The saliva secreted from submandibular gland (SMG) accounts for 60%-65%. It plays an important role in maintaining the human function of swallow, digestion, testing, speech, protection of oral mucosa, and prevention from dental carries. The SMG is frequently resected during the treatment for various kinds of oral and maxillofacial diseases, resulting in xerostomia and decreased quality of life. During the past 15 years, Research Center of Salivary Gland Diseases in Peking University School and Hospital of Stomatology conducted a series of studies on new techniques for preservation of SMG and achieved remarkable results. The clinicopathologic and imaging characteristics of IgG4-related sialadenitis (IgG4-RS) were clarified based on systematic studies. The results of studies on the pathogenesis of IgG4-RS showed that unbalance of inflammatory factors mediated the abnormality of secretion of SMG. IL-4 participates in occurring and development of glandular fibrosis of SMG. Regulation of tumor necrosis factor α (TNF-α) and cleaning of senescent cells might be taken as the targets for treatment of IgG4-RS. The combination of glucocorticoid and steroid-sparing agents showed effective results for treating IgG4-RS, clinical remission was achieved in all the patients, serum IgG4 levels decreased, and salivary gland secretion significantly increased. Sialoendoscopy-assisted sialolithectomy was applied in the treatment of about 1 000 cases with submandibular hilar calculi with a success rate of more than 90%. Transfer of SMG was used for prevention from radiation-induced xerostomia in the patients with head and neck carcinoma. SMG was transferred to the submental region before radiotherapy and was kept away from the ra-diation field. The results of prospective clinical controlled study showed this technique could effectively preserve the function of SMG and prevent from xerostomia. Based on the micro-anatomical study on the blood vessels and ducts of SMG, partial sialoadenectomy was applied for treatment of benign tumors in the SMG. A clinical controlled study confirmed its safety for control of the tumors and its advantage of preservation of SMG function. The studies on the involvement of SMG in oral squamous cell carcinoma (OSCC) provided the anatomical and histopathological basis for preservation of SMG during neck dissection for early cases with OSCC. A innovated surgical modality "four preservations including SMG" was used during the neck dissection for the early cases with OSCC. A prospective randomized clinical controlled study confirmed its safety, feasibility, effectiveness for control of the carcinoma, and advantages of preservation of SMG function.
Humans ; Carcinoma, Squamous Cell/pathology* ; Glucocorticoids ; Immunoglobulin G ; Interleukin-4 ; Mouth Neoplasms/pathology* ; Prospective Studies ; Quality of Life ; Sialadenitis/surgery* ; Submandibular Gland/surgery* ; Tumor Necrosis Factor-alpha ; Xerostomia/prevention & control* ; Randomized Controlled Trials as Topic

OBJECTIVE: To investigate the protective effect of Zengye Decoction (, ZYD) on the submandibular glands (SMGs) in nonobese diabetic (NOD) mice. METHODS: Twenty-seven female NOD mice were randomly equally divided into 3 groups: the model group, the hydroxychloroquine (HCQ) group, and the ZYD group. Nine C57/B6 mice served as the normal group. After 1-week acclimation, the HCQ and ZYD groups were intragastrically administered with HCQ and ZYD, respectively, and the normal and model groups were administered with normal saline. Changes in the salivary flow rate were observed. Mice from all 4 groups were sacrificed at the age of 20 weeks. The serum and SMGs were collected. Serum cytokines gamma-interferon (IFN-γ), interleukin-10 (IL-10) were detected by enzyme-linked immunosorbent assay. Histological changes in the submandibular glands were examined by hematoxylin and eosin staining. The mRNA expression of IFN-γ, IL-10 and vasoactive intestinal peptide (VIP) in the submandibular glands were measured by real-time polymerase chain reaction. RESULTS: Compared with the model group, the salivary flow of the ZYD group significantly increased (P<0.05), the extent of the histological changes was ameliorated (P<0.05), and the Th1/Th2 cytokine imbalance was remedied (P<0.05). In the ZYD-treated mice, the VIP mRNA was up-regulated (P<0.05). CONCLUSIONS ZYD is beneficial in protecting structure and function of SMGs in NOD mice. The mechanism may be associated with the correction of the Th1/Th2 cytokine imbalance, and with the prevention of a progressive decline of the VIP level.
Animals ; Cytokines ; blood ; Drugs, Chinese Herbal ; pharmacology ; Female ; Mice ; Mice, Inbred C57BL ; Mice, Inbred NOD ; Salivation ; drug effects ; Sjogren's Syndrome ; drug therapy ; immunology ; Submandibular Gland ; drug effects ; pathology ; Th1 Cells ; immunology ; Th2 Cells ; immunology ; Vasoactive Intestinal Peptide ; genetics

