Idiopathic hyperplasia of the sublingual gland in a partially edentulous individual; A case report

Abstract

Background: Salivary glands swellings are frequently encountered in the dental clinic. Their causes include but not limited to neoplasm, infection, stone, and inflammation. Sublingual salivary gland enlargements are commonly caused by ranula, while neoplasms rarely occur and if found they tend to be malignant. Another cause is idiopathic hyperplasia of the sublingual gland (IHSG), which is characterized as asymptomatic swelling of unknown cause, protrude from the mouth floor with normal appearance of the overlying mucosa. The one factor found to be associated with these enlargements is the absence of mandibular posterior teeth. Although IHSG is a relatively frequent condition, to the authors’ knowledge only a few related studies were found in the literature. Case description: A 61 years old male patient presented with a complaint of a swelling at the floor of the mouth. It was painless, asymptomatic and noticed by the patient for two years with unremarkable size changes. Examination revealed a lobulated swelling, mobile, non-ulcerated, sessile and arising from the left sublingual gland. No lymphadenopathy was observed. The left side of the mandible presented with missing molars. Panoramic radiographs examination was unremarkable. Contrast-enhanced CT scan showed asymmetric hypodensity at the mouth floor, just lateral to the left geniohyoid muscle. With ranula as a tentative diagnosis, we planned to perform marsupialization and the procedure carried out under local anesthesia. Exposure of the tissue revealed a lobulated mass, mimics the appearance and texture of typical salivary gland tissue. An incisional biopsy was obtained. Microscopic examination of the tissue revealed a normal appearing mucous and serous salivary glandular lobules while part of the specimen was characterized by the presence of fibrosis and inflammation with preservation of the main ductal structure. On follow-up appointments, the swelling was asymptomatic without changes. After correlation between the histopathological and the clinical presentation, a decision made to keep the patient with no intervention unless symptoms arise or swelling progress then surgical excision is indicated. Clinical implication: The present case was reported to highlight a variation in sublingual gland swellings. Recognition of such cases is vital to avoid unnecessary investigations and misdiagnosis or invasive surgical approaches.