#Pleomorphic adenoma

[alphasurgical]

Understanding Parotid Tumor Surgery: What to Expect

Parotid tumor surgery is a crucial procedure for those diagnosed with tumors in the parotid gland, the largest salivary gland located near the jaw and ear. These tumors can be benign or malignant, and surgical removal is often necessary to ensure health and wellbeing.

Types of Tumors

Most parotid tumors are benign, such as pleomorphic adenomas, but some may be cancerous. Accurate diagnosis through imaging studies and biopsies is essential to determine the appropriate surgical approach.

The Surgical Procedure

During parotid tumor surgery, an incision is typically made in front of the ear. The surgeon carefully dissects through the tissue to access the gland and remove the tumor, ensuring minimal damage to surrounding nerves and structures. If the tumor is malignant, additional treatments like radiation may be necessary.

Recovery

Post-surgery, patients can expect some swelling and discomfort, which is manageable with pain medications. Recovery usually takes a few weeks, during which patients should follow their surgeon's aftercare instructions closely. Regular follow-up appointments are critical to monitor healing and check for any recurrence.

Risks and Considerations

As with any surgery, there are risks involved, including facial nerve damage and infection. Discussing these risks with your healthcare provider can help mitigate concerns and prepare you for a successful outcome.

Understanding parotid tumor surgery can empower patients to make informed decisions about their treatment and recovery. With proper care, many individuals lead healthy lives post-surgery.

[littlelambrants]

Having surgery on Monday to remove the pleomorphic adenoma on my neck, I try not to think because I know if I think I’ll hurt myself more and my body won’t be able to recover. Because I know my heart skips beats, because my immune system attacks itself, because I will faint and get hives. I don’t know if this is normal but no one will listen to me about it, days like these I’m thankful for the brain fog

[krishnankrish22]

Diet Recommendations for Pleomorphic Adenoma Parotid Patients in Bangalore

You may also want to know what foods should be avoided and what foods are recommended for patients with pleomorphic adenoma parotid in Bangalore. Appreciate knowledge on various aspects of a well-planned diet towards enhancing the healing process in the body, boosting the immune system as well as the management of various symptoms that enhance the overall functioning of the body.

[vasanthasworld]

Salivary Gland Important Question And Answers

[pochacco]

What did you have surgery for?

i had this lil lump under my ear right behind my jaw that i thought was an enlarged lymph node (my primary physician didn't even notice anything weird about it)!! after a bunch of diagnostic tedious stuff when i became more nervous about it, they did a fine needle biopsy and i had something called a pleomorphic adenoma ?? it's a benign tumor. but it has a chance of turning cancerous. so i had it removed !!!

[alphasurgical]

Parotid Tumor Surgery: What to Expect

Parotid tumors affect the parotid glands, the largest of the salivary glands, located just in front of the ears. While many parotid tumors are benign, some can be malignant, making surgery an essential treatment for removal and analysis. The primary surgery for this condition is a parotidectomy, where part or all of the parotid gland is removed.

Before surgery, doctors will perform imaging studies like MRI or CT scans to assess the size and location of the tumor. A biopsy may also be performed to evaluate whether the tumor is benign or malignant. The goal of surgery is to remove the tumor entirely while preserving facial nerve function, as the facial nerve runs directly through the parotid gland and controls facial expressions.

During surgery, depending on the tumor's location, the surgeon will make an incision near the ear to access and remove the tumor. In some cases, partial removal of the gland is sufficient, while in others, complete removal might be necessary. Post-surgery, patients may experience swelling, temporary numbness, or weakness in facial muscles, which usually improves over time. The recovery process typically takes a few weeks.

Parotid tumor surgery has a high success rate, especially for benign tumors. However, in cases where the tumor is cancerous, additional treatments like radiation or chemotherapy may be required. Close follow-up care is vital to monitor recovery and ensure no recurrence of the tumor.

[littlelambrants]

In Summer 2022, I suddenly “lost my mobility” - if we are being honest here, for years I have had pains walking and moving my legs but they had always been dismissed as “growing pains” however summer 2022 over seemingly a few days to a week after the holidays began I began experiencing a lot of pains where it ached to even just exist. It began affecting how I walked and sometimes I woke up with temporary paralysis where I couldn’t even move my leg without physically moving it with my hands, this only just got worse.

When I first told my caretakers about this, they dismissed me, even worse they made me use an umbrella as a crutch for months - until about a few weeks after starting school again - and I had to struggle and grovel and suffer because I had “growing pains”. Before they let me use some old crutches, because they didn’t and still don’t want me to be “dependent” - I was 17. When I told a doctor they asked if I was double jointed over the phone, didn’t even see me face to face, and I was put on the physiotherapy list. Months past and in November I saw her. She said I was fine, said I needed to build up strength but didn’t know what caused the paralysis episodes - no follow up or referral.

On my birthday I woke up early in the morning in unbearable pain, I physically moved my leg in an upright position before passing out because it hurt so much. That’s was on the 3rd of Dec, today it is the 15th and there’s a huge bruise under my knee and my pain is horrible.

This could have been avoided if someone had just listened to me. I have 0 support and I’m in all honesty pissed off and I’m scared, I have no idea what’s going on. I plan to go to the doctor, every time I bring it up my caretaker goes “have you done the exercises?” It’s made it worse. I am in pain laying down and standing and sitting and existing and I am tired. On top of this I have a pleomorphic adenoma, salivary gland tumour that has started to hurt when I even touch the area next to it, again, 0 sympathy or assistance. This is a cry for help.

