Imaging of salivary gland cancers derived from a sublingual gland herniated into the submandibular space: a report of three cases.

Sublingual gland herniation into the submandibular space through a mylohyoid muscle defect is a common anatomical variation; however, salivary gland cancers that arise from a herniated sublingual gland have not been described yet. Here, we report three patients with salivary gland cancers originating from a herniated sublingual gland. All tumors were detected as palpable submandibular masses, located anterior to the submandibular gland, medial to the mandible, and lateral to the mylohyoid muscle, with contact with the sublingual gland through a mylohyoid muscle defect. Intraoperative findings confirmed that the masses were derived from herniated sublingual glands. Pathological examination showed one case of mucoepidermoid carcinoma and two cases of adenoid cystic carcinoma. Imaging findings of the tumor location, in addition to the continuity with the sublingual gland through the mylohyoid muscle defect, are crucial for accurately diagnosing the tumor origin, which is essential for determining the appropriate clinical management.

Giant submandibular sialolipoma masquerading as huge goitre: a case report.

BACKGROUND: Sialolipoma is a rare tumour which may arise from both major and minor salivary glands and has recently been described as a variant of salivary gland lipomatous lesions. CASE PRESENTATION: We report a 54-year-old male who presented with a 7-year history of large right anterior neck swelling. He was clinically euthyroid and had no compressive or infiltrative symptoms. He sought medical attention due to the discomfort exerted by the weight of the mass and was keen for excision. The swelling appeared like a goitre but physical examination proved otherwise. Imaging was suggestive of a benign tumour arising from the right parapharyngeal fossa. The mass was surgically excised and was noted to be adherent to part of the submandibular gland. Histopathological examination revealed a new variant of benign adipocytic tumour of salivary gland or sialolipoma arising from the submandibular gland. Besides being the largest sialolipoma to be reported, there are also no reports of giant submandibular sialolipomas masquerading as a huge goitre in appearance. CONCLUSION: Submandibular sialolipomas can present in really large sizes and appear as a giant goitre. It is important to differentiate between benign lipomas from liposarcomas and tailor the management accordingly. Surgical enucleation is the preferred choice of treatment for these benign tumours with low recurrence rates.

Absence of Neck Scars With Total Endoscopic Submandibular Sialadenectomy Using a Chest Wall Approach: A New Technique.

INTRODUCTION: This study aims to demonstrate the safety, surgical feasibility, and esthetic features of total endoscopic submandibular sialadenectomy through a chest wall approach without the creation of any neck incisions. METHODS: Four patients with benign submandibular gland lesions underwent a total endoscopic submandibular sialadenectomy through a chest wall approach using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). RESULTS: The operative time ranged from 140 to 170 minutes. Conversion to the open technique was only necessary in one case with good visualization of the facial vein and artery, marginal mandibular and lingual nerve. No significant perioperative complications were encountered. All patients were discharged on the third postoperative day, and they were satisfied with the cosmetic outcome. CONCLUSION: Total endoscopic submandibular sialadenectomy through a chest wall approach is technically feasible and safe with satisfactory cosmetic results. It may be a valid alternative to conventional surgery when performed in select patients. The absence of neck scars and the ability to avoid potential nerve injuries are the most obvious advantages of this innovative technique.

Salivary gland malignancies - an update on current management for oral healthcare practitioners.

Salivary gland tumours represent a diverse range of tumours with many histological subtypes which occur in major and minor salivary glands. The management of these tumours is complex owing to their heterogeneity. Surgery together with radiotherapy and/or chemotherapy remains the treatment strategy for these tumours. The aim of this review is to examine the current management of these tumours.

Distant Metastases in Patients with Carcinoma of the Major Salivary Glands.

