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Clinical and histopathologic characteristics of submandibular gland in Stevens-Johnson syndrome: A comparative study

  • Yi-Ping Wang
    Affiliations
    Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
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  • Jia-Zeng Su
    Affiliations
    Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
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  • Zhi-Peng Sun
    Affiliations
    Department of Oral Radiology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
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  • Kyungpyo Park
    Affiliations
    Department of Physiology, School of Dentistry, Seoul National University, Oromaxillofacial Dysfunction Research Center for the Elderly(ODRCE), Seoul, Korea
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  • Sang-Woo Lee
    Affiliations
    Department of Physiology, School of Dentistry, Seoul National University, Oromaxillofacial Dysfunction Research Center for the Elderly(ODRCE), Seoul, Korea
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  • Zhi-Gang Cai
    Affiliations
    Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
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  • Xiao-Jing Liu
    Affiliations
    Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
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  • Yan Gao
    Affiliations
    Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
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  • Lei Zhang
    Correspondence
    Reprint requests: Lei Zhang Department of Oral and Maxillofacial SurgeryPeking University School of Stomatology22 Zhongguancun South StreetBeijing 100081China
    Affiliations
    Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
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  • Guang-Yan Yu
    Correspondence
    Reprint requests: Lei Zhang Department of Oral and Maxillofacial SurgeryPeking University School of Stomatology22 Zhongguancun South StreetBeijing 100081China
    Affiliations
    Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
    Search for articles by this author
Published:September 18, 2021DOI:https://doi.org/10.1016/j.oooo.2021.09.005

      Objective

      The objective of this study was to investigate the clinical manifestations and pathologic appearances of the submandibular gland (SMG) in Stevens-Johnson syndrome (SJS).

      Study Design

      Patients with autologous transplantation of SMG for treatment of severe dry eye between March 1998 and May 2018 were divided into the SJS group (70 cases) and non-SJS group (50 cases) according to the history of SJS. The SMG weight and computed tomography volume and salivary flow rate were measured. The concentration index and secretion index were estimated using scintigraphy with technetium-99m-pertechnetate. Histopathology studies of SMG tissues were conducted, and the acini parameters were measured using a digital image analyzer.

      Results

      A decreased computed tomography volume and weight was observed in 48.57% the SJS group and 2% in the non-SJS group (P < .01). The rest whole, acid-stimulated whole, and SMG rest salivary flow rates decreased in the SJS group (P < .05). The normal SMG concentration index (37.5% vs 96.67%, P < .001) and secretion index (35% vs 96.67%, P < .001) rates were lower in the SJS group than in the non-SJS group. The glandular parenchyma was reduced, the acinar space was widened, and the fat content was increased in the SJS group.

      Conclusion

      SMG atrophic and degenerative changes occurred in the SJS group, with a decrease in salivary secretion function in more than half of the patients.
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      References

