Morphology and morphometry of the human sublingual glands in mouth floor enlargements of edentulous patients
Identifieur interne : 002F79 ( Pmc/Corpus ); précédent : 002F78; suivant : 002F80Morphology and morphometry of the human sublingual glands in mouth floor enlargements of edentulous patients
Auteurs : Josiane Costa Rodrigues De Sá ; Elen De Souza Tolentino ; Luciana Reis Azevedo-Alanis ; Liogi Iwaki Filho ; Vanessa Soares Lara ; José Humberto DamanteSource :
- Journal of Applied Oral Science [ 1678-7757 ] ; 2013.
Abstract
Asymptomatic mouth floor enlargements may be observed in edentulous patients. These masses, which protrude from the mouth floor, may complicate the fitting of dentures and require surgery. Whether this "entity" may be considered an anatomical variation of the mouth floor or represent specific alterations in the sublingual gland is not known.
The aim of this work is to investigate the morphological and morphometric aspects of the sublingual glands of edentulous patients with mouth floor enlargements and compare the glands of these patients with the sublingual glands of human cadavers.
Microscopic evaluation was performed on human sublingual glands from edentulous patients with mouth floor enlargements (n=20) and edentulous cadavers (n=20). The patients and cadavers were of similar ages. The data were compared using Mann-Whitney U, Fisher's exact and Student's t tests (p<0.05).
Acinar atrophy, duct-like structures, mononuclear infiltrates, replacement of parenchyma with fibrous/adipose tissue, mucous extravasation and oncocytosis were similar between the groups (p>0.05). Only the variables "autolysis" and "congested blood vessels" presented statistical difference between groups (p=0.014; p=0.043). The morphometric study revealed that the volume densities of acini, ducts, stroma and adipose tissue were similar between the groups (p>0.05).
The microscopic characteristics of the sublingual glands in mouth floor enlargements in edentulous patients correspond to characteristics associated with the normal aging process. The glands are not pathological and represent an age-related alteration that occurs with or without the presence of the mouth floor enlargements.
Url:
DOI: 10.1590/1679-775720130342
PubMed: 24473720
PubMed Central: 3891278
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Morphology and morphometry of the human sublingual glands in mouth floor
enlargements of edentulous patients</title><author><name sortKey="De Sa, Josiane Costa Rodrigues" sort="De Sa, Josiane Costa Rodrigues" uniqKey="De Sa J" first="Josiane Costa Rodrigues" last="De Sá">Josiane Costa Rodrigues De Sá</name><affiliation><nlm:aff id="aff01"> Aeronautical Central Hospital. Rio de Janeiro, RJ, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Tolentino, Elen De Souza" sort="Tolentino, Elen De Souza" uniqKey="Tolentino E" first="Elen De Souza" last="Tolentino">Elen De Souza Tolentino</name><affiliation><nlm:aff id="aff02"> Department of Dentistry, Maringá State University, Maringá, PR, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Azevedo Alanis, Luciana Reis" sort="Azevedo Alanis, Luciana Reis" uniqKey="Azevedo Alanis L" first="Luciana Reis" last="Azevedo-Alanis">Luciana Reis Azevedo-Alanis</name><affiliation><nlm:aff id="aff03"> Departament of Dentistry, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Iwaki Filho, Liogi" sort="Iwaki Filho, Liogi" uniqKey="Iwaki Filho L" first="Liogi" last="Iwaki Filho">Liogi