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.

Oral somatosensory alterations and salivary dysfunction in head and neck cancer patients.

PURPOSE: Patients with head and neck cancer (HNC) are at high risk of malnutrition due to eating difficulties partly mediated by sensory alterations and salivary dysfunction. Clinical studies have mostly focused on taste and smell alterations, while changes in oral somatosensory perception are largely understudied. The study aimed to investigate oral somatosensory (tactile, texture, chemesthetic, and thermal) responses and salivary functions of HNC patients in comparison to healthy controls. METHODS: A cross-sectional study was conducted using psychophysical tests in HNC patients (n = 30) and in age- and gender-matched control subjects (n = 30). The tests included measurements of point-pressure tactile sensitivity, whole-mouth chemesthetic stimulation, food texture discrimination, and temperature discrimination. Salivary functions, including hydration, saliva consistency, pH, volume, and buffering capacity, were also evaluated. RESULTS: HNC patients demonstrated significantly lower chemesthetic sensitivity (for medium and high concentrations, p < 0.05), thermal sensitivity (p = 0.038), and salivary functions (p = 0.001). There were indications of lower tactile sensitivity in the patient group (p = 0.101). Patients were also less sensitive to differences in food roughness (p = 0.003) and firmness (p = 0.025). CONCLUSION: This study provided evidence that sensory alterations in HNC patients extend beyond their taste and smell. The measurements demonstrated lower somatosensory responses, in part associated with their reduced salivary function. Oral somatosensory alterations and salivary dysfunction may consequently impart the eating experience of HNC patients. Thus, further investigations on food adjustments for this patient group seem warranted.

Composición y función salival en niños con labio con/sin paladar hendido no sindrómico / Salivary composition and function in children with non-syndromic cl w/wo p / Composição e função salivar em crianças com fissuras labiais e/ou palatinas não sindrômicas

Resumen Introducción y Objetivo: La saliva cumple una importante función en la homeostasis oral, aunque no es evaluada rutinariamente en pacientes con labio con/sin paladar hendido (LH±PH). Este estudio pretendió comparar las características salivares de niños con LH±PH no sindrómico vs. niños sin esta diferencia craneofacial. Materiales y métodos: Se incluyeron 17 niños con LH±PH no sindrómico y 25 niños sin LH±PH, de los cuales se colectaron muestras de saliva estimulada (SE) y no estimulada (SNE). Se realizaron pruebas fisicoquímicas, cuantificación de iones (Ca, Mg y P), proteína total y recuento de streptococcus mutans en ambos grupos para ambas muestras de saliva. Para establecer comparaciones entre grupos se realizó la prueba no paramétrica de Mann-Whitney. Resultados: Hubo diferencias estadísticamente significativas en el pH de SE y SNE, así como en proteína total y capacidad amortiguadora de SNE. El pH (p=0,002) y capacidad amortiguadora (p=0,023) de SNE de los niños con LH±PH fueron menores, mientras que la concentración de proteína total (p=0,003) fue mayor con respecto al grupo control. Se encontró mayor proporción de estreptococo mutans en SNE de niños con LH±PH (6,39x104 UFC mL-1) respecto al grupo control (2,21x104 UFC mL-1), aunque sin detectar diferencias estadísticamente significativas (p=0,243). Conclusiones: Estos hallazgos sugieren una alteración en la función y composición de la SNE en pacientes con LH±PH no sindrómico, que correspondería a una alteración en la formación y función de las glándulas salivales en estos individuos que requiere ser investigada.

