BACKGROUND AND OBJECTIVES: The traditional surgical method for submandibular gland resection includes ligation of facial artery. In this study, we used ultrasound preoperatively and tried to preserve the facial artery if facial artery passed on an extra-glandular course with a glandular branch. SUBJECTS AND METHOD: Patients undergoing submandibular gland resection either because of submandibular gland tumor or submandibular gland stone were prospectively included. Preoperative sonographic assessment was done to evaluate the intra-glandular or extra-glandular course of facial artery. For the cases with extra-glandular course with a glandular branch of facial artery, we tried to preserve facial artery by ligation of the glandular branch. RESULTS: A total of 34 cases were included in this study. Among them, 6 cases (17%) hadfacial artery passing on an extraglandular course with glandular branching. For these 6 cases, we easily could find the facial artery and glandular branch in the operative field and were able to preserve the facial artery. For the remaining 28 cases, however, the facial artery penetrated through the submandibular gland, thus we opted for the ligation of facial artery rather than preserving it to minimize bleeding or trauma during the surgery. There were no statistic difference between two groups with respect to clinical and surgical variables. CONCLUSION: Extra-glandular course of facial artery was easily assessed by preoperative ultrasound. In those cases, we could preserve facial artery easily without bleeding or trauma to the submandibular gland by ligation of glandular branch. As facial artery is animportant vessel for reconstruction and facial rejuvenation, it is preferable to preserve this artery if the course of this artery makes it possible to preserve.
Arteries* ; Hemorrhage ; Humans ; Ligation ; Prospective Studies ; Rejuvenation ; Submandibular Gland* ; Ultrasonography*

OBJECTIVE: To compare the accuracy of ultrasound (US)-guided and non-US-guided botulinum toxin (BTX) injection into the salivary glands (parotid and submandibular glands) of cadavers. METHODS: Two rehabilitation physician injected dye into three sites in the salivary glands (two sites in the parotid gland and one site in the submandibular gland) on one side of each cadaver (one was injected on the right side, while the other was injected on the left side), using either a non-US-guided injection procedure based on superficial landmarks or a US-guided procedure. Orange dye was used for the US-guided procedure, and green dye was used for the blind procedure. Two physicians uninvolved with the injection procedures and who were blinded to the method of injection dissected the cadavers to identify whether the dye was accurately injected into each target site. RESULTS: The accuracies of the blind and US-guided injections into the parotid gland were 79.17% and 95.83%, respectively. In the submandibular gland, the accuracies of the blind and US-guided injections were 50.00% and 91.67%, respectively. The difference in accuracy between the two procedures was statistically significant only in the submandibular gland (p=0.025). There were no significant differences in the accuracy of US-guided and non-US-guided injections between the two physicians for the two sites in the parotid gland (p=0.278 and p=0.146, respectively). CONCLUSION: US-guided BTX injection into the submandibular gland offers significantly greater accuracy over blind injection. For the treatment of drooling by injecting BTX into the submandibular gland, clinicians should consider using US guidance for improved accuracy.
Botulinum Toxins* ; Cadaver* ; Citrus sinensis ; Methods ; Parotid Gland ; Rehabilitation ; Salivary Glands* ; Sialorrhea ; Submandibular Gland ; Ultrasonography

Hemangiomas are relatively common benign lesions in head and neck, and are easily diagnosed when they present as cutaneous lesions. However, when a vascular lesion is located within the deeper tissues without a cutaneous component, it results in a large differential diagnosis and sometimes is misdiagnosed even using modern imaging studies. In certain instances, simple radiographic studies may be helpful in diagnosis. Hemangioma in the submandibular gland is extremely rare and when it has phleboliths within it, it is easily confused with calculis in the salivary gland. Recently we experienced one such case. The 63-years-old man complained of a painful bulging mass without cutaneous lesions in the right submandibular area, which had occurred in 2 or 3 times over a 2 year periods. Plain skull films revealed two radioopaque densities in submandibular area and ultrasonography revealed similar findings. Preoperatively he was thought to have sialoliths of a submandibular gland, but it was confirmed as a hemangioma with phleboliths after the operation.
Calculi ; Diagnosis ; Diagnosis, Differential ; Head ; Hemangioma* ; Neck ; Salivary Gland Calculi* ; Salivary Glands ; Skull ; Submandibular Gland* ; Ultrasonography

