Salivary Gland Swelling Research Articles

Atypical Mumps; are We Heading Towards an Outbreak?

Mumps, caused by the mumps virus, is a contagious disease primarily affecting children and young adults. While typically presenting with salivary gland swelling and systemic symptoms, mumps can lead to various complications including SNHL, orchitis/ oophoritis, aseptic meningitis. Recent observations suggest atypical features in mumps cases, raising concerns of a potential outbreak in India. To discuss the etiopathogenesis and clinical presentation in cases of atypical mumps with increasing number of cases, a prospective multicentric study was conducted across five major centers - SMS Medical College Jaipur, RDBP Jaipuria Hospital, Jaipur, Shri Ashwini Saxena ENT Hospital Rewari, AIIMS Bhubaneswar and SP Medical College Bikaner, in India to evaluate patients with acute salivary gland swellings. Clinical and laboratory data were collected, including demographics, presenting symptoms, history of vaccination, imaging findings, and treatment outcomes. Patients were followed for four weeks post-treatment to monitor for delayed complications. Among 53 patients, a bimodal age distribution was observed, with peaks in early adolescents and middle-aged individuals. Vaccination status was recorded based on recall. Fever and salivary gland swelling were predominant symptoms, with a significant proportion experiencing submandibular gland involvement. Elevated serum amylase and CRP levels correlated with disease severity and prolonged symptomatic resolution. Notably, cases of sensorineural hearing loss (SNHL) and airway complications emerged as significant concerns. The study highlights a shift in mumps demographics, with higher age groups affected and increased incidence of complications like SNHL and airway compromise. International trends also suggest periodic outbreaks and evolving clinical manifestations post-COVID-19 pandemic. Factors contributing to mumps resurgence include lack of vaccination or vaccine efficacy, population immunity, and seasonal variations. India appears to be facing a potential mumps outbreak, characterized by atypical features and increased risk of complications like SNHL and airway compromise. Serum amylase and CRP serve as valuable markers for disease severity. Early recognition and management of complications are crucial, emphasizing the importance of mumps immunization to mitigate the impact of the disease. ENT specialists should remain vigilant for emerging complications, particularly SNHL, advocating for comprehensive immunization strategies.

Ultrasonography-Guided Fine Needle Aspiration Cytology Versus Histopathology: Diagnostic Consistency in Salivary Gland Neoplasms.

Introduction Salivary gland lesions include a diverse range of histological types and biological behaviors, making accurate diagnosis and effective treatment challenging for specialists. Fine needle aspiration cytology (FNAC) plays a significant role in making preoperative diagnoses and further plans of surgery. In differentiating malignant from benign salivary gland tumors, the diagnostic accuracy of fine needle aspiration cytology (FNAC) is high. However, the final diagnosis is histopathological. The aim of this study is to correlate cytological and histopathological interpretations in salivary gland lesions. Materials and method Thirty patients were included in this study, all of them were diagnosed with salivary gland swellings and operated on in the ear, nose, and throat (ENT) department of Mata Gujri Memorial (MGM) Medical College, Kishanganj, in the northeastern region of India, between December 2020 and November 2022. Ultrasonography (USG) and computed tomography (CT) scans were performed in each case, and FNAC was done to make a preoperative diagnosis. After surgery, specimens were collected for histopathological examination. A correlation was then made between the findings of the preoperative cytological examination and the results of the postoperative histopathological examination. The comparison was performed using a 2×2 table, and the analysis of sensitivity, specificity, positive predictive value(PPV), and negative predictive value (NPV) was carried out using Microsoft Excel (MicrosoftCorp., Redmond, WA) and SPSS software (IBM SPSS Statistics, Armonk, NY). Results An equal number of male and female samples were included in the study, in which parotid involvement was predominant (60%). On FNAC, 53% of parotid gland tumors were found to be benign, whereas only 23.3% of submandibular gland tumors were benign. Pleomorphic adenoma was the most common finding. In the present study, the sensitivity, specificity, positive predictive value, and negative predictive value of USG-guided FNAC, compared to the gold standard histopathology, were 96%, 33.3%, 92.3%, and 50%, respectively. The diagnostic accuracy was found to be 89.3%. Conclusion The findings of this study suggest that FNAC is a reliable technique for the preoperative diagnosis of salivary gland tumors, as it is minimally invasive and offers valuable diagnostic information. An accurate cytological diagnosis can help avoid unnecessary surgery.