[ourhaileydavies]

Juniper Publishers-Open Access Journal of Head Neck & Spine Surgery

Pleomorphic Adenoma of the Tongue Base: A Case Report

Authored by Mutsukazu Kitano

Abstract

An 86-year-old woman underwent bronchoscopy after developing aspiration pneumonia. She was found to have a tumor of the tongue base and was referred to our department. Fiberscopy revealed a pendulous mass at the tongue base. On computed tomography, a smooth pendulous mass (2cm × 1.7cm) was seen at the base of the tongue, with no deep invasion. The biopsy report indicated possible mucoepidermoid carcinoma. The risk of surgery was high due to her age and co-morbidities, so the patient and her family did not agree to resection of the tumor. Aspiration pneumonia recurred several times over several months, after which she could not take anything orally and became bedridden for weeks. To improve her quality of life by minimally invasive surgery, the tumor was excised transorally under general anesthesia. The pathological diagnosis was pleomorphic adenoma, and the surgical margins were negative. The patient’s postoperative course was good. Pleomorphic adenoma often arises from the major salivary glands, especially the parotid gland, but pleomorphic adenoma of the tongue base is rare. This case is reported along with a review of the literature.

Keywords:  Pleomorphic adenoma; Tongue base; Surgery

Introduction

Pleomorphic adenoma is a common benign tumor in the field of otolaryngology/head and neck surgery. It often arises from the major salivary glands, especially the parotid gland, but also from the minor salivary glands of the oral cavity. Benign and malignant tumors of the minor salivary glands are usually found on the palate, upper lip, gums, cheek, floor of the mouth, pharynx, larynx, and trachea [1]. In contrast, pleomorphic adenoma of the tongue base is rare and only 13 cases have been reported (Table 1). Here we report a patient with pleomorphic adenoma of the tongue base and review the relevant literature.

Case Report

An 86-year-old woman had noted discomfort on swallowing for several years. She developed slight dysphagia and fever six months previously. Aspiration pneumonia was diagnosed by her local physician and she was treated with antibiotics. Although her symptoms resolved within a few days, bronchoscopy revealed a tumor at the tongue base and she was referred to our department. Transnasal fiberscopy demonstrated a pendulous mass at the tongue base (Figure 1). Computed tomography revealed a smooth-surfaced pendulous mass (2cm × 1.7cm) at the tongue base without deep invasion (Figure 2). Biopsy of the tumor gave a diagnosis of possible mucoepidermoid carcinoma. It was considered that this tumor might have caused her dysphagia and aspiration pneumonia. She had a history of diabetes mellitus, schizophrenia, femoral fracture, and dementia.

Surgery was considered to be high risk due to her age and co-morbidities. Because the patient and her family did not agree to resection of the tumor, she was followed up by her local physician. Aspiration pneumonia recurred several times over several months, after which she could not take anything orally and became bedridden for weeks. To improve her quality of life by minimally invasive surgery, the tumor of her tongue base was excised transorally under general anesthesia. The working space in the oral cavity and pharynx is limited, so we resected the mass by using laparoscopic instruments. The postoperative pathological diagnosis was pleomorphic adenoma and the surgical margins were negative (Figure 3). After surgery, she could eat without discomfort on swallowing or recurrence of aspiration pneumonia. The tumor has not recurred after followup for seven months (Figure 4).

Discussion

Pleomorphic adenoma was first described by Missen in 1874. About 80% of pleomorphic adenomas arise in the parotid gland, followed by 10% in the submandibular gland and 10% in the minor salivary glands [2]. Tumors of the minor salivary glands usually arise on the palate, upper lip, gums, cheek, floor of the mouth, pharynx, and trachea [1]. The most frequent site for pleomorphic adenomas of minor salivary glands is the palate (50%), followed by the upper lip [3]. In contrast, pleomorphic adenoma rarely arises from the tongue base and only 13 cases have been reported previously (Table 1) [2,4-15].

Surgery is the accepted treatment for pleomorphic adenoma and the tumor was subjected to surgical resection in all of the previous reported cases. Because of its anatomical features, approaching the tongue base for surgery raises several problems. In particular, the site is difficult to view by direct vision and the working space is narrow. The surgical approach depends on the size and location of the tumor, so the surgeon should plan treatment carefully. Various surgical approaches have been used, including the transoral, transhyoid, transpharyngeal, transmandibular, and combined transoral-transcervical approaches. We performed transoral excision to minimize surgical invasion, because the patient was elderly and had a history of schizophrenia and dementia, suggesting that brief hospitalization was required. The tumor was pedunculated and not deeply infiltrative, so we decided that transoral resection was reasonable. Because the working space in the oral cavity and pharynx is very narrow, laparoscopic instruments were used. However, the devices were actually too long for the transoral approach, so a new approach such as robot support is needed for resection of tongue base tumors [16].

For more articles in Open access Journal of Head Neck & Spine Surgery |  please click on: https://juniperpublishers.com/jhnss/index.php

For more about Juniper Publishers | please click on: https://juniperpublishers.com/pdf/Peer-Review-System.pdf

[tiffanycrystalauthor]

2018...Meh.

2018...Meh. #writerslife #yearendreview

So. It occurs to me, that I did not do an “end of year” review type post. Honestly though, I don’t really have anything to write about for this year. It was 2017 when all the “important” crap happened. The tumor behind my eye was discovered and removed. Sis’ skin cancer was discovered and removed. The first full year without my brother-in-law. Everything and anything happened that year.