BACKGROUND: This study aimed to show the incidence of distant metastases (DM) in salivary gland cancer as well as the types of histology most commonly associated with it and to identify factors predictive of DM. METHODS: The study identified 301 patients who underwent surgery for cancer of the major salivary glands at Memorial Sloan-Kettering Cancer center between 1985 and 2009. Clinical, tumor, and treatment characteristics were recorded. Tumors were categorized as low-, intermediate-, and high-risk pathology based on histologic subtype and grade. Factors predictive of distant recurrence-free probability (DRFP) were determined by uni- and multivariable analyses. RESULTS: The primary tumor was parotid in 266 patients (88 %), and 96 tumors (32 %) were clinical T3/T4. For 57 patients (18.9 %), DM developed with a 5-year DRFP of 72.7 %. The most common site of metastasis was the lung (50 %). The clinical predictors were male gender, cT4 stage, cN+ stage, and clinical overall stage. The multivariable analysis of clinical variables showed male gender (p = 0.018), cT4 stage (p < 0.001), and cN+ stage (p = 0.004) to be significant. The pathologic predictors were high-risk and high-grade pathology, vascular invasion, perineural invasion, positive margins, pT4 stage, pN+ stage, and overall stage. The multivariable analysis of pathologic variables showed high-grade pathology (p < 0.001), perineural invasion (p = 0.005), and pN+ stage (p = 0.002) to be significant. CONCLUSIONS: Distant metastases developed in approximately 20 % of the patients with salivary gland cancer. The most common site of metastases was the lung. The significant predictors of DM were cT4, cN+, male gender, high-grade pathology, perineural invasion, and positive nodal disease.

Adenoid cystic carcinoma of submandibular salivary gland with late metastases to lung and choroid: a case report and literature review.

PURPOSE: Adenoid cystic carcinoma (ACC) is a rare type of cancer that can exist in many body sites. Distant metastasis (DM) is one of the most common features of ACC, usually occurring several years after the initial diagnosis. Approximately half the patients with ACC are found to develop DM after initial treatment of the primary tumor. This report describes a case of ACC with late metastasis to the lung and choroid, which is extremely rare. MATERIALS AND METHODS: A 43-year-old female patient had a history of ACC of the submandibular salivary gland. Five years after total resection and postoperation radiotherapy, distant metastases were found in the left lung and left choroid by immunohistochemistry and imaging examinations. RESULTS: After radiotherapy of lesions of the lung and eye, the patient had a partial response and remained free of progression at almost 7 months. CONCLUSION: Although many metastatic sites have been reported, currently, there are only 6 cases in the literature on ACC metastasizing to the choroid. For those patients with metastatic ACC, although modality treatments, including chemotherapy and radiotherapy, are administered, most patients have continuous metastasis and have a fatal outcome.

Head and neck salivary gland carcinomas--elective neck dissection, yes or no?

PURPOSE: Surgical resection and subsequent neck dissection (ND) in cases of clinically positive lymph nodes is an accepted primary treatment strategy for salivary gland carcinomas. Because of uncertainty in the extent of lymphogenic metastasis, the authors advocate a strategy of surgical resection and elective ND (END) for all patients. The authors evaluated their treatment by estimating the frequency of metastatic disease and identifying factors associated with an increased risk for metastatic disease. MATERIALS AND METHODS: A retrospective cohort study was implemented using patient data obtained from the university's interdisciplinary board for head and neck tumors. Data were screened for age, gender, tumor entity, localization, grade, and TNM Classification of Malignant Tumors (by UICC, International Union Against Cancer) status. Statistical analysis was performed to identify possible predictors of lymph node metastasis. Nodal status groups (N(+) and N0) were compared with respect to age by t tests; other comparisons involved χ(2) tests. RESULTS: Ninety-four patients (50% female, 50% male; mean age, 59.12 yr) were identified, of whom 87 had an indication for END. On postsurgical histopathologic examination, 34 (39%; 17 male, 17 female) were diagnosed with N(+). Statistical analysis for nodal status produced explorative P values (age, P = .001; gender, P = .792; anatomic region, P = .114; tumor entity, P = .854; tumor status, P = .263; grade, P = .000). CONCLUSION: All studied malignancies were capable of lymph node dissemination. Therefore, no reliable preoperative predictors for lymphogenic metastasis are currently identifiable. Because of difficulties in safely predicting lymphogenic metastasis and the high rate of N(+) results on postoperative examination, the authors strongly advise END for all patients with salivary gland carcinoma.

