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.

Extrapulmonary tuberculosis: atypical presentation in otorhinolaryngology.

Tuberculosis (TB) continues to be a major health burden globally more so in low/middle-income countries like India. There is an increase in the prevalence of extrapulmonary TB (EPTB) because of HIV epidemics and increased usage of immunomodulating drugs. EPTB constitutes 15%-20% of all patients with TB and >50% of HIV-TB coinfected patients. We present three such atypical presentations of EPTB in head and neck region. EPTB can mimic any disease, hence knowledge of the unusual presentations helps in making early diagnosis and thereby reduces the morbidity and mortality involved with the disease.

Massive sialadenitis resulting in critical airway after elective craniotomy: case report.

The authors report an unusual case of acute, rapidly progressive, unilateral neck swelling following extubation after elective left anterior temporal lobectomy with amygdalohippocampectomy. Due to severe neck swelling, the patient developed critical airway compromise, brachial plexopathy, and Horner's syndrome. After critical airway management and appropriate rehabilitation, the patient recovered completely and remains seizure free at 1.5 years of follow-up. This case highlights the importance of early recognition of acute postoperative sialadenitis and the steps needed to prevent serious morbidity and possible mortality from this rare complication.

Tuberculosis of the oral cavity.

Tuberculosis (TB) of the tongue is not a common finding diagnosis, even if consider endemic areas. Tuberculosis of the tongue sometimes can mimic lingual neoplasm. Oral tuberculosis is rarely primary as mechanism, and frequently secondary to pulmonary tuberculosis. There are many suspect lesions that can be classified as tuberculosis, such as tumor mass, ulcerative lesion or fissure. It is very important for diagnosis to perform histopathological examination of the biopsy. We present here the case of a 74-year-old man who developed lingual tuberculosis with a tumor aspect concomitant with pulmonary tuberculosis. Histopathological and immunohistochemical examinations established the diagnosis of lingual tuberculosis.

Tuberculosis of parotid gland: a rare clinical entity.

Tuberculosis (TB) can affect almost any organ of the body; however, TB of the salivary glands is a rare condition. The purpose of this paper was to report a case of a 14-year-old boy who presented with a painless swelling and discharging sinus in the parotid gland and cervical region on the left side. There was no clinical evidence of systemic signs and symptoms of active TB elsewhere in the body. The combination of clinical suspicion, a positive family history, and the cytological findings confirmed the diagnosis. The patient was successfully treated via antitubercular therapy for six months. This case report suggests that, although primary TB of the parotid gland is an unusual clinical presentation, it should be considered in the differential diagnosis of patients presenting with a parotid gland swelling.

Tuberculosis: oral alveolus and pulmonary alveoli coexisting.

Tuberculosis of the oral cavity is uncommon in this antibiotic era. We report a case of a long standing non-healing ulcer of the right upper maxillogingival sulcus, found to be tuberculosis of a rather unusual site in the oral cavity, the alveolus.

Oral tuberculosis: unusual radiographic findings.

Oral tuberculosis and its radiographic findings are not commonly encountered in an oral and maxillofacial radiology practice. Literature has occasional mention of the radiographic findings of oral tuberculosis, which are still ambiguous. When affected, it is manifested majorly in the oral mucosa and rarely in the jaw bones. Here, we report certain unusual radiographic findings of oral tuberculosis which have been rarely mentioned in the literature. Four illustrative cases describe bony resorption, condylar resorption, resorption of the inferior border of the mandible and rarefaction of the alveolar bone as radiographic findings of oral tuberculosis. Follow up of the first case demonstrated regeneration of the condylar head after anti-Kochs therapy was completed, a hitherto unreported phenomenon. The importance of including tuberculosis in the differential diagnosis of some of the unusual radiographic manifestations is emphasized.

Primary tooth abscess caused by Mycobacterium bovis in an immunocompetent child.

Bovine tuberculosis is a zoonotic disease, and although its incidence has dramatically decreased in developed countries where effective control measures are applied, it still remains a potential health hazard in the developing world. Tuberculosis of the oral cavity is extremely rare and is usually secondary to pulmonary involvement. We present the unusual case of an immunocompetent 6-year-old child residing in an urban area with primary oral tuberculosis due to Mycobacterium bovis, which was confirmed by the application of a molecular genetic approach. M. bovis belongs to Mycobacterium tuberculosis complex which comprises species with close genetic relationship, and for this reason, the use of new molecular techniques is a useful tool for the differentiation at species level of the closely related members of this complex.

Tuberculous parotitis: a review of seven cases.