PURPOSE: To describe the normal sonographic anatomy of the submandibular duct and to assess the value of sonography in the diagnosis of sialolithiasis of the submandibular gland. MATERIALS AND METHODS: Using continuous injection of saline via a sialography needle, we evaluated the normal sonographic anatomy of the submandibular duct in healthy volunteers (n=5). We also reviewed sonographic findings in 47 patients with (n=29) or without (n=18) stones. In each case, the presence or absence of stone was proved by sialography or surgery. RESULTS: In control subjects, sonography accurately depicted the ductal anatomy of the submandibular glands and its relationship with adjacent tissues. For the detection of stones, sonography had a sensitivity of 86%, a specificity of 100%, and an accuracy of 91%. For ductal dilatation, its sensitivity was 91%, its specificity, 100%, and its accuracy, 94%. In 68% of cases with stones, a circumferential low echoic rim surrounding the stone ("rim sign") was present on sonogram. CONCLUSION: Ultrasound is a useful procedure and could replace sialography in most patients with sialolithiasis of the submandibular gland.
Diagnosis* ; Dilatation ; Healthy Volunteers ; Humans ; Needles ; Salivary Gland Calculi* ; Sensitivity and Specificity ; Sialography ; Submandibular Gland* ; Ultrasonography*

BACKGROUND AND OBJECTIVES: The choice of optimal treatment methods among various gland preserving procedures including transoral surgery, sialendoscopy and extracorporeal lithotripsy for submandibular stones is mainly determined by the size of the stone. We tried to assess the accuracy of ultrasonography (USG) and computerized tomography (CT) for the preoperative estimation of submandibular gland stone size. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 251 patients who were treated for submandibular stones from January 2008 to December 2014. Eighty patients who checked both preoperative USG and CT were included. Preoperative USG and CT measurements of the submandibular stones were compared to postoperative measurements of removed stones. Effects of stone location and presence of acute infection on preoperative measurements were also assessed. RESULTS: The mean submandibular gland stone size was 6.60+/-3.8 mm by USG, 7.23+/-4.0 mm by neck CT and 7.89+/-4.7 mm by the postoperative measurement. USG and CT showed good correlation with the postoperative measurement (correlation coefficient 0.912 and 0.940, respectively). The location of stone and presence of combined infection showed no significant impact on the accuracy of USG and CT measurement. CONCLUSION: USG and neck CT showed high accuracy for predicting submandibular gland stone size. However, it should be taken into consideration that the stone size could be greater than that shown by preoperative measurement.
Humans ; Lithotripsy ; Medical Records ; Neck ; Retrospective Studies ; Salivary Gland Calculi ; Submandibular Gland* ; Ultrasonography

Oncocytic lipoadenoma is a rare salivary gland tumor composed of adipose tissue and oncocytic epithelial cells in varied proportions. We report a case of an oncocytic lipoadenoma of the submandibular gland, which presented as a submandibular gland mass. The patient was a 65-year-old woman with a right submandibular mass measuring 2 × 2 × 1.6 cm. As a sonographic evaluation and computed tomograph scan gave us the impression of benign submandibular gland tumor such as pleomorphic adenoma, we resected the right side submandibular gland. Grossly, the tumor was well circumscribed with yellow to brown cut surface. Microscopically, the tumor was surrounded by a thin, fibrous capsule and composed of oncocytic epithelial cells admixed with mature adipose tissue. Final diagnosis was an oncocytic lipoadenoma. We discussed here radiologic and pathologic finding of this rare salivary gland tumor.
Adenoma, Pleomorphic ; Adipose Tissue ; Aged ; Diagnosis ; Epithelial Cells ; Female ; Humans ; Salivary Glands ; Submandibular Gland ; Ultrasonography