Hemangioblastoma arising from the submandibular gland.

OBJECTIVE: The objective was to document and describe the clinical features of a hemangioblastoma arising from a submandibular gland. METHODS: A case report of a 63-year-old man with a right submandibular gland hemangioblastoma. RESULTS: Submandibular gland excision and histological examination revealed a hemangioblastoma. Subsequent evaluation with imaging studies found no association with von Hippel-Lindau disease. CONCLUSION: We report the first presentation of a hemangioblastoma arising in a salivary gland. Further evaluation of patients with a hemangioblastoma is recommended given the neoplasms' association with von Hippel-Lindau disease.

Transcervical extirpation of the submandibular gland: the University of Marburg experience.

Surgical excision of the submandibular gland is the treatment of choice for lesions affecting this gland. The data of 87 patients, who underwent a transcervical extirpation of the submandibular gland as a single operation over the past 10 years at a single institution in Germany, were available for analysis. Sialolithiasis (73.5%) was the most common reason leading to excision, followed by benign (18.5%) and malignant tumors (8%). Complications included temporary palsies of the marginal mandibular branch of the facial nerve (5.7%), the lingual nerve (5.7%), and the hypoglossal nerve (1.1%), and wound infections in the form of hematoma (3.4%) and seroma (1.1%).

Perioperative difficulties and early postoperative complications of transoral approach in mouth base surgery.

OBJECTIVE: The aim of this study was to discuss perioperative difficulties and temporary or permanent complications that can be seen at early postoperative period in cases undergoing transoral surgical approach for disorders of mouth base. STUDY DESIGN: The study included 19 patients undergoing transoral surgical approach between September 2011 and January 2013 who were retrospectively evaluated. Exclusion criteria were patients with malign submandibular gland tumor or other suspected tumors at mouth base, those with a benign solid mass larger than 10 × 10 cm, and those who did not accept the transoral approach. RESULTS: Mean age was 28.47 ± 17.89 years (range, 8-76 years) in 19 patients included (9 male and 10 female subjects). Of these, submandibular gland excision was performed in 9 cases, whereas thyroglossal duct cyst excision was performed in 3 (2 transfrenulum approach and 1 lateral lingual approach), lymphangioma excision in 1, diagnostic lymph node excision at the posterior of submandibular gland in 3 cases, and dermoid cyst excision (2 with midline and 1 with left submandibular localization) in 3 cases. Perioperative difficulties included dissection problems due to adhesion, partial adhesion between Wharton canal and lingual nerve, fragmented dissection of the gland, capsule rupture of submandibular adenoma, and facial artery rupture. While visualization of surgical field and retraction of mouth base muscles are an important issue in midline approaches, resection of hyoid bone corpus is challenging in lateral approaches. Early postoperative complications included edema at mouth base, lingual ecchymosis, and postoperative temporary abnormal tongue sensation. CONCLUSIONS: Transoral mouth base surgery is a safe approach in selected patients. Permanent injuries of neural structures are rarely encountered, which is considered as a concern by head and neck surgeons. Temporary complications are at a level that can be tolerated by patients.

Extracapsular dissection versus total excision for benign submandibular gland tumors.

