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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
RESEARCH ARTICLE Table of Contents   
Year : 2003  |  Volume : 7  |  Issue : 1  |  Page : 21-24
 

An analysis of salivary gland lesions - an institutional Experience


Department of Oral Pathology, Ragas Dental College, Chennai, India

Correspondence Address:
T P Sajeevan
Department of Oral Pathology, Ragas Dental College, Chennai
India
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Source of Support: None, Conflict of Interest: None


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   Abstract 

This report describes the prevalence of salivary gland lesions reported in the Department of Oral Pathology, Ragas Dental College from 1993 to 2001. In the period of 9 years, 1118 cases were subjected to histopathological examination. Of these 30 cases (2.68%) were salivary gland lesions. Of the 30, 60%was mucous extravasation cyst, 20% salivary gland neoplasm, 16.67% sialadenitis and 3.3% Sjogren's syndrome. These lesions showed no statistical significant difference in age, sex and site distribution, due to limited number of cases, except mucous extravasation cyst, which showed statistical significance in relation to sex.


Keywords: Salivary gland lesions, statistical analysis, Ragas Dental College


How to cite this article:
Sajeevan T P, Elizabeth J, Saraswathi T R, Ranganathan K. An analysis of salivary gland lesions - an institutional Experience. J Oral Maxillofac Pathol 2003;7:21-4

How to cite this URL:
Sajeevan T P, Elizabeth J, Saraswathi T R, Ranganathan K. An analysis of salivary gland lesions - an institutional Experience. J Oral Maxillofac Pathol [serial online] 2003 [cited 2019 Oct 14];7:21-4. Available from: http://www.jomfp.in/text.asp?2003/7/1/21/41002



   Introduction Top


Secretion of saliva from the salivary glands has many important functions other than maintaining the oral mucosa in a moist condition. Salivary glands are classified according to the size (Major and Minor), location (Extra oral & Intra oral) and type of secretion (Serous, mucous and mixed). The major salivary glands are Parotid, Submandibular and Sublingual gland. In addition to these, there are hundreds of tiny gland called minor salivary glands located in the lip, buccal mucosa and other mucosal lining of mouth and throat.

Salivary gland is subjected to different types of pathological process constituting a variety of lesions ranging from inflammatory lesions to neoplasms. Statistical data related to salivary gland lesions is not available in this part of South India.

The purpose of this study was to analyze the relative frequency and distribution of different salivary gland lesions and to provide data with reference to age, sex and site distribution of these lesions reported in Ragas Dental College and Hospital, Chennai, South India from 1993 to 2001.


   Methods Top


Salivary gland lesions were retrieved from the pool of 1118 oral biopsy specimen submitted to Oral Pathology Department of Ragas Dental College Chennai, South India between the years 1993 to 2001. The age, sex and location of the lesions were collected. The lesions were broadly classified as cystic lesions, inflammatory, neoplastic and autoimmune diseases.

Chi-square test was performed and the significant differences were considered at the 5% level of significance.


   Results Top


Out of 1118 oral biopsies retrieved during the 9-year period between 1993 to 2001. there were 30 cases (2.68%) of salivary gland lesions. Of these 30 cases, 60% were mucous extravasation cysts, 20% were salivary gland tumors. 16.67% were inflammatory lesion and 3.37% constituted Sjogren's syndrome (Graph I). The sex distribution of these lesions is given in [Table 1], Graph 1-[Figure 5].


   Mucous Extravasation Cyst Top


Age, Sex and Site Distribution (Graph 2)

Mucous extravasation cysts were seen in 72.3% of males and 27.7% of females with a male to female ratio of 2.6:1 and this was statistically significant. 33.3% of the cases occurred in younger age group between 10 to 29 years of age. In the second decade the distribution was equal in both the genders whereas higher prevalence was seen in males in the third decade. 16.6% of males and mucous extravasation cyst in the age group of 30 to 39 years. No case was recorded above 40 year age group. Graph 2-[Figure 6]

Mucous extravasation cyst predominantly occurred in the lower lip (88.8%). In 5.5% of cases it occurred in the cheek and ventral surface of the tongue respectively. In males all the cases of mucous extravasation cyst occurred in the lower lip (100%) where as in females it was 60%.