Ectopic cervical thymus is an extremely uncommon etiology of neck mass in infants. We report a case of ectopic thymus in five months old male baby, presenting as a submandibular mass. Ultrasonography and CT scan revealed a 5.2 x 1.6 x 1.5 cm-sized solid mass in the left suprahyoid neck between parotid and submandibular gland, which was regarded as malignant lesion though it was soft, non-tender on examination. For differential diagnosis of malignant lymphoma and soft tissue sarcoma, an incisional biopsy was performed to confirm ectopic cervical thymus. He is under our observation without having gone through surgical excision because the thymus will involute spontaneously and he has no symptoms.
Biopsy ; Choristoma ; Diagnosis, Differential ; Humans ; Infant ; Lymphoma ; Male ; Neck ; Sarcoma ; Submandibular Gland ; Thymus Gland* ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: To evaluate the usefulness of shear wave elastography in the diagnosis of oral and maxillofacial diseases. MATERIALS AND METHODS: Ten patients with oral and maxillofacial diseases and 28 volunteers drawn from our student doctors were examined by shear wave elastography with a 14-MHz linear transducer using an Aplio 300 apparatus (Canon Medical Systems, Otawara, Japan). A statistical analysis of the shear elastic modulus (kPa) of healthy tissue (the sublingual gland, submandibular gland, anterior belly of the digastric muscle, and geniohyoid muscle) in the 28 volunteers was performed using 1-way repeated measures analysis of variance with the Tukey honest significant difference test. The maximum shear elastic modulus (kPa) of 8 patients with squamous cell carcinoma (SCC) and 2 patients with benign lesions was evaluated with the Mann-Whitney U test. The analysis used a 5% significance level. RESULTS: The mean shear elastic modulus of the sublingual gland (9.4±3.7 kPa) was lower than that of the geniohyoid muscle (19.2±9.2 kPa, P=.000) and the anterior belly of the digastric muscle (15.3±6.1 kPa, P=.004). The maximum shear elastic modulus of the SCCs (109.6±14.4 kPa) was higher than that of the benign lesions (46.4±26.8 kPa, P=.044). CONCLUSION: Our results demonstrated the usefulness of shear wave elastography in the diagnosis of oral and maxillofacial diseases. Shear wave elastography has the potential to be an effective technique for the objective and quantitative diagnosis of oral and maxillofacial diseases.
Carcinoma, Squamous Cell ; Diagnosis ; Elastic Modulus ; Elasticity Imaging Techniques ; Humans ; Neck ; Sublingual Gland ; Submandibular Gland ; Transducers ; Ultrasonography ; Volunteers

OBJECTIVE: To investigate the effect of botulinum toxin type A (BTA) injection into the salivary gland and to evaluate the changes of drooling in varied postures in tetraplegic patients with brain injury. METHODS: Eight tetraplegic patients with brain injury were enrolled. BTA was injected into each parotid and submandibular gland of both sides under ultrasonographic guidance. Drooling was measured by a questionnaire-based scoring system for drooling severity and frequency, and the sialorrhea was measured by a modified Schirmer test for the patients before the injection, 3 weeks and 3 months after the injection. Drooling was evaluated in each posture, such as supine, sitting, and tilt table standing, and during involuntary mastication, before and after the injection. RESULTS: The severity and frequency of drooling and the modified Schirmer test improved significantly at 3 weeks and 3 months after the injection (p<0.05). Drooling was more severe and frequent in tilt table standing than in the sitting position and in sitting versus supine position (p<0.05). The severity of drooling was significantly increased in the patients with involuntary mastication (p<0.05). CONCLUSION: Salivary gland injection of BTA in patients with tetraplegia resulting from brain injury who had drooling and sialorrhea could improve the symptoms for 3 months without complications. The severity and frequency of drooling were dependent on posture and involuntary mastication. Proper posture and involuntary mastication of the patients should be taken into account in planning drooling treatment.
Botulinum Toxins* ; Botulinum Toxins, Type A ; Brain Injuries* ; Brain* ; Humans ; Mastication ; Posture ; Quadriplegia ; Salivary Glands ; Sialorrhea* ; Submandibular Gland ; Supine Position ; Ultrasonography

We describe a rare complication of acute unilateral submandibular gland swelling following the use of laryngeal mask airway (LMA) in two patients with otherwise uneventful perioperative airway management. This is likely to be a consequence of the pressure exerted by the airway cuff on the tissues within the submandibular triangle. As this complication is rarely reported, its true incidence may in fact be higher, suggesting a need for greater attention on LMA cuff pressures and degree of cuff inflation. We discuss the presenting clinical features, pathophysiology and utilisation of ultrasonographic confirmation of sialadenopathy, and review the current anaesthetic literature to raise awareness of this unusual and under-reported complication of LMA. This complication can be mitigated by incorporating routine manometric checks and limiting intracuff pressures to < 60 cmH2O, potentially avoiding LMA insertions in patients with sialolithiasis and avoiding the use of nitrous oxide.
Adult ; Anesthetics ; therapeutic use ; Female ; Humans ; Laryngeal Masks ; adverse effects ; Male ; Pressure ; Submandibular Gland ; diagnostic imaging ; pathology ; Ultrasonography