Differential diagnosis of submandibular gland swellings

Abstract:

Objective: The differential diagnosis of submandibular triangle swellings can be challenging to the clinician. In this study, we retrospectively analyzed clinical and histopathological characteristics of these swellings referred to our clinic and integrated our results with current literature in terms of various diagnostic aspects.

Methods: A total number of 64 transcervical submandibular gland extirpations were reviewed and evaluated regarding age, gender, fineneedle aspiration biopsy and specimen reports.

Results: This study comprised 34 male (53.1%) and 30 female (46.9%) patients. We classified submandibular triangle swellings clinicopathologically as tumoral and non-tumoral lesions for better evaluation. We had 15 patients with primary epithelial submandibular gland neoplasm, 10 (66.7%) of them were benign cases, all of the benign cases were pleomorphic adenoma with a male to female ratio of 1:2.33 and a mean age of 30.8 years, 5 (33.3%) of them were malignant with a mean age of 55 years. There were also 37(57.8%) patients with chronic sialadenitis associated with sialolithasis, 1 (1.6%) had acute sialedenitis, 2 (3.1%) had granulomatous sialadenitis, 2 (3.1%) had reactive cervical lymphadenopathy and 5 (7.8%) were treated for cystic lesion removal. Ultrasonography and fine needle aspiration cytology were our major diagnostic tools for differential diagnosis. Our institution’s sensitivity of fine-needle aspiration cytology for identifying malignancy was 60% and the specificity was 100%.

Conclusion: Submandibular gland excision for primary lesions has relatively low incidence compared with other surgical implications. Although chronic sialadenitis caused by symptomatic sialolithiasisis the most frequent indication for surgery, diverse clinical entities should be ruled out for differential diagnosis of swellings of this region.