Sis ♥

[robbialy]

From • @pathologeek Warthin's Tumor Warthin's tumor (WT), AKA papillary cystadenoma lymphomatosum, cystadenolymphoma or just simply adenolymphoma. It is a relatively frequent and benign neoplasm of the major salivary glands. The WT was first described by Dr. Hildebrand who reported it in 1895. But in 1929, the pathologist Dr. Aldred Scott Warthin (1866 − 1931) described extensively two cases, and it now bears his name. Dr. Warthin is regarded as "the father of cancer genetics". PEARLS: - Second most common benign salivary gland tumor after pleomorphic adenoma. - Usually in male smokers age 40+ years. - Subtype(s): Infarcted/metaplastic Warthin Tumor. - Localization: almost exclusively restricted to parotid glands. - Clinical features: painless, slow-growing, and fluctuant swellings. Pain or facial nerve palsy may occur in metaplastic / infarcted variants. - Pathogenesis: probably arises from salivary ductal inclusions in parotid lymph nodes. - Histopathology: A circumscribed mass with spaces lined by double layer of oncocytic epithelium with a papillary and cystic architectural pattern and lymphoid stroma including germinal centers. - Differential Diagnosis: The main differential diagnosis of the metaplastic WT subtype is Warthin-like mucoepidermoid carcinoma; however, Warthin tumors lack MAML2 gene rearrangement. - Cytology smears triad: Cohesive sheets of oncocytes, numerous lymphocytes and granular background debris. - The malignant transformation of Warthin's tumor is extremely rare and occurs in about 0.3%-1%, to lymphoma and less common epithelial neoplasms. https://www.instagram.com/p/ChUmzdyDx0dMExVRjUj6Di3EzUaEQMtrpQhatE0/?igshid=NGJjMDIxMWI=

[alphasurgical]

Navigating Parotid Tumor Surgery: What to Expect

Parotid tumor surgery is a crucial procedure for managing tumors that develop in the parotid glands, the largest of the salivary glands located near the ears. These tumors can be benign, such as pleomorphic adenomas, or malignant, making surgical intervention an important step in treatment.

Preparing for Surgery

Before the surgery, your medical team will conduct a thorough evaluation, including imaging tests like CT scans or MRIs, and possibly a biopsy, to determine the tumor’s nature and extent. Pre-surgical preparation may involve discussions about anesthesia, potential risks, and post-operative care.

The Procedure

During parotid tumor surgery, the surgeon makes an incision near the ear to access the parotid gland. The goal is to remove the tumor while preserving as much healthy tissue as possible. For benign tumors, complete removal usually results in a favorable outcome with minimal complications. In cases of malignant tumors, additional treatments such as radiation therapy may be necessary.

Recovery and Aftercare

Post-surgery, patients may experience swelling, bruising, and discomfort in the affected area. A drain might be placed to prevent fluid accumulation. Recovery typically involves a few weeks of rest, during which it’s important to follow your surgeon’s advice on wound care and activity restrictions. Pain management and regular follow-up appointments are crucial to monitor healing and detect any signs of recurrence.

Long-Term Outlook

The prognosis for parotid tumor surgery largely depends on the tumor type and how well it was removed. Benign tumors generally have a high success rate with minimal recurrence. Malignant tumors require more vigilant follow-up and possibly additional therapies to ensure effective management.

By understanding the process and adhering to your care team’s recommendations, you can navigate parotid tumor surgery with greater confidence and achieve the best possible outcome.

[ourhaileydavies]

Juniper Publishers-Open Access Journal of Head Neck & Spine Surgery

Parapharyngeal Space Tumors - "A Surgical Challenge"

Authored by Gauri Kokane

Abstract

Parapharyngeal space tumors are rare entity. Overall incidence is less than 0.5%. These tumors are divided into prestyloid and post styloid tumors. Salivary gland neoplasma are common in prestyloid compartment whereas Neurogenic tumors in post styloid compartment. As these tumors are painless and does not express signs and symptoms at early stage, diagnosis of such tumors needs critical evaluation. Anatomic complexity of PPS makes surgical excision more challenging. We have reported 4 cases of parapharyngeal space tumors over a period of 10 years.

Keywords: Parapharyngeal; Schwannoma; Paraganglioma; Neurogenic; Transcervical

Background

Parapharyngeal space is an inverted pyramid from base of the skull to hyoid bone. It is bounded medially by pharynx, anteriorly pterygomandibular raphe, posterolaterally carotid sheath, posteromedially retropharyngeal space, laterally above the level of mandible it is bounded by ramus of mandible, deep lobe of parotid and medial pterygoid muscle, below the level of mandible; it is bounded by posterior belly of diagastric muscle. It is divided into prestyloid and poststyloid compartment by aponeurosis of zuckercandle and testus [1]. 80% of the PPS tumours are benign while 20% are malignant [2]. Incidence of parapharyngeal space tumors is less than 0.5% [3]. Majority of the tumours are slow growing, painless and progressive in nature. If untreated might result in severe life threatening complications like airway obstruction and cranial nerve deficit resulting in significant morbidity. Systematic diagnostic evaluation plays an important role in diagnosis. Surgical excision has Pivotal significance in PPS tumors. We have identified and reported four cases of parapharyngeal space tumors at our centre over a period of 10 years.