Sialolithiasis, the most common salivary gland pathology, is caused by calculi in the gland itself and its duct. While patients with small sialoliths can undergo conservative treatment, those with standard-size or larger sialoliths require sialolithotomy. In the present case study, we removed two sialoliths located beneath the mucosa in the posterior and anterior regions of Wharton's duct, respectively. For the posterior calculus, we performed sialolithotomy via an intra-oral approach; thereafter, the small anterior calculus near the duct orifice was removed by hydraulic power. This method has not previously been reported. There were no complications either during the operation or postoperatively, and the salivary function of the gland remained normal.
Calculi* ; Humans ; Methods* ; Mucous Membrane ; Needles* ; Pathology ; Salivary Ducts ; Salivary Gland Calculi ; Salivary Glands ; Submandibular Gland

A case of Schwannoma in the submandibular gland was reported which had been misdiagnosed as pleomorphic adenoma before operation. The tumor was originated from lingual nerve which in turn invaded the Schwann membrane near the submandibular ganglion.
Adenoma, Pleomorphic ; Diagnostic Errors ; Humans ; Neurilemmoma ; diagnosis ; Submandibular Gland ; pathology ; Submandibular Gland Neoplasms ; diagnosis

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Castleman Disease ; immunology ; pathology ; Cyclophosphamide ; therapeutic use ; Diagnostic Errors ; Doxorubicin ; therapeutic use ; Humans ; Immunoglobulin G ; blood ; Kidney ; Lymph Node Excision ; Lymph Nodes ; pathology ; surgery ; Lymphatic Diseases ; drug therapy ; immunology ; pathology ; surgery ; Male ; Middle Aged ; Nephrectomy ; Pancreas ; Plasma Cells ; immunology ; pathology ; Prednisone ; therapeutic use ; Submandibular Gland ; Vincristine ; therapeutic use

OBJECTIVETo analyze the risk factors for level Ib lymph node enlargement on CT in patients with nasopharyngeal carcinoma (NPC) and provide clinical evidence for defining the indications of prophylactic level Ib irradiation.

METHODSA total of 435 newly diagnosed NPC patients receiving radiotherapy in Nanfang Hospital in the past 2 years were enrolled in this analysis. The correlations were analyzed with Logistic regression between level Ib lymphadenopathy and the clinical risk factors including T stage, N stage, diameter of level II lymph nodes, submandibular gland involvement, nasal cavity involvement, oropharyngeal involvement, and involvement of 4 or more lymphatic drainage regions.

RESULTSUnivariate analysis showed that level Ib lymphadenopathy were positively correlated with N stage (P=0.023), submandibular gland involvement (P=0.045), and level II lymph node diameter (P<0.001). Multivariate Logistic regression analysis suggested a significant correlation only between the diameter of the level II lymph nodes and level Ib lymphadenopathy (P=0.013).

CONCLUSIONLevel Ib lymphadenopathy is positively correlated with the size of ipsilateral level II lymph nodes in NPC patients.

Carcinoma ; Humans ; Lymph Nodes ; pathology ; Lymphatic Diseases ; epidemiology ; Lymphatic Metastasis ; Nasopharyngeal Neoplasms ; epidemiology ; Neck ; Paranasal Sinuses ; Risk Factors ; Submandibular Gland

IgG4-related disease (IgG4-RD) is characterized by a systemic involvement of tumor-like lesions with IgG4-positive plasmacytes. We experienced a case of IgG4-RD developed in a patient with bronchial asthma (BA) and chronic rhinosinusitis (CRS). A 55-yr-old female patient with BA and CRS complained of both eyes and neck swelling as well as a recurrent upper respiratory infection in recent 1 yr. The serum levels of IgG4, creatinine, and pancreatic enzymes were elevated. A biopsy of the submandibular gland showed an abundant infiltration of IgG4-positive plasmacytes. Her symptoms remarkably improved after the treatment of a systemic steroid that has been maintained without recurrence. We report a rare case of IgG4-RD developed in a patient with BA and CRS.
Asthma/complications/*diagnosis ; Chronic Disease ; Creatinine/blood ; Female ; Humans ; Immunoglobulin G/*blood ; Middle Aged ; Pancreas/enzymology ; Plasma Cells/physiology ; Prednisolone/therapeutic use ; Republic of Korea ; Rhinitis/complications/*diagnosis/drug therapy ; Sinusitis/complications/*diagnosis/drug therapy ; Submandibular Gland/pathology ; Tomography, X-Ray Computed