Iwaki Filho</name><affiliation><nlm:aff id="aff02"> Department of Dentistry, Maringá State University, Maringá, PR, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Lara, Vanessa Soares" sort="Lara, Vanessa Soares" uniqKey="Lara V" first="Vanessa Soares" last="Lara">Vanessa Soares Lara</name><affiliation><nlm:aff id="aff04"> Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Damante, Jose Humberto" sort="Damante, Jose Humberto" uniqKey="Damante J" first="José Humberto" last="Damante">José Humberto Damante</name><affiliation><nlm:aff id="aff04"> Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24473720</idno><idno type="pmc">3891278</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891278</idno><idno type="RBID">PMC:3891278</idno><idno type="doi">10.1590/1679-775720130342</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">002F79</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002F79</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Morphology and morphometry of the human sublingual glands in mouth floor
enlargements of edentulous patients</title><author><name sortKey="De Sa, Josiane Costa Rodrigues" sort="De Sa, Josiane Costa Rodrigues" uniqKey="De Sa J" first="Josiane Costa Rodrigues" last="De Sá">Josiane Costa Rodrigues De Sá</name><affiliation><nlm:aff id="aff01"> Aeronautical Central Hospital. Rio de Janeiro, RJ, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Tolentino, Elen De Souza" sort="Tolentino, Elen De Souza" uniqKey="Tolentino E" first="Elen De Souza" last="Tolentino">Elen De Souza Tolentino</name><affiliation><nlm:aff id="aff02"> Department of Dentistry, Maringá State University, Maringá, PR, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Azevedo Alanis, Luciana Reis" sort="Azevedo Alanis, Luciana Reis" uniqKey="Azevedo Alanis L" first="Luciana Reis" last="Azevedo-Alanis">Luciana Reis Azevedo-Alanis</name><affiliation><nlm:aff id="aff03"> Departament of Dentistry, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Iwaki Filho, Liogi" sort="Iwaki Filho, Liogi" uniqKey="Iwaki Filho L" first="Liogi" last="Iwaki Filho">Liogi Iwaki Filho</name><affiliation><nlm:aff id="aff02"> Department of Dentistry, Maringá State University, Maringá, PR, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Lara, Vanessa Soares" sort="Lara, Vanessa Soares" uniqKey="Lara V" first="Vanessa Soares" last="Lara">Vanessa Soares Lara</name><affiliation><nlm:aff id="aff04"> Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Damante, Jose Humberto" sort="Damante, Jose Humberto" uniqKey="Damante J" first="José Humberto" last="Damante">José Humberto Damante</name><affiliation><nlm:aff id="aff04"> Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Applied Oral Science</title><idno type="ISSN">1678-7757</idno><idno type="eISSN">1678-7765</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Asymptomatic mouth floor enlargements may be observed in edentulous patients. These
masses, which protrude from the mouth floor, may complicate the fitting of dentures
and require surgery. Whether this "entity" may be considered an anatomical variation
of the mouth floor or represent specific alterations in the sublingual gland is not
known. </p><sec><title>Objective</title><p>The aim of this work is to investigate the morphological and morphometric aspects
of the sublingual glands of edentulous patients with mouth floor enlargements and
compare the glands of these patients with the sublingual glands of human cadavers.