Case Description

Case 1

29 year old male presented with complain of painless lateral neck swelling since 3 months. There was no history of dysphagia, Hoarseness of voice. There was no cranial nerve involvement. FNAC showed spindle cell tumor. On MRI there was 50x 37mm well circumscribed lesion over left side of neck suggestive of schwannoma. Surgical Excision of the tumor was done using transcervical approach (Figure 1). There was no intra-operative complication. ICA, ECA, Vagus nerve and IJV were identified and preserved. Tumor was excised completely (Figure 2). Post operatively there was reduction in high pitch sounds. Origin of tumor from vagus nerve was confirmed intra-operatively. Microscopic picture revealed presence of mixed Antoni A and Antoni B cells concluding to the microscopic features of schwannoma.

Case 2

34 year old female presented with painless swelling over right side of neck. CT neck showed 64x46x35mm lesion in the carotid space compressing right IJV and displacing it anterolaterally (Figure 3). Superiorly it was extended up to carotid canal. Differential diagnosis includes paraganglioma in view of intense enhancement of lesion and vagal schwannoma in view of displacement pattern of vessel. FNAC was suggestive of spindle cell tumor. Intraoperatively there was rupture of internal carotid artery which was repaired with 6-0 ethilon, vagus nerve was also sacrificed due to the severe adherence of the tumor to the nerve.

Case 3

24 year old female complains of painless progressive swelling with dysphagia to solids and liquids since 4yrs. CT scan showed heterogeneously enhancing lesion 85x31mm with retrosternal extension displacing major vessels laterally. Intraoperatively transcervical incision was taken and tumor was dissected to free it from the major vessels and nerves and it was removed in to (Figure 4).

Case 4

40 year female patient presented with swelling of left submandibular region since 1 month (Figure 5). FNAC showed spindle cell tumor, USG showed 41x39mm Heterogenous mass and left submandibular gland. CT Scan Showed 4.5cm enhancing well circumscribed lesion, left submandibular gland and another 1.3x1cm lesion adjacent to it. No dysphagia or hoarseness of voice, intra-operatively Hypoglossal nerve was sacrificed. Lingual nerve was identified and preserved. Histopathology report showed neurogenic tumour i.e. schwannoma.

Discussion

Para-pharyngeal space (PPS) tumors are very rare. We have identified 4 patients after reviewing 10 years retrospective data of all head and neck tumors presented at Manavata curie cancer centre Nashik. Incidence of parapharyngeal space tumors at our institute was 0.004%. Overall incidence of these tumors is less than 0.5%. These tumors are slow growing, painless and patients express at later stage when the size become considerably large. Usually patients are asymptomatic but may exhibit dysphagia or hoarseness of voice. In our 4 patients only one patient had dysphagia to solids and liquids rest of the patients were asymptomatic [4,5]. 80% of the tumors arising in this region are benign [2]. Pleomorphic adenoma is the most common tumor of prestyloid compartment where poststyloid tumors are mostly neurogenic like shwannoma, paraganglioma, neurofibroma, hemangiomas etc. Chordomas, lypomas, lymphomas, chemodectomas, rhabdomyomas, chondrosarcomas, desmoid tumours, ameloblastomas, amyloid tumours, ectomesenchymomas, fibrosarcomas and plasmocytomas have also been reported [2].

Diagnosis of these tumors is difficult as they are asymptomatic. Diagnostic evaluation constitutes CT scan and MRI to clearly define the extent of the tumor mass. Arteriography also plays a significant role to assess vascular compression. In our identified cases CT scan was performed in 3 cases and MRI in one case. MRI has been shown to gives better dimensions of the parapharyngeal space tumors. Advantage of MRI is, it distinguishes tumor from Muscular structures and give better dimentions of the tumor [6].

Arteriography was not performed in any of our cases. Once the nonvascular nature of tumor is confirmed by radio-imaging, FNAC can be performed for definitive diagnosis. FNAC is accurate in 90-95% of the cases and helps in surgical planning [7]. Limited role is explained in post styloid compartment. We performed FNAC in all our patients and it was conclusive [8,9].

Schwannoma may arise at any age but in our institute patient's age ranged from 3rd to 4th decades of life. There is no gender predilection. Schwannoma may be of two types histologically consisting of either Antoni A cells or Antoni B cells. We had two patients with Antoni A cells and other one was of mixed variety [10]. Paragangliomas are tumors of autonomic nervous system. Head and neck paragangliomas are unique in its variety as they don't release catecholamines. Incidence of paraganglioma is 1 in 30,000 cases [11]. Histopathological picture shows two types of cells; Chief cells and sustantecular cells. One of our patient's histological features were identical to it.

Surgical management of parapharyngeal space tumors is very challenging owing to anatomic complexity ofthe space and vicinity of the tumor with major neurovascular structures. There are 7 different approaches described for PFS tumors. Transcervical, Transcervical- transparotid, Transoral-transcervical approach, Extended approach, Transcervical-mandibulotomy aaproach, Transcervical-transmastoid approach have been explained [12]. 4cm is the limit for radical tumour excision with the transcervical approach without mandibulotomy. For a safe and radical resection of tumours > 4cm the “swing” approach or the transmandibular with a double osteotomy is required [2]. We used transcervical approach without mandibulotomy in all cases. Accesiblity was compromised in larger tumors but we could enucleate entire tumor without much difficulty. ICA was ruptured in one case but it was managed. Minimal accessibility may be a compromise but there is less surgical morbidity and post op recovery is faster in our experience.