OBJECTIVES: Tuberculous parotitis is rare even in countries where tuberculosis is widespread. We evaluated seven patients with tuberculous parotitis together with clinical and histopathologic findings, and management. PATIENTS AND METHODS: In a period of 13 years, seven patients (5 males, 2 females; mean age 32 years; range 23 to 47 years) were diagnosed and treated for tuberculous parotitis. All the patients had a clinical suspicion of a parotid gland tumor. RESULTS: The lesions were localized on the left in four patients, and on the right in three patients. The duration of disease varied from seven months to three years. The masses were localized, mobile, and measured 3 to 6 cm in diameter; one was fistulized. There was no evidence for active pulmonary tuberculosis. Chest radiograms showed old tuberculous lesions in two patients. The PPD skin test results were positive (>12 mm induration) in five patients (71%). Computed tomography or magnetic resonance imaging obtained in five patients showed mass formation suggesting a benign parotid gland tumor. Fine-needle aspiration cytology performed in three patients and cultivation performed in the fistulized case were all non-diagnostic. Superficial parotidectomy was performed in six patients and enucleation was performed in one patient. Histopathologic examination showed tubercles composed of macrophages, epithelioid cells and Langhans giant cells, and central caseous necrosis. Following diagnosis, all patients were treated with a four-drug chemotherapy regimen. There was no evidence for recurrence within a mean of 15-month follow-up. CONCLUSION: Tuberculosis of the parotid gland should be considered in the differential diagnosis of patients presenting with a solitary tumor in the parotid gland.

[Acute sialoadenitis of the parotid gland]. / Acute sialoadenitis van de glandula parotidea.

An 88-year-old diabetic women was hospitalized because of a pheripheral vascular disorder. During her hospitalization she developed a right-sided facial swelling which was not limited by anatomical structures in this area. Ultrasound and computertomographic scanning supported the clinical diagnosis acute sialoadenitis of the parotid gland. The swelling resolved shortly after starting antibiotic therapy.

Diseases of the submandibular gland as demonstrated using high resolution ultrasound.

In this review the high resolution ultrasound appearances of the normal anatomy and pathology involving the submandibular gland are demonstrated. The submandibular gland is affected by a number of disease processes that may be difficult to distinguish clinically. Its superficial location makes it ideal for ultrasound evaluation and a useful adjunct to clinical examination. In the assessment of submandibular pathology ultrasound allows intraglandular and extraglandular lesions to be localized and differentiated. These lesions can be further characterized as being benign or malignant and the extent of any extraglandular extension determined. Ultrasound is the first-line investigation in the assessment of sialolithiasis due to its high specificity and sensitivity. In severe infective sialadenitis ultrasound can confirm the presence and guide drainage of abscesses. Ultrasound also has an important role in the assessment of chronic inflammatory disorders such as sarcoidosis and Sjogren's syndrome.

Tuberculosis of the parotid gland: sonographic manifestations and sonographically guided aspiration.

OBJECTIVE: Involvement of the parotid gland by tuberculosis (TB) is rare. If treated properly, the prognosis of TB of the parotid gland is good. In this retrospective study, we report our experience with sonography and sonographically guided aspiration in the diagnosis of parotid TB. METHODS: Over 12 years, 9 adults (mean age, 48 years) with parotid gland TB had been examined with high-resolution sonography and color Doppler sonography for their clinical problems of swelling on the mandibular angle. Sonographically guided fine-needle aspiration was done for cytologic study, stains for acid-fast bacilli, and cultures for mycobacterium. RESULTS: The sonographic patterns were classified as chiefly the parenchymal type (4 patients) and chiefly the periparotid type (5 patients). The parenchymal type appeared as a diffusely enlarged, comparatively hypoechoic gland (compared with the contralateral asymptomatic gland), with or without focal intraparotid nearly anechoic zones, which might have a cavity or cavities within it. The periparotid type appeared as hypoechoic nodules located in the peripheral zone of the hyperechoic parotid gland, consistent with enlarged periglandular lymph nodes. The diagnosis of parotid TB was made in 8 of 9 patients on the basis of sonographically guided aspiration for acid-fast bacilli stains, cytologic study, and cultures for mycobacterium. CONCLUSIONS: Sonographic examination contributes substantially in the diagnosis of parotid TB infection. In the presence of diffuse parotid echo pattern changes with periparotid lymphadenopathy, and with or without focal hypoechoic zones, TB infection should be differentiated. Sonographically guided fine-needle aspiration may provide further diagnostic information by means of stains, cultures, and cytologic study.

Parotid tuberculosis simulating malignancy.

An interesting case of parotid tumour simulating malignancy is reported. The rarity of this lesion and the associated clinical and diagnostic problems are emphasized together with the relevant literature.

[Sialo-ultrasonographic approach of primary tuberculosis of the salivary glands. Apropos of 3 cases]. / Approche sialo-échographique de la tuberculose primitive des glandes salivaires. A propos de 3 observations.

Primary tuberculotic involvement of the salivary glands makes up two per cent of all cases of salivary gland tumefaction that we have had to explore with ultrasonography and sialography. The patients are generally young adults of a low socioeconomic status. Sialography is nonspecific, whereas ultrasonography can suggest the diagnosis in the presence of heterogeneous, hypoechogenic intraglandular lesions associated to adenopathies. An IDR with tuberculin is essential for the diagnosis before treatment.

Unilateral gallium-67 uptake in primary tuberculosis of the major salivary glands.

Unilateral radionuclide accumulation in salivary glands is an uncommon finding on gallium scintigraphy. The differential diagnosis includes malignant tumors and inflammatory processes of these organs. Two cases of unilateral gallium uptake of the parotid and submandibular gland respectively, verified as solitary tuberculosis, are presented, together with the correlative findings of Tc-99m pertechnetate scintigraphy, sialography, and sonography. None of these imaging modalities is specific enough to provide pathognomonic signs for tuberculosis. When assessing unilateral gallium uptake of the salivary glands, one should be aware of the possibility of tuberculosis.