        • Stevens A
        • Johnson F.
        A new eruptive fever associated with stomatitis andophthalmia: report on two cases in children.
        Am J Dis Child. 1922; 24: 526-533
        • Lyell A.
        Toxic epidermal necrolysis: an eruption resembling scalding of the skin.
        Br J Dermatol. 1956; 68: 355-361
        • Bastuji-Garin S
        • Rzany B
        • Stern RS
        • et al.
        Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme.
        Arch Dermatol. 1993; 129: 92-96
        • Lerch M
        • Mainetti C
        • Terziroli Beretta-Piccoli B
        • et al.
        Current perspectives on Stevens-Johnson syndrome and toxic epidermal necrolysis.
        Clin Rev Allergy Immunol. 2018; 54: 147-176
        • Roujeau JC
        • Phlippoteau C
        • Koso M
        • et al.
        Sjögren-like syndrome after drug-induced toxic epidermal necrolysis.
        Lancet. 1985; 1: 609-611
        • Sotozono C
        • Ueta M
        • Yokoi N.
        Severe dry eye with combined mechanisms is involved in the ocular sequelae of SJS/TEN at the chronic stage.
        Invest Ophthalmol Vis Sci. 2018; : 59
        • Singh S
        • Narang P
        • Vashist U
        • et al.
        Histomorphological changes in lachrymal glands of patients with chronic Stevens-Johnson syndrome.
        Cornea. 2019; 38: p39-e40
        • Chosidow O
        • el Wady Z
        • Devanlay M
        • et al.
        Hyperamylasemia in toxic epidermal necrolysis.
        Arch Dermatol. 1993; 129: 792-793
        • Zhu ZH
        • Yu GY
        • Zhou LH
        • et al.
        Drug allergy induced salivary and lacrimal diseases: clinical analysis of 25 cases.
        Zhonghua Yi Xue Za Zhi. 2005; 85: 422-423
        • Bachot N
        • Roujeau JC.
        Differential diagnosis of severe cutaneous drug eruptions.
        Am J Clin Dermatol. 2003; 4: 561-572
        • Dodiuk-Gad RP
        • Chung WH
        • Valeyrie-Allanore L
        • et al.
        Stevens-Johnson syndrome and toxic epidermal necrolysis: an update.
        Am J Clin Dermatol. 2015; 16: 475-493
        • Zhang L
        • Su JZ
        • Cai ZG
        • et al.
        Factors influencing the long-term results of autologous microvascular submandibular gland transplantation for severe dry eye disease.
        Int J Oral Maxillofac Surg. 2019; 48: 40-47
        • Heo MS
        • Lee SC
        • Lee SS
        • et al.
        Quantitative analysis of normal major salivary glands using computed tomography.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 92: 240-244
        • Marten K
        • Auer F
        • Schmidt S
        • et al.
        Inadequacy of manual measurements compared to automated CT volumetry in assessment of treatment response of pulmonary metastases using RECIST criteria.
        Eur Radiol. 2006; 16: 781-790
        • Li W
        • Sun ZP
        • Liu XJ
        • et al.
        Volume measurements of human parotid and submandibular glands.
        Beijing Da Xue Xue Bao Yi Xue Ban. 2014; 46: 288-293
        • Wang Z
        • Shen MM
        • Liu XJ
        • et al.
        Characteristics of the saliva flow rates of minor salivary glands in healthy people.
        Arch Oral Biol. 2015; 60: 385-392
        • Navazesh M.
        Methods for collecting saliva.
        Ann N Y Acad Sci. 1993; 694: 72-77
        • Wolff A
        • Begleiter A
        • Moskona D.
        A novel system of human submandibular/sublingual saliva collection.
        J Dent Res. 1997; 76: 1782-1786
        • Zhang L
        • Zhu ZH
        • Dai HJ
        • et al.
        Application of 99mTc-pertechnetate scintigraphy to microvascular autologous transplantation of the submandibular gland in patients with severe keratoconjunctivitis sicca.
        J Nucl Med. 2007; 48: 1431-1435
        • Li W
        • Chen Y
        • Sun ZP
        • et al.
        Clinicopathological characteristics of immunoglobulin G4-related sialadenitis.
        Arthritis Res Ther. 2015; 17: 186
        • García HF
        • García-Poblete E
        • Moro-Rodríguez E
        • et al.
        Histomorphometrical study of the submandibular gland ductal system in the rat.
        Histol Histopathol. 2002; 17: 813-816
        • Carranza M
        • Ferraris ME
        • Galizzi M.
        Structural and morphometrical study in glandular parenchyma from alcoholic sialosis.
        J Oral Pathol Med. 2005; 34: 374-379
        • Wang YP
        • Cai ZG
        • Peng X
        • et al.
        Measurement of the weight and volume of submandibular gland in vitro.
        Beijing Da Xue Xue Bao Yi Xue Ban. 2020; 53: 126-132
        • Dawes C
        • Wood CM.
        The contribution of oral minor mucous gland secretions to the volume of whole saliva in man.
        Arch Oral Biol. 1973; 18: 337-342