Histopathology [Figure 1]

All the cases showed cystic lesion in the connective tissue of oral mucosa. The wall of the cyst was made of compressed fibro vascular connective tissue, with the presence of a mixed inflammatory cell infiltrate of polymorphs, lymphocytes, and plasma cells. The lumen of the cystic cavity was filled with eosinophillie coagulum containing varying number of leukocytes and phagocytes. In some of the cases, the lumen appeared empty.


   Sialadenitis Top


Age, Sex and Site Distribution (Graph 3)

Sialadenitis was encountered in submandibular gland alone involving40% of males and 60% of females. 20% of cases occurred in age group between 30 to 39 years of age in females. 80% of cases occurred in age group between 40 to 49 years with equal distribution in both the sexes. No case was recorded in age group between 10 to 29 years and above 50 years.Graph 3-[Figure 7]

Histopathology [Figure 2]

The submandibular salivary gland showed varying stages of destruction of acini, ductal proliferation and fibrosis associated with chronic inflammatory cell infiltration. The architecture of the gland was maintained. Areas of necrosis showed foci of basophilic staining suggestive of dystrophic calcification within the gland.


   Tumours Top


Age, Sex and Site Distribution (Graph 4)

Salivary gland tumors were encountered in 66.7% of females and 33.3% of males. Pleomorphic adenoma and mucoepidermoid carcinoma were the salivary gland neoplasms encountered in this study showing equal distribution of 50% in each with female to male sex ratio of 2:1. Age of occurrence of these tumours was from 20 to 29 years to above 60 years of age. 50% of these tumors occurred in the age group of 30 to 39 years, showing female predilection (100%). 83.3%of cases involved the palate and 16.7% affecting the submandibular gland. Graph 4-[Figure 8]

Histopathology

Pleomorphic Adenoma [Figure 3]

All the cases showed well-encapsulated tumor exhibiting glandular epithelium and areas of myoepithelial cells separated by connective tissue stroma. The epithelium exhibited ductal pattern of varying sizes containing mucin. In some areas they presented islands or sheets of epithelial cells. The stroma showed myxomatous, chondroid and osteoid areas as well as areas of hyalinization.

Mucoepidermoid Carcinoma [Figure 4]

There were two cases of low grade and one case of high-grade mucoepidermoid carcinoma in this series. The low-grade neoplasms showed areas of mucous cells, dilated spaces of varying size containing mucin, polygonal cell arranged in sheets representing the epidermoid differentiation. In addition, basaloid type of cells and intermediate type cells were also seen.

The glandular architecture was lost. The high-grade neoplasm showed predominant squamous dif erentiation with hyperchromatism of the nuclei and cellular pleomorphism. Few areas of mucous cells with spaces containing mucin and intermediate cells were also seen. These neoplastic cell showed infiltration of the overlying mucosa resulting in surface ulceration.


   Sjogren' Syndrome Top


A single case of Sjogren's syndrome was reported in a 29-year old female patient.

Histopathology

Biopsy of the lower lip showed lymphocytic infiltration of mucous salivary glands with destruction of the acinar units.


   Discussion Top


Statistical data pertaining to salivary gland lesions, in a hospital population is not available in this part of the country. This retrospective study over a period of 9 years evaluates the clinical and histopathological characteristics of salivary gland lesions retrieved from the department of Oral pathology, Ragas Dental College and Hospital, Chennai, South India, with respect to age, sex and site distribution of lesions. The total number of salivary gland lesions constituted 2.68% of oral mucosal biopsies studied.

Among the salivary gland lesions analysed, mucous extravasation cyst had the highest prevalence (60%). On further analysis these lesions mostly occurred in children and young adults where trauma plays a major role. However mucoceles have been reported in patients of all age groups including newborn infants' and older people. Standish and Shafer considered birth trauma could also be the cause of congenital mucocele. They also stated that there are four potential situations where trauma could occur in the baby's oral tissue during gestation and delivery: Intrauterine finger suction, passage through delivery canal, forceps usage and pediatric or nurse manipulation of the baby.

Our results indicate the mucous extravasation cyst predominantly occurred in male patients with a male to female ratio of 2.6:1 showing statistical significance (p<0.05).

Results of the study also suggest the Mucous extravasation cyst predominantly occurred in the lower lip accounting for 88.8%. The distribution of this lesion was almost similar to that reported by Allen [3] accounting for 75%.

