ducts of salivary glands. We conducted a prospective trial in patients receiving definitive chemoradiotherapy (CRT) for oropharyngeal cancer where we preferentially spared the major parotid ducts (localized via MRI sialography) during treatment planning. We hypothesized that (1) this technique would yield improvements in patient reported xerostomia (PRX) at 6- and 12-months post-CRT compared to a prospectively accrued cohort of similar patients, and (2) that parotid duct doses would be predictive for PRX.A total of 38 Patients were prospectively enrolled and underwent MRI sialography guided ductal sparing. 28/38 patients received de-escalated CRT (60Gy). PRX was classified as none/mild versus moderate to very severe. (1) PRX in the 28 de-escalated patients were compared using a fisher exact test to a cohort of 232 patients on the same clinical trials but who did not undergo ductal sparing. (2) Competing nested multivariate logistic models (+/- parotid duct doses) were assessed using dosimetric data from all 38 patients for their ability to predict PRX. Models included contralateral submandibular mean dose, mean parotid gland dose (both) +/- parotid duct mean dose (both). The two nested models were compared using a likelihood ratio test to determine if incorporating mean parotid duct doses significantly improved model fit.(1) Patients reporting moderate to very severe xerostomia was lower in patients with vs without parotid-ductal sparing at 6 months post-CRT (46% vs 67%, P = 0.03), and trended lower at 12 months post-CRT (32% vs 49%, P = 0.11). At 6 months post CRT, the mean parotid duct dose was the only covariate significantly associated with PRX (P = 0.047). At 12 months post CRT, no covariate was significantly associated with PRX but both mean contralateral submandibular dose and mean parotid duct dose approached significance (P = 0.06 and 0.07, respectively). (2) The models +/- parotid duct doses were compared and the addition of parotid ductal mean dose significantly improved model fit at 6- and 12-months post CRT (P = 0.030 and 0.047, respectively).The absolute rates of moderate to very severe patient reported xerostomia were approximately 20% lower for those undergoing MRI sialography guided parotid ductal sparing versus those without ductal sparing at 6- and 12-months post CRT. The significant improvement of model fit upon adding mean parotid ductal dose to the mean major salivary gland doses at 6 and 12 months suggests that the dose received by the parotid ducts relates to patient reported xerostomia severity even when considering traditional metrics such as mean parotid and contralateral submandibular dose.

Saliva and its potential in coronavirus disease 2019 (COVID-19) cannot be ignored: A point of view.

Abstract It has been demonstrated that salivary gland duct cells have similar receptors as ACE2-positive cells/keratin epithelial cells of the lung which have high potential to be infected by SARS-CoV 2 virus. The aerosols carrying virus have penetration into the healthy human body and lungs via inhalation through nose or mouth.

Fine structure of Drosophila larval salivary gland ducts as revealed by laser confocal microscopy and SEM

The functions of the larval salivary glands (SGs) of Drosophila are traditionally associated with the production of a massive secretion during puparium formation; it is exocytosed into a centrally located lumen and subsequently expectorated via ducts, the pharynx and mouth. This so-called proteinaceous glue serves as an adhesive to attach the puparial case to a solid substrate. Great attention has been paid to the secretory cells of SGs, which are famous for their giant polytene chromosomes. However, substantially less attention has been devoted to individual or common ducts that form the most proximal portion of the SG organ via which the glue is released into the pharynx. In the present paper, we describe the organization and fine structure of the taenidia, highly specialized circumferential ring-like extracellular (cuticular) components on the internal side of these tubes. Two chitin-specific probes that have previously been used to recognize taenidia in Drosophila tracheae, Calcofluor White M2R (also known as Fluorescent Brightener 28) and the novel vital fluorescent dye SiR-COOH, show positively stained ductal taenidia in late larval SGs. As seen using scanning electron microscopy (SEM), the interior of the ductal tube contains regular and densely-arranged ridge-like circumferential rings which represent local thickenings of the cuticle in various geometries. The microtubular arrays that optically colocalize with taenidia in both the trachea and SG ducts are specifically and strongly recognized by fluorescently-conjugated colchicine as well as anti-tubulin antibody. In contrast to taenidia in the tracheae, the analogous structures in SG ducts cannot be detected by fluorescently-labeled phalloidin or even actin-GFP fusion protein, suggesting that the ducts lack a cortical network made of filamentous actin. We speculate that these taenidia may serve to reinforce the duct during the secretory processes that SGs undergo during late larval and late prepupal stages.

