Fig 37 - uploaded by Philippe Katz
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Longitudinal sonogram of gland parotid gland. Heterogeneous tumor inside the parenchyma, with a hypoechogenic cyst. Histology was adenoid cystic carcinoma.
Source publication
Ultrasound investigation of the major salivary glands has been routinely used for the past 25 years. Ultrasound provides an immediate diagnosis in acute or chronic inflammatory salivary diseases and can visualize sialolithiasis as small as 0.4 mm. Ultrasound is also an important imaging modality for salivary gland tumors, guiding fine needle aspira...
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Objective: The study was to evaluate the adequacy and diagnostic accuracy of discarded residual materials of fine-needle aspirations (FNA) processed using ThinPrep TM on four different organs; breast, thyroid, lymph nodes and salivary glands. Study Designs: Aspirated materials of these lesions were directly smeared on glass slides as routinely done...
Tuberculosis is a common illness found in Indian subcontinent. It can involve wide spectrum of organs ranging from lungs, lymph nodes, brain and many others including salivary glands. However isolated involvement of salivary glands by tuberculosis is a rare entity with very little number of cases reported worldwide. We hereby present a case of tube...
Salivary gland tumours most often present as painless enlarging masses. Most are located in the parotid glands and most are benign. The principal hurdle in their management lies in the difficulty in distinguishing benign from malignant tumours. Investigations such as fine needle aspiration cytology and MRI scans provide some useful information, but...
Citations
... Ultrasound with color doppler is useful not only in discriminating between blood vessels and non-vascular ductal elements but may direct more accurate size measurement of the submandibular gland by identifying where blood vessels are surrounded by gland parenchyma ( Figure 5). 3,29 Although the arterial blood supply to the submandibular gland may also arise from the lingual, deep lingual, and external carotid arteries, the dominant blood supply is from the facial artery (including the submental branch of the facial artery). Li et al identified that the facial artery runs along a "groove" within the submandibular gland and can be surrounded by the cortex of the gland. ...
... Li et al identified that the facial artery runs along a "groove" within the submandibular gland and can be surrounded by the cortex of the gland. 29,30 F I G U R E 3 Medial (deep) view of right submandibular complex with relabeling of the submandibular duct (DSM) associated with the uncinated process (ASM, "accessory submandibular gland") in relation to sublingual glands (GSL, "greater sublingual gland," LSL, "lesser sublingual gland") (with permission Leppi 1967 ...
Objectives
The Salivary Gland Committee of the American Academy of Otolaryngology‐Head and Neck Surgery seeks to standardize terminology and technique for ultrasonograpy used in the evaluation and treatment of salivary gland disorders.
Methods
Development of expert opinion obtained through interaction with international practitioners representing multiple specialties. This committee work includes a comprehensive literature review with presentation of case examples to propose a standardized protocol for the language used in ultrasound salivary gland assessment.
Results
A multiple segment proposal is initiated with this focus on the submandibular gland. We provide a concise rationale for recommended descriptive language highlighted by a more extensive supplement that includes an extensive literature review with additional case examples.
Conclusion
Recommendations are provided to improve consistency both in performing and reporting submandibular gland ultrasound.
... 17 However, when compared among the parotid and submandibular glands, the submandibular glands are hypoechoic than the parotid gland. 18,19 The measurement of echogenicity was not the objective in this study. The present study was conducted to provide reference data related to dimensions of submandibular gland in Nepalese population in Chitwan. ...
Background: There various disease condition which can leads to increased size of the submandibular gland. Normal dimensions of salivary gland is useful for identification and diagnosis of various associated pathology. The study objective was to assess the normal dimension of submandibular gland using ultrasonograph at a tertiary care centre of Nepal. Methods: The descriptive cross-sectional study was conducted in Department of Radiology and Imaging College of Medical Sciences, Bharatpur, Nepal among 126 patients. Ultrasound of submandibular gland was done of all patients with Toshiba Aplio 500 superficial probe. The data was collected and entered into Statistical Package for the Social Sciences version 16 and analyzed using descriptive statistics. Later the data was presented in form of tables. Results: There were in total 126 patients who participated in the study. Among them 78 (61.9%) were females and rest were males. The mediolateral width of right submandibular salivary gland (2.70±0.40 cms) was slightly greater than the left side. The volume of left salivary gland (6.91±2.32 cm3) was slightly larger than the right side in male. However, there was no statistically significant difference between male and female Conclusion: This study concluded that the volume of left salivary gland was slightly larger than the right side. The volume of salivary gland of females was more than male. Keywords: Submandibular gland, Salivary gland, Ultrasonography.
