Descending Necrotizing Mediastinitis Resulting From Sialadenitis Without Sialolithiasis.

Descending necrotizing mediastinitis (DNM) is an uncommon and life-threatening condition that arises from an oropharyngeal infection and descends along the cervical fascial planes into the mediastinum. Without aggressive surgical management, a high mortality rate exists. We report a case of an otherwise healthy 49-year-old male who presented with an abscess formation of the right submandibular gland secondary to sialadenitis without sialolithiasis. Computed tomography revealed fluid collection around the right submandibular gland suggestive of sialadenitis without sialolithiasis with severe inflammation and leftward deviation of the aerodigestive tract. Despite multiple drainages, the infection eventually progressed inferiorly into the mediastinum, resulting in DNM. After multiple takebacks to the operating room for exploration and washout of the neck and chest, intensive care unit management, and aggressive IV antibiotic therapy, the patient eventually had a successful recovery and was discharged home. In this paper, the etiology, anatomy, pathophysiology, and management of DNM are discussed. To our knowledge, this is the first report in the literature of DNM developing from sialadenitis without sialolithiasis in the submandibular gland.

Secretory Carcinoma of the Salivary Gland - Systematic Review of the Literature and Report of 2 Cases.

PURPOSE: Secretory carcinoma (SC) of the salivary gland, formerly known as mammary analogue secretory carcinoma, is an uncommon and fairly newly described low grade malignant neoplasm of the salivary gland. Given the small number of cases reported in the literature to date, treatment guidelines are scarce. This study aimed to describe the clinical characteristics of SC, discuss prior management strategies, and provide recommendations for future treatment. METHODS: We performed a systematic review of all the cases of SC reported in the literature since it was first recognized in 2010. Using Pubmed, Crossref, and Google Scholar, we identified all articles reporting cases of SC. RESULTS: We identified 657 cases of SC in 109 articles. In addition, we provided 2 new cases, for a total of 659 cases in 110 articles. To our knowledge, this is the largest review of cases of SC in the literature to date. We summarized the clinical characteristics of SC, as well as the nodal status, clinical management, recurrence rate, and death rate. CONCLUSIONS: SC occurs on average in middle age (with a large age range), presents most often initially as localized disease without metastasis, and has a low but not insignificant recurrence rate. Deaths have been reported. The generalized recommendations for treatment of SC are in line with those of other low-grade salivary gland malignancies.

Mandibular Condylar Fractures.

Mandibular condyle fractures can result in short-term and long-term morbidity. As a weak area of the mandible, the condyle is vulnerable to injury by a direct impact or an indirect force. Current treatment recommendations aim to better match the severity of the fracture with the choice of closed or open approach. Long-term follow-up of patients provides the best opportunity to monitor the degree of functional restoration after treatment. There is a growing consensus regarding the use of standardized fracture classification methods and outcomes measures that will allow better assessment of treatment results and strengthen the quality of outcomes research.