Escisión de Glándula Submandibular por Sialoadenitis Crónica Esclerosante Asociada a Sialolito en el Conducto Submandibular / Submandibular Gland Excision Due to Chronic Sclerosing Sialadenitis Associated With Sialolith in Submandibular Duct

La sialoadenitis crónica esclerosante puede extenderse desde una sialoadenitis focal hasta una cirrosis completa de la glándula. Aparece entre los 40 y 70 años de edad y afecta principalmente a la glándula submandibular. Se asocia con sialolitos y agentes infecciosos inespecíficos. La causa más frecuente de sialolitiasis es la formación de cálculos macroscópicamente visibles en una glándula salival o en su conducto excretor, de los cuales el 80 % al 90 % provienen de la glándula submandibular. Esta predilección probablemente se deba a que su conducto excretor es más largo, más ancho y tiene un ángulo casi vertical contra la gravedad, contribuyendo así a la estasis salival. Además, la secreción semimucosa de la misma es más viscosa. El sitio principal de ubicación de los litos en el conducto submandibular es la región hiliar con un 57 %. La sintomatología típica de la sialolitiasis es el cólico con tumefacción de la glándula y los dolores posprandiales. Reportamos el caso de un paciente masculino de 55 años, quien ingresa al servicio de Cirugía Oral y Maxilofacial del Hospital General Balbuena de la Ciudad de México por presentar un aumento de volumen en la región submandibular izquierda de consistencia dura y dolorosa a la palpación de 15 días de evolución, acompañada de aumento de temperatura en la zona compatible con un absceso. Los estudios de imagen reportan un sialolito en la región hiliar del conducto submandibular de 2,0 x 1,7 x 1,0 cm. Debido a su localización y tamaño, el tratamiento ideal en estos casos es la escisión de la glándula junto con el lito previo drenaje del absceso e inicio de terapia antibiótica doble.

Chronic sclerosing sialadenitis can range from focal sialadenitis to complete cirrhosis of the gland. It appears between 40 and 70 years of age and mainly affects the submandibular gland. It is associated with sialoliths and nonspecific infectious agents. The most common cause of sialolithiasis is the formation of macroscopically visible stones in a salivary gland or its excretory duct, of which 80 % to 90 % come from the submandibular gland. This predilection isprobably due to the fact that their excretory duct is longer, wider and has an almost vertical angle against gravity, thus contributing to salivary stasis. In addition, the semimucous secretion of it is more viscous. The main location of the stones in the submandibular duct is the hilar region with 57 %. The typical symptomatology of sialolithiasis is colic with swelling of the gland and postprandial pain. We report the case of a 55-year-old male patient, who was admitted to the Oral and Maxillofacial Surgery Service of the Hospital General Balbuena in Mexico City due to an increase in volumen in the left submandibular region that was hard and painful on palpation of 15 days of evolution, accompanied by increased temperature in the area compatible with an abscess. Imaging studies report a 2.0 x 1.7 x 1.0 cm sialolith in the submandibular duct hilar region. Due to its location and size, the ideal treatment in these cases is excision of the gland together with the stone previous drainage of the abscess and initiation of dual antibiotic therapy.

Sialolitiasis, sialoadenitis y sialoadenosis. Revisión de literatura y reporte de un caso clínico / Sialolithiasis, sialadenitis and sialadenosis. Review of literature and report of a clinical case

Introducción: la formación de sialolitos se considera la alteración más común en las glándulas salivales. Su origen aún no es claro en cuanto a qué provoca la obstrucción parcial o total del sistema de conductos salivales, con una predilección significativa en las glán - dulas submandibulares, lo que permite un desplazamiento retrógrado de bacterias a través del conducto salival hacia la glándula afectada, el cual se traducirá clínicamente como inflamación unilateral o bila - teral. El tratamiento para la sialolitiasis y sialoadenitis puede variar desde un manejo conservador hasta tratamientos que implican la remoción de la glándula salival afectada. La sialoadenosis difiere de las anteriores en su origen, ya que ésta no se considera inflamatoria ni neoplásica y no afecta la función glandular de excretar saliva. Presentación de caso clínico: se trata de paciente masculino con diagnósticos presuntivos de sialoadenitis y sialolitiasis, al cual se le realizó biopsia escisional de la glándula afectada, su estudio histo- patológico corroboró los diagnósticos mencionados anteriormente que además confirmó un diagnóstico de sialoadenosis. Conclusio- nes: la escisión de la glándula salival involucrada se realizará en casos diagnosticados de sialoadenitis y sialolitiasis con sialolitos de gran tamaño y procesos supurativos crónicos que no resuelven con antibioticoterapia (AU)