... Inflammatory changes make the gland diffusely hypoechoic and with more rounded, globular margins. Color Doppler shows hypervascularization. [12] The accuracy of ultrasound (US) in the assessment of sialolithiasis is approximately 90%. [13] Differentiation from calcified lymph nodes and phleboliths in facial veins from sialolithiasis can be done accurately. ...
... This will help the identification of small lithiasis and the echogenic lithiasis by improving contrast. In experienced hands, US is the primary method for detecting salivary calculi [12] magnetic resonance imaging or sialography is the investigation of choice for those patients with inconclusive sonographic results or for patients with negative sonographic results but a typical clinical presentation of ductal obstruction. [14] High-resolution US can differentiate various salivary gland lesions. ...
... [1] Under US examination, the normal major salivary glands are homogeneous echogenic organs. [2] Although the US is sensitive for detecting salivary glandular tumors, its specificity in the differentiation of these tumors is limited by individual characteristics. Besides, US is technique and operator dependent; it is also difficult in evaluating deep lobe parotid tumors, and no single feature is sufficient to differentiate benign from malignant salivary gland tumor. ...
Background
The aim of this study was to compare multiple objective ultrasound (US) texture features and develop an objective predictive model for predicting malignant major salivary glandular tumors.
Methods
From August 2007 to May 2018, 144 adult patients who had major salivary gland tumors and subsequently underwent surgery were recruited for this study. Representative brightness mode US pictures were selected for texture analysis and used to develop a prediction model.
Results
We found that the grayscale intensity and standard deviation of the intensity were significantly different between malignant and pleomorphic adenomas. The contrast, inverse difference (INV) movement, entropy, dissimilarity, and INV also differed significantly between benign and malignant tumors. We used stepwise selection of predictors to develop an objective predictive model, as follows: Score = 1.138 × Age − 1.814 × Intensity + 1.416 × Entropy + 1.714 × Contrast. With an optimal cutoff of 0.58, the diagnostic performance of this model had a sensitivity, specificity, overall accuracy, and area under the curve of 83% (95% confidence interval [CI]: 74%–92%), 74% (65%–84%), 78% (72%–85%), and 0.86 (0.80–0.92), respectively.
Conclusion
We have developed a novel computerized diagnostic model based on objective US features to predict malignant major salivary gland tumor. Further improving the computer-aided diagnosis model might change the US examination for major salivary gland tumors in the future.
... In studies, the mean antero-posterior length of the submandibular glands was found to be 35 mm±5.7 mm, the superio-inferior length (paramandibular dimension, depth) 14.3 mm±2.9 mm, and the medio-lateral length (transverse dimension) 33.7 mm±5.4 mm. [1][2][3] Ultrasonography (USG), depending on the difference in the sound permeability of the tissues; it is a radiological imaging method that provides real-time information about the state of tissues. USG is an important technique for imaging the salivary glands because it does not contain ionizing radiation and shows the localizations of the submandibular and parotid glands without superposition. ...
... Ultrasound evaluation of acute sialadenitis typically reveals salivary duct dilatations, hypoechoic parenchyma, and enlarged intraglandular lymph nodes. 12,13 Doppler may show hypervascularization resultant from inflammation. 14 Although ultrasound is often sufficient to evaluate cases of sialadenitis, alternative causes of unilateral neck swelling may be better evaluated with CT angiography. ...
BACKGROUND
Acute postoperative sialadenitis is a rare and potentially morbid complication of cranial neurosurgery. This rapidly progressive, unilateral neck swelling often presents within hours of extubation. Diagnosis is made by imaging and exclusion of other causes of etiologies, such as neck hematoma, sialolithiasis, and dependent soft tissue edema.
OBSERVATIONS
The authors presented a case of acute postoperative sialadenitis after suboccipital resection of a right cerebellar metastasis. Shortly after extubation, extensive left-sided neck swelling was apparent in the postanesthesia care unit. No central lines were placed during the procedure. Imaging revealed submandibular gland edema and fluid accumulation in the surrounding tissue. The patient was managed conservatively with steroids, antibiotics, and warm compresses, with complete resolution of symptoms 2 weeks after the procedure.
LESSONS
This case emphasizes the broad differential of acute neck swelling after cranial surgery. Physical examination of the neck and airway protection should guide initial treatment. If a patient is stable, bedside ultrasound and computed tomography can be helpful with the differential diagnosis. Here the authors proposed an algorithm for diagnosis and treatment of acute neck swelling after cranial surgery.
