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Symptomatic unilateral submandibular gland aplasia
Letters to the Editor / British Journal of Oral and Maxillofacial Surgery 47 (2009) 241–250
243
doi:10.1016/j.bjoms.2008.08.015
Any of the three major groups of salivary glands may be congenitally absent. Aplasia may be partial or total and its cause is unknown, but it probably results from a disturbance during fetal development.3 Matsuda et al2 found 44 cases of salivary gland aplasia in a recent review, only 9 of whom had aplasia of one of the four major salivary glands. In our case case it was not associated with other developmental anomalies. Most reported cases of unilateral submandibular aplasia were asymptomatic, probably because secretions from other salivary glands compensated for the aplasia.4 If xerostomia is present, salivary production can be increased with the use of sialogogues (pilocarpine or cevimeline) or the use of salivary substitutes. Dental health can be maintained with energetic preventive care and good oral hygiene.5
Symptomatic unilateral submandibular gland aplasia
References
Sir,
1. Gruber W. Congenital Mangel beider Glandulae submaxillares bei einem wohlgebildeten, erwachsenen Subjects. (Congenital lack of both submandibular glands in adults). Arch Pathol Anat 1885;cii:9–11. 2. Matsuda C, Matsui Y, Ohno K, Michi K. Salivary gland aplasia with cleft lip and palate: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:594–9. 3. Garcia-Consuegra L, Gutiérrez LJ, Castro JM, Granado JF. Congenital unilateral absence of the submandibular gland. J Oral Maxillofac Surg 1999;57:344–6. 4. Mathison CC, Hudgins PA. Bilateral submandibular gland aplasia with hypertrophy of sublingual glands. Otolaryngol Head Neck Surg 2008;138:119–20. 5. Mandel L. An unusual pattern of dental damage with salivary gland aplasia. J Am Dent Assoc 2006;137:984–9.
Reference 1. General Medical Council (2003):Tomorrow’s Doctors, London:GMC www.gmc-uk.org/education.
Amandip Sandhu ∗ Queen’s Medical Centre, Nottingham, NG7 2UH, United Kingdom ∗7
Johnson Close, Watnall, Nottingham, NG16 1GJ. Tel.: +44 0781 1607897. E-mail address: [email protected] 29 August 2008 Available online 15 October 2008
Aplasia of the main salivary glands is rare. Since the first case was described in 1885,1 fewer than 30 cases have been reported, in most of which the agenesis was associated with hypoplasia of other ectodermal structures, particularly defects in the lacrimal apparatus.2 We report a case of symptomatic unilateral aplasia of a submandibular gland. A 35-year-old woman presented to our hospital complaining of dry lips and mouth, difficulty with swallowing solid foods, changes in taste, and occasional angular cheilitis over the previous four years. Physical examination, including those of the oral cavity and the neck was within normal limits. No dental or periodontal disease was seen, but no saliva was expelled from the right ductal orifice on pressure of the right submandibular area. Computed tomography (CT) showed complete aplasia of the right submandibular gland with compensatory hypertrophy of other mayor salivary glands (Fig. 1). Pilocarpine was used as the sialogogue, and salivary substitutes were prescribed twice a day. Dental health was maintained with good oral hygiene and fluorides. The patient’s recovery was excellent.
Lorena Gallego a Luis Junquera b,∗ Paz Cuesta c Pablo Rosado a a Clinical Tutor, Department of Oral and Maxillofacial Surgery, Central University Hospital, Oviedo, Spain b Professor of Oral and Maxillofacial Surgery, University of Oviedo Dental School and Central University Hospital, Oviedo, Spain c Staff Surgeon, Department of Otolryngology, Cabue˜ nes Hospital, Gijón, Asturias ∗ Corresponding
author. Department Oral and Maxillofacial Surgery, University Central Hospital, Celestino Villamil s/n, 33009, Oviedo, Spain. E-mail address: [email protected] (L. Junquera) 29 August 2008 Available online 1 November 2008 doi:10.1016/j.bjoms.2008.08.014
Tracheal tear following elective tracheostomy Sir, Fig. 1. Computed tomogram of the neck showing absence of the right submandibular gland.