Sialoendoscopia y abordaje mixto para el manejo dela patología obstructiva de las glándulas salivales / Sialoendoscopy and mixed approach for the management of obstructive pathology of the salivary glands

Introducción. La sialoendoscopia es un procedimiento cuya finalidad es visualizar los conductos salivales. Se utiliza como método diagnóstico y terapéutico de procesos inflamatorios, estenosis de los conductos y procesos obstructivos. Métodos. Describir los procedimientos realizados para el tratamiento de pacientes con patología inflamatoria y obstructiva de las glándulas salivales, de forma única con sialoendoscopia o con abordajes mixtos. Resultados. Un total de 24 pacientes fueron incluidos en el estudio, con edad promedio de 42 años, en su mayoría mujeres y compromiso submaxilar en 58,3 % y de parótida en 41,7 %. Respecto a la intervención, al 29,2 % de los sujetos se le realizó extracción de cálculos, al 29,2 % sialoplastia, al 25 % dilatación de conductos y al 37,5 % lavado de conductos en el mismo momento quirúrgico. Conclusión. La sialoendoscopia y el abordaje mixto es un procedimiento que puede garantizar el manejo de patologías obstructivas y estenosis de los conductos salivales, con buen pronóstico y resultados, preservando la glándula y evitando las complicaciones de la cirugía.

Introduction. Sialoendoscopy is a procedure which purpose is to visualise the salivary ducts. It is used as a diagnostic and therapeutic method for inflammatory and obstructive processes and duct stenosis. Methods. To describe the procedures performed for the management of patients with inflammatory and obstructive pathology of the salivary glands, only with sialoendoscopy or with mixed approaches. Results. A total of 24 patients were included in the study, with mean age of 42 years, mostly female, and 58.3% submaxillary involvement 41.7% parotid involvement. Regarding the intervention, 29.2% of the subjects underwent stone extraction, 29.2%, sialoplasty, 25% duct dilatation, and 37.5% duct lavage at the same surgical time. Conclusions. Sialoendoscopy and the mixed approach is a procedure that can guarantee the management of obstructive pathologies and stenosis of the salivary ducts with good prognosis and results, preserving the gland and avoiding the complications of surgery.

Sialoadenitis esclerosante asociada a enfermedad por IgG4: reporte de un caso / Sclerosing sialadenitis associated with IgG4 disease: case report

Las enfermedades relacionadas con IgG4 (ER-IgG4) son entidades fibroinflamatorias e inmunomediadas, caracterizadas por la afección multiorgánica, con la formación de pseudotumores que provocan lesión tisular y daño orgánico subsecuente. Se describe el caso de un paciente de 43 años que presentó sialoadenitis esclerosante y cumplió todos los criterios diagnósticos de enfermedad relacionada con IgG4.

IgG4-related diseases (IgG4-RD) are fibroinflammatory immune-mediated entities characterized by multiorgan involvement with the development of pseudotumors that cause tissue injury and subsequent organ damage. We describe the case of a 43-year-old man who presented sclerosing sialadenitis and fulfilled the diagnostic criteria for IgG4-related disease.

Concordancia diagnóstica del sistema de graduación Chisholm Mason y Focus Score en la sialoadenitis linfocítica focal como aproximación al síndrome de Sjögren / Diagnostic agreement of the Chisholm Mason and Focus Score grading system in focal lymphocytic sialadenitis in patients with dry symptoms