Glomerulonephritis with severe nephrotic syndrome induced by immune complexes composed of galactose-deficient IgA1 in primary Sj\xf6gren\u2019s syndrome: a case report

BackgroundPrimary Sjögren’s syndrome (pSS) is an auto-immune disease characterized by sialadenitis and dacryoadenitis with lymphoplasmacytic cell infiltration. In pSS, not only sicca symptoms, but also extra-glandular involvement induced by immune abnormalities based on pSS occurs. Renal involvement is one such important life-threatening extra-glandular involvement. Although the aberrant glycosylated IgA in pSS as a product of over-activated B cells is a risk factor of renal involvement, its association has not been clarified. Here we report a case of glomerulonephritis (GN) induced by immune complexes (IC) composed of galactose-deficient IgA1 (Gd-IgA1) in a patient with pSS.Case presentationA 48-year-old Japanese woman with pSS was admitted to our hospital because of a two-month history of nephrotic syndrome. Seven years before she had been diagnosed with pSS from keratoconjunctivitis sicca, elevation of serum anti-Ro/SSA antibody titer and lymphoplasmacytic cell infiltration around salivary ducts of the small salivary glands. Renal biopsy revealed diffuse bubbling appearance in glomerular basement membrane (GBM) with scarce mesangial proliferation. Immunofluorescence showed granular IgA, C3 and Gd-IgA1 staining of GBM. Light chain staining showed no monoclonality. Electron microscopy showed electron dense deposits mainly in the intra-membranous and paramesangial areas and slightly in the subepithelial area. Additional serum analysis confirmed elevation of Gd-IgA1 (13.5 μg/mL), which was comparable with that seen in IgA nephropathy, and qualitative enzyme-linked immunosorbent assay of IgA-containing circulating immune complex (IgA-CIC) was positive. Thus, we diagnosed GN induced by IC composed of Gd-IgA1. Furthermore, retrospectively performed immunofluorescence of the small salivary gland evaluated at the diagnosis of pSS showed positive Gd-IgA1 staining of infiltrating lymphoplasmacytic cells. Therefore, we concluded that Gd-IgA1 produced by over-activated B cells in pSS formed circulating IC and thereby induced GN. After induction therapy with high dose prednisolone and mycophenolate mofetil, the nephrotic syndrome remitted within 3 weeks, the serum Gd-IgA1 level decreased to the normal range (3.8 μg/mL), and serum IgA-CIC disappeared in the 6th month after induction therapy.ConclusionsOur findings clearly demonstrate an association between aberrant glycosylated IgA and the renal involvement seen in pSS, thereby helping to clarify the renal significance of aberrant glycosylated IgA in pSS.

Excision of Lower Lip Mucocele Using Scalpel and Diode Laser: Two Case Reports

The term “Mucocele” originates from Latin words ‘mucus’ which means ‘fluid’ and ‘coele’ which means ‘cavity’. It is defined as the accumulation of mucus in the oral cavity’s subepithelial tissue secreted from salivary glands and their ducts. It is a frequently occurring salivary gland lesion which is seen in the oral cavity. They occur as mucus extravasation and mucus retention type. They may be obstructive in nature and occur due to trauma to a minor salivary gland duct which results in pooling in the epithelial tissue. Clinically, a mucocele appears as a typical blue colored dome shaped swelling which is soft in consistency and contains salivary fluid. It lies superficial or deeply attached to the tissues.&#x0D; &#x0D; Management of mucocele includes surgical excision, marsupialization, micro marsupialization, cryosurgery, laser vaporization, and laser excision. Recently, high - intensity lasers have been proven to be more beneficial than conventional surgery as it causes prompt hemostasis, minimal blood loss and reduced healing time of the site.

Immunohistochemical localization of carbonic anhydrase IV in the human parotid gland

ABSTRACT Carbonic anhydrases (CAs) catalyze the hydration and dehydration of carbon dioxide. They are important for regulating ions, fluid and acid-base balance in many tissues. The location of CAs by cell type is important for understanding their roles in these functions. CAs II and VI have been demonstrated using immunohistochemistry (IHC) in the serous acinar cells of human salivary glands and ducts of rat salivary glands. CA IV has been localized by IHC to the ducts of rat salivary glands. CA IV also is present in human parotid glands as shown by real time-polymerase chain reaction (RT-PCR), but this method does not show the distribution of the CA isozymes by cell type. We investigated the cell-specific distribution of CA IV in the human parotid gland. Sections from five formalin fixed, paraffin embedded specimens of human parotid gland were subjected to IHC for CA IV using a commercial antibody. Moderate to strong reactions were found in the cell membranes and cytoplasm of the intercalated, striated and excretory ducts and capillaries, and reactions in the acini were limited to faint areas in some cells. These results indicate that CA IV participates in the regulation of bicarbonate/carbon dioxide fluxes in the ductal system of the human parotid gland.

