Idiopathic submandibular sialoceles in the neck

Abstract

A submandibular sialocele is a subcutaneous cavity containing saliva. The clinical and radiologic features of 3 patients with an idiopathic submandibular sialocele are presented. All 3 patients were males in their twenties. Submandibular sialocele presents as a soft cystic and compressible neck mass, with no history of previous trauma or diseases of the salivary gland. Computed tomography (CT) of the neck revealed a homogenous lesion with enhancing rim. The lesion appeared to be insinuating into the surrounding tissue. Excision of the sialocele, leaving the submandibular gland intact, was performed for the first patient. Recurrence of a neck mass occurred after 4 months. Complete excision of the sialocele with associated submandibular gland was subsequently performed. There was no recurrence after a follow-up period of 3 years. Excision of gland and sialocele was performed for the other 2 patients. There was no recurrence after a follow-up of 2 years and 10 months, respectively.

Modern management and pathophysiology of ranula: Literature review

“…This operation was more successful in dog than in human, with 9 of 12 excisions successful in dog 74,88 and only 5 of 28 excisions successful in human. 7,15,19,22,29,49,58,59,65,75,76 The greater success in dog probably relates to the anatomy because the posterior part of the sublingual gland is within the capsule of the submandibular gland, from which the anterior part of the sublingual gland extends anteriorly. 43 Thus part or all of the sublingual gland is likely to have been removed with the submandibular gland in dog.…”

“…43 Thus part or all of the sublingual gland is likely to have been removed with the submandibular gland in dog. Another important factor in the successful excisions of the submandibular gland is the postoperative fibrosis that could fortuitously seal the leak from the sublingual gland, particularly given that 4 of the 5 successful excisions in human involved extensive dissection of the ranula to remove it, 58,76 which would almost certainly have involved the origin from the sublingual gland.…”

“…7,19,29,43,47,49,[59][60][61]63,65,[74][75][76] The greater success with oral ranulas probably relates to the involvement in the dissection of the precise source of these ranulas, which was found by McGurk et al 13 in every case to be a ruptured duct of Rivinus. However, removal of the ranula itself is essentially unnecessary because it consists of mucus contained by inflamed granulation tissue, which will eventually disappear.…”

“…58,70,72,73,76 This is in spite of the experimental and clinical evidence that the secretory force of the submandibular gland is insufficient to overcome the opposing effect of the macrophages and granulation and fibrous tissue to produce persistent extravasation, and that the secretory flow from the submandibular gland is not continuous, as in the sublingual gland, but occurs only on stimulation, which is particularly gustatory. Thus, although damage to the submandibular gland may be followed by extravasation, the submandibular swelling is gustatory and does not persist, and the gland may eventually become functionless because of obstruction from fibrosis.…”

Iatrogenic salivary duct injury in head and neck cancer patients: report of four cases and review of the literature

“…There is no consensus regarding the management of sialocele. There have been described different approaches such as percutaneous needle aspiration, pressure dressings, antisialogogue therapy, or radiotherapy, botulinum toxin and surgical approaches as duct repair, diversion, ligation, different drainage systems and even parotidectomy/submaxilectomy (4,5,6). The skin incision and drainage are often unsuccessful because of the recurrence of accumulation of fluid (1).…”