RESUMEN Introducción: Existen diferentes sistemas de graduación para interpretar la biopsia de glándula salival menor (BGSM) en pacientes con síntomas secos. En la actualidad la metodología recomendada (Focus Score [FS]), aunque no se emplea de forma rutinaria, conlleva discrepancias diagnósticas. Objetivo: Determinar la concordancia de la lectura histopatológica de BGSM entre las técnicas FS y Chisholm Mason (CM) para el diagnóstico de sialoadenitis linfocítica focal en el hospital de San José, entre enero de 2017 y junio de 2018. Métodos: Estudio de concordancia. Se incluyeron BGSM de pacientes con síntomas secos. Se excluyó material no apto para el estudio, o con menos de 4 lóbulos o menos de 8 mm de área. Se clasificaron utilizando las técnicas FS y CM por 2 evaluadores independientes. Se evaluó el acuerdo interobservador, intraobsevador y global entre las pruebas mediante el coeficiente de Kappa de Cohen. Resultados: Se evaluaron 130 biopsias. Los valores K intraobservador entre FS y CM fueron 0,42 para el observador 1 y 0,23 para el observador 2. Los valores K del acuerdo interobservador fueron 0,47 para FS y 0,65 para CM. La concordancia entre los 2 sistemas de puntuación fue K de 0,13. Conclusiones: Se evidencia una probable sobreestimación de focos con CM, que resalta sus debilidades, y mayor precisión con FS. Por ende, la concordancia entre las 2 pruebas es débil. Es necesario un mayor esfuerzo para el uso del método estandarizado de lectura de BGSM con el FS para una correcta interpretación y beneficio en la clasificación de pacientes con síndrome seco.

ABSTRACT Introduction: There are different grading systems for interpreting the minor salivary gland biopsy (MSGB) in patients with dry symptoms (Sicca). The recommended methodology is currently the Focus Score (FS), which, although not performed routinely, results in diagnostic discrepancies. Objective: To determine the concordance of the histopathological reading of MSGB between the FS and Chisholm Mason (CM) techniques for diagnosis of focal lymphocytic sialadenitis at the San José Hospital between January 2017 and June 2018. Methods: Concordance study. MSGB of patients with sicca symptoms were included. Material not suitable for study and / or with less than 4 lobules and / or less than 8 mm of surface area was excluded. They were classified, using the FS and CM techniques, by two independent evaluators. The inter-observer, intra-observer, and overall agreement between the tests were evaluated using Cohen's Kappa coefficient. Results: A total of 130 biopsies were evaluated. The intra-observer K values between FS and CM were 0.42 for observer 1, and 0.23 for observer 2. The K values of the inter-observer agreement were 0.47 for FS, and 0.65 for CM. The concordance between the two scoring systems was K = 0.13. Conclusions: There is evidence of a probable over-estimation of foci with CM, highlighting its weaknesses and greater precision with FS technique, resulting in the weak concordance between the two tests. A greater effort is necessary for the use of the standardised MSGB FS reading method for a correct interpretation and benefit in the classification of patients with dry syndrome.

Sialolitectomía canicular por sialolito de gran tamaño / Canicular sialolithectomy of a giant sialolith

RESUMEN Introducción: La sialolitiasis es una afección frecuente de las glándulas salivales mayores que se manifiesta con mayor frecuencia en pacientes de sexo masculino. Objetivo: Presentar un caso clínico de una sialoadenitis por sialolitiasis de glándula submandibular, tratado exitosamente mediante sialolitectomía canicular intraoral. Caso clínico: Paciente de 45 años de edad atendido en el Departamento de Cirugía Maxilofacial de la Clínica de Especialidades "Manuel de Jesús Cedeño", Granma, Cuba, por presentar molestias en el suelo de la boca con aumento de volumen de consistencia dura, móvil y fácilmente desplazable. Radiográficamente, se observó una imagen radiopaca de bordes definidos, ovoide de aproximadamente 4 cm de largo y 2 cm de ancho. Se comprobó que se trataba de una sialoadenitis por sialolitiasis de la glándula submandibular derecha. Se trató la sintomatología mediante analgésicos-antiinflamatorios y antibióticos. Se realizó sialolitectomía canicular intraoral. Posteriormente se efectuó una recanalización del conducto lo que permitió la permeabilización de este. Conclusiones: La sialoadenitis por sialolitiasis es una afección con pronóstico favorable, pues cuando se realiza el tratamiento adecuado se logra que la glándula vuelva a su fisiología normal, lo que mejora la calidad de vida del paciente. En nuestro caso se realizó la remoción quirúrgica a través de sialolitectomía canicular intraoral, sin complicaciones. El paciente mostró excelente recuperación tras un mes de evolución, constituyendo un tratamiento satisfactorio a corto y largo plazo(AU)