Abstract Introduction and objective: Saliva plays an important role in oral homeostasis, although it is not routinely evaluated in patients with CL±P. This study aimed to compare these characteristics in children with non-syndromic CL±P vs. children without this craniofacial difference. Materials and methods: This descriptive study included 17 children with non-syndromic CL±P from Fundación Clínica Noel and 25 children without CL±P. Stimulated (SS) and non-stimulated saliva (NSS) from both groups were collected for physicochemical tests, quantification of ions (Ca, Mg and P), total protein and streptococcus mutans count. Results: There were statistically significant differences in pH of SS and NSS, as well as in total protein concentration and buffer capacity in NSS. The pH (p = 0.002) and buffering capacity (p = 0.023) of NSS of CL±P children decreased, while total protein concentration (p = 0.003) increased compared to the control group. A higher streptococcus mutans count was found in NSS of CL±P children (6.39x104 CFU UFC mL-1) compared to the control group (2.21x104 UFC mL-1), although without detecting statistically significant differences (p = 0.243). Conclusions: These findings suggest an alteration in the function and composition of NSS in patients with non-syndromic CL±P; which could possibly be explained from the genetic/biological point of view by an alteration in the salivary glands formation and function in these individuals that requires further investigation.

Resumo Introdução e objetivo: A saliva desempenha um papel fundamental na homeostase oral, não é avaliada rotineiramente em pacientes com FL/P. Portanto, este estudo objetivou indagar essas características em crianças com FL/P não sindrômico. Materiais e métodos: 17 crianças com FL/P não sindrômico da Fundación Clínica Noel, e 25 crianças sem FL/P foram incluídas neste estudo. Amostras de saliva estimulada (SE) e saliva não estimulada (SNE) foram coletadas para realização de testes físico-químicos, quantificação de íons (Ca, Mg e P), proteína total e contagem de streptococcus mutans. Resultados: Houve diferenças estatisticamente significativas no pH de SE e SNE, bem como na concentração de proteína total e capacidade tampão de SNE. O pH (p=0,002) e a capacidade tampão (p=0,023) de SNE de crianças com FL/P foram menores, enquanto a concentração de proteína total (p=0,003) foi maior, quando comparado ao grupo controle. Um contagem maior de streptococcus mutans foi encontrada na saliva não estimulada de crianças com FL/P (6,39x104 UFC mL-1) em comparação ao grupo controle (2,21x104 UFC mL-1), embora sem detectar diferenças estatisticamente significativas (p=0,243). Conclusão: Esses achados sugerem uma alteração na função e composição da SNE em pacientes com FL/P não sindrômico; isso possivelmente poderia ser explicado do ponto de vista genético/biológico por uma alteração na formação e função das glândulas salivares nesses indivíduos que requer investigação.

Clinical anatomy of the inferior labial gland: a narrative review.

OBJECTIVE: In this article we review the literature on the inferior labial gland from a clinical and anatomical perspective. BACKGROUND: Regardless of its importance in clinical practice, there are no medical literature that comprehensively reviewed the inferior labial gland. METHODS: A database search using PubMed and Google Scholar was conducted. The following keywords were used in the search: "lower labial salivary gland", "lower labial gland", "inferior labial salivary gland", AND "inferior labial gland". CONCLUSIONS: The human labial glands are types of minor salivary gland that continuously secrete small amounts of mucous and serous substances to maintain oral health. The inferior labial glands are innervated by the inferior labial branch of the mental nerve, and the inferior labial branch of the facial artery is the main arterial supply to the lower lip. Although they only have an auxiliary role in saliva production compared to the major salivary glands, minor salivary glands provide a certain amount of lubrication in the oral cavity by the continuous outflow of saliva. The inferior labial gland not only promotes moisturization in the oral cavity but also secretes substances with antibacterial effects, which is important for the function of the oral cavity. A recent study showed that the rate of salivary secretion from the inferior labial glands does not change with age, and in some cases the inferior labial glands are used for diagnosing intractable diseases such as Sjogren's syndrome and cystic fibrosis. In addition, since the inferior labial glands themselves can be the site of cyst and/or neoplasia development, we should be careful to distinguish them from other diseases. Elucidation of the anatomy, physiology, and pathology of the inferior labial glands, is important for understanding human health and diseases.

