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Accessory duct in the submandibular gland
Roentgeno-oddities Each month this section will bring to the reader of ORAL SURGERY, ORAL MEDICINE, AND ORAL one or more roentgenogramsthat demonstrate unusual, unexpected, rare, or bizarre roentgenographic changes.These roentgenogramswill be accompanied by an explanation or by words of inquiry regarding the particular change. Please submit 5 by 7 inch glossy black and white prints along with two copies of the description of the case. All material for publication should be submitted to Dr. John W. Preece,Department of Dental Diagnostic Sciences,School of Dentistry, The University of Texas Health Science Center, 7703 Floyd Curl Dr., San Antonio, Texas 78284. PATHOLOGY
ACCESSORY GLAND
DUCT IN THE SUBMANDIBULAR
A
n accessoryparotid gland is often encountered in sialography, and there are many embryologic, morphologic, and clinical reports with respect to this gland. However, an accessoryduct of the mandibular gland is rare, with the only known case being that reported by Rahmathulla’ in 1973. Two Wharton’s ducts were observed when the right submandibular gland of a patient was examined sialographically. The patient was a 73-year-old Japaneseman with the chief complaints of swelling and pain in the right submandibular region. The patient had experienced recurrent swelling in the right submandibular gland and had received antibiotics and antiphlogistics, resulting in disappearance of the swelling. One month after the above treatment the patient was re-examined, and his face was seento be slightly asymmetrical. A diffuse swelling was noted in the right submandibular region, and the skin was mildly red. Two submandibular nodes, which were as large as a small fingertip, were palpated in the right submandibular region. These were movable and tender, but no trismus was noted. Zntruoruljindings. There were tooth stumps in the right mandibular canine and left maxillary incisor regions. The right third molar remained, but other teeth had been lost. Rednessand mild swelling were noted around the sublingual papilla. There were no abnormal findings in the gingiva and intraoral mucosa. Sialography was performed with local anesthesia and injection of 20 ml of 76% Urografin into the right submandibular gland (Figs. 1 to 3). Radiographic findings. The orifice of the right submandibular gland was slightly larger than that of the normal gland, and two Wharton’s ducts running
Fig. 1. Occlusal-view sialogram showing Wharton’s duct and accessoryduct.
in a posteroinferior direction from the vestibule of the mouth were noted in each radiograph. The ducts bent downward and individual bifurcations could be observed within the gland. The two Wharton’s ducts were enlarged, with some constriction and loss of definition in the posterior region and some enlargement in the deflection region. The bifurcation of the ducts also showed irregular enlargement, disruption, 607
608
Roentgen&oddities
Fig. 2. Section accessory ducts.
of panoramic
Oral November,
view showing
main and
and stenosis. Each duct presented an appearance of chronic inflammation. Discussion
Radiographically, in a normal submandibular gland Wharton’s duct begins at the vestibule of the mouth and runs in a posteroinferior direction with an increase in its thickness, bending downward in the posterior region of the mouth floor. This deflection site is called the transitional region, and bifurcation begins near this region. The gland is located around it and is defined more sharply than in the parotid gland. In this patient, however, bifurcation began near the orifice of the sublingual papilla and the two ducts ran parallel with each other into the gland, showing an image of arborization.
Fig. 3. Oblique glands.
lateral
view showing
Surg. 1986
two ducts
and
It was difficult to distinguish between the major duct and the accessory one. It seemed more reasonable to consider that this patient had two ducts, but it could not be known definitely whether or not they belonged to one gland. This is a rare case of two ducts appearing in the right submandibular gland. REFERENCE8 1. Rahmathulla M: A rare case of accessory duct in submandibular sialography. J Indian Dent Assoc 45: 563-564, 1973. Shin-ichiro Mori, Tadako Wada, Yoshiyuki Harada. Shoji Toyoshima,
D.D.S., D.D.S., D.D.S., D.D.S.,
D.D.Sc. D.D.Sc. D.D.Sc. D.D.Sc.
ACCESSORY GLAND
DUCT IN THE SUBMANDIBULAR
A
n accessoryparotid gland is often encountered in sialography, and there are many embryologic, morphologic, and clinical reports with respect to this gland. However, an accessoryduct of the mandibular gland is rare, with the only known case being that reported by Rahmathulla’ in 1973. Two Wharton’s ducts were observed when the right submandibular gland of a patient was examined sialographically. The patient was a 73-year-old Japaneseman with the chief complaints of swelling and pain in the right submandibular region. The patient had experienced recurrent swelling in the right submandibular gland and had received antibiotics and antiphlogistics, resulting in disappearance of the swelling. One month after the above treatment the patient was re-examined, and his face was seento be slightly asymmetrical. A diffuse swelling was noted in the right submandibular region, and the skin was mildly red. Two submandibular nodes, which were as large as a small fingertip, were palpated in the right submandibular region. These were movable and tender, but no trismus was noted. Zntruoruljindings. There were tooth stumps in the right mandibular canine and left maxillary incisor regions. The right third molar remained, but other teeth had been lost. Rednessand mild swelling were noted around the sublingual papilla. There were no abnormal findings in the gingiva and intraoral mucosa. Sialography was performed with local anesthesia and injection of 20 ml of 76% Urografin into the right submandibular gland (Figs. 1 to 3). Radiographic findings. The orifice of the right submandibular gland was slightly larger than that of the normal gland, and two Wharton’s ducts running
Fig. 1. Occlusal-view sialogram showing Wharton’s duct and accessoryduct.
in a posteroinferior direction from the vestibule of the mouth were noted in each radiograph. The ducts bent downward and individual bifurcations could be observed within the gland. The two Wharton’s ducts were enlarged, with some constriction and loss of definition in the posterior region and some enlargement in the deflection region. The bifurcation of the ducts also showed irregular enlargement, disruption, 607
608
Roentgen&oddities
Fig. 2. Section accessory ducts.
of panoramic
Oral November,
view showing
main and
and stenosis. Each duct presented an appearance of chronic inflammation. Discussion
Radiographically, in a normal submandibular gland Wharton’s duct begins at the vestibule of the mouth and runs in a posteroinferior direction with an increase in its thickness, bending downward in the posterior region of the mouth floor. This deflection site is called the transitional region, and bifurcation begins near this region. The gland is located around it and is defined more sharply than in the parotid gland. In this patient, however, bifurcation began near the orifice of the sublingual papilla and the two ducts ran parallel with each other into the gland, showing an image of arborization.
Fig. 3. Oblique glands.
lateral
view showing
Surg. 1986
two ducts
and
It was difficult to distinguish between the major duct and the accessory one. It seemed more reasonable to consider that this patient had two ducts, but it could not be known definitely whether or not they belonged to one gland. This is a rare case of two ducts appearing in the right submandibular gland. REFERENCE8 1. Rahmathulla M: A rare case of accessory duct in submandibular sialography. J Indian Dent Assoc 45: 563-564, 1973. Shin-ichiro Mori, Tadako Wada, Yoshiyuki Harada. Shoji Toyoshima,
D.D.S., D.D.S., D.D.S., D.D.S.,
D.D.Sc. D.D.Sc. D.D.Sc. D.D.Sc.