ABSTRACT Introduction: Sialolithiasis is a common disorder of the major salivary glands which presents more frequently in male patients. Objective: Present a clinical case of sialadenitis due to sialolithiasis of the submandibular gland successfully treated by intraoral canicular sialolithectomy. Case report: A male 45-year-old patient attending the Maxillofacial Surgery Department at Manuel de Jesús Cedeño Specialty Clinic in Granma, Cuba, presents with discomfort on the floor of the mouth and a hard, mobile and easily movable mass of increased volume. Radiographic examination revealed a radiopaque oval-shaped image of well-defined edges, approximately 4 cm long x 2 cm wide. A diagnosis was made of sialadenitis due to sialolithiasis of the right submandibular gland. Symptoms were treated with analgesics / anti-inflammatories and antibiotics. Intraoral canicular sialolithectomy was performed. Rechanneling of the duct was then conducted to allow permeabilization. Conclusions: Sialadenitis due to sialolithiasis is a condition of a favorable prognosis. Appropriate treatment will have the gland return to its normal physiology, improving the patient's quality of life. In our case, surgical removal was conducted by intraoral canicular sialolithectomy without any complications. The patient had completely recovered after one month's evolution, the treatment being satisfactory both short- and long-term(AU)

Salivary Gland Disorders in Children and Adolescents: A 15-year Experience

Abstract Introduction Diseases of the salivary glands are rare in children and adolescents, with the exception of viral-induced infections. Objective To determine the clinical course of the disease, the diagnostic procedures, the treatment and the outcome of all children and adolescents affected with salivary gland diseases at our clinic over a period of 15 years. Methods A retrospective chart review including a long-term follow-up was conducted among 146 children and adolescents treated for salivary gland disorders from 2002 to 2016. Results Diagnosing acute sialadenitis was easily managed by all doctors regardless of their specialty. The diagnosis of sialolithiasis was rapidly made only by otorhinolar- yngologists, whereas diagnosing juvenile recurrent parotitis imposed difficulties to doctors of all specialties - resulting in a significant delay between the first occurrence of symptoms and the correct diagnosis. The severity-adjusted treatment yielded improve- ments in all cases, and a full recovery of 75% of the cases of sialolithiasis, 73% of the cases of juvenile recurrent parotitis, and 100% of the cases of acute sialadenitis. Conclusions Due to their low prevalence and the lack of pathognomonic symptoms, salivary gland diseases in children and adolescents are often misdiagnosed, resulting in an unneces- sarily long period of suffering despite a favorable outcome following the correct treatment.

Ultrasonography Echotexture as a surrogate for Sialadenitis secondary to 131I Radioiodine Therapy for differentiated Thyroid Cancer: a review and metaanalysis

To systematically review and analyze the medical literature to assess ultrasonography echotexture changes in thyroid cancer patients for the detection of chronic sialadenitis caused by radioiodine therapy. Methods: Sources were retrieved from PubMed, Scopus, EMBASE and LILACS through November 2018. All studies that assessed ultrasonographic features before 131I administration and at 12 months after 131I administration were selected. After data extraction, statistical analysis was performed by using Stata software. Results: From a total of 435 studies, 4 studies involving 665 patients were considered eligible, and echotexture heterogeneity was found with a significant difference. Conclusions: Ultrasound echotexture may detect chronic sialadenitis secondary to salivary radioiodine therapy.

Sialoadenite esclerosante crônica em glândula salivar menor / Chronic sclerosing sialoadenitis in small salivary gland

A sialoadenite esclerosante crônica, também conhecida como tumor de Kutner, é uma condição, que acomete, predominantemente, glândulas salivares maiores. Clinicamente, apresenta-se como um nódulo, móvel, assintomático e de consistência endurecida. Seu diagnóstico definitivo só é conseguido através da análise histopatológica onde estão presentes: intenso infiltrado inflamatório linfocítico, atrofia acinar, fibrose do parênquima glandular e graus variáveis de esclerose. Neste artigo, é relatado um caso clínico raro de sialoadenite esclerosante crônica, localizada em glândula salivar menor... (AU)

Chronic sclerosing sialoadenitis, also known as Kutner's tumor, is a condition that predominantly affects major salivary glands. Clinically it presents as a nodule, mobile, asymptomatic, and of hardened consistency. Its definitive diagnosis is only achieved through the histopathological analysis where they are present: intense lymphocytic inflammatory infiltrate, acinar atrophy, fibrosis of the glandular parenchyma and variable degrees of sclerosis. In this article we report a rare clinical case of chronic sclerosing sialoadenitis located in the minor salivary gland... (AU)