</p></sec><sec><title>Material and Methods</title><p>Microscopic evaluation was performed on human sublingual glands from edentulous
patients with mouth floor enlargements (n=20) and edentulous cadavers (n=20). The
patients and cadavers were of similar ages. The data were compared using
Mann-Whitney U, Fisher's exact and Student's t tests (p<0.05). </p></sec><sec><title>Results</title><p>Acinar atrophy, duct-like structures, mononuclear infiltrates, replacement of
parenchyma with fibrous/adipose tissue, mucous extravasation and oncocytosis were
similar between the groups (p>0.05). Only the variables "autolysis" and
"congested blood vessels" presented statistical difference between groups
(p=0.014; p=0.043). The morphometric study revealed that the volume densities of
acini, ducts, stroma and adipose tissue were similar between the groups
(p>0.05). </p></sec><sec><title>Conclusion</title><p>The microscopic characteristics of the sublingual glands in mouth floor
enlargements in edentulous patients correspond to characteristics associated with
the normal aging process. The glands are not pathological and represent an
age-related alteration that occurs with or without the presence of the mouth floor
enlargements.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Azevedo, Lr" uniqKey="Azevedo L">LR Azevedo</name></author><author><name sortKey="Damante, Jh" uniqKey="Damante J">JH Damante</name></author><author><name sortKey="Lara, Vs" uniqKey="Lara V">VS Lara</name></author><author><name sortKey="Lauris, Jrp" uniqKey="Lauris J">JRP Lauris</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Campos, La" uniqKey="Campos L">LA Campos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dayan, D" uniqKey="Dayan D">D Dayan</name></author><author><name sortKey="Vered, M" uniqKey="Vered M">M Vered</name></author><author><name sortKey="Paz, T" uniqKey="Paz T">T Paz</name></author><author><name sortKey="Buchner, A" uniqKey="Buchner A">A Buchner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Domaneschi, C" uniqKey="Domaneschi C">C 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Damante</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mandel, L" uniqKey="Mandel L">L Mandel</name></author><author><name sortKey="Romao, M" uniqKey="Romao M">M Romao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mccord, Jf" uniqKey="Mccord J">JF McCord</name></author><author><name sortKey="Grant, Aa" uniqKey="Grant A">AA Grant</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moreira, Cr" uniqKey="Moreira C">CR Moreira</name></author><author><name sortKey="Azevedo, Lr" uniqKey="Azevedo L">LR Azevedo</name></author><author><name sortKey="Lauris, Jrp" uniqKey="Lauris J">JRP Lauris</name></author><author><name sortKey="Taga, R" uniqKey="Taga R">R Taga</name></author><author><name sortKey="Damante, Jh" uniqKey="Damante J">JH Damante</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nery, Lr" uniqKey="Nery L">LR Nery</name></author><author><name sortKey="Moreira, Cr" uniqKey="Moreira C">CR Moreira</name></author><author><name sortKey="Cestari, Tm" uniqKey="Cestari T">TM Cestari</name></author><author><name sortKey="Taga, R" uniqKey="Taga R">R Taga</name></author><author><name sortKey="Damante, Jh" uniqKey="Damante J">JH Damante</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Radfar, L" uniqKey="Radfar L">L Radfar</name></author><author><name sortKey="Kleiner, De" uniqKey="Kleiner D">DE Kleiner</name></author><author><name sortKey="Fox, Pc" uniqKey="Fox P">PC Fox</name></author><author><name sortKey="Pillemer, Sr" uniqKey="Pillemer S">SR Pillemer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Scott, J" uniqKey="Scott J">J Scott</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Scott, J" uniqKey="Scott J">J Scott</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Scott, J" uniqKey="Scott J">J Scott</name></author><author><name sortKey="Flower, Ea" uniqKey="Flower E">EA Flower</name></author><author><name sortKey="Burns, J" uniqKey="Burns J">J Burns</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tagawa, S" uniqKey="Tagawa S">S Tagawa</name></author><author><name sortKey="Inui, M" uniqKey="Inui M">M Inui</name></author><author><name sortKey="Mori, A" uniqKey="Mori A">A Mori</name></author><author><name sortKey="Seki, Y" uniqKey="Seki Y">Y Seki</name></author><author><name