A prospective study to assess clinicopathological correlation of head and neck masses

Background: One of the most frequent clinical manifestations in the field of otorhinolaryngology is a mass in the head and neck area. A thorough history and good clinical examination including the findings of inspection and palpation are key factors for near accurate provisional diagnosis but histopathological is the gold standard for confirmation. FNAC is an easy, efficient, and affordable way to sample superficial neck masses. Methods: The present research has been performed on 100 patients presenting with clinically palpable head and neck masses in the ENT OPD of Rajindra Hospital, Patiala for duration of 2 years (2021-2023). Clinical diagnosis was correlated with cytology and histopathology findings. The data was compiled and evaluated using adequate statistical tools. Results: In this research, 100 cases of head and neck swellings were examined. Out of 100 swellings, 39 patients had lymph node swellings, 31 presented with thyroid swelling, 20 had salivary gland swelling and 10 were miscellaneous. In this study, most of the swellings found to be inflammatory in nature. Women were far more likely to be involved than men. Clinical and cytological diagnoses were made in all cases. Conclusions: When compared to a biopsy, the procedure of fine needle aspiration cytology for head and neck swellings is not only less invasive but also more cost-effective, and causes far less pain. It is possible to execute the procedure successfully on elderly people and children without the need for anesthesia.

Ultrasound Evaluations of Major Salivary Gland Pathology

No single sonographic feature is enough to distinguish gland disorders. Major salivary gland diseases are either localized or diffuse. Imaging must identify neoplastic from non-neoplastic diseases using Ultrasound, which is a non-invasive, low-cost, and accessible imaging method for the major salivary gland evaluation. Color Doppler in addition to B-mode ultrasound assesses gland enlargement and detects inflammatory, benign, and malignant gland enlargement. Moreover, this study aims to assess the diagnostic effectiveness of ultrasonography in diagnosis of major salivary gland pathology. Method: Ninety Major Salivary Gland swelling patients underwent preoperative ultra-sonography with a high-frequency linear probe. Echotexture, internal Calcification, focal lesion borders, lymphadenopathy, tumor shape, duct dilatation, and blood supply distribution were examined using color Doppler and B-mode Ultrasound. Result: A histological investigation of 62 tumors identified 18 malignant and 44 benign, with 68.2% of the benign group being pleomorphic adenoma and 61.1% of the malignant group being mucoepidermoid carcinoma. The rest of the cases, 28 cases were inflammatory, 50% of which were sialolithiasis. The sonographic features of malignant and benign differ significantly in echogenicity, posterior echo-enhancement, vascularity, morphology, and homogeneity and Calcification. All groups show considerable differences in duct dilatation, duct calcification, and homogeneity. Conclusion: Ultrasonography demonstrating excellent diagnostic efficacy in assessing salivary gland function, based on these results Ultrasonography may help reduce unnecessary biopsies especially in inflammatory cases.

Diagnostic Accuracy of Fine Needle Aspiration Cytology (FNAC) in Salivary Gland Tumors.

Professor Oral Pathology, Islamabad Dental Hospital, Islamabad 6Demonstrator Oral Pathology Margalla Institute of Health Sciences, Islamabad Author`s Contribution 1Conception and idea acquisition of data, 2Data Analysis, 3Results interpretation, 4Editing and drafting, 5Critical Revision, 6Final approval of the study to be published Funding Source: None Conflict of Interest: None Received: February 02, 2024 Accepted: May 27, 2024 Address of Correspondent Dr. Zainab Niazi Associate Professor Oral Pathology, Islamabad Dental Hospital, Islamabad dr.zainabniazi@gmail.com ABSTRACT Objectives: To evaluate the diagnostic accuracy of fine needle aspiration cytology (FNAC) by comparing its findings with the gold standard histological features of salivary gland lesions. Methodology: This retrospective study was conducted at the Department of Histopathology, Islamabad Medical and Dental Hospital (IMDC), from January 2023 to December 2023, patients presenting with salivary gland swellings. Fifty-seven patients having salivary gland swelling were included on which both histological and cytological evaluation had been done. Twenty cases were excluded because either they had lack of correlation between FNAC and histology or on view of inadequate material. All the patients were clinically evaluated clinically and FNAC was done using 10ml disposable syringe and 23/24-gauge needle without using local anesthesia. The histopathology of the surgical specimens and cytology of the FNAC specimens were compared, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. Results: On FNAC, 37 cases were diagnosed cytologically, as 9 cases identified malignant and 28 as benign. Histopathological examination confirmed 9 malignant cases and 25 benign cases, whereas 3 cases were classified as false positive. The specificity and sensitivity of FNAC were 75% and 94%, respectively. Overlapping cytological features, heterogeneity, and unsampled areas were the primary factors contributing to false-positive. Conclusion: This study showed that salivary gland FNA cytology is a valuable diagnostic technique for salivary gland lesions, however due to great variation in pleomorphic adenoma, the samples must be confirmed by histopathological features.

