Abstract
Mucoceles are common lesions of minor salivary glands. Mucoceles of the major salivary glands including the submandibular gland are extremely rare, but should be considered in the differential diagnosis of submandibular space swellings. We present a rare case of a 25-year old man, who was diagnosed with a submandibular gland mucocele and had a history of sialolithiasis and intraductal sialolith excision, as well as numerous evacuating punctures and needle aspirations of the mass. The cyst was surgically excised and the specimen included the sublingual gland, in order to prevent recurrence. No postoperative complications were noted.
1
Introduction
Mucoceles are common lesions of the minor salivary glands, however they rarely occur in major salivary glands. They usually appear as a lateral cervical swelling and their differential diagnosis from other neck masses can be at times difficult, even with the use of imaging diagnostic modalities. We report an uncommon case of a mucocele, whose origin from the submandibular gland was confirmed intraoperatively.
2
Case reports
A 25-year-old man referred to the ear nose and throat (ENT) department complaining of a swelling in the right submandibular space, present for at least 6 weeks. Fluctuation of its size was reported, without any mechanical symptoms. Patient’s history included the removal of an intraductal sialolith of the ipsilateral submandibular gland under local anesthesia and an episode of sialadenitis 20 months previously, for which he had received antibiotic and anti-inflammatory drugs. He had also undergone needle aspirations of the cystic lesion in the previous 4 weeks.
Physical examination revealed a soft, painless, cystic mass, 8 cm in size, extending posteriorly from the right angle of the mandible to the midline anteriorly.
Computerized tomography (CT) scan with contrast showed a well defined “hourglass” shaped cystic mass 8.5 cm × 4.3 cm in the right submandibular space, extending from the base of the tongue to the larynx. The radiographic “tail-sign”, diagnostic of a sublingual plunging ranula, was present ( Fig. 1 ).
Surgical exploration through a submandibular collar incision region was performed. Intraoperatively a cystic mass emanating from the atrophic right submandibular gland was uncovered, in association with the deeper part of the sublingual gland ( Fig. 2 ). The cyst was removed in continuity with the submandibular and the sublingual glands, protecting adjacent vital structures as the lingual, the hypoglossal and the facial nerves from damage.
Histopathologic analysis confirmed the origin of the cyst from the submandibular gland, excluded malignancy and showed degenerative atrophy with chronic inflammation of the submandibular gland, namely sialoadenitis due to sialolithiasis. The patient had an uneventful recovery and was discharged 3 days after the surgery and remains without any recurrence 12 months postoperatively.
2
Case reports
A 25-year-old man referred to the ear nose and throat (ENT) department complaining of a swelling in the right submandibular space, present for at least 6 weeks. Fluctuation of its size was reported, without any mechanical symptoms. Patient’s history included the removal of an intraductal sialolith of the ipsilateral submandibular gland under local anesthesia and an episode of sialadenitis 20 months previously, for which he had received antibiotic and anti-inflammatory drugs. He had also undergone needle aspirations of the cystic lesion in the previous 4 weeks.
Physical examination revealed a soft, painless, cystic mass, 8 cm in size, extending posteriorly from the right angle of the mandible to the midline anteriorly.
Computerized tomography (CT) scan with contrast showed a well defined “hourglass” shaped cystic mass 8.5 cm × 4.3 cm in the right submandibular space, extending from the base of the tongue to the larynx. The radiographic “tail-sign”, diagnostic of a sublingual plunging ranula, was present ( Fig. 1 ).
Surgical exploration through a submandibular collar incision region was performed. Intraoperatively a cystic mass emanating from the atrophic right submandibular gland was uncovered, in association with the deeper part of the sublingual gland ( Fig. 2 ). The cyst was removed in continuity with the submandibular and the sublingual glands, protecting adjacent vital structures as the lingual, the hypoglossal and the facial nerves from damage.
