OBJECTIVETo investigate the feasibility and safety of intraoral submandibular gland excision.

METHODSAnalyze the relationship between the external maxillary artery and submandibular gland, and offer a reliable anatomical base for 10 cases of intraoral submandibular gland excision, including 8 cases of chronic sialadenitis, 1 case of pleomorphic adenoma and 1 case of cyst of submandibular gland.

RESULTSThe external maxillary artery went across the surface of gland submandibular, and its branches provided nutrition for the gland in most cases. The results of 10 cases intraoral submandibular gland excision were effective and satisfied, without major complications. The average time of operation was 50 minutes and the average hemorrhage of operation was 60 ml.

CONCLUSIONIntraoral submandibular gland excision is safe and feasible for chronic sialadenitis and cyst of submandibular gland and some of benign tumor submandibular gland as long as indications strictly controlled and the external maxillary artery well coped with.

Adolescent ; Adult ; Female ; Humans ; Maxillary Artery ; surgery ; Middle Aged ; Sialadenitis ; surgery ; Submandibular Gland ; anatomy & histology ; surgery ; Submandibular Gland Diseases ; surgery ; Submandibular Gland Neoplasms ; surgery ; Treatment Outcome ; Young Adult

Endoscopy ; Humans ; Neoplasms/surgery* ; Submandibular Gland/surgery* ; Thyroidectomy

The submandibular gland is the second largest major salivary gland, which secretes 40% of the total daily saliva. Owing to its anatomic characteristics as well as the high viscosity and basicity of the saliva, sialolithiasis is found most commonly in the submandibular gland. Sialolithiasis that cannot be treated by conservative treatment is conventionally removed by an excision of the submandibular gland. Generally, an excision of the submandibular gland is performed via an extra-oral approach but the disadvantages of this treatment include a risk of injuring the facial nerve and scar formation. Case reports have revealed an even less invasive intraoral surgical technique for the removal of sialolith that does not affect the submandibular gland function. The functional recovery of the gland, complications and recurrence rates after surgery with this conservative intraoral procedure were all successful. We report 5 patients from the department of Oral and Maxillofacial Surgery at Dental Hospital, Yonsei University, who had undergone a resection of the sialolith though the intraoral approach with successful results.
Cicatrix ; Facial Nerve ; Humans ; Recurrence ; Saliva ; Salivary Gland Calculi ; Salivary Glands ; Submandibular Gland ; Surgery, Oral ; Viscosity

Salivary glands, major and minor, are susceptible to a wide variety of pathologic conditions. Excision of the submandibular gland is a surgical procedure often undertaken. The procedure is the treatment of choice for patients with neoplasm of the submandibular gland and those with non-neoplastic submandibular disorders which are not controlled with conservative medical measures. Extirpation of the submandibular gland may also be undertaken for diagnostic purposes. We evaluated 84 patients who had been admitted to the Dept. of oral and maxillofacial surgery of Pusan National University Hospital from January, 1989 to December, 2002 and had been performed submandibular gland excision. The results are as follows : 1. The patients undertaken the excision of the submandibular gland showed an age range of 16 to 71 years. The average was 49.1. 2. They consisted of 60 males(71.4%) and 24 females(28.6%), having 2.5 : 1 of genda ratio. 3. The most common symptom was swelling in 41 cases(48.8%), followed by the pain in 23 cases(27.4%). Other symptoms included mass, dysphagia, facial abnormaly and neck dyscinesia. 4. 42 cases(50.0%) showed sialadenitis and sialodochitis associated with salivary calculus. 5. According to the histopathologic study, all cases consisted of 17 neoplasmatic conditions(20.3%) and 67 non-neoplasmatic(79.7%). The neoplasmatic cases included 13 benign tumors and 4 primary malignant tumors. Sialadenitis and sialodochitis associated with or without salivary calculus were most marked, found in 50 cases(59.3%), in the non-neoplasmatic conditions. Pleoomorphic adenoma showed the highest frequency of the benign tumor.
Adenoma ; Busan ; Deglutition Disorders ; Humans ; Neck ; Salivary Calculi ; Salivary Glands ; Sialadenitis ; Submandibular Gland* ; Surgery, Oral