Complications after surgical management are unavoidable. Expected complications are due to sacrifice of cranial nerves. There may be unexpected neurological complications in spite of preservation of nerves like first bite syndrome, Trismus, facial nerve weakness, orocutaneous fistula, Seroma. We experienced loss of high pitched sounds in two of our patients and there was hypoglossal nerve palsy as hypoglossal nerve was sacrificed in one case.

Conclusion

CT scan or MRI should always be performed in order to distinguish prestyloid from poststyloid lesions and assessment of the extension of the tumour and its relationship with adjacent structures. Trans-cervical approach is safe and should be the first choice for large tumors; other approaches are reserved for selected cases.

Clinical Significance

These are painless slow growing non malignant tumors with very less incidence of recurrance. Management of PPS tumors is challenging for surgeons. Neurological and Surgical complications should always be explained to patients preoperatively. Preoperative assessment and careful surgical manipulation are of utmost importance.

For more articles in Open access Journal of Head Neck & Spine Surgery | Juniper Publishers please click on: https://juniperpublishers.com/jhnss/index.php

[biomedgrid]

Biomed Grid | Classification of Salivary Gland Diseases among Yemenis: (A Prospective Hospital-Based study)

Abstract

Objective: This study aims to classification of salivary gland diseases among Yemenis to established data base, determine the common disease, common site and the relation of these disease to the age and gender.

Material and Methods: The present study designed as a prospective descriptive hospital –based study carried out at Al-gomhori –Teaching Hospital in Sana’a. All patients attending to the department of oral and maxillofacial surgery and to the consultant unit of the head and neck surgery complain of salivary gland disease were examination. Data were collected from patient history (using a questionnaire form), clinical examination of patients, radiographs examination and from the histopathology results of the biopsies. Biopsy result used to confirm the diagnosis.

Results: A total of 140 cases of salivary gland diseases were studied,64 cases (45.7%) were males, and 76 cases (54.3%) were females, male to female ratio was 0.8-1. The age of patients was ranged from 3 to 82 years, with mean age for both gender of 40. 09±21.149. The majority of patients (79%) were over the age of 20 years. The most common disease of salivary glands tumor was salivary gland tumor, accounting 43.6%, followed by cystic lesions 20.7% and sialolithiases (20.0%). The less common salivary gland diseases were sialadenitis and sialadenosis, accounting,12.9% and 2.9% respectively. Sqaumous cell carcinoma was the most common types of salivary gland malignancy, accounting 50. 0%. Pleomorphic adenoma was the most common types of benign tumors accounting,78.3%. Major salivary glands were the most involving site by both tumors. Rhanula was the most common type of salivary gland cyst accounting, 75.9%, usually found on the sublingual glands. Sialolithiases, usually found on the major salivary glands, 89.3% of this disease were located on the submandibular gland. Sialadenitis, frequently caused by bacterial and viral infections, 77% of them were bacterial sialadenitis and 22.2% were viral sialadenitis. Bacterial sialadenitis, commonly located on the submandibular gland, whereas, viral sialadenitis restricted to the parotid glands.

Conclusion: One hundred and forty cases of salivary gland disease among Yemenis were studied,64 cases (45.7%) were males, and 76 cases (54.3%) were females, male to female ratio was 0.8-1. The age of patients was ranged from 3 to 82 years, with mean age for both gender of 40. 09±21.149. The majority of patients (79%) were over the age of 20 years. Salivary glands tumor was the most common salivary gland disease, accounting 43.6%, followed by the salivary gland cyst and sialolithiases accounting, 20.7% and 20.0% respectively. Sqaumous cell was the most common type of salivary gland malignancies accounting 50. 0%. Pleomorphic adenoma was the most common type of benign tumors accounting 78. 3%. Both salivary gland tumors commonly located on the major salivary glands. Rhanula was the most common type of salivary gland cyst, accounting 75.9%,usually located on the sublingual gland. Sialolithiases, accounting 20.0% of all salivary gland disease, 89.3% of this disease were located on the submandibular gland. The less common types of salivary gland disease were sialadenitis and Sialosis, accounting 12.09% and 2.9% respectively.

Keywords: Salivary gland disease; Sialadenitis; Sialolithiases; Salivary gland tumors; Salivary gland cyst

Introduction

Salivary glands divided into major and minor salivary glands. Major salivary glands include three paired of the glands ; parotid, submandibular and sublingual glands. Of minor salivary glands, there are a hundred of these glands’ distribution throughout the mucosal membrane of the upper digestive tract. Saliva is the product of the major and minor salivary glands. It is a highly complex mixture of the water, organic and non-organic components. They also produce enzyme lubrication, mixing agents and immune factors that play an important role of lubrication of the mouth, mastication and swallowing of the food and protection of the oral cavity and teeth [1-4]. Salivary gland disease was related to many causes. The most common causes were; sialadenitis (bacterial and viral infections), sialolithiases (stone formation within the glands or on the duct), sialadenosis (systemic disease), cystic lesions and salivary gland neoplasms. Clinically, salivary gland disease presented as painless or painful swelling on the affected gland. Parotid gland disease presented as swelling below and front of the ear. Submandibular disease presents as swelling on the upper part of the neck. Whereas, sublingual gland and minor salivary gland diseases were presented as submucosal swelling on the oral cavity [5].

