The occurrence, clinico-pathological presentation and management of salivary gland diseases at Muhimbili National Hospital, Dar es salaam

Abstract

ABSTRACT Background: Salivary glands are mainly distributed in the head and neck region, with major ones comprising the paired parotid, submandibular and sublingual salivary glands. The minor salivary glands are situated in the palate, lips, cheeks and floor of the mouth. Both major and minor salivary glands are subjected to different diseases. The clinical presentation of salivary gland diseases is complex and mimics several other conditions or they do occur in conjunction with other conditions. Due to this complexity the diagnosis and treatment of these diseases are very variable. Currently little is known on the occurrence and clinico/pathologic presentation of salivary gland diseases and their management in Tanzania. This study aimed at determining the occurrence, clinical and pathologic characteristics of different salivary gland diseases. Objective: The main objective was to determine the occurrence, clinico-pathological presentation and management of salivary gland diseases at Muhimbili National Hospital. Study Design: This was a hospital clinical based cross-sectional prospective study. Setting: The study was conducted at the Oral and Maxillofacial Surgery department at Muhimbili National Hospital (MNH). Methods: All patients who attended at the Oral and Maxillofacial Surgery department were examined and those found with salivary gland diseases were interviewed using a structured questionnaire. Clinical examination and histological/cytological investigations were done. Data including age, sex, location, type of the disease, histological/cytological diagnosis and treatment modality offered were collected and recorded in a special clinical form designed for this study. Patients were treated accordingly depending on the diagnosis and the treatment modalities included surgery, antibiotics, analgesics, radiotherapy and chemotherapy. Data were analyzed using Statistical Package for Social Sciences (SPSS version 15.0) Results: A total of 5174 patients comprised of 2184 (42.2%) males and 2990 (57.8%) females were attended in the department during the study. Out of these, 56 patients consisting of 36 (64.3%) females and 20 (35.7%) males had salivary gland diseases. The male to female ratio was 1:1.8 and the most affected age group was 20-29 years. Pleomorphic adenoma observed in 12 (21.4%) patients was the commonest encountered vii salivary gland tumor, followed by adenocarcinoma in 7 (12.5%) patients, mucoepidermoid carcinoma and adenoid cystic carcinoma in 2 (3.6%) patients each. Ranula detected in 16 (28.6%) patients was the most frequently encountered salivary gland cyst followed by mucocele in 3 (5.3%) patients. The results indicate that, regardless of histopathological diagnosis majority 39 (69.6%) of salivary gland diseases were detected in major salivary glands, and the rest 17 (30.4%) were observed in minor salivary glands. Minor salivary glands were affected mostly by malignant tumors in 8 (47.1%) patients followed by the benign tumors mainly pleomorphic adenoma in 6 (35.3%) and mucoceles in 3 (17.6%) patients. The submandibular gland was mostly affected by sialolithiasis in 9 (56.25%) patients, followed by pleomorphic adenoma in 4 (25%) patients, malignant tumors in 2 (12.5%) and non specific chronic sialoadenitis in 1 (6.25%) patient. The parotid gland was mostly affected by malignant salivary gland tumors in 4 (57.14%) patients and less by pleomorphic adenoma, sialolithiasis and lymphoepithelial cyst each affecting 1 (14.28%) patient. The sublingual gland was mainly affected by ranula. Swelling was the commonest clinical presentation observed in all patients with salivary gland diseases, followed by pain in 15 (26.8%) patients, infection in 7 (12.5%) patients and ulceration in 5 (8.9%) patients. Facial palsy was detected in 2 (3.6%) patients and no patient presented with dry mouth. Conclusion Generally the clinico-pathological presentation of salivary gland diseases seen in this study is similar to other studies. Pleomorphic adenoma is the most common benign salivary gland tumor while adenocarcinoma is the most common malignant tumor and ranula is the most common salivary gland cyst. Majority of salivary gland diseases occurred in major salivary glands similar to other studies. High number of malignant tumors in the parotid salivary gland is contributed by the fact that malignant salivary gland tumors in the parotid gland grow with pain and that is why these are frequently reported unlike the benign salivary gland tumors in the same gland which grow without pain and are likely to present late. Patients with salivary gland tumors presented with advanced lesions. Surgery was the treatment of choice for the majority of conditions. Adjuvant radiotherapy or chemotherapy was given to patients with malignant lesions.