OBJECTIVE: To investigate the feasibility of endoscope assisted resection of submandibular gland through a dermatoglyph incision. METHOD: We choose 5 patients diagnosed as benign diseases of submandibular gland from 2005 to 2010 in Beijing Tongren Hospital. Each patient was given a careful design of dermatoglyph incision preoperatively and an endoscope assisted surgery on the submandibular gland. The details of surgery procedure were described as follow. The inferior edge of the capsule of the submandibular gland was incised, and the traveling characteristics of facial artery, submandibuar gland branch of submental artery, branches of anterior facial vein were identified with endoscopic assistance. Branches of vascular and submandibular postganglionic fibers were treated with bipolar coagulation hemostasis. The submandibular duct was identified and isolated, teased downward from the floor of the mouth, and then ligated. The gland was lifted off the digastric tendon and removed. Suction drainage was used with a plastic tube and the incision was closed with mattress suture. The incision length, intraoperative bleeding, complication and operation duration were retrospectively, reviewed in the traditional group. RESULT: Of the endoscopic group, the incision lengths varied from 2.0-2.5 cm with an average of 2.3 cm. The operation durations varied from 41-87 min, with an average of 64 min. The total intraoperative bleeding was about 5 to 10 ml. No facial paralysis nor infection occurred both intra-and post-operatively. No relapse was detected in the long-term follow-up (4 months to 5 years). Compared with the traditional group, the incision length and bleeding decreased dramatically while the operational duration increased. CONCLUSION Endoscope assisted resection of submandibular gland through dermatoglyph incision will minimize the damage to surrounding tissue and obtain good cosmetic results.
Adolescent ; Adult ; Aged ; Endoscopes ; Endoscopy ; methods ; Feasibility Studies ; Female ; Humans ; Male ; Retrospective Studies ; Submandibular Gland ; surgery

OBJECTIVETo analyze the clinicopathologic features of chronic sclerosing submaxillaritis (CSS).

METHODSThe clinical and pathological characteristics of 9 CSS were analyzed.

RESULTSIn the 9 patients, there were 6 males and 3 females. The age of patients ranged from 51 - 77 years old. All of the tumors were located in the submandibular gland, presenting with painless and firm mass. Histologically, a well-defined mass lesion with extensive lymphocytes and plasma cells infiltration, preservation of lobular architecture, with acinar atrophy. The reactive hyperplasia of lymphoid follicles may be found in CSS. The phlebitis and obliterating phlebitis also formed. Immunohistochemistry showed evidence of diffuse infiltration of plasma cells. The mean number of IgG4-positive plasma cell per high-power field (HPF) was 186, mean value of the IgG4:IgG ratio was 0.71. Three of these 9 cases had manifestations of IgG4-associated systemic disease.

CONCLUSIONSCSS is considered as a part of IgG4-related sclerosing diseases, recognition of which is very essential for a successful treatment. When diagnosis is made, it is necessary to ascertain whether lesion occurs within salivary gland only or in combination with outside IgG4-related sclerosing disease. The establishment of follow-up is also necessary. Some patients show good response to steroid therapy.

Aged ; Female ; Humans ; Immunoglobulin G ; metabolism ; Male ; Middle Aged ; Plasma Cells ; immunology ; Sclerosis ; Sialadenitis ; metabolism ; surgery ; Submandibular Gland ; pathology ; surgery

OBJECTIVEA study was conducted to evaluate the clinical application of sialendoscopy combined with conven tional laparoscopy in a 30 degree angle in depth salivary calculus of submandibular glands.

METHODSA total of seventeen patients were presented with repeated swelling in the unilateral submandibular area from June 2013 to August 2015. All patients underwent CT examinations of the mandible and salivary gland function imaging preoperatively. Sialoendoscopy and conventional endoscopy were applied to do intraoral lithotomy. Among the study group, thirteen cases were males and four cases were females. A total of twelve were left cases and five were right cases. Results Seventeen patients had deep positive calculus in the submandibular glands under CT. Photo technetium function was basically normal, whereas secretion of ipsilateral decreased significantly in salivary function tests. Double endoscope assisted surgeries were performed successfully through the mouth to remove the stones. The operation time was (42+21) min. There were no obvious complications in perioperative periods.

CONCLUSIONIntraoral lithotomy assisted by sialoendoscopy and conventional laparoscopy for deep stones in the submandibular glands is a new technique. This technique will possibly lead to complete avoidance of gland resection because of early deep sialolithiasis.

