A painful submandibular lump occurs usually due to inflammatory or infected conditions like sialadenitis, submandibular gland abscess or lymphadenitis. Neoplastic diseases of the submandibular gland usually presented as a painless lump (3).
Depending upon radiological diagnosis for submandibular gland lesion, radiology alone gives scarce information about the exact type of the lesion; FNAC is very helpful in providing valuable information about the type of the lesion.
Ultrasound examination can differentiate cystic from solid lesions, but it is operator dependant, that has specifity up to 90% of benign versus malignant tumors (Gritzman, 1989).
Technetium scan can give us information about some types of tumors only as Warthin and oncocytic tumors (Higashi et al, 1989).
MRI and CT scan can determine the extension and exact site of the lesion only.
Of the 116 cases, 69 patients were having sialadenitis, about 1/3 of them were associated with sialolithiasis and 2/3 are not associated or caused by stones. Submandibular sialadenitis usually presents earlier than other salivary gland sialolithiasis which produce earlier symptoms and signs requiring early intervention (4). .Radio opaque stones or calculi were reported in 70% of cases with obstructive sialadenitis, this favor plain head and neck radiography use (5).previous studies shows reservation about the value of sialography as histologically proven sialadenitis was frequently associated with normal sialogram(5). Typical presentations are soft or firm, painful lesion of the infected gland. In the majority of lesions, staphylococci bacteria are found by bacterial culture as causative organism. As management, large-doses of antibiotics are needed. In case of suppuration or aphlegmon, incision and evacuation of the pus has to be performed (6). The main etiologic factor in chronic sialadenitis of the submandibular gland is salivary calculi (7) in contrast to our study as about 2/3 of sialadenitis were free of sialolithiasis (Table 1).
It is known that, submandibular gland neoplasms constitute (8%) of the whole salivary gland tumors with slightly more than 50% of them are benign neoplasms. (8).
It is better to know the origin of the primary tumors and to differentiate primary from secondary cancerous neoplasms in order to plan who needs further treatment and or to avoid un needed further subsequent surgeries as most of those tumors arise from head and neck regions. ).
In Bangkok, during the period2001-2003, the incidence rate of salivary gland malignant tumor was 0.5 and 0.6 per 100,000 population for females and males, respectively (Khuhaprema et al., 2010), in Jordan there is no yet true documented statistical report of the male to female age standardized incident rate for submandibular gland cancers.
In our study, Pleomorphic adenoma found to be the commonest tumors in both females and males in every age group. Submandibular gland tumors are found to be less common in females’ gender than males, in this study.
The specificity and sensitivity of Fine Needle Aspiration Cytology (FNAC) for malignant neoplastic lesions were 80% and 82%, respectively, whereas for benign neoplastic lesions were 88%, and 90%, respectively, this accuracy reaches nearly a worldwide accuracy with value of 90% (Sismanis et al, 1981).the best mood of treatment begins by prober diagnosis using FNAC, clinical and radiological diagnosis all together and not only one separately.
98% of the patients had complete cure post operatively within the follow up period for up to 12 months postoperatively.
Excision of the submandibular gland is safe as 4 patients only had wound infection and 3 developed primary hemorrhage which were treated within the few post operative days, while neurological damage of the facial nerve occurred in 6 patients that last for about 2 months and lingual nerve injury occurred in 2 patients only (Table 2).the mean post operative follow up was up to 12 months.
Temporary marginal mandibular nerve injury in this study has better results than other reports (9); this is due to the experience of the surgeon (17% vs. 5.2%). This depends upon the surgeon’s skills and experience which can decrease complications.
This retrospective study has limitations in that patients who did not do surgery were not included in this study, this lead to underestimation of the prober pathological diagnosis.
Excision of the submandibular gland is a safe procedure with acceptable complications for both malignant and benign lesions in the hands of the experienced surgeons.
Diagnosis is best achieved by combination of FNAC, clinical and radiological and not by FNAC alone.
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