Sialadenitis or salivary glands infections, frequently caused by bacterial or viral infections. Bacterial sialadenitis most commonly caused by staphylococcus micro-organisms that usually found normally within the oral cavity [2]. It’s most commonly related to the chronic reduction of the salivary flow that lead to diminished mechanical flushing, which allow bacteria to colonize the oral cavity and then invaded the salivary glands (retro-grad infection) [6-8]. Bacterial sialadenitis divided into acute and chronic sialadenitis. Acute sialadenitis presented as a redness and tenderness swelling of the affected gland, whereas, chronic sialadenitis presented as painless swelling and in sometimes associated with pus discharged [5]. Mumps was the most common type of viral sialadenitis, commonly caused by RNA paramyxovirus, which transmitted by direct contact with salivary droplets. Mumps usually presented as acute painful swelling of the parotid gland, frequently bilateral. Children are most affected with peak incidence occurring at approximately 4 to 6 years of the age [2,9]. Sialolithiases or stone formation within the salivary glands or on the ducts occur frequently on submandibular salivary gland. Exact causes of stone formation are unknown, it’s felt to be ; secondary to the stagnation of saliva, partial obstruction of the salivary gland duct, trauma, dehydration, medication effects (such as diuretic and anticholinergic agents) and smoking [10]. Sialolithiasis presented as painless swelling or may be noted incidentally during physical or radiograph examinations. Occasionally, it’s can cause painful swelling or progress to acute sialadenitis [10,11]. Sialolithiases more commonly affects adults in their 3rd to 6th decades of life, it can find also in children. Submandibular gland and it’s duct were the most affected site, accounting 80%, followed by the parotid gland 20%. Sublingual gland and minor salivary glands are rarely affected [12-14].

Sialadenosis or Sialosis defined as a bilateral, persistent, nonneoplastic, non-inflammatory painless swelling of the salivary glands, more commonly on the parotid glands [2,15]. Sialadenosis occurs most commonly in relation to alcoholism but can develop in relation to many systemic disorders such as ; diabetes mellitus, malnutrition and even idiopathic disease [16-18]. Rhanula and mucocele are the most common type of salivary gland cysts. Both types classified as extravasation and retention cyst. Rhanula, defined as a cystic lesion of the salivary glands, most commonly on the sublingual gland, occur due to extravasation or retention of mucous from sublingual gland or duct due to trauma or obstruction. It’s classified into superficial and deep rhanula. Superficial rhanula, appear as a bluish lesion on the anterior part of the floor of the mouth. Whereas, deep rhanula occurs when the sublingual salivary gland lobe and its duct penetrates through the floor of the mouth muscles and present as extraoral mass (plunging rhanula) on the submandibular or submental regions [2,19,20]. Mucocele is a clinical term that describes minor salivary gland cyst, that appear as a bluish swelling, more commonly on the lower lip, buccal mucosa and ventral surface of the tongue. It’s caused by the accumulation of the saliva at the site of a traumatized or obstruction minor salivary gland duct [19]. Salivary gland tumors are specific neoplasms in the oral and maxillofacial region and accounts for about 3 - 6 % of all head and neck tumors. It’s more frequent in adult than in children, the maximum age of incidence is the 4th decade of life for benign tumors and 5th decade for malignant tumors [21-24].

Pleomorphic adenoma was the most frequently type of benign tumor, accounts for about 64. 0 %, followed by Wharton’s tumor and haemangioma, accounting 4. 8% and 2. 4% respectively. Of malignant tumors, adenoid cystic carcinoma was the most common type of salivary gland malignancies, followed by mucoepidermoid carcinoma and carcinoma in expleomorphic adenoma [25]. Other study showed that, Squamous cell carcinoma, was the most common type of salivary gland malignancies, followed by mucoepidermoid carcinoma and adenoid cystic carcinoma [26]. Both types of salivary gland tumors, present as a painless mass in the affected gland. Findings that are concerning for malignancy include ; pain, facial paresis, fixation of the mass to the skin or underling tissues and palpable neck- lympho-adenopathy [27-30]. Most salivary gland tumors (80%) occurring in the parotid gland, the remaining 20% occur in the submandibular gland, sublingual gland and minor salivary glands. The present study aimed to studied of salivary gland diseases among Yemenis to determine the common disease, common site, the relation of these diseases to the age and gender of the patients and to comparison the provides data with previously published studies from different geographical sites.

Material and Methods

This study design as a prospective, descriptive hospital based –study, carried out at AL-gomhori Teaching Hospital in Sana’s Republic of Yemen. The material consisted 140 of Yemeni patients who attending to the Department of Oral and Maxillofacial Surgery and to the Consultant Unit of the Head and Neck Surgery and who were diagnosed clinically and radiographically as having salivary gland diseases. Histopathological examination used to confirm the diagnosis. Data were collected from, patient history (using a questionnaire sheet), clinical examination of the patients, radiograph examinations (plain radiographs, sialographs, ultrasonograph, and CT-Scan) and histopathological examination (Fin Needle Aspiration biopsy and excisional biopsy). Histopathological results were used to confirm the diagnosis. Data were analysis using SPSS programversion 24. Results were presented as simple frequencies and descriptive statistics. Pearson’s Chi-Square Test was used to assess the association and level of significance among categorical variables, P-value less than 0. 05 is considered as statically significant.

Ethical clearance

The respondent was adequately informed about all relevant aspects of the study including; the aim of the study, the need of investigations, and regular follow up. Privacy of patient is the most of our priority.