Distribution of Non-thyroid Neck Swellings according to Tissue of Origin and Their Radio-pathological Correlation

Introduction: Neck swellings are commonly found and can be presented as simple benign to malignant. Due to extensive differential diagnosis and similar presentation, the evaluation of neck swellings is more challenging. Most of the cases can be diagnosed after a detailed history and clinical examination of the head and neck, but the final diagnosis will be achieved by histopathological examination. Materials and Methods: The study was conducted from February 2020 to February 2023 on the basis of retrospective and prospective sampling. This study included all the patients with neck swellings, excluding thyroid, who had undergone excisional or incisional biopsy. The present study was carried out on 74 patients with non-thyroid neck swellings, which were classified five into main headings, i.e. lymph node swelling, salivary gland swellings, adipose tissue, neural tissue and skin and soft-tissue swellings as miscellaneous. Data were collected from patient records for retrospective sampling and radiological investigation, and ultrasonography (USG) and excisional or incisional biopsy were done for prospective sampling. A radiological and pathological correlation was analysed as benign and malignant. Results: Out of the 74 patients, n = 60, 81% were benign and n = 14, 19% were malignant. The most common swelling according to the tissue of origin was lymph node (n = 31, 41.9%) followed by salivary gland n = 15 (20.3%), adipose tissue (n = 7, 9.5%) and neural tissue (n = 6, 8.1%) origin. Other soft-tissue swellings were 20.3%. The overall sensitivity, specificity, positive predictive value, negative predictive value and radiological (USG) diagnosis accuracy to differentiate between benign and malignant are very similar to gold standard histopathological examination. Conclusion: Lymph node swellings were the most common swelling involving the neck region. USG diagnosis is highly sensitive for diagnosing malignant swellings but less good at confirming benign swellings. Radiological diagnosis is not a substitute for conventional surgical histopathology but is regarded as a precious complement in diagnosis. Newer diagnostic techniques are required to be infallible and accurate for further management.

Neurosarcoidosis-Induced Winging Scapula: Efficacy of Infliximab Treatment in Addressing Multifaceted Challenges.

Sarcoidosis, a systemic granulomatous disease primarily affecting the respiratory and lymphatic systems, can rarely manifest as neurosarcoidosis either in isolation or alongside other systemic symptoms. Here, we describe the case of a 45-year-old male with a history of recurrent sinusitis refractory to antibiotics, who presented to the emergency department with sinus congestion and dysphagia. Clinical examination revealed left lower motor neuron facial palsy and enlarged submandibular salivary glands. Despite obtaining negative results from various antibody panels, the patient exhibited elevated Angiotensin Converting Enzyme levels of 83 nmol/kg/min. Additionally, computed tomography chest scans revealed bilateral hilar and mediastinal lymph node enlargement, findings consistent with sarcoidosis. Otorhinolaryngology evaluation for dysphagia confirmed left vocal cord palsy. Following a negative infectious disease workup, submandibular salivary gland biopsy confirmed sarcoidosis. Treatment with mycophenolate mofetil and oral steroids led to gradual improvement in salivary gland swelling, dysphagia, and facial palsy. However, worsening left shoulder pain prompted further investigation, revealing winging of the left scapula on repeat examination. Magnetic resonance imaging (MRI) of the cervical spine revealed a six mm hyperintensity in the left dorsal cord at the C5 level, suggesting possible neurosarcoidosis vs. demyelinating disease. Subsequently, the patient was prescribed anti-tumor necrosis factor alpha inhibitor infliximab. Subsequent MRI of the cervical spine, conducted six months after initiating Infliximab therapy, indicated resolution of the lesions. This positive outcome was supported by the patient's report of symptom improvement, notably reduced shoulder pain and improvement in left scapular winging. This case underscores the unusual co-occurrence of Bell's palsy and vocal cord palsy in the same patient, along with the potential contribution of neurosarcoidosis to the winged scapula. Additionally, it sheds light on the positive response of neurosarcoidosis to Infliximab therapy.