Neurofibromin expression by normal salivary glands

IntroductionNeurofibromin, a protein encoded by the NF1 gene, is mutated in neurofibromatosis 1, one of the most common genetic diseases. Oral manifestations are common and a high prevalence of hyposalivation was recently described in individuals with neurofibromatosis 1. Although neurofibromin is ubiquitously expressed, its expression levels vary depending on the tissue type and developmental stage of the organism. The role of neurofibromin in the development, morphology, and physiology of salivary glands is unknown and a detailed expression of neurofibromin in human normal salivary glands has never been investigated.AimTo investigate the expression levels and distribution of neurofibromin in acinar and ductal cells of major and minor salivary glands of adult individuals without NF1.Material and methodTen samples of morphologically normal major and minor salivary glands (three samples of each gland: parotid, submandibular and minor salivary; and one sample of sublingual gland) from individuals without neurofibromatosis 1 were selected to assess neurofibromin expression through immunohistochemistry. Immunoquantification was performed by a digital method.ResultsNeurofibromin was expressed in the cytoplasm of both serous and mucous acinar cells, as well as in ducts from all the samples of salivary glands. Staining intensity varied from mild to strong depending on the type of salivary gland and region (acini or ducts). Ducts had higher neurofibromin expression than acinar cells (p = 0.003). There was no statistical association between the expression of neurofibromin and the type of the salivary gland, considering acini (p = 0.09) or ducts (p = 0.50) of the four salivary glands (parotid, submandibular, minor salivary, and sublingual gland). Similar results were obtained comparing the acini (p = 0.35) and ducts (p = 0.50) of minor and major salivary glands. Besides, there was no correlation between the expression of neurofibromin and age (p = 0.08), and sex (p = 0.79) of the individuals, considering simultaneously the neurofibromin levels of acini and duct (n = 34).ConclusionNeurofibromin is expressed in the cytoplasm of serous and mucous acinar cells, and ductal cells of salivary glands, suggesting that this protein is important for salivary gland function.

Interpretation of the mucous plug through sialendoscopy.

The purpose of this manuscript is to highlight the behaviour of mucus inside the ducts of the major salivary glands, in presence of typical pathologies, through images obtained with sialendoscopy. The authors present and comment on some sialendoscopies that show mucous plug in the ducts of the major salivary glands. In primary Sjogren's syndrome, mucous plugs confirm the qualitative anomaly of the mucins and acidification saliva. Instead, salivary calculations behave like foreign bodies that generate mechanical pressure and friction on the duct walls of major salivary glands, so mucus deposits in the duct in its defence; in case of infected stone, mucous plugs are formed also with the function of protecting the ducts from the aggression of germs. During sialadenitis, there is a conflict between mucus and bacteria which explains sialendoscopic evidence such as white duct walls and mucous plugs. The study of the salivary ducts through sialendoscopy often confirms the clinical diagnosis or hypothesize it. During its execution, it is necessary not only to liberate the ducts of the major salivary glands but also analyse the appearance of the mucous plugs and the ductal walls as they are useful to guide the physician towards diagnosis.

Ultrasound-guided sialo-irrigation for the treatment of chronic sialodochitis with sialolithiasis.

Sialolithiasis is one of the most common causes of salivary duct obstruction. In the last 20years, minimally invasive procedures like sialendoscopy, extracorporeal lithotripsy, and basket snaring are increasingly being used for the treatment of salivary gland duct stones. Sialo-irrigation of the salivary gland is an effective procedure for treating inflammation and providing symptomatic relief. This procedure can be employed for the treatment of sialolithiasis using the back pressure of instilled saline. Sialo-irrigation under ultrasound (US) guidance allows for dynamic studies showing real-time images during diagnostic or surgical procedure and can be used for the removal of sialoliths. In addition, it can also be used to remove primitive sialoliths and microliths by washing out the ductal system, which prevents the recurrence of sialoliths. The aim of this study was to propose a minimally invasive technique for sialolithiasis using US-guided sialo-irrigation.

Sialolith of The Submandibular Gland: A Case Report

Sialolithiasis is described as the existence of calcified structures in ducts of salivary glands and is the most widespread disease of the salivary glands. 80-95 % of sialoliths occur at the submandibular salivary gland. Sialoliths with an average frequency of occurrence of 12: 1000 are approximately twice as common in men as in women. Sialoliths may be diagnosed with clinical examination, conventional radiography, computed tomography and ultrasonography. Common clinical signs in cases of sialoliths include painless swelling, large swelling often accompanied by trismus associated with eating, symptoms ranging from moderate discomfort to severe pain. In this case report clinical, radiological signs and surgical therapy of salivary stone in the submandibular gland is represented.