A total of 140 cases of salivary gland diseases were studied,64 cases (45.7%) were males, and 76 cases (54.3%) were females, male to female ratio was 0.8-1. The age of patients was ranged from 3 to 82 years, with mean age for both gender of 40. 09+21.149. The majority of patients (79%) were over the age of 20 years. The peak age of occurrence (35.7%) was between the fourth and sixth decades of life (Table 1). The most common disease of salivary glands was salivary gland tumor, accounting (43.6%), followed by, salivary gland cyst and sialolithiases, accounting 20.7% and 20.0 % respectively. The less common disease were sialadenitis and sialadenosis, accounting 12.9% and 2.9% respectively (Table 2). Of salivary gland tumors,61 cases were reported, 26 cases (42.6%) were males and 35 cases (57.4%) were females, male to female ratio was 0.7-1. Thirty-eight cases (62.3%) of salivary gland tumors were malignant tumors and 32 cases (37.7%) were benign tumors (Table 3) Of malignant tumors, 38 cases were reported, 18 cases (47.4%) were males and 20 cases (52.6%) were females. Male to female ratio was 0.9-1. The majority of patients (89.4%) were over the age of 40 years. The peak occurrence (60.5%) was in between 4th and 6th decades of life (Table 4). Squamous cell carcinoma was the most common type, accounting (50.0%), followed by adenoid cystic carcinoma and muco epidermoid carcinoma, accounting (15.8% and 10.5% respectively). The less common types were, cainexpleomorphic adenoma, acinic cell carcinoma and lymphoma accounting 7.9% for each one (Table 5). More than 92 percent of salivary gland malignancies found on the major salivary glands, 45.7% of these were found on the parotid glands, 31.4% on the submandibular gland and 22. 9% on the sublingual glands (Table 6).

Of benign tumors, 23 cases were reported, 8 cases were males and 15 cases were females, male to female ratio was 0.5:1. The majority of patients (70%) were found between the 3rd and 6 th decades of life. Pleomorphic adenoma was the communist type, accounting (78.3%), followed by Wharton’s tumor and hemangioma accounting (13.0% and 8.7% respectively) (Table 8). Thirteen cases of benign tumors (59.1%) were found on the major salivary glands and 9 cases (40.9%) on the minor salivary glands (Table 9). Ninety two percent of benign tumors of the major salivary gland’s tumors were located on the parotid glands, 53.8 % of these tumors were pleomorphic adenoma, 23. 1% were Wharton’s tumors and 15. 4 % were haemingioma (Table 10). Of cystic lesion,29 cases were reported, 11 cases (37.9%) were males and 18 cases (62.1%) were females, male to female ratio was 0.6:1. The majority of patients (96.5%) were found between the 1st to 4th decades of life, the peak age of occurrence (58.6%) was in the 1st and 2nd decades of life (Table 11). Rhanula and mucocele were reported, accounting 75.9% and 24.1% respectively. Major salivary glands (sublingual glands) were the most affected site (75.9%) (Table 12). Of sialolithiases (or stone formation) 28 cases were seesn, 14 cases were males and 14 cases were females, male to female ratio was I:1. More than (90%) of patients were found over the age of 20 years. Patients on the middle age were commonly affected(78.6%) (Table 13). Submandibular gland was the most common affected site, accounting (89.3%), followed by parotid glands (10. %) (Table 14).

Of sialadenitis (or salivary gland infections),18 cases were reported, 13 cases (72.2%) were males and 5 cases (27.8%) were females, male to female ratio was 2.6:1 (Table 1). Patient age was ranged from 3 to 82 years with mean age of 42. 5±SD. Fourteen cases of sialadenitis (77.8) were bacterial sialadenitis and 4 cases (22.2%) were viral sialadenitis (Table 15). The majority of bacterial sialadenitis (64.3%) were found on the Submandibular gland and the residual percentage 35.7% on the parotid gland. Whereas, viral sialadenitis restricted to the parotid gland (Table 16). Sialadenosis (non-neoplastic, non-inflammatory disease of the salivary glands which commonly related to some systemic disease or disorder) was the less common type, 4 cases were reported accounting 2. 9% of all salivary gland disease. All cases were found in female patients.

Dissection

In the present study, salivary gland tumors were the most common type of salivary gland diseases, 61 cases were reported, 38 cases (62.3%) of them were malignant tumors and 23 cases (37.7%) were benign tumors. Of malignant tumors, males were affected less than females, male to female ratio was 0.9:1. Patients age ranged from 26 to-80 years, the average of the age was 53 years. The majority of patients (89.4%) were over the age of 40 years. These findings are in agreement nearly to many literatures studies that showed a higher frequency of salivary gland malignancy among females, with male to female ratio was 1:1. 8. These studies also showed that, salivary gland malignancy most commonly found over the age of 40 years and the mean age of patients were distributed between, 40 years, 41.38 years, 46 years and 48 years respectively [31,35]. Our study also showed that, Squamous cell carcinoma was the most common type, accounting 54.3%,followed by muco-epidermoid carcinoma 11. 4% and carcinoma- inexpleomorphic adenoma 8.6%. Same findings were reported by Ali AL-Zamzami and Ahmed Suleiman [26] who founds that, sqaumous cell carcinoma was the most common histological type of salivary gland malignancies, followed by mucoepidermoid carcinoma and carcinoma in ex-Pleomorphic adenoma. On the other hand, the prevalence of salivary gland malignancies was various. Many literature studies have reported, adenoid cystic carcinoma [35], carcinoma inexpleomorphic adenoma [36], sqaumous cell carcinoma [37] as the most common type of salivary gland malignancies.