INTRODUCTION: Benign submandibular gland tumors pose challenges in balancing treatment effectiveness and preserving gland function. This study aimed to compare gland-preserving surgery, extracapsular dissection (ECD), with total excision in managing these tumors, focusing on function preservation and recurrence rate. METHODS: Fifty consecutive patients with treatment-naïve benign submandibular gland tumors were alternatively allocated to receive ECD (n = 25) or total excision (n = 25) without randomization procedures. Intraoperative findings, postsurgical complications, subjective satisfaction, and gland function were assessed. Follow-up data were collected for a median duration of 55 months (24-80 months) to monitor recurrences. RESULTS: ECD demonstrated significant advantages, including shorter operation time, reduced bleeding, and preservation of the facial artery and vein (P < 0.05). Both groups exhibited acceptable postsurgical pain and taste sensations. Complications were minimal and similar between the two groups. ECD resulted in superior facial contour satisfaction (P = 0.030) and preserved gland function, as evidenced by salivary scintigraphy. No recurrences were observed in either group during the follow-up period. CONCLUSIONS: ECD is a practical approach for benign submandibular gland tumors, offering favorable functional outcomes, reduced surgical morbidity, shorter operation times, and improved cosmetic results.

[Clinical application of retroauricular hairline approach in submandibular gland resection assisted by endoscope].

Objective:To investigate the clinical effect of retroauricular hairline approach in submandibular gland resection assisted by endoscope. Methods:A total of 18 patients with submandibular gland benign tumors treated in our hospital from September 2022 to September 2023 were selected. A 5 cm incision was designed in the retroauricular hairline, and the flap was turned over directly to the anterior edge of sternocleidomastoid muscle, then the flap was turned over to build the cavity through endoscopic surgery, and submandibular gland resection was completed with the assistance of endoscope. After operation, a negative pressure drainage was placed into the hairline, and the wound was closed by continuous intracutaneous suture. The clinical effect was evaluated after 3-6 months follow-up. Results:All patients underwent submandibular gland resection with endoscopic assistance as planned, and none of them converted to submaxillary incision during operation. The operation time was 65-97 min, with an average of 75 min. Intraoperative bleeding was 10-20 mL, with an average of 14 mL.No tongue numbness, wound infection, or tumor recurrence occurred after operation. However, there were 10 patients with ear numbness and discomfort of auricle after surgery, which gradually recovered after 6-9 months of follow-up. Two patients had crooked mouth after surgery, and the symptoms were gradually relieved after follow-up. All incisions healed in stage I and were concealed. Conclusion:Endoscopic retroauricular hairline approach is a choice for submandibular gland resection with good cosmetic effect, less trauma and fewer complications.

Solitary liver metastasis from adenoid cystic carcinoma of the submandibular gland.

Adenoid cystic carcinoma (ACC) is a rare tumour of the salivary glands characterised by distant metastases, mainly to lungs and bone. Isolated metastasis to the liver is unusual. We present the case of a woman with an ACC of the submandibular gland (pT1N0) who underwent radical submandibular gland excision and selective neck dissection. Preoperative imaging identified a liver lesion with features suggestive of a haemangioma. Two-year postoperatively, a surveillance CT neck/trunk showed an increase in size of the left liver lobe lesion. Subsequent MR liver and US-guided biopsy confirmed the lesion to be metastatic ACC. The patient underwent a successful left lateral liver sectionectomy. She remains disease-free 2.5 years after her liver resection. A literature search revealed only four other similar cases. This report highlights that even early-stage ACCs of the salivary gland may present with synchronous solitary liver metastasis which can be effectively treated with curative surgery.

Leiomyoma of submandibular gland.

Leiomyoma is a benign tumour of smooth muscle origin. Leiomyoma arising in major salivary gland is under-reported. We report a case of a woman in her 40s with a submandibular gland tumour which represented a diagnostic challenge during preoperative assessment. The core needle biopsy of submandibular gland tumour revealed a spindle cell tumour suggestive of an undifferentiated tumour. As a malignancy could not be excluded, the submandibular gland tumour was removed en bloc with surrounding lymph nodes in level Ib of the neck. Leiomyoma may be included in the differential diagnosis of spindle cell salivary gland tumours, particularly when there are no signs of infiltration and preoperative investigations are inconclusive.