Sialadenitis predominantly occurred in middle age ranging from 40 to 49 years. It was more common in females with a male to female ratio ranging from 1 1.5. This finding was consistent with those of Ellis[4] .

Sialolith is thought to be the major pathogenic factor of chronic sclerosing Sialadenitis [5] . Harrison et al [7] reported that salivary calculi were found in 83% of cases with chronic sclerosing sialadenitis. Harrison et al [7] suggested the importance of obstruction of duct by microlith and ascending infection in the development of chronic Submandibular Sialadenitis. In our study out of 5 cases of Sialadenitis, only one case was associated with sialolith.

Plemorphic adenoma and mucoepidermoid carcinoma occurred in a wide range of age, from 20 to 29 years to above 60 years. These findings arc consistent with the findings of Allen [8] . Results of the study suggest that pleomorphic adenomas are more common in females, with a female to male ratio ranging from 2:1. In our study 83.3% of cases involved the palate and 16.67% affected submandibular gland. This finding is in contrast to the distribution of tumours reported by Lucas in which 43% occurred in minor salivary glands and 60% in Submandibular gland.

Sjogren's Syndrome was first described by Hadden in the late 19 th century and Milkulitz a few years later, but it was named after a Swedish ophthalmologist Sjogren whose classic report of this syndrome appeared in 1993 [10] . Sjogren's syndrome is frequently described as a disease of middle-aged women, with a sex ratio of 10:1 [11] . Results of our - study showed a single case of Sjogren's syndrome in a 29 year-old female.

The present retrospective study of hospital based population showed the different types of salivary gland lesions in a dental teaching institution over a period of 9 years. Each type of lesion showed variation in age, sex, and site distribution constituting 18 cases of mucous extravasation cysts, 5 cases of sialadenitis, 6 cases of tumour's, and 1 case of sjogren syndrome.

 
   References Top

1.Gatti. AP, M.M. Moreti, Cardoso. S.V, Loyda. A.M: Mucous Extravasation Phenomenon in new born report of 2 cases. International Journal of Pediatric Dentistry. Jan 2001: 11: 74-76.  Back to cited text no. 1    
2.Standish S.M. et al: The mucous retention phenomenon. Journal of Oral Surgery 1959: 17: 15-22.  Back to cited text no. 2    
3.Allen, Bouquot, Neville et al.: Oral and Maxillofacial Pathology. W.B. Saunders Pub. 1 st ed. 1995: 322-323.  Back to cited text no. 3    
4.Ellis G.L., Auchlair, Gnepp D.R.: Surgical Pathology of the salivary gland,: WB Saunders. 1991: 25: 92.  Back to cited text no. 4    
5.Shigeski Sekine, Illegate and Watnaba et al: Chronic sclerosing sialdentitis of Submandibular gland associated with idiopathic retropertioneal fibrosis. 1999: 49:663-667.  Back to cited text no. 5    
6.Isacsson G, Isbery A, Harvesting M, Lundquist PG: Salivary calculi and chronic submandibular sialadenitas. A clinicopathologic investigation of 154 cases. Histopathology 1997:31,237-237,  Back to cited text no. 6    
7.Harrison J.D.. Bhatia S.N. et al: Role of microlith in aetiology of chronic Submandibular sialadenitas. A clinicopathologic investigation of 154 cases. Histopathology 1997:31,237-237.  Back to cited text no. 7    
8.Allen, Bouquot, Neville et al.: Oral and Maxillofacial pathology. WB Saunders I` 1995:340-341.  Back to cited text no. 8    
9.Ellis G.L, Auclair P.L, Gnepp D.R.: Surgical pathology of salivary gland. W. B. Saunders: 1991:25:166.  Back to cited text no. 9    
10.Drag N.A., Brown J.E. and Shirlaw D. et al.: Sialographic changes in Sjogres syndrome and sox syndrome. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radio Endod 1998: 86: 104-9.  Back to cited text no. 10    
11.Ibtisam, Sadik Khuder, Naghighat, Zipp: frequency and predictive value of the clinical manifestations in Sjogren's Syndrome. J.Oral Pathol. Med.2001.30:1-6.  Back to cited text no. 11    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1]



 

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    Abstract
    Introduction
    Methods
    Results
    Mucous Extravasa...
    Sialadenitis
    Tumours
    Sjogren' Syndrome
    Discussion
    References
    Article Figures
    Article Tables

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