Surgical Treatment of Chronic Parotitis

Abstract Introduction chronic parotitis (CP) is a hindering, recurring inflammatory ailment that eventually leads to the destruction of the parotid gland. When conservative measures and sialendoscopy fail, parotidectomy can be indicated. Objective to evaluate the efficacy and safety of parotidectomy as a treatment for CP unresponsive to conservative therapy, and to compare superficial and near-total parotidectomy (SP and NTP). Methods retrospective consecutive case series of patients who underwent parotidectomy for CP between January 1999 and May 2012. The primary outcome variables were recurrence, patient contentment, transient and permanent facial nerve palsy and Frey syndrome. The categorical variables were analyzed using the two-sided Fisher exact test. Alongside, an elaborate review of the current literature was conducted. Results a total of 46 parotidectomies were performed on 37 patients with CP. Neartotal parotidectomy was performed in 41 and SP in 5 cases. Eighty-four percent of patients was available for the telephone questionnaire (31 patients, 40 parotidectomies) with a mean follow-up period of 6,2 years. Treatment was successful in 40/46 parotidectomies (87%) and 95% of the patients were content with the result. The incidence of permanent and transient facial nerve palsy was 0 (0%) and 12 (26.1%), respectively. Frey syndrome manifested in 20 (43.5%) patients. Neither this study nor careful review of the current literature resulted in evident difference between SP and NTP regarding the primary outcome variables. Conclusion parotidectomy is a safe and effective treatment for CP in case conservative therapy fails. There is no evidence of a distinct difference between SP and NTP regarding efficiency, facial nerve palsy or Frey syndrome. (AU)

Patología calcificante de las glándulas salivales: presentación de dos casos clínicos / Pathological calcification of the salivary glands: presentation of two clinical cases

La calcificación extraesquelética es una entidad patológica de depósito de sales minerales fuera de las estructuras óseas. Los casos frecuentes se presentan por obstrucción mecánica de la glándula salival o de su conducto excretor, asociada con la formación de sialolitos en el parénquima, su verdadera causa no se conoce con exactitud, pero hay distintas hipótesis con respecto a factores locales y sistémicos. La sialolitiasis es la afección más común de las glándulas salivales en adultos jóvenes, 12 de cada 1,000 pacientes sufren de esta patología, con un predominio del sexo masculino. El diagnóstico se puede establecer mediante ecografía, radiografías oclusales, panorámicas o tomografía cone beam. Estudiamos dos casos de calcificaciones de los tejidos glandulares. El primero de una formación mineral dentro de su conducto y el segundo de una calcificación completa del conducto salival (AU)

Extra bone calcification is a pathological entity of deposit of mineral salts outside bone structures. Frequent cases are due to mechanical obstruction of the salivary gland or its excretory duct, associated with the formation of sialoliths in the parenchyma, its true cause is unknown, but there are different hypotheses regarding the influence local and systemic factors. Sialolithiasis is the most common condition of the salivary glands in young adults, 12 out of 1,000 patients suffer from this pathology, with a predominance of males. Diagnosis can be established by ultrasound, occlusal radiographs, panoramic or cone beam tomography. We studied two cases of calcification of glandular tissues. The first is a mineral formation inside the duct and the second is a complete calcification of the salivary duct (AU)

Sialoadenitis por sialolito inusual de la glándula submaxilar derecha en un adulto / Sialadenitis due to uncommon sialolith of the right submaxillary gland in an adult patient

Se presenta el caso clínico de un paciente de 45 años de edad, atendido en el Departamento de Cirugía Maxilofacial del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres por presentar molestias en el suelo de la boca con 3 años de evolución. Después de un estudio minucioso se comprobó que se trataba de una sialoadenitis por sialolitiasis de la glándula submaxilar derecha. Se realizó sialolectomía canalicular intrabucal. El cálculo extraído tenía forma cónica, más ancho en su porción posterior, de 3,8 cm de largo y 4,2 cm de circunferencia externa, color amarillo-verdoso y consistencia dura friable

