Salivary gland cysts

Cystic lesions most often occur in the minor salivary glands, less often in the parotid and submandibular glands. The provoking factor may be trauma to the gland duct, leading to its atresia and accumulation of contents. The accumulation, increasing, presses on the walls of the cavity, increasing the cavity of the salivary gland cyst.

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Symptoms

In small glands located in the submucosal tissue of the lips, cheeks, sublingual region, the formed cystic formations appear as a clearly delimited formation that has an elastic consistency upon palpation, and their contents are felt under the fingers. Under the influence of trauma during eating, when biting the mucous membrane, a salivary gland cyst can be emptied with the release of a mucous transparent secretion. Subsequently, the cystic cavity is again filled with contents, and cicatricial changes in the form of whitish spots are formed on the mucous membrane of its surface. After trauma, especially chronic, retention cysts of the salivary glands can become inflamed; when collateral edema is formed in the circumference, the mucous membrane turns red, and pain is felt upon palpation.

Parotid salivary gland cyst

The presence of a limited formation of soft elastic consistency in the thickness of the gland is characteristic. The formation can be located in the superficial or deep parts of the gland. The skin above the gland and the cyst enclosed in it has a normal color, freely gathers into a fold. In the oral cavity, the outlet is of normal shape, from which saliva of normal color and consistency is released.

Diagnosis is based on clinical data, and in case of deep localization in the thickness of the gland - on data from a cytological examination of the puncture material.

Histologically, the membrane has a connective tissue base on the outside and is lined with stratified squamous epithelium on the inside. The contents of the salivary gland cyst are represented by a mucous fluid with separate inclusions of thicker mucus.

Cystic formations should be differentiated from adenoma, branchiogenic cyst of the salivary glands and other tumors originating from connective tissue.

Treatment is surgical. The cystic formation is removed. If it is located in the superficial parts of the parotid gland, it is removed by external access, taking into account the location of the trunk and branches of the trigeminal nerve. If it is localized in the lower pole of the gland, removal is performed by access from the submandibular triangle. If it is located deep in the thickness of the parotid salivary gland, surgical access depends on the size of the cyst. If it is small and palpated under the mucous membrane, enucleation by intraoral access with mandatory fixation of the duct is possible. If it is large, external access is used. It is quite difficult to dissect the branches of the facial nerve when approaching the cyst. In all cases, the cyst is removed with the adjacent fragment of the gland parenchyma.

The prognosis is favorable. In some cases, when localized in the deep sections of the gland, injury to the middle branches of the facial nerve is possible, and then the innervation of individual facial muscles is disrupted, creating aesthetic disorders. The patient should be warned about this before the operation.

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Submandibular salivary gland cyst

The presence of a soft, limited formation in the thickness of the submandibular salivary gland is characteristic. If the cystic formation is large, its upper section extends through the gap of the mylohyoid muscle into the sublingual region, manifesting itself as a bulge. The bulge is covered with a thinned mucous membrane. Saliva of normal color and consistency is secreted from the duct.

Diagnosis and differential diagnosis are based on clinical data, cytological studies and, in some cases, on sialography data with a contrast agent. When diagnosing, it is necessary to bimanually palpate the cyst to differentiate it from a cyst of the sublingual salivary gland. It is also necessary to differentiate from other tumors originating from soft tissues (lipomas, hemangiomas, lymphangiomas, etc.). The results of puncture, sialography and radiographic contrast study of the cystic formation are considered fundamental.

The treatment is surgical and involves removing the salivary gland cyst together with the submandibular gland. Certain complications may arise when removing a cystic formation that grows into the sublingual region. In such cases, a method is used to isolate part of the gland by access from the oral cavity and, having separated it from the adjacent tissues, shift it to the submandibular region. Having sutured the wound in the sublingual region, at the second stage, the cystic formation together with the gland is removed by access from the submandibular region.

The prognosis is favorable.

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Sublingual salivary gland cyst (so-called ranula of the salivary glands)

A salivary gland cyst originates from the sublingual salivary gland and is localized in the anterior part of the sublingual region. During clinical examination, a round or oval firm bulge covered with a thinned mucous membrane, often transparent and sometimes bluish, is determined in the sublingual region. As the cystic formation grows, it spreads to the distal parts of the sublingual space, creating difficulties in eating and talking. Palpation of the formation establishes fluctuation due to the swaying of the contents of the salivary gland cyst. If there is a layer of connective tissue above the membrane of the cystic formation, it has an elastic consistency. Quite often, especially with significant sizes, its membrane breaks through with the outpouring of mucous contents. The salivary gland cyst collapses and gradually refills with secretion and can spread from the sublingual region through a gap in the mylohyoid muscle down into the submandibular triangle, forming an hourglass-shaped figure.

The diagnosis is based on the clinical picture and, if the cystic formation was emptied during the examination, on the study of its contents and cytology data.

Microscopically, the salivary gland cyst membrane is granulation and fibrous tissue originating from the interlobular connective tissue layers of the gland. The inner lining also consists of fibrous tissue, but there may be areas covered by cubic or columnar epithelium.

Differential diagnostics are performed with a cyst of the submandibular gland, using bimanual palpation, sialography. Also differentiated from hemangioma, lymphangioma, dermoid cyst of the salivary glands.

The treatment is surgical. The cystic formation is excised, very carefully separating the membrane from the mucous membrane. The duct of the submandibular salivary gland should be fixed on a salivary probe. Having isolated the cyst, it is removed together with the sublingual gland. The wound is sutured layer by layer. In case of growth of the salivary gland cyst beyond the sublingual space, first the lower part of the cystic formation is separated by access from the submandibular triangle and excised. The remaining part of the cyst and the sublingual gland are separated by access from the oral cavity. The wound is sutured. A polyvinyl catheter is left in the duct for 1-3 days.

The prognosis is favorable.

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Diagnostics

Salivary gland cysts are diagnosed based on the characteristic clinical picture.

A retention cyst is differentiated from tumors. The latter have a dense consistency, their surface is often bumpy, and they are mobile upon palpation. Morphologically, the membrane of a cystic formation is represented by connective tissue, often denser and fibrous in places. The inner surface is lined with stratified squamous epithelium. In some cases, the inner epithelial lining is represented by connective tissue.

The treatment is surgical and consists of enucleating the cystic formation. Two semi-oval converging incisions are made through the mucous membrane on the bulging outer surface of the formation. The mucous membrane section is carefully fixed with a "mosquito", the membrane of the cystic formation is separated from the adjacent tissues. If individual minor salivary glands are adjacent to the membrane of the cystic formation, they are removed by blunt dissection together with the cystic formation. The edges of the wound are brought together and fixed with sutures, using either chromic catgut or polyamide thread. If the size of the salivary gland cyst reaches 1.5-2 cm in diameter, it may be necessary to apply immersion sutures from thin catgut to better bring the edges of the wound together and then sutures on the mucous membrane. When applying immersion sutures with a needle, only the loose submucosal base should be fixed and the glands should not be injured, which may lead to a relapse of the cystic formation. If the technique for removing a retention cyst of the salivary glands is incorrect, its membrane may rupture, which will complicate its complete excision and may also be the cause of a relapse.

The prognosis is favorable.

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