Sialolithiasis in Sublingual Glands Involving the Floor of the Mouth: A Case Report

Sialolithiasis is a benign condition involving the formation of stones within the ducts of the major salivary glands: parotid, submandibular, and sublingual glands. It is the most frequent cause of salivary gland swelling, with a reported incidence of 1 in 10000–1 in 30000. It can obstruct the salivary ducts, leading to inflammation, superimposed bacterial infection termed sialadenitis, or, in rare cases, abscess formation. And decreased salivary flow rate. Treatment options for sialolithiasis, including sialogogues, direct massage of distal stones out of the duct, and other procedures, including interventional sialography, sialoendoscopy, and surgical management. In this article, we report a 20-year-old female presented with a case of sublingual gland Sialolithiasis treated with simply milking of the duct.

Bilateral Sialadenitis as an Uncommon Initial Manifestation of Infectious Mononucleosis: A Case Report.

Sialadenitis has rarely been reported in patients with infectious mononucleosis (IM). Our patient was a 22-year-old man who presented with bilateral swelling of the parotid and submandibular glands, a fever, malaise, and splenomegaly. Laboratory tests revealed an increased percentage of atypical lymphocytes in the leukocyte fraction. Serological testing for antibodies against Epstein-Barr virus (EBV) revealed an acute infection pattern. The patient was diagnosed with sialadenitis associated with IM caused by EBV infection. With symptomatic treatment, the salivary gland swelling completely resolved within a week. This case suggests that EBV-induced IM should be included in the differential diagnosis of diffuse sialadenitis with elevated atypical lymphocyte counts.

Clinical profile and outcome profile of salivary gland swellings: A prospective hospital-based study

Clinical profile and outcome profile of salivary gland swellings: A prospective hospital-based study

Molecular B-cell clonality assay in minor salivary glands as a useful tool for the lymphoma risk assessment in Sjögren's syndrome

ObjectivesNon-Hodgkin's lymphoma (NHL) risk assessment is crucial in Sjögren's syndrome (SS). We studied the prevalence of clonal immunoglobulin gene rearrangements in minor salivary glands (MSG) and their correlations with lymphoma occurrence and with previously established NHL predictors. MethodsMolecular B-cell expansion was studied in fresh-frozen MSG of 207 patients with either suspected SS or with suspected lymphoma during SS, using a standardised multiplex PCR assay combined with heteroduplex analysis by microcapillary electrophoresis. The assignation of clonal cases was based on EuroClonality consortium guidelines. ResultsAmong 207 studied patients, 31 (15%) had MSG monoclonal B-cell infiltration. Monoclonality was significantly more frequent in patients with SS (28/123, 22.8%) compared with patients without SS (3/84, 3.6%, P<0.001). Monoclonal B-cell infiltration in MSG of SS patients correlated significantly with ongoing salivary gland NHL, salivary gland swelling, CD4+ T-cell lymphopenia, rheumatoid factor (RF) activity, low complement levels and type 2 mixed cryoglobulinemia. The accumulation of biological risk factors was associated with a higher rate of MSG B-cell monoclonality given that patients with only positive RF had no probability of MSG B-cell monoclonality, RF-positive patients with 1 or 2 other risk factors had a 25.0% and 85.7% probability of MSG B-cell monoclonality, respectively. ConclusionThe detection of MSG monoclonal B-cell expansion by this easy-to-perform molecular assay is useful, both at the time of diagnosis and during the course of SS. Monoclonal B-cell expansion is associated with a subset of SS patients presenting either ongoing lymphoma or other established lymphoma predictive factors.

An Uncommon Salivary Gland Swelling- Parotid Duct Cyst and Its Management.

Cysts in the parotid region are more common in the gland than in the duct. Isolated cyst of parotid duct is a rare presentation. The treatment for most of the cystic lesions of the parotid or the parotid duct is the excision of the cyst with superficial parotidectomy. However, these lesions can be approached intra-orally for marsupialization achieving the same surgical results with less morbidity. This paper presents a rare case of parotid duct cyst which was managed by intraoral drainage and marsupialization. A 53-year-old female presented with swelling in the right cheek, associated with frequent fluid drainage inside the oral cavity for four months. Radiology and Fine needle aspiration revealed a benign parotid duct cyst with normal parotid gland. It was managed by a simple surgical technique of marsupialization. The patient was followed up for 1 year with no evidence of recurrence. Marsupialization obviates the need for parotidectomy in the simple cystic lesion of the parotid duct, unlike the cystic lesion in the gland per se and also reduces risk of recurrence. The simplicity and lack of major complications make it an effective treatment for salivary duct cysts.