The case report of a 45 years patient was presented. He was assisted in the Maxillofacial Surgery Department of Saturnino Lora Torres Clinical Surgical Provincial Hospital in Santiago de Cuba due to discomfort in the floor of the mouth with a course of 3 years. After a detailed study it was confirmed that it was a sialadenitis due to sialolithiasis of the right submaxillary gland. An intraoral canalicular sialolectomy was carried out. The stone removed had a conic form, wider in its posterior portion, 3.8 cm long and 4.2 cm in the external circumference, yellow-green color and friable hard consistency

Rânula bilateral com recidiva em glândula mandibular e sublingual em cão / Ranula bilateral with recurrence in submandibular gland and sublingual in dog

A mucocele sublingual é uma afecção incomum em cães, porém de grande importância para a medicina veterinária, devido aos prejuízos gerados por suas consequências. Deste modo, o presente relato tem como objetivo descrever o caso de mucocele sublingual em cão com posterior recidiva em glândula mandibular e sublingual, bem como discutir sua importância para a medicina veterinária. Foi atendido no Hospital Veterinário Dix-Huit Rosado Maia ­ HOVET/ Universidade Federal Rural de Semiárido (UFERSA), um cão macho, com um ano e 10 meses de idade, apresentando aumento de volume bilateral na região sublingual há, aproximadamente, dois meses. Após exame clínico suspeitou-se de mucocele da glândula sublingual bilateral (rânula) indicando-se o tratamento de ressecção da glândula sublingual esquerda devido ao aspecto nodular e marsupalização da glândula sublingual direita. Passado um mês da alta médica o animal retornou ao HOVET ­ UFERSA com queixa de aparecimento de um novo aumento de volume sublingual e na região cervico-ventral suspeitando-se de uma possível mucocele cervical e recidiva da mucocele sublingual esquerda. Indicou-se como tratamento a sialoadenectomia sublingual e mandibular. Cerca de dez dias após a última cirurgia o cão não apresentava mais aumento de volume da área afetada e não havia sinais de alteração quanto à produção de saliva. O tratamento sugerido proporcionou bons resultados promovendo a reparação tecidual e reestruturação do local afetado e diminuindo o índice de recidiva.

Sialadenitis submandibular supurativa aguda neonatal / Acute neonatal suppurative submandibular sialadenitis

En la literatura cubana no existen reportes de pacientes neonatales con sialadenitis submandibular supurativa aguda. Con el objetivo de presentar y describir las características clínicas de un recién nacido con sialadenitis submandibular supurativa aguda, se expone el caso de un neonato con diagnóstico de sialadenitis submandibular supurativa aguda, quien ingresó en el servicio de Neonatología del Hospital Pediátrico Universitario “Juan Manuel Márquez”, y es el único que se ha presentado en 22 años (desde 1992 hasta 2013) en esta institución, con esa entidad. La sialadenitis submandibular supurativa aguda neonatal es de presentación rara, no es común en el recién nacido a término como nuestro caso, se distingue fácilmente por los signos inflamatorios focales, además de secreción purulenta en la boca a través del conducto de Wharton, y es el Staphylococcus aureus el microorganismo causal habitual de esta infección.

There is not a single report in the Cuban scientific literature on neonates with acute suppurative submandibular sialadenitis. With the objective of presenting and describing the clinical characteristics of a newborn with this disease, this report presented the case of a newborn diagnosed with acute suppurative submandibular sialadenitis, which was admitted to the neonatology service of “Juan Manuel Marquez” university pediatric hospital and is the only one seen at this institution in 22 years (1992 through 2013). Acute neonatal suppurative submandibular sialadenitis is rare in term newborn as it occurred here; it can be easily recognized by focal inflammatory signs in addition to purulent secretion in the mouth through Wharton's duct. Staphylococcus aureus is the regular causative agent of this infection.

Submandibular gland excision / Ressecção da glândula submandibular

OBJECTIVE: To analyze the value of fine needle aspiration and the rates of postoperative complications in patients undergoing resection of the submandibular gland. METHODS: we analyzed the records of patients treated with resection of the gland from January 1995 to December 2008. The data collected included age, gender, findings on clinical history, surgical procedure, results of fine needle aspiration (FNA), pathological diagnosis and complications. RESULTS: 117 patients were studied, aged 12-89 years (mean 48), 70 women and 47 men. Thirty-nine patients (33.3%) were affected by inflammatory diseases (28 patients with lithiasis), 70 had benign tumors, and malignant tumors, eight. Regarding FNA, the sensitivity and specificity were 85.7% and 100%, respectively. Nine patients (7.7%) had temporary paralysis of the marginal mandibular nerve and one had permanent paralysis. CONCLUSION: resection of the submandibular gland is a safe procedure, with low complication rates.

