Perception of Risk Among Aesthetic Plastic Surgeons

Background With continuous innovation in plastic surgery, new procedures are constantly being introduced. A number of these procedures are generally safe but have the potential for rare yet serious complications. Many surgeons steer clear of these procedures due to safety concerns. Objectives The aim of this paper was to survey the membership of The Aesthetic Society to elicit perception of risk of several novel or less mainstream procedures. Methods A 24-item survey was sent out to members of The Aesthetic Society. The survey focused on surgeon experience and attitude towards 3 procedures: filler rhinoplasty, gluteal augmentation with fat grafting, and submandibular gland excision. Results In total, 189 completed surveys were returned. Of the responders, 50%, 49%, and 89% of surgeons said they do not perform filler rhinoplasty, gluteal augmentation with fat grafting, or submandibular gland excision in their practices, respectively. The majority of those who do not perform the procedures selected “danger to the patient” as the primary concern for each of the 3 procedures. Surgeons overwhelmingly reported not learning these procedures in training. Additionally, surgeons perceive the risks of more common procedures such as abdominoplasty and breast augmentation-mastopexy to be significantly lower and more acceptable than those of the studied procedures. Conclusions When comparing the perceived complication rates with data published in the literature, particularly when looking at rates of serious or life-threatening complications, plastic surgeons overestimate the risks of procedures with which they are less familiar. This perception of risk, accompanied by the lack of exposure to novel techniques in training, may contribute to surgeons avoiding these procedures.

CLINICOPATHOLOGICAL AUDIT OF SUBMANDIBULAR GLAND SURGERY

Aim:- Aim of this study is to evaluate clinical profile and histopathological findings in patient undergoing submandibular gland excision (due to sialadenitis and primary tumors of submandibular gland benign or malignant). Method:-we carried out retrospective analysis of submandibular gland excisions performed in our hospital over five year period and analysed clinical data and postoperative histopathological findings of excised glands. Results:- In 43 cases of submandibular gland excision main presenting symptom was swelling of submandibular gland (100%). Patients presented with pain 26 (60%), swelling 43 (100%), recurrent swelling 30 (70%), persistent swelling 13 (30%). On palpation, firm consistency was seen in 42 cases (97.67%) and hard consistency in 1 case (2.3%). Swelling was tender in 20 Cases (46.5%) and non tender in 23 cases (53.4%). Most frequent indication of submandibular gland excision was sialadenitis with sialolithiasis (37 patients, 86%). Neoplastic pathology was present in 6 patients (14%). Benign pathology (4 patients, 9.3%) was more common than malignancy (2 patients, 4.7%). Most common benign tumour was pleomorphic adenoma of submandibular gland. Among the malignant tumour 2 cases were identified in histopathogy, one of adenoid cystic carcinoma and 1 of acinic cell carcinoma of submandibular gland. Overall benign/malignant ratio was 2:1.Conclusion:- Inflammatory submandibular gland swelling are mainly enlarged and tender while neolastic swellings are non tender. The most common pathology of the patients undergoing submandibular gland excision was chronic sialadenitis followed by neoplastic Pathology. In neoplastic pathologies benign tumors were more common than malignancy

Surgical Management of Sialorrhea: A Systematic Review and Meta-analysis

Objective Chronic sialorrhea commonly occurs in patients with neurodevelopmental disorders. While conservative management can provide sufficient symptom control, surgical intervention is often required. One of the most common procedures utilized is submandibular gland excision (SMGE), with or without parotid duct ligation or rerouting (PDL or PDR). This study aims to compare these surgical approaches and their outcomes. Data Sources PubMed, Web of Science, and Embase. Review Methods This systematic review includes studies of patients with chronic sialorrhea treated with SMGE alone or SMGE plus PDR or PDL and reports on postintervention outcomes and complications. Two independent investigators assessed study eligibility, rated quality, and extracted data for analysis. A random effects model was used for meta-analysis of pooled data. Results Of 3186 studies identified, 21 met inclusion criteria, with 708 patients: 103 underwent SMGE alone (15%); 299 (42%), SMGE and PDL; and 306 (43%), SMGE plus PDR. Overall, a majority of patients had significant improvement, with very good to excellent control of symptoms after surgery: SMGE, 82% (95% CI, 73%-89%); SMGE and PDL, 79% (95% CI, 73%-85%); and SMGE and PDR, 85% (95% CI, 75%-92%). Importantly, there was no significant difference in outcomes with the addition of PDL or PDR. Reported complications included sialocele, parotitis, dental caries, and dry mouth. Conclusion Our systematic review identified consistent positive outcomes with SMGE for patients with chronic sialorrhea but no additional benefit when PDR or PDL was performed as a concurrent procedure.

Applied Physiology of the Parotid Gland

The major function of salivary glands is the production of saliva, which performs many functions including lubrication of the food bolus, maintaining the oral cavity pH within 6 to 7, maintaining teeth integrity, fighting bacteria, aiding taste and digestion, and providing a continuous lavaging biofilm for the oral cavity. Saliva is actively produced in high volumes relative to the mass of the salivary glands and is almost completely controlled extrinsically by both parasympathetic and sympathetic divisions of the autonomic nervous system. Some researchers used bilateral tympanic neurectomy for patients with ptyalism (drooling) with good initial results. Others advocated bilateral parotid duct rerouting ± bilateral submandibular gland excision for long-term treatment of drooling. Intra-glandular Botulinum toxin may also have good results for patients with hyper-sialorrhea. Most resting salivary gland flow arises from the submandibular glands and surgery should focus on this gland to control uncontrolled sialorrhea.

Synchronous Ipsilateral Pleomorphic Adenomas of Parotid and Submandibular Glands: An Unusual Finding

A rare case of synchronous ipsilateral pleomorphic adenomas (PA) of the left parotid and submandibular glands is reported. Simultaneous multiple PA in major salivary glands are a very rare entity, and merely few cases of ipsilateral synchronous PA involving parotid and submandibular glands are reported in the literature. The case of a 40-year-old female with a six-year history of asymptomatic growing lesion in both left parotid and left submandibular regions is presented. Left superficial parotidectomy and left submandibular gland excision at the same surgery have been performed. The aim of this article is to highlight the importance of an accurate head and neck presurgery examination both clinically and radiologically, keeping in mind the possibility of multiple tumor location.

Schwannoma of the Submandibular Gland

Introduction Mesenchymal tumours of submandibular gland are extremely rare. Schwannoma of the salivary glands is a particularly rare form of an extracranial neurogenic tumour. Case Report Here, we present an unusual case of schwannoma of submandibular gland in a 16 year old girl, who underwent total excision of mass with submandibular gland excision with no cranial nerve deficits. The details of the histopathologic features are present . Discussion Schwannoma of the salivary gland is a particularly rare form of an extracranial neurogenic tumour. Our case indicates good prognosis in a case of submandibular gland schwannoma after surgical excision.