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Accessory salivary gland — Clinical Guidelines

Overview

Accessory salivary glands refer to minor salivary glands distributed throughout the oral cavity and other mucosal surfaces, distinct from the major salivary glands (parotid, submandibular, sublingual). These glands play a crucial role in maintaining oral moisture and comfort but can be involved in various pathological conditions including infections and neoplasms.

Diagnosis

Clinical Examination: Essential for identifying symptoms and physical signs 8 10.

Imaging: Ultrasound is valuable for anatomic identification and assessment of salivary gland lesions 3.

Radionuclide Imaging: Useful in evaluating salivary gland neoplasms, sialadenitis, and sialolithiasis 13.

Fine Needle Aspiration (FNA) Biopsy: Critical for diagnosing salivary gland neoplasms, though accuracy can vary 6 9.

Sialendoscopy: Diagnostic and therapeutic tool for evaluating ductal abnormalities and performing procedures like sialolithotomy 2 4.

Cytopathology: The Milan System for Reporting Salivary Gland Cytopathology provides structured reporting guidelines 5.

Management

Infections: Management of acute suppurative parotitis includes hydration, antibiotics, and supportive care 8.

Neoplasms: Treatment varies by type and stage; includes surgery, radiation, and chemotherapy as indicated 1.

Sialendoscopy: Can be performed under conscious sedation for diagnostic and therapeutic purposes, reducing need for general anesthesia 2 4.

Conservative Management: For minor issues like sialolithiasis, endoscopic procedures can be effective 2.

Follow-Up: Regular monitoring post-treatment is crucial, especially for malignancies 1.

Special Populations

Pediatrics: Salivary gland agenesis can lead to significant oral health issues requiring early intervention 10.

Elderly: Increased risk of complications like acute suppurative parotitis due to comorbid conditions and immunosuppression 8.

Comorbidities: Patients with debilitating conditions or immunosuppression are at higher risk for severe infections 8.

Key Recommendations

Utilize standardized ultrasound views for accurate anatomic identification in resident training to improve diagnostic accuracy 3 (Evidence: Moderate).

Consider sialendoscopy under conscious sedation for minor salivary gland procedures to minimize risks and enhance patient comfort 2 4 (Evidence: Moderate).

Implement structured reporting systems like the Milan System for Salivary Gland Cytopathology to enhance diagnostic consistency and communication 5 (Evidence: Expert opinion).

Regularly monitor patients post-treatment for salivary gland neoplasms to ensure effective management and detect recurrence early 1 (Evidence: Strong).

Address salivary gland agenesis promptly in pediatric patients to prevent severe oral health complications 10 (Evidence: Case series).

References

1 van Herpen C, Vander Poorten V, Skalova A, Terhaard C, Maroldi R, van Engen A et al.. Salivary gland cancer: ESMO-European Reference Network on Rare Adult Solid Cancers (EURACAN) Clinical Practice Guideline for diagnosis, treatment and follow-up. ESMO open 2022. link 2 Badger CD, Benito DA, Joshi AS. Incorporating Sialendoscopy into the Otolaryngology Clinic. Otolaryngologic clinics of North America 2021. link 3 Straughan AJ, Badger CD, Benito DA, Joshi AS. Salivary gland ultrasound training: Improving anatomic identification in residents. American journal of otolaryngology 2020. link 4 Bawazeer N, Carvalho J, Djennaoui I, Charpiot A. Sialendoscopy under conscious sedation versus general anesthesia. A comparative study. American journal of otolaryngology 2018. link 5 Rossi ED, Faquin WC, Baloch Z, Barkan GA, Foschini MP, Pusztaszeri M et al.. The Milan System for Reporting Salivary Gland Cytopathology: Analysis and suggestions of initial survey. Cancer cytopathology 2017. link 6 Schmidt RL, Jedrzkiewicz JD, Allred RJ, Matsuoka S, Witt BL. Verification bias in diagnostic accuracy studies for fine- and core needle biopsy of salivary gland lesions in otolaryngology journals: a systematic review and analysis. Head & neck 2014. link 7 Etit D, Tan A, Bakir K, Cakalagaoglu F, Elagoz S, Elpek GO et al.. Interobserver agreement in salivary gland neoplasms by telepathology: An analysis of 47 cases. Analytical and quantitative cytopathology and histopathology 2013. link 8 Lampropoulos P, Rizos S, Marinis A. Acute suppurative parotitis: a dreadful complication in elderly surgical patients. Surgical infections 2012. link 9 Mosunjac MB, Siddiqui MT, Tadros T. Acinic cell carcinoma-papillary cystic variant. Pitfalls of fine needle aspiration diagnosis: study of five cases and review of literature. Cytopathology : official journal of the British Society for Clinical Cytology 2009. link 10 Heath N, Macleod I, Pearce R. Major salivary gland agenesis in a young child: consequences for oral health. International journal of paediatric dentistry 2006. link 11 Jenzano JW, Su HW, Featherstone GL, Lundblad RL. Molecular diversity of tissue kallikrein in human saliva. Agents and actions. Supplements 1992. link 12 Hamper K, Schmitz-Wätjen W, Mausch HE, Caselitz J, Seifert G. Multiple expression of tissue markers in mucoepidermoid carcinomas and acinic cell carcinomas of the salivary glands. Virchows Archiv. A, Pathological anatomy and histopathology 1989. link 13 Schall GL, Smith RR, Barsocchini LM. Radionuclide salivary imaging usefulness in a private otolaryngology practice. Archives of otolaryngology (Chicago, Ill. : 1960) 1981. link

Accessory salivary gland