OBJETIVO: Analisar o valor da punção aspirativa por agulha fina e os índices de complicações pós-operatórias em pacientes submetidos à ressecção da glândula submandibular. MÉTODOS: foram analisados os prontuários de pacientes tratados com a ressecção da glândula, de janeiro de 1995 a dezembro de 2008. Os dados coletados foram: idade, sexo, achados na história clínica, procedimento cirúrgico, resultados da punção por aspiração com agulha fina (PAAF), diagnóstico anatomopatológico e complicações. RESULTADOS: foram estudados 117 pacientes, com idade variando de 12 a 89 anos (média, 48 anos), sendo 70 mulheres e 47 homens. Trinta e nove pacientes (33,3%) foram acometidos por doenças inflamatórias (28 pacientes com litíase), 70 tiveram tumores benignos e oito tumores malignos. A respeito da PAAF, a sensibilidade e especificidade foram de 85,7% e 100%, respectivamente. Nove pacientes (7,7%) tiveram paralisia temporária do nervo mandibular marginal e um apresentou paralisia definitiva. CONCLUSÃO: a ressecção da glândula submandibular é um procedimento seguro, com baixa taxa de complicações.

Tratamento cirúrgico de sialolitíase em glândula submandibular - relato de caso / Surgical treatment of sialolithiasis in the submandibular gland - case report

A sialolitíase é responsável por metade das patologias que acometem as glândulas salivares e, em função disso, vem sendo tratada e estudada há décadas. Nos últimos anos, com o advento de novos recursos de diagnóstico e métodos de tratamento, propostas terapêuticas vêm sendo continuamente sugeridas para abordagem dos cálculos salivares. Este trabalho apresenta o caso clínico de um paciente de gênero masculino, de trinta e sete anos que procurou atendimento profissional devido aumento volumétrico e dor em região submandibular esquerda com seis meses de evolução. A avaliação clínica associada aos exames de imagem levaram à confirmação diagnóstica de sialolitíase, com o cálculo salivar localizado no ducto da glândula submandibular esquerda. Foi planejada e realizada a remoção cirúrgica por acesso intrabucal do sialolito, de forma que num pós-operatório imediato já se observa funcionamento normal da glândula e de seu sistema secretor. Com base no caso apresentado, este trabalho ainda discute os mais recentes métodos de diagnóstico e tratamento de sialolitíase.

Considering that sialolithiasis is responsible for half of disorders that affect the salivary glands, and therefore it has been studied and treated during decades. Therapeutic alternatives have been suggested to treat salivary calculi over the last years due to development of diagnostic and treatment resources. The aim of this study is to report the case of a male patient, 37 years old, who reported pain and volume expansion in left submandibular region during 6 months. Clinical evaluation combined with radiographic exams confirmed the diagnosis of sialolithiasis with salivary calculus in the duct of left submandibular gland. After definitive diagnostic of sialolithiasis, surgical removal of calculus was planned and performed through intraoral approach of calculus in left submandibular duct. Normal function and drainage recovery was achieved in an immediate postoperative period. According to the present report, this study still discusses the current methods for diagnosis and treatment of sialolithiasis.

Sialoadenitis purulenta submaxilar producida por cuerpo extraño en el conducto de Wharton / Submandibular sialoadenitis due to a foreign body in the Wharton duct

Una causa frecuente de infección crónica de la glándula submaxilar es la obstrucción de su conducto excretor que puede ser causada por litiasis, tapones de moco o a por la presencia de un cuerpo extraño. En las tres circunstancias se desarrollan cuadros de inflamación crónica del conducto (sialodoquitis) y de la glándula (sialoadenitis). Los estudios de imágenes radiográficas adecuadas son de gran utilidad para el diagnóstico, puesto que revelan el elemento obstructivo La presencia dentro del conducto salival de un cuerpo extraño es extremadamente rara. En este reporte se presenta un caso inusual de un paciente masculino de 23 años de edad que presentaba secreción purulenta debajo de la lengua y dolor crónico en la región submaxilar izquierda, de diez años de duración, donde el examen radiográfico convencional y la tomografía espiral multicorte contribuyeron al diagnóstico, identificando un mondadientes de madera alojado dentro del con ducto de Wharton. Se discute la importancia de la anamnesis y la interpretación de las imágenes en el manejo del caso.