P166 Parotid benign lymphoepithelial cyst in connective tissue disease: a rare case series and literature review

Abstract Background/Aims Benign lymphoepithelial lesions are swellings of salivary glands caused by a reactive lymphoid infiltrate with follicular hyperplasia, obliterating the acinar glands and causing proliferation and disruption of the ductal epithelium. These have been described in HIV, lymphoma and Sjögren's syndrome. We report a case series with mixed connective tissue disease/Sjögren's syndrome and reviewed the literature with similar presentations in order to highlight this unusual manifestation. Methods Index patient: A 25-year-old lady presented with a history of arthralgia, fatigue and Raynaud's 3 years ago and was diagnosed by rheumatologist to have MCTD with ANA showing U1RNP, Ro positive and histones antibody positive. She was managed with mycophenolate and improved. A year ago she developed parotitis which improved with antibiotics. She recently came to the outpatient department with painful swelling in the parotid region. Blood counts remain normal, ESR 36 mm/hr , CRP 6 mg/dl, ACE level, HIV screening normal. MRI parotid showed bilateral multiple lymphoepitheial cysts in the parotid glands. Opinion was obtained from oncology and the ENT surgeon. No evidence of malignancy was found. In view of this, consensus opinion among rheumatologists was to stop mycophenolate and give 2gm rituximab. We also reviewed 10 cases of benign lymphoepithelial cyst arising in the parotid region in acquired immunodeficiency syndrome negative patients. Cases were from 8 published articles plus the three cases of benign lymphoepithelial cyst in a mixed connective tissue disease/Sjögren's syndrome in AIDS negative patients reported in Table 1. Most of the patients had been treated surgically, however, immune therapy is sufficient. Results: Conclusion Benign lymphoepitheial cysts have been described in patients with sarcoidosis, HIV, cancer and CTD. Our patients had features of MCTD with Sjögren's syndrome and manifested with benign lymphoepithelial cysts in the parotids, which is very unusual. Parotid swelling in connective tissue disease requires evaluation and multidisciplinary input. Benign lymphoepithelial cysts will not require any surgery; once malignancy is excluded, they will require modification of immune therapy. Disclosure N. Palaniappan: None. S. Nallasivan: None.

FINE NEEDLE ASPIRATION CYTOLOGY OF SALIVARY GLAND LESIONS: REPORTING BY THE MILAN SYSTEM

Background: In the salivary gland lesions most common presentation is of a swelling or palpable mass of varying duration. In infective lesions, pain is another presenting feature. The most accurate method of diagnosing salivary gland lesions is histopathology, yet the role of ne needle aspiration cytology (FNAC) for the diagnosis of salivary gland masses is well documented and is signicantly accurate. The present study comprise analysis of FNAC of all salivary gland lesions using Milan system of classication. The present retrospective Material and Methods: study involves 234 cases of salivary gland swellings, referred for FNAC to the Department of Pathology, Government Medical College, Jammu for a period of ve years w.e.f November, 2016 to 31 October, 2021. This study includes cytomorphological features of various salivary gland lesions on FNAC and their classication by the Milan system of reporting. It was obs Results: erved that peak incidence of salivary gland tumours was seen in the age group of 31-45 yrs. The majority of benign lesions were seen in the age group 16-30 yrs and the malignant lesions were seen in the age group 46-61yrs. There was female predominance over the male with F:M ratio is 1.46:1. The most frequently involved site was parotid gland (48.7%) followed by submandibular gland (40.6%). 109 cases were diagnosed as non-neoplastic, 98 as benign and 16 cases as malignant. Conclusion: FNAC is an important diagnostic tool to clinch the correct diagnosis of salivary gland tumours Fine needle aspiration cytology was able to distinguish between non-neoplastic and neoplastic lesions and benign and malignant tumours

Patterns of salivary gland lesions on fine needle aspiration cytology (FNAC)