... Katz et al are more than right pointing out that a clinical US is to be indicated as soon as the first symptoms of sialadenitis occur. 32 US is more than useful in the detection of structural changes of the salivary gland parenchyma, vascularization, condition of the duct system, sialoliths 9,10 and even mucous plugs 31 . The authors note that approximately 20 to 40% of the salivary stones are not opaque on plain radiography, but most of these sialoliths are visible upon sialography. ...
... The authors note that approximately 20 to 40% of the salivary stones are not opaque on plain radiography, but most of these sialoliths are visible upon sialography. 32 2.0-mm and longer sialoliths can be detected on gray scale US. 32 Practitioners must keep in mind the possible calcifications in the area of major salivary glands as potential mimickers of sialoliths. These can be: healed tuberculous lymphadenitis, phleboliths, tonsilloliths, segmental ossification of the stylohyoid ligament. ...
... The authors note that approximately 20 to 40% of the salivary stones are not opaque on plain radiography, but most of these sialoliths are visible upon sialography. 32 2.0-mm and longer sialoliths can be detected on gray scale US. 32 Practitioners must keep in mind the possible calcifications in the area of major salivary glands as potential mimickers of sialoliths. These can be: healed tuberculous lymphadenitis, phleboliths, tonsilloliths, segmental ossification of the stylohyoid ligament. ...
Sialolithiasis, as the most common reason (60–85 percent) of obstructive salivary gland disease, in the rare cases, may be complicated by soft tissues abscess or/and fistula. The purpose of this report is to present a rare case of submandibular gland sialolithiasis complicated with severe neck phlegmon in a 47-year-old Caucasian male. Ultrasonography and transcutaneous removal of sialolith upon the purulent locus lancing are highlighted. Our literature review based on the existed ones with a total 24 complication cases is presented. Wakoh et al`s classification of submandibular gland sialolith-associated fistulas types is analyzed. The ultrasound imaging is still underestimated and not adequately popularized among head and neck and oral and maxillofacial surgeons. Presented case and published reports show the usefulness of this constantly developing diagnostic technique in a combination with knowledge of possible extraoral purulent complications’ and its management.
... [25][26][27] Tükürük bezlerindeki malignitenin teşhisinde de yararlıdır. 28 Normal parotis ve submandibuler bezler, ultrasonda homojen bir ekotek dokusuna sahiptir. Ultrason, bir lezyonun tükürük bezinin içinde ya da dışında olup olmadığını kolayca gösterir. ...
GİRİŞ Ultrason(US), insanların duyabileceği sınırın ötesindeki 2 ila 20 MHz frekans-lı sesleri ifade eder. Gerçek zamanlı ekografi veya tomografi olarak da adlandırı-lan ultrasonografi(USG), ultrason dalgalarının vücut dokularına yayılmasına ve yansımasına dayanan bir görüntüleme tekniğidir. Ultrasonda, yüksek frekanslı ses dalgaları bir dönüştürücü tarafından vücuda iletilir ve doku arayüzünden yan-kılar algılanır ve ekranda görüntülenir. USG tendonlar, kaslar, eklemler, damarlar ve iç organlar gibi vücut iç yapılarını görüntülemek için kullanılır. 1950'lerden bu yana, tıbbın çeşitli alanlarında karın, göğüs, karaciğer, dalak, böbrekler ve di-ğer yüzeysel yumuşak doku lezyonlarının patolojilerinin saptanmasında yaygın olarak kullanılmaktadır. 1 USG' de yüzeysel yapıları görüntülemek için yüksek fre-kanslı transdüserler (10-15 MHz aralığına kadar) ve derin yapıları görüntülemek için düşük frekanslı transdüserler (tipik olarak 2-5 MHz) kullanılır. 2 Oral ve maksillofasiyal cerrahide çenedeki lezyonlara öncelikle tanı koymak, ardından tedavi planlaması ve takibi için radyografik muayeneler büyük ölçü-de önemlidir. Son yıllarda oral ve maksillofasiyal bölgede USG kullanımı, artan radyasyon dozu endişeleri ve ekonomik kısıtlamalar nedeniyle popüler hale gel-miştir. USG, oral ve maksillofasiyal görüntüleme için diğer gelişmiş görüntüleme tekniklerine kıyasla iyonlaştırıcı radyasyonun olmaması, taşınabilirlik, dinamik ve tekrarlı inceleme imkanı ve düşük maliyet gibi çeşitli avantajlar sağlar. USG tükrük bezi lezyonlarında, temporomandibular eklemin görüntülenmesinde, kı-rıkların ve vasküler lezyonların değerlendirilmesinde, lenf nodu muayenesinde, kas kalınlığının ölçümü ve boyun damarlarının görselleştirilmesinde, periapikal lezyonların değerlendirilmesi ve periapikal kemik iyileşmesinin takibi gibi oral ve maksillofasiyal bölgede pek çok amaç için kullanılma potansiyeline sahiptir. Ayrıca USG, doku örneği gerektiğinde ince iğne aspirasyonu sitolojisi (İİAS) ve çekirdek biyopsisi için gerçek zamanlı rehberlik sağlar.