One of the more frequent causes of submandibular sialoadenitis is the obstruction of its duct. The obstruction can be caused by lithiasis, mucus plug or a foreign body. The three circumstances produce inflammation and infection of the duct and the gland. Appropriated radiographic image techniques are very useful to demonstrate the obstructive object. The presence of a foreign body in the salivary duct is extremely rare. In this article is reported an unusual case of a 23-year-old male patient that presented purulent secre tion in the floor of the mouth and complained of chronic pain in the submandibular salivary gland, both lasting for ten years. Conventional radiographies and computed radiographs allowed to identify a wood toothpick inside the WhartonÆs duct. Data obtained during anamnesis and interpretations of radiographic findings are discussed for the adequate management of the case.

Enfermedad de Mikulicz: reporte de un caso / Mikulicz disease: a case report

La enfermedad de Mikulicz, descrita por Johann von Mikulicz-Radecki en 1888, constituye una patología benigna que compromete de manera simétrica las glándulas lagrimales y salivares. Su causa es desconocida; sin embargo, se ha asociado con el síndrome de Sjõgren, pero la patogénesis de ambas entidades es distinta. En el síndrome de Mikulicz se ha observado un aumento de la concentración sérica de IgG4 e infiltración linfocitaria en las glándulas salivales y lagrimales. En cuanto al tratamiento, se ha demostrado una adecuada respuesta a los glucocorticoides, sobre todo en estadios tempranos de la afección. Se presenta el caso de una paciente femenina de 31 años, con un curso de siete años de evolución, caracterizado por crecimiento indoloro y progresivo de las glándulas lagrimales y submaxilares, sin xerostomía ni xeroftalmia. El estudio histopatológico evidencia infiltración linfoproliferativa benigna compatible con enfermedad de Mikulicz.

Mikulicz’s disease was described by Johann Von Mikulicz-Radecki in 1888, it is a benign condition that involves symmetrically lacrimal and salivary glands, its etiology is unknown. It has been associated with Sjogren’s syndrome, being the pathogenesis of both diseases different. It has been observed in Mikulicz syndrome an increased serum IgG4 and infiltration of abundant plasmatic cells in lacrimal and salivary glands. It has shown an adequate response to glucocorticoids especially in early stages of the disease. We report a case of a female patient 31 years old, with an evolution of 7 years of painless, progressive growth of the lacrimal glands and submaxillary gland without xerostomia or xerophthalmia. Histopathological examination shows benign lymphoproliferative infiltration compatible with Mikulicz disease.

Sialoadenite supurativa aguda em glândula submandibular / Acute suppurative sialoadenitis in the submandibular gland

A sialoadenite aguda consiste em uma inflamação aguda das glândulas salivares de origem infecciosa. Geralmente se caracteriza por edema, aumento de temperatura, enrijecimento, dor e diminuição ou ausência de salivação da glândula afetada. Porém, é difícil avaliar corretamente essas mudanças, somente através de exame clínico, portanto, os exames complementares podem auxiliar de forma fundamental no diagnóstico e tratamento. Neste trabalho, é descrito um caso de sialoadenite supurativa aguda em glândula submandibular no qual uma paciente de 70 anos, leucoderma, gênero feminino, apresentava queixa de discreta sintomatologia dolorosa, tendo o diagnóstico sido confirmado através do exame de ultrassonografia e o tratamento de escolha medicamentoso.

Acute sialoadenitis is an acute inflammation of the salivary glands resulting from an infection. It is generally characterized by edema, an increase in temperature, stiffness, pain, and reduced or absent salivation of the gland affected. However, it is difficult to correctly evaluate these alterations relying solely on a clinical examination, since complementary investigations may be of fundamental importance in the diagnosis and treatment of this disorder. This paper reports a case of a white 70-year-old female patient, leukoderma, presenting with mild pain, who was diagnosed as having acute suppurative sialoadenitis in the submandibular gland. The diagnosis was confirmed by ultrasound and drugs were the treatment of choice.