Short-term and long-term unstimulated saliva flow following unilateral vs bilateral radiotherapy for oropharyngeal carcinoma.

BACKGROUND: We aimed to compare unstimulated saliva flow using 3-minute modified Schirmer test (MST) following bilateral vs unilateral radiotherapy (RT) in oropharyngeal carcinoma (OPC). METHODS: We reviewed OPC patients treated with definitive intensity-modulated radiation therapy (IMRT) between 2011 and 2017. MST was measured at baseline, 1-/6-/12-/24-month post-RT. MST values were compared between bilateral-RT vs unilateral-RT groups. Multivariable logistic regression analysis (MVA) identified predictors of hyposalivation (MST < 25 mm). RESULTS: Total 498 bilateral-RT and 36 unilateral-RT patients were eligible. The MST values at 1-/6-/12-/24-month post-RT were all significantly reduced from baseline for the entire cohort. Baseline unilateral-RT and bilateral-RT MST values (in mm) were similar (P = .2), but much higher for unilateral-RT 1-month (mean: 19.1 vs 13.0, P = .03), 6-month (20.5 vs 9.3, P < .001), 12-month (20.1 vs 11.9, P < .01), and 24-month post-RT (22.2 vs 13.9, P = .04). MVA confirmed that unilateral RT reduced the likelihood of hyposalivation vs bilateral RT (OR 2.36, P = .006). CONCLUSION: Unilateral RT reduces unstimulated salivary flow in OPC patients.

How common is dry mouth? systematic review and meta-regression analysis of prevalence estimates

Abstract The aim of this paper is to systematically review the literature to estimate the overall prevalence of xerostomia/hyposalivation in epidemiological studies. An electronic search was carried out up to February 2018 with no language restrictions. A total of 5760 titles were screened and just twenty-nine papers were included in review and the meta-analysis after a two independently reviewers applied the selection criteria. Data were extracted from PubMed and Web of Science databases. Eligibility criteria included original investigations from observational population-based studies that reported the prevalence of xerostomia or data that allowed the calculation of prevalence of xerostomia and/or hyposalivation. Studies conducted in samples with specific health conditions, literature reviews, case reports and anthropological studies, as conferences or comments were excluded. Sample size, geographic location of the study, study design, age of the studied population, diagnosis methods, and evaluation criteria used to determine xerostomia e/or hyposalivation were extracted for meta-analysis and meta-regression. Multivariate meta-regression analysis was performed to explore heterogeneity among studies. The overall estimated prevalence of dry mouth was 22.0% (95%CI 17.0-26.0%). Higher prevalence of xerostomia was observed in studies conducted only with elderly people. Despite diverse approaches to the condition's measurement, just over one in four people suffer from xerostomia, with higher rates observed among older people. Moreover, the measurement methods used currently may over- or underestimate xerostomia. These findings highlight the need for further work on existing and new clinical measure and will be useful to determine which one is more reliable in clinical and epidemiological perspectives.

Resumo O objetivo do estudo é revisar sistematicamente a literatura afim de estimar a prevalência global de xerostomia/hiposalivação em estudos epidemiológicos. Uma busca eletrônica foi conduzida até Fevereiro de 2018 sem restrições de linguagem. Um total de 5760 títulos foram inicialmente identificados e somente vinte e nove artigos foram incluídos na revisão e meta-análise após dois revisores independentes aplicarem os critérios de seleção. Os artigos foram extraídos das bases de dados PubMed/Medline e Web of Science. Os critérios de elegibilidade incluíram investigações originais de estudos observacionais de base populacional os quais reportaram a prevalência de xerostomia ou dados que permitissem o cálculo da prevalência de xerostomia e/ou hiposalivação. Estudos realizados em populações com condições de saúde específicas, revisões de literatura, relato de casos e estudos antropológicos, assim como, conferências ou comentários foram excluídos. Tamanho amostral, localização geográfica aonde foi realizado o estudo, desenho do estudo, idade da população estudada, métodos de diagnóstico e o critério de avaliação para determiner xerostomia e/ou hiposalivação foram extraídos para a meta-análise e metaregressão. Análise de meta-regressão multípla foi realizada para explorar a heterogeneidade entre os estudos. A prevalência global estimada de boca seca foi de 22.0% (95%IC 17.0-26.0%). Uma maior prevalência de xerostomia foi observada em estudos realizados exclusivamente em populações idosas. Apesar de diferentes abordagens utilizadas para mensurar as condições de interesse, cerca de uma em quatro pessoas é acometida por xerostomia, com taxas mais elevadas sendo observadas na população idosa. Além disso, os métodos de mensuração podem ter super- ou subestimado os valores de xerostomia. Os achados do presente estudo salientam a necessidade de mais estudos acerca das existentes e novas formas de avaliação clínica, os quais serão úteis para determinar qual é a mais confiável para as perspectivas clínicas e epidemiológicas.