sortKey="Murata, T" uniqKey="Murata T">T Murata</name></author><author><name sortKey="Tagawa, T" uniqKey="Tagawa T">T Tagawa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Takahashi, S" uniqKey="Takahashi S">S Takahashi</name></author><author><name sortKey="Shinzato, K" uniqKey="Shinzato K">K Shinzato</name></author><author><name sortKey="Nakamura, S" uniqKey="Nakamura S">S Nakamura</name></author><author><name sortKey="Domon, T" uniqKey="Domon T">T Domon</name></author><author><name sortKey="Yamamoto, T" uniqKey="Yamamoto T">T Yamamoto</name></author><author><name sortKey="Wakita, M" uniqKey="Wakita M">M Wakita</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vered, M" uniqKey="Vered M">M Vered</name></author><author><name sortKey="Buchner, A" uniqKey="Buchner A">A Buchner</name></author><author><name sortKey="Haimovici, E" uniqKey="Haimovici E">E Haimovici</name></author><author><name sortKey="Hiss, Y" uniqKey="Hiss Y">Y Hiss</name></author><author><name sortKey="Dayan, D" uniqKey="Dayan D">D Dayan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Waterhouse, Jp" uniqKey="Waterhouse J">JP Waterhouse</name></author><author><name sortKey="Chisholm, Dm" uniqKey="Chisholm D">DM Chisholm</name></author><author><name sortKey="Winter, Rb" uniqKey="Winter R">RB Winter</name></author><author><name sortKey="Patel, M" uniqKey="Patel M">M Patel</name></author><author><name sortKey="Yale, Rs" uniqKey="Yale R">RS Yale</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Weibel, Er" uniqKey="Weibel E">ER Weibel</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Appl Oral Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Appl Oral Sci</journal-id><journal-id journal-id-type="publisher-id">J. Appl. Oral. Sci.</journal-id><journal-title-group><journal-title>Journal of Applied Oral Science</journal-title></journal-title-group><issn pub-type="ppub">1678-7757</issn><issn pub-type="epub">1678-7765</issn><publisher><publisher-name>Faculdade de Odontologia de Bauru da Universidade de São
Paulo</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24473720</article-id><article-id pub-id-type="pmc">3891278</article-id><article-id pub-id-type="doi">10.1590/1679-775720130342</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>Morphology and morphometry of the human sublingual glands in mouth floor
enlargements of edentulous patients</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>de SÁ</surname><given-names>Josiane Costa Rodrigues</given-names></name><xref ref-type="aff" rid="aff01">1</xref></contrib><contrib contrib-type="author"><name><surname>TOLENTINO</surname><given-names>Elen de Souza</given-names></name><xref ref-type="aff" rid="aff02">2</xref><xref ref-type="corresp" rid="c01"></xref></contrib><contrib contrib-type="author"><name><surname>AZEVEDO-ALANIS</surname><given-names>Luciana Reis</given-names></name><xref ref-type="aff" rid="aff03">3</xref></contrib><contrib contrib-type="author"><name><surname>IWAKI FILHO</surname><given-names>Liogi</given-names></name><xref ref-type="aff" rid="aff02">2</xref></contrib><contrib contrib-type="author"><name><surname>LARA</surname><given-names>Vanessa Soares</given-names></name><xref ref-type="aff" rid="aff04">4</xref></contrib><contrib contrib-type="author"><name><surname>DAMANTE</surname><given-names>José Humberto</given-names></name><xref ref-type="aff" rid="aff04">4</xref></contrib></contrib-group><aff id="aff01"><label>1</label> Aeronautical Central Hospital. Rio de Janeiro, RJ, Brazil.</aff><aff id="aff02"><label>2</label> Department of Dentistry, Maringá State University, Maringá, PR, Brazil.</aff><aff id="aff03"><label>3</label> Departament of Dentistry, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil.</aff><aff id="aff04"><label>4</label> Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.</aff><author-notes><corresp id="c01"><bold>Corresponding address:</bold> Elen de Souza Tolentino - Faculdade de
Odontologia de Bauru - Universidade de São Paulo - Al. Dr. Otávio Pinheiro Brisolla
9-75 - 17.012-901 - Bauru - SP - Brazil - Phone/fax: +55 (14) 3234-8251 - e-mail:
<email>elen_tolentino@hotmail.com</email></corresp><fn fn-type="conflict"><p><bold>CONFLICT OF INTEREST STATEMENT:</bold> The authors have no conflicts of interest to report.</p></fn></author-notes><pub-date pub-type="ppub"><season>Nov-Dec</season><year>2013</year></pub-date