A diverse range of inflammatory, cystic and neoplastic processes affect salivary glands.Fine needle aspiration cytology (FNAC) is a reliable tool for evaluation of salivary gland lesions. To analyse the cytomorphological features of salivary gland lesions and to assess the frequency of distribution of these lesions. It was an observational study conducted in the Department of Pathology, Govt. Medical College, Jammu. FNAC was performed on patients presenting with salivary gland swelling. May-Grunwald-Giemsa (MGG) and Papanicolaou (PAP) stained smears were examined under light microscope. The cytomorphological features were analysed and diagnosis was made. There were 65 cases which included 31 (47.7%) males and 34 (52.3%) females. The mean age of patients was 42.96 years. On microscopic examination, neoplastic lesions were 35 (53.8%) and non neoplastic lesions were 30 (46.2%). Pleomorphic adenoma was the most common benign neoplastic lesion and also was the most frequently diagnosed lesion in our study (21, 32.3%). Mucoepidermoid carcinoma cases were maximum among malignant lesions (4, 6.2%). Parotid gland was involved in majority of cases. FNAC is a simple, rapid, reliable tool for the evaluation of salivary gland lesions thereby helping clinicians in deciding the further management plan.

Homoeopathic Treatment of Submandibular Sialolithiasis with Baryta iodatum: A Case Report

Abstract Introduction Sialolithiasis is the most common cause of salivary gland swelling affecting mostly the parotid, submandibular and sublingual salivary glands in which submandibular gland is most commonly affected. Only a few documented cases with non-surgical management are available on literature search, as surgery is considered to be the mainstay for this clinical condition. Case Summary A 25-year-old male patient presented with the symptoms of pain and swelling under the right side of the tongue for the past 15 days. The case was diagnosed by X-ray floor of mouth and ultrasonography neck as right submandibular sialolithiasis. His doctor advised him for surgery but he instead preferred to go for homoeopathic treatment. After constructing the totality and repertorisation, homoeopathic medicine Baryta iodatum was prescribed in centesimal potency which resulted in the expulsion of the stone with the improvement in the associated symptoms.The causal attribution between the homoeopathic intervention and outcome of treatment was assessed by Modified Naranjo Criteria for Homeopathy score recorded at the final visit suggestive of a high likelihood that the improvement in the patient may be attributed to the homoeopathic treatment provided. Conclusion This clinical case report is presented here to show the positive effect of individualised homoeopathic treatment in right submandibular sialolithiasis.

Probiotic Bacteria Cannot Mitigate the Adverse Effects of Radioactive Iodine-131 Treatment.

Thyroid carcinoma is the most common cancer of the endocrine system, accounting for 12% of all cancer cases in adolescents in the United States. Radioiodine therapy plays a key role in differentiated thyroid cancer (DTC) treatment. This double-blind, randomized, placebo-controlled clinical trial was aimed at evaluating the effect of probiotics supplementation in reducing the acute side-effects of radioiodine therapy in PTC patients. Fifty-six patients were randomly divided into four groups: one placebo and three intervention groups. The probiotics product used in this study was LactoCare (ZistTakhmir Co., Tehran, Iran), a multi-strain commercially available symbiotic containing 12 strains of probiotic species including Lactobacillus strains, Bifidobacteria strains, and Streptococcus thermophilus, plus Fructo-oligosaccharides as the prebiotic. Group 0 was our placebo group (no probiotics), while the other three groups received probiotics capsules for 2/4 days, starting only 2 days prior to radioiodine therapy, only 4 days after radioiodine therapy or 2 days prior and 4 days after radioiodine therapy. Six patients were withdrawn during the study because of poor compliance or at their own request. The symptoms reported by patients including data about the incidence and duration of each complication were recorded. The probiotics' effectiveness was confirmed for dry mouth and taste loss or change when it was administered prior to the radioiodine treatment. The benefit was not confirmed for other radiation-induced complications such as pain and swelling in the neck, nausea and vomiting, salivary gland swelling, and diarrhea. Further large-scale clinical trials are warranted to improve our knowledge in this quickly evolving field.

Anesthesia mumps with airway obstruction after radical nephrectomy: A case report and literature review.