Our findings also showed, the majority of salivary gland malignancies (92%) were located on the major salivary glands, 45. 7% of these tumors were located on the parotid gland, 31.4% on the submandibular gland and 22. 9% on the sublingual gland. Similar observations were reported by Ahmed Suleiman et al. [31] who founds that, major salivary glands (parotid gland and submandibular gland) were the most affected sites with salivary gland malignancies. The above findings were confirmed by Mohammed Isa Kara [25] who found that, parotid gland and submandibular gland were the main affected sites, accounting 61.6% and 16% respectively. Of benign tumors, our study showed, males were affected less than females, male to female ratio was 0.5:1. Patients age was ranged from 3- 82 years with average of 42.5 years. The majority of patients (70%) were over the age of 20 years. Pleomorphic adenoma was the most common type, accounting 77.3% followed by Wharton’s tumors and hemangioma accounted 13. 6% and 9. 1% respectively. Major salivary gland was the most affected site and 90 % of these tumors were located on the parotid gland. Our findings are nearly agreement to literature studies that showed that, males were affected less than females, male to female ratio was 1 : 1. 6. Patient age was ranged from 1 – 88 years with median age of 45 years [30,38]. Other studies showed that, Pleomorphic adenoma was the most common type of benign salivary gland tumors, accounting 64 %, followed by Wharton,’ tumor and hemangioma, accounting 4. 8% and 2. 4% respectively. These studies also showed that, partied gland was the main affected site [21,23,24,32-35].

In our study,rhanula and mucocele were reported. Rhanula was the most common type, accounting 75.9%, the second type was mucocele, accounting 24.1%. Male were affected less than females, male to female ratio was 0.6 –1. Patients age was ranged from 1 to 35 years, the mean age was 18 years±sd. The majority of patients (93%) were found below the age of 35 years. . Major salivary glands (sublingual glands) were the most affected site (75.9%). These findings are similar to many previous studies that showed, salivary gland cyst usually occurred in children and adults with the peak frequency in the second decade of life, the mean age was 18. 5 years. Males were affected less than females, male to female ratio was 1:1.4. These studies also showed that, rhanula was the most common type of salivary gland cyst and frequently found on the major salivary glands, particularly sublingual salivary gland p [37,39-41]. Of sialolithiases or salivary gland stone. This study showed, males and females were equal affected, male to female ratio was 1 : 1. Patients age was running between 19 and 82 years, the mean age was 47. 25 years±SD. The majority of patients (90%) were found over the age of 20 years. All cases of sialolithiases were found on the major salivary glands, 89.3% of these cases were found on the submandibular gland and 10. 7% were found on the parotid gland. Similar findings were reported by Lustman J et al. [13] who founds that, sialolithiases or salivary gland stone can occur in any age, more commonly on the adults. Both sexes were equal affected. Most cases 83% were located on the submandibular gland and 10% on the parotid gland. Other study is coinciding with the above findings. It’s showed that, sialolithiases or salivary gland stone can be found in children, but more commonly on the adults in their third to sixth decades of life. Over 80% of salivary stones occur in the submandibular gland and less than 20 % occurs in the parotid gland [14].

In the current study, sialadenitis (salivary gland infection) occur in males more than females, male to female ratio was 2.6:1. Patient age was ranged from 3 to 82 years; the mean age was 42.5±SD. More than 77% of sialadenitis were bacterial sialadenitis and 22.2% were viral sialadenitis. Bacterial sialadenitis founded on the submandibular gland and parotid gland which represented 64.3% and 35.7% respectively. Whereas, viral Literature studies showed that, sialadenitis occur in males more than females. patient age was ranged from 14-58 years, the majority of patients were found between 4th and 6th decades of life. These observations also showed that, sialadenitis usually caused by bacterial and viral infection, more commonly occur on the major salivary gland(58. 2% on the submandibular gland and 41.8% on the parotid gland [42-44].

Conclusion

Salivary gland disease among Yemenis was studied,140 cases were reported,64 cases (45.7%) were males, and 76 cases (54.3%) were females, male to female ratio was 0.8-1. The age of patients was ranged from 3 to 82 years, with mean age for both gender of 40.09±21.149. The majority of patients (79%) were over the age of 20 years. Salivary gland tumor was the most common disease of salivary glands, accounting (43.6%), followed by salivary gland cyst, sialolithiases, sialadenitis and sialadenosis, accounting (20.7%), (20.0%),(12.9%) and (2.9%) respectively. Sqaumous cell carcinoma was the most common type of salivary gland malignancy, accounting 50.0%. Pleomorphic adenoma was the most common type of benign tumors, accounting 78.3%. Both salivary gland tumors commonly located on the major salivary glands. Rhanula was the most common type of salivary gland cyst, accounting 75.9%. Sublingual gland was the most affected site (75.9%). Sialolithiases (or salivary gland stone) usually located on the major salivary gland and 89.3% of them were found on the submandibular gland. Sialadenitis (or salivary gland infection), frequently caused by bacterial and viral infections, 77% of sialadenitis were bacterial sialadenitis and 22.2% were viral sialadenitis. Bacterial sialadenitis, commonly located on the submandibular gland and less commonly on the parotid gland. Whereas, viral sialadenitis restricted to the parotid glands. Sialadenosis (non-neoplastic, non-inflammatory disease of the salivary glands) was the less common type of salivary gland disease, accounting 2.9% and found only in female patient

Read More About this Article: https://biomedgrid.com/fulltext/volume4/classification-of-salivary-gland-diseases-among-yemenis-a-prospective-hospital-based-study.000800.php

For more about: Journals on Biomedical Science :Biomed Grid | Current Issue