Endoscopy ; methods ; Face ; Female ; Humans ; Male ; Mandible ; Minimally Invasive Surgical Procedures ; Neck ; Perioperative Period ; Salivary Gland Calculi ; surgery ; Submandibular Gland ; surgery

OBJECTIVE: To evaluate the long-term efficacy of submandibular gland transfer for prevention of xerostomia after radiotherapy for nasopharyngeal carcinoma. METHOD: Sixty-five cases of nasopharyngeal carcinoma patients were randomly divided into study group of 32 patients and control group of 33 patents. The submandibular gland was transferred to submental region on 32 cases with nasopharyngeal carcinoma before receiving conventional radiotherapy and a block was used to cover the submental region. Before radiotherapy, two groups of submandibular gland function was detected by imaging of the submandibular gland. At 60 months after radiotherapy, submandibular gland function was detected by 99mTc radionuclide scanning, the questionnaire about the degree of xerostomia was investigated respectively. Five-year survival rate was counted. RESULT: After following up for 60 months, submandibular gland uptake and secretion function in the study group was significantly higher than that in the control group, there was significant difference between the two groups (P < 0.01) respectively. The incidence of moderate or severe xerostomia in the study group was significantly lower than that in the control group (15.4% vs 76.9%, P < 0.01). Five-year survival rate of the study group and control group was 81.3% and 78.8% respectively, there was no significant difference between the two groups (P > 0.05). CONCLUSION The long-term efficacy of submandibular gland transfer for prevention of xerostomia after radiotherapy for nasopharyngeal carcinoma was well. It could improve the quality of life in nasopharyngeal carcinoma patients after radiotherapy, and did not affect the long-term efficacy of nasopharyngeal carcinoma.
Adult ; Carcinoma ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; radiotherapy ; surgery ; Prospective Studies ; Radiotherapy ; adverse effects ; Submandibular Gland ; surgery ; Xerostomia ; etiology ; prevention & control

OBJECTIVETo observe the effect of capsaicin on the secretion of the transferred gland in "latent period".

METHODSForty-two patients (45 sides of eye), who received the microvascular autologous submandibular gland transfer in our hospital, were treated with two different types of capsaicin stimulations. The secretion function of the transferred glands was evaluated by Schirmer's test. The effect of capsaicin and its time-variation regularity were observed. In the meantime, the results of capsaicin were compared with some other stimulation methods, such as acid, chewing and physiotherapy with infrared rays.

RESULTSThe capsaicin gargle, capsaicin cream and physiotherapy could all promote the secretion of the transferred gland, while the effects of the capsaicin stimulation were more obvious. The other two stimulations (acid and chewing) had no effect on the secretion of the transferred gland.

CONCLUSIONSThe capsaicin stimulation can be taken as one of the effective means to promote the secretion of the transferred glands in "latent period" and to prevent the obstruction of the ducts. Because of its convenience and blandness, the capsaicin cream is the first choice of the clinical application options for the transferred submandibular gland in "latent period".

Adolescent ; Adult ; Capsaicin ; pharmacology ; Child ; Female ; Humans ; Keratoconjunctivitis Sicca ; surgery ; Male ; Middle Aged ; Saliva ; secretion ; Submandibular Gland ; secretion ; transplantation ; Transplantation, Autologous ; Young Adult

OBJECTIVETo summarize operation key points, prevention and management of complications in vascularized autotransplantation of submandibular gland for treatment of severe keratoconjunctivitis sicca.

METHODS23 patients with severe keratoconjunctivitis sicca were treated by this procedure. Postoperative (99m)Tc images, follow-up studies, and management of complications were performed.

RESULTSThe transplantations were successful in 19 cases, whose symptoms of xerophthalmia disappeared. The patients could stop applying artificial tears. In 4 patients the transplanted glands did not survive. Epiphora occurred in 5 cases. They were successfully treated by reducing the size of the graft. Obstruction of the Wharton's duct took place in one case and was treated by reconstructing the duct. When the superficial temporal vein was too small, venous bridging was applied. To select a relevant vein for anastomosis, blood oozing from the three veins was carefully inspected prior cutting off the gland when the external maxillary artery was preserved and was infused with heparin after the gland had been freed.

CONCLUSIONSIf every point has been properly managed, the successful rate of operation could be warranted.

Adolescent ; Adult ; Child ; Female ; Humans ; Keratoconjunctivitis Sicca ; surgery ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Submandibular Gland ; blood supply ; transplantation ; Transplantation, Autologous ; Treatment Outcome