Robotic-assisted neck dissection in submandibular gland cancer: preliminary report.

PURPOSE: Robot-assisted neck dissection (ND) in patients with head and neck cancer has been developed as a plausible substitute for conventional surgery and it provides an excellent cosmetic outcome. The authors hypothesized that surgery for submandibular gland (SMG) cancer could be achieved with a gasless retroauricular (RA) approach using the robotic system. This study evaluated the feasibility of robot-assisted ND using an RA approach for SMG cancer. PATIENTS AND METHODS: Primary tumor resection with robot-assisted ND using an RA incision was performed in 6 patients with SMG cancer. RESULTS: All cases of robot-assisted ND combined with primary tumor resection were conducted successfully without any significant intraoperative complication, need for an additional incision, or conversion to open conventional ND. The amount and duration of drainage, length of hospital stay, number of retrieved lymph nodes, and complications were generally acceptable. The postoperative scar was completely hidden by the auricle and hair. CONCLUSIONS: Robot-assisted ND with primary tumor excision using an RA approach is a feasible and useful method, with excellent cosmetic results, for surgical treatment of selected cases of SMG cancer.

Cytologic features of low-grade cribriform cystadenocarcinoma of the submandibular gland: a case report.

BACKGROUND: Low-grade cribriform cystadenocarcinomas (LGCCC) are rare salivary gland tumors, classified into a variant of cystadenocarcinoma by the 2005 WHO classification. All previously reported cases arose from parotid glands, except for a case from a minor salivary gland. We report here for the first time a case of LGCCC arising from the submandibular gland. CASE: A 65-year-old man presented with a 4-cm multicystic mass in the left submandibular gland. Smears from fine-needle aspiration cytology showed tumor cells, appearing solitarily or partly in clusters, with thick cytoplasm and central nuclei. Some clustering tumor cells showed large cytoplasmic vacuoles and peripherally dislocated nuclei. Although these findings indicated a possible mucoepidermoid carcinoma in the submandibular gland, the final diagnosis of the resected specimen was LGCCC. CONCLUSION: LGCCC can arise not only from the parotid glands, but also in the submandibular glands. LGCCC is thought to be of low-grade malignancy; no reported cases have shown tumor metastasis and there are no patients who are known to have died of this disease. Thus, differential diagnosis of this tumor from other malignant salivary gland tumors is quite important; however, this might be difficult when based solely on cytological findings.

Submandibular gland excision: long-term clinical outcome in 139 patients operated in a single institution.

In transcervical resection of the submandibular gland for benign lesions, only a limited risk of damage to neural structures can be accepted and a cosmetically satisfactory result is mandatory. In this retrospective case series, we evaluated 139 patients operated over a 10-year period and completed long-term clinical follow-up of 113 of these patients after a median of 81 months. In all patients, the operation was effective. We found a 4.3 % risk of reoperation for wound infection or postoperative hematomas and an 18.7 % risk of early paresis of the marginal branch of the facial nerve, which decreased to 2.7 % on long-term follow-up. We found a 4.4 % risk of permanent lingual nerve paresis, and no patients had damage to the hypoglossal nerve. Xerostomia was found in 22.1 % of the patients and could be quantified by the easily performed biscuit test. Only 2.5 % reported an unsatisfactory cosmetic result and all scars were ≤ 6 on the Vancouver Scar Scale. Problems with scarring were more common if there had been postoperative infection. We continue to use the lateral transcervical approach as standard in our institution for patients who cannot be managed by gland-sparing procedures.

Submandibular triangle masses.