Anesthesia mumps have rarely been reported. This article presents the diagnosis and treatment of a case of anesthesia mumps with airway obstruction in the urology department and reviews previous cases of the disease. A 58-year-old man had a history of hypertension and diabetes, and his blood pressure and glucose levels were well controlled. He underwent laparoscopic radical nephrectomy for a right renal tumor. Postoperatively, a swelling of approximately 5 × 4 cm was observed in the left parotid region and left eyelid, no palpable crepitation was detected, and the skin overlying the left parotid gland was mildly hyperemic and tender. Enhanced computed tomography of the head and neck revealed obvious swelling of the laryngopharyngeal airway, and electronic laryngoscopy showed narrow airway. Laboratory test results including white blood cell count, C-reactive protein, serum amylase, and lipase levels were normal. Glycosylated hemoglobin level was 6.8%, and the salivary culture from Stensen's duct was negative. The patient was managed with endotracheal intubation and a ventilator to maintain breathing along with anti-infection, expectorant, and symptomatic treatment. The swelling in the left parotid gland gradually resolved without recurrence, and the patient was extubated on the 7th postoperative day. In this case, the pathophysiology of anesthesia mumps may have been related to the incorrect positioning of the thick short neck and the use of a head ring, which can result in the squeezing of vessels. In most cases, the salivary gland swelling resolves with observation and symptomatic treatment. In patients with anesthesia mumps, emergency airway management and careful observation are necessary if upper airway obstruction occurs. This case report should increase awareness of anesthesia mumps and its complications among anesthesiologists, surgeons, and postoperative caregivers.

Management of iodine contrast induced salivary gland swelling (sialadenitis): experiences from an observational study

Background Iodine contrast-induced sialadenitis (CIS) is an uncommon adverse effect to iodine-containing contrast exposition. There is scarce literature about its clinical course and demography. Objectives (1) To determine the clinical course and management of CIS. (2) To understand if CIS might be as rare as reported. Material and Methods A 2-month prospective observational study was conducted in the emergency room of a tertiary institution. ENT physicians on call received clinical formation about CIS while emergency physicians did not. During the study period, patients admitted at the emergency room matching the clinical and radiological features of CIS, were included. Information about demographics, iodine exposure, diagnostic workup, clinical course, and management was analyzed. Results ENT physicians on call detected 4 cases, however, emergency physicians did not. Patients were aged 68–76 years and presented a bilateral submandibular gland swelling debuting 12 to 72 h after an exposure to iodinated contrast. Characteristic ultrasonographic findings supported the diagnosis and the clinical course was self-limited after 60 to 150 h. Conclusions and significance Physicians’ familiarity with CIS allows its detection and avoids costly and potentially harmful therapeutic/diagnostic efforts. The incidence is probably underestimated; however, further incidence studies are needed.

Significance of Nuclear Morphometry in Salivary Gland Neoplasms: A Cross-sectional Study

Introduction: Fine Needle Aspiration Cytology (FNAC) is one of the commonest and most efficient investigation done for salivary gland swellings, which is of much help in diagnosing inflammatory, benign and malignant lesions. The morphology of nucleus determines the behaviour of the cell/tissue as benign or malignant. Nuclear morphometry analysis is done by using various software. Aim: To determine the nuclear morphometry parameters in salivary gland neoplasm of FNAC smears by Image J software and to determine its association with the cytological diagnosis. Materials and Methods: This was a retrospective laboratory observational cross-sectional study done for four years (2018- 2021) at a tertiary healthcare centre, attached to Sri DevarajUrs Medical College, Kolar, Karnataka, India. All the FNAC smears of salivary gland neoplasms were considered and classified by cytomorphology as benign and malignant tumours. All smears were analysed using Image J software for nuclear morphometric parameters such as area of the nucleus, perimeter of the nucleus, feret diameter, minimum ferret and skewness. The nuclear morphometric findings of benign and malignant tumours were compared and statistical analysis was doneby using Student’s t-test, p-value of &lt;0.05 was considered statistically significant. Results: A total of 52 cases were studied. The average age of presentation of benign and malignant salivary gland neoplasm was 38.7 and 49.4 years, respectively. Among, 30 (57.6%) benign neoplasms there were 23 (76.7%), pleomorphic adenoma was the commonest and among 22 (42.4%) malignant squamous cell carcinoma 16 (72.7%) deposits was the commonest. The nuclear morphometry analysis showed that the mean values of area (p-value ≤0.001), perimeter (p-value≤0.001), ferret diameter (p-value≤0.001) and minimum ferret (p-value=0.001) of malignant lesions were comparatively higher than benign and was statistically significant. Conclusion: Nuclear morphometry along with routine cytopathological evaluation will improve the accuracy of diagnosis of neoplastic lesions of salivary gland. This information can be used to plan better treatment and predict prognosis of the disease. Digital morphological analysis helps in obtaining quantitative values from qualitative data which can be utilised further for automation.