Ectopic sublingual glands

Ectopic sublingual glands Report

of a case

Jerome Friedman, D.D.S., Philadelphia, Pa.

I

n a survey of the literature no cases of a sublingual gland within the confines of the mandible itself were found to have been reported. Nor has there been reported a case in which aberrant salivary gland tissue has been located in or near the midline of the mandible. Amaral and Jacobs1 state that there have been reported traumatic cysts of the mandible which, in reality, were lobes of submaxillary gland lodged therein. Richard and Ziskind2 found a defect in the mandibular left canine and premolar area but could not demonstrate surgically that this was associated with any salivary gland. Thoma,3 reports that Carmalt, in 1913, showed many accessory and secondary glands present, especially relative to the submaxillary system. Aberrant glands are similar to secondary glands but are located a greater distance from the main gland. Such glands may be found on the side of the mandible near the lower border. The ectopic placement of the gland is probably an inclusion phenomenon, although in the case reported here it appears that erosion played a large part in its location. Surgical intervention is usually not necessary if the cavity can be shown to represent normal gland tissue. Sialography is one method that can be used for the differential diagnosis. Microscopic study of the tissue will give a definite diagnosis. CASE

REPORT

A 54.year-old man ration of the mandible procedure. Clinical

was referred to me for extraction of the remaining for a prosthesis. The patient was admitted to the

teeth and prepahospital for this

examination

Some crepitus was found to be present labially in the region of the mandibular central and lateral incisors. All of the remaining teeth were vital, with the exception retained root of the mandibular right first premolar. The results of a physical examination and laboratory studies were within normal

right of the limits.

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Volume Number

Ectopic

18 2

Roentgenographic

sublingual

glands

221

examination

A fairly well circumscribed area of translucency was found in the region of the anterior mandible, extending from the right canine to the left canine (Figs. 1 and 2). A granulomatous area was found surrounding the apex of the mandibular right first premolar, but it was not connected with the other area described. Procedure

Under general anesthesia, the patient’s remaining mandibular teeth were extracted. The mucoperiosteum was reflected from premolar to premolar. In the area of the central and right lateral incisors the bone was found to be extremely thinned, and a bluish capsule was found to have eroded through the labial plate. The thinned labial cortical plate was removed and the mass of tissue, which appeared glandular, was exposed. A specimen was obtained and sent to the Pathology Department for a frozen section report. The region of the mandible in which the mass was contained was explored. The lingual plate was found to be eroded completely from the right to the left canine areas. Both sublingual glands were found to be encapsulated. They were, in turn, removed from the bony cavity and pushed lingually to their normal positions. The bony cavity was packed with Gelfoam. The granuloma in the region of the mandibular right first premolar was removed. The bony edges were smoothed

Fig. 9. Photomicrograph scattered

serous

cells

are

showing specimen to consist found throughout. (Magnification,

mostly x200;

of mucous cells. reduced M.)

A

few

Pathology

report

The frozen section showed chronic inflammatory glandular tissue. The permanent paraffin section was found t,o consist of a salivary gland typ(b with some chronic inflammatory fibrosis associated with the glandular structure,. The diagnosis was chronic inflammatory salivary gland tissue (Fig. 3). Postoperative

The sublingual

of tissue

course

patient was discharged glands appeared to

the day after be functioning

the surgical normally.

procedure

was

performed.

Both

SUMMARY The purpose of this article is to report an interesting cast in which the sublingual glands eroded the lingual plate of the mandible and located themselves within its confines. No surgical intervention other than the exploratory procedure performed was deemed necessary. Microscopic examination offers the only definite means of diagnosis. REFERENCES

1. Amaral, W. J., and Jacobs, D. S.: Aberrant Salivary Gland Defect in Mandible; Report of a Case, ORAL SURG., OUL MED. & ORAL PATH. 14: 748-752, 1961. 2. Richard, E. L., and Ziskind, J.: Aberrant Salivary Gland Tissue in Mandible; ORAL SURG., ORAL MED. & ORAL PATH. 10: 1086-1090, 1957. 3. Thoma, K. H.: Oral Pathology, St. Louis, 1954, The C. V. Mosby Company, p. 1141. 4. Thoma, K. H.: A Contribution to the Knowledge of the Development of the Submaxillary and Sublingual Salivary Glands, J. D. Res. 1: 95, 1919.