OBJECTIVE: The study aims to analyze the demographic data of a large case series operated on because of submandibular triangle mass for more than 10 years and presents a review of the literature. MATERIALS AND METHODS: The charts of patients who underwent surgical intervention for submandibular triangle mass between January 2000 and November 2010 were reviewed. The medical history, age, sex, duration of symptoms, clinical presentation, preoperative investigations, and histopathologic diagnosis were reviewed. RESULTS: The study included 66 subjects; 12 patients (18.2%) with submandibular sialolithiasis, 18 patients (27.2%) with sialadenitis, 10 patients with lymphadenitis (15.1%), and 26 patients (39.3%) with tumors. Of the tumors, 23% was malignant and 77% was benign. Benign tumors of submandibular gland comprised 22.7% and malign tumors of submandibular gland comprised 3% of all submandibular mass. The most common benign tumor was pleomorphic adenoma. The most frequent histopathologic diagnoses of submandibular masses originated from the submandibular gland, and these comprised 71.2% of all submandibular mass pathologies. The main symptom was a painless mass. Ultrasonography was the most common preoperative diagnostic procedure. Fine-needle aspiration biopsy was performed in 26 patients. A clear diagnosis could not be provided in 3 (12%) patients. CONCLUSION: Infectious conditions and benign tumors are more frequent than malign tumors in the submandibular region. The histopathologic diagnoses mainly consisted of submandibular sialadenitis, sialolithiasis, pleomorphic adenoma, and lymphadenitis. Ultrasonography is the first option of radiologic evaluation. Fine-needle aspiration biopsy is a very useful and usually sufficient diagnostic procedure for histopathologic diagnosis. Excisional biopsy can be performed when the fine-needle aspiration biopsy failed.

Warthin tumor in an unusual site: a case report.

Warthin tumor (papillary cystadenoma lymphomatosum, adenolymphoma) is a benign neoplasm from salivary glands and is almost restricted to the parotid gland and the periparotid lymph nodes. Its etiopathogenesis has been associated with tobacco smoke. Several authors believe that the tumor develops from heterotopic salivary gland tissues or through the attraction of a heavy lymphoid reaction. Most cases involve the lower pole or the tail of the parotid. Since its description, a few cases have been reported in other sites, like the submandibular salivary gland. This study aimed to describe a rare presentation of a Warthin tumor and discuss its etiology and differential diagnosis. A 72-year-old male patient presented an asymptomatic, nodular mass adjacent to the submandibular salivary gland. Based on clinical diagnosis of cervical lymphadenopathy, the patient underwent a surgical excision of the lesion. Histopathological exam revealed a benign neoplasm from salivary glands composed of two components: epithelial and lymphoid. The findings were consistent with Warthin tumor. Warthin tumor from submandibular salivary gland is a rare lesion. Professionals should not misinterpret their site of origin, as if they were from the lower pole or the tail of the parotid.

Benign submandibular gland tumours: outcomes of gland-preserving excision by endoscopic or conventional approach.

Endoscope-assisted surgery is becoming a preferred technique in salivary gland surgery. However, this technique has not yet been applied in submandibular gland (SMG) preservation surgery. This retrospective study was performed to evaluate the outcomes of endoscope-assisted gland-preserving surgery through a hairline incision in patients with benign SMG tumours. The study included 38 patients with benign SMG tumours who underwent tumour excision with gland preservation: 19 who underwent local excision of the tumour through an endoscope-assisted hairline approach and 19 who received the conventional cervical approach. The feasibility of the surgical procedure, perioperative patient variables, and postoperative appearance and functional outcomes were evaluated. Patients in both groups had their tumours removed successfully with tumour-free margins. The intraoperative blood loss, postoperative amount of drainage, mean length of the incision, and unstimulated saliva flow rate did not differ between the two groups. There was no difference in the stimulated saliva flow rate between the preserved gland and unaffected SMG. The aesthetic result was better in the endoscope-assisted hairline incision group. No tumour recurrence occurred during follow-up (range 12-52 months). Thus, gland-preserving tumour dissection appears to be a safe method for benign SMG tumours, with good functional results. Furthermore, the endoscope-assisted hairline incision is a feasible method with excellent cosmetic results.