Xerostomia is a severe side effect of radiation therapy in head and neck cancer patients. To date, no satisfactory treatment option has been established. Because mesenchymal stem cells (MSCs) have been identified as a potential treatment modality, we aimed to evaluate stem cell distribution following intravenous and intraglandular injections using a surgical model of salivary gland damage and to analyse the effects of MSC injections on the recruitment of immune cells. The submandibular gland ducts of rats were surgically ligated. Syngeneic adult MSCs were isolated, immortalised by simian virus 40 (SV40) large T antigen and characterized by flow cytometry. MSCs were injected intravenously and intraglandularly. After 1, 3 and 7 days, the organs of interest were analysed for stem cell recruitment. Inflammation was analysed by immunohistochemical staining. We were able to demonstrate that, after intravenous injection, MSCs were recruited to normal and damaged submandibular glands on days 1, 3 and 7. Unexpectedly, stem cells were recruited to ligated and non-ligated glands in a comparable manner. After intraglandular injection of MSCs into ligated glands, the presence of MSCs, leucocytes and macrophages was enhanced, compared to intravenous injection of stem cells. Our data suggest that injected MSCs were retained within the inflamed glands, could become activated and subsequently recruited leucocytes to the sites of tissue damage.
Animals ; Antigens, Polyomavirus Transforming ; immunology ; Cell Culture Techniques ; Cell Movement ; physiology ; Cell Transformation, Viral ; Clone Cells ; physiology ; Flow Cytometry ; Immunohistochemistry ; Injections, Intralesional ; Injections, Intravenous ; Leukocytes ; pathology ; Macrophages ; pathology ; Mesenchymal Stem Cell Transplantation ; methods ; Mesenchymal Stromal Cells ; pathology ; physiology ; Necrosis ; Rats, Wistar ; Salivary Ducts ; pathology ; Sialadenitis ; pathology ; therapy ; Simian virus 40 ; immunology ; Submandibular Gland ; pathology ; Submandibular Gland Diseases ; pathology ; therapy ; Time Factors

Carcinoma, Squamous Cell ; pathology ; Child ; Cysts ; pathology ; Diagnosis, Differential ; Epithelium ; pathology ; Female ; Follow-Up Studies ; Humans ; Keratin-19 ; metabolism ; Keratin-5 ; metabolism ; Keratin-6 ; metabolism ; Keratin-7 ; metabolism ; Keratins ; metabolism ; Neoplasm Recurrence, Local ; surgery ; Reoperation ; Submandibular Gland ; surgery ; Submandibular Gland Neoplasms ; metabolism ; pathology ; surgery ; Transcription Factors ; metabolism ; Tumor Suppressor Protein p53 ; metabolism ; Tumor Suppressor Proteins ; metabolism

Botulinum toxin A (BTXA) has been used in several clinical trials to treat excessive glandular secretion; however, the precise mechanism of its action on the secretory function of salivary gland has not been fully elucidated. In this study, we aimed to investigate the effect of BTXA on secretion of submandibular gland in rabbits and to identify its mechanism of action on the secretory function of salivary gland. At 12 weeks after injection with 5 units of BTXA, we found a significant decrease in the saliva flow from submandibular glands, while the salivary amylase concentration increased. Morphological analysis revealed reduction in the size of acinar cells with intracellular accumulation of secretory granules that coalesced to form a large ovoid structure. Expression of M3-muscarinic acetylcholine receptor (M3 receptor) and aquaporin-5 (AQP5) mRNA decreased after BTXA treatment, and distribution of AQP5 in the apical membrane was reduced at 1, 2 and 4 weeks after BTXA injection. Furthermore, BTXA injection was found to induce apoptosis of acini. These results indicate that BTXA decreases the fluid secretion of submandibular glands and increases the concentration of amylase in saliva. Decreased expression of M3 receptor and AQP5, inhibition of AQP5 translocation, and cell apoptosis might involve in BTXA-reduced fluid secretion of submandibular glands.
Amylases ; drug effects ; Animals ; Apoptosis ; drug effects ; Aquaporin 5 ; antagonists & inhibitors ; Botulinum Toxins, Type A ; pharmacology ; Cell Membrane ; drug effects ; In Situ Nick-End Labeling ; Male ; Microscopy, Electron, Transmission ; Neuromuscular Agents ; pharmacology ; Organ Size ; Rabbits ; Random Allocation ; Receptor, Muscarinic M3 ; antagonists & inhibitors ; Saliva ; drug effects ; secretion ; Salivary Proteins and Peptides ; drug effects ; Salivation ; drug effects ; Secretory Rate ; drug effects ; Secretory Vesicles ; drug effects ; Submandibular Gland ; drug effects ; pathology ; secretion ; Time Factors