Differences in salivary secretory function between patients with erosive esophagitis and those with nonerosive reflux disease.

BACKGROUND AND AIM: It has been speculated that impaired salivary flow contributes to abnormal acid clearance in patients with erosive esophagitis (EE). For easy and objective assessment of salivary function, we developed a salivary gland blood flow measurement technique using continuous-wave Doppler sonography. In the present study, we evaluated the salivary secretory function in patients with EE and those with nonerosive reflux disease (NERD) using this method. METHODS: Doppler waveform analysis was performed on the facial artery to assess blood inflow to the submandibular gland of 30 healthy subjects (HS). Blood flow was compared before and after secretory stimulation with 1 mL of lemon juice. Saliva was simultaneously collected and weighed before and after stimulation. Continuous-wave Doppler sonography was also performed in patients with EE and NERD. The size of the submandibular gland was compared in 26 patients with EE, 41 patients with NERD, and 86 HS. RESULTS: The submandibular gland blood flow increased after stimulation in all HS. Both within-day and day-to-day reproducibility were good. There was a significant correlation between the percent increase in the maximum velocity and the percent increase in salivary secretion. Although the size of the submandibular gland was not significantly different among the three groups, the percent increase in the maximum velocity in patients with EE was significantly smaller than that in HS. CONCLUSIONS: We have established an easy method of assessing salivary function in daily practice. This study revealed that a decrease in salivary secretory function is involved in the pathology of EE.

Selective Deep Lobe Parotidectomy for Preservation of Parotid Function: A Case Report

Tumors of the deep lobe of parotid gland are rare. These benign tumors have usually been treated by total parotidectomy, which has functional and esthetic side effects. Recently, there has been a trend for operations of parotid gland benign tumors to be less radical and selective deep lobe parotidectomy has been introduced. This technique preserves the superficial lobe and facial nerve when tumor is located in the deep lobe. Selective deep lobe parotidectomy preserves parotid salivary function, minimizes the incidence of facial nerve damage and gustatory sweating (Frey's syndrome) and improves cosmetic outcome. We report a case of pleomorphic adenoma of the deep lobe that was successfully treated by selective deep lobe parotidectomy with satisfactory result.

Advance in MR imaging for evaluation of postradiotherapy salivary function in patients with head and neck cancer / 中国癌症杂志

Salivary gland damage with subsequent xerostomia has been an unavoidable complication in most head and neck cancer patients after radiotherapy.However,there were many shortcomings of each current detecting technique.Magnetic resonance sialography(MRS) and diffusion-weighted magnetic resonance imaging(DW MRI) ,as two of the most important progresses in the latest MRI techniques,with the virtue of non-invasion and non-ionizing radiation,has been rapidly developed in salivary function assessment in recent years,and it has kept on improving technically.This article mainly reviewed the clinical applications and research advances of these two MRI technologies in post-radiotherapy salivary function assessment in patients with head and neck cancers,so as to provide reference for further study.