... The primary imaging modalities utilized to detect the number, size, and location of sialoliths include ultrasound (US) and computerized tomography (CT, preferably without contrast), while dental X-rays, MRI, sialography, or MR sialography are used less frequently. Ultrasound has the advantage of being a safe and inexpensive study that can provide real-time, in-clinic, or intraoperative information if performed by the surgeon [10][11][12]. Ultrasound may be sufficient in most cases with acceptable accuracy for ruling in or out sialoliths, and high interrater reliability in the detection of sialolithiasis [13••]. Sonopalpation, whereby the non-scanning hand is used to move floor of mouth soft tissue toward the ultrasound transducer, has been shown to improve the accuracy of detection of submandibular sialoliths [14]. ...
Purpose of Review
This study aimed to discuss the etiology of obstructive sialadenitis, as well as discuss common pathologies and current standards of treatment focusing on gland-preservation techniques.
Recent Findings
The advent of sialendoscopy and associated techniques has allowed for innovative surgical adaptations to allow gland-preservation for complex obstructive pathologies using transoral, endoscopic, and external combined surgical approaches.
Summary
Obstructive sialadenitis can present a challenging clinical scenario for patients with significant symptoms, especially in the acute setting. The combination of medical management and thoughtful surgical intervention can result in high success rates with resolution of symptoms and reversal of obstructive pathology.
... The technological advances in high-resolution transducers and the superficial location of the major salivary glands, makes it most accessible by USG [2] . The in-office use of USG in oral medicine clinics for evaluation of salivary gland pathologies will help to have a better idea about the lesion. ...
... It is a low-cost alternative to CT or MRI for evaluating the superficial lobe lesions of salivary glands. But USG is operator dependent and it is sometimes not possible to visualize examined lesions completely at USG because of their location, penetrating to the deep lobe of the parotid gland or behind the acoustic shadow of the mandible [2] . Also, in cases of suspected malignant lesions, further diagnostic methods (i.e., CT or MRI) should be applied to assess possible infiltration of bones or deeper structures invisible at USG (the base of the skull, parapharyngeal space and to evaluate deep-lying lymph nodes) [3] . ...
... The performance indicators of USG V/S Clinical diagnosis is shown in Table.1. In acute inflammation, salivary glands are enlarged, hypoechoic, with no evidence of posterior acoustic enhancement with well-defined borders and increased vascularity on colour Doppler (Fig.4).Many studies showed that in sialadenitis, the gland may be inhomogeneous; may contain multiple small, oval, hypoechoic areas; and may have increased blood flow at USG. Enlarged lymph nodes with increased central blood flow can also be observed in acute inflammation of the salivary glands [1][2][3]5,6] . ...
Background & Objectives: Ultrasonography (USG) has been shown to be a highly sensitive means of evaluating the major salivary glands. It is difficult to differentiate between salivary gland pathologies by clinical examination alone [1]. So the aim of this study is to outline the spectrum of salivary gland pathologies using USG with Colour Doppler (Duplex Ultrasound) and to validate the performance indicators in terms of sensitivity, specificity and diagnostic accuracy with respect to clinical diagnosis/ histopathology report [HPR] as gold standard. Methodology: The retrospective USG images of cases from July 2017 to January 2019 from the archived database of the Dept. of Oral Medicine and Radiology in Tertiary teaching hospital were used. Results & Discussions: Out of the 59 cases(M=32, F=27) of salivary gland pathologies, the cases were grouped as 16(27%) cases of sialadenitis, 12(20%) cases of sialolithiasis, 10(17%) cases of salivary gland neoplasm, 17 (29%) cases of mucocele and 4(7%) cases of ranula. In our study the sensitivity of USG in acute sialadenitis was 88.88%.In sialolithiasis, salivary gland neoplasm, mucocele and ranula the sensitivity was 100%. But the malignant nature could only be better ascertained following advanced diagnostic modalities/FNAC. The intraductal and intra glandular sialoliths can be differentiated with the help of USG. Conclusion: Duplex ultrasound can be used as a valuable diagnostic adjunct along with the clinical assessment for salivary gland diseases in oral medicine clinics.