We would like to bring to your attention the danger of relying on palpation of a pilot balloon to assess the adequacy
243
doi:10.1016/j.bjoms.2008.08.015
Any of the three major groups of salivary glands may be congenitally absent. Aplasia may be partial or total and its cause is unknown, but it probably results from a disturbance during fetal development.3 Matsuda et al2 found 44 cases of salivary gland aplasia in a recent review, only 9 of whom had aplasia of one of the four major salivary glands. In our case case it was not associated with other developmental anomalies. Most reported cases of unilateral submandibular aplasia were asymptomatic, probably because secretions from other salivary glands compensated for the aplasia.4 If xerostomia is present, salivary production can be increased with the use of sialogogues (pilocarpine or cevimeline) or the use of salivary substitutes. Dental health can be maintained with energetic preventive care and good oral hygiene.5
Symptomatic unilateral submandibular gland aplasia
References
Sir,
1. Gruber W. Congenital Mangel beider Glandulae submaxillares bei einem wohlgebildeten, erwachsenen Subjects. (Congenital lack of both submandibular glands in adults). Arch Pathol Anat 1885;cii:9–11. 2. Matsuda C, Matsui Y, Ohno K, Michi K. Salivary gland aplasia with cleft lip and palate: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:594–9. 3. Garcia-Consuegra L, Gutiérrez LJ, Castro JM, Granado JF. Congenital unilateral absence of the submandibular gland. J Oral Maxillofac Surg 1999;57:344–6. 4. Mathison CC, Hudgins PA. Bilateral submandibular gland aplasia with hypertrophy of sublingual glands. Otolaryngol Head Neck Surg 2008;138:119–20. 5. Mandel L. An unusual pattern of dental damage with salivary gland aplasia. J Am Dent Assoc 2006;137:984–9.
Reference 1. General Medical Council (2003):Tomorrow’s Doctors, London:GMC www.gmc-uk.org/education.
Amandip Sandhu ∗ Queen’s Medical Centre, Nottingham, NG7 2UH, United Kingdom ∗7
Johnson Close, Watnall, Nottingham, NG16 1GJ. Tel.: +44 0781 1607897. E-mail address: [email protected] 29 August 2008 Available online 15 October 2008
Aplasia of the main salivary glands is rare. Since the first case was described in 1885,1 fewer than 30 cases have been reported, in most of which the agenesis was associated with hypoplasia of other ectodermal structures, particularly defects in the lacrimal apparatus.2 We report a case of symptomatic unilateral aplasia of a submandibular gland. A 35-year-old woman presented to our hospital complaining of dry lips and mouth, difficulty with swallowing solid foods, changes in taste, and occasional angular cheilitis over the previous four years. Physical examination, including those of the oral cavity and the neck was within normal limits. No dental or periodontal disease was seen, but no saliva was expelled from the right ductal orifice on pressure of the right submandibular area. Computed tomography (CT) showed complete aplasia of the right submandibular gland with compensatory hypertrophy of other mayor salivary glands (Fig. 1). Pilocarpine was used as the sialogogue, and salivary substitutes were prescribed twice a day. Dental health was maintained with good oral hygiene and fluorides. The patient’s recovery was excellent.
Lorena Gallego a Luis Junquera b,∗ Paz Cuesta c Pablo Rosado a a Clinical Tutor, Department of Oral and Maxillofacial Surgery, Central University Hospital, Oviedo, Spain b Professor of Oral and Maxillofacial Surgery, University of Oviedo Dental School and Central University Hospital, Oviedo, Spain c Staff Surgeon, Department of Otolryngology, Cabue˜ nes Hospital, Gijón, Asturias ∗ Corresponding
author. Department Oral and Maxillofacial Surgery, University Central Hospital, Celestino Villamil s/n, 33009, Oviedo, Spain. E-mail address: [email protected] (L. Junquera) 29 August 2008 Available online 1 November 2008 doi:10.1016/j.bjoms.2008.08.014
Tracheal tear following elective tracheostomy Sir, Fig. 1. Computed tomogram of the neck showing absence of the right submandibular gland.
We would like to bring to your attention the danger of relying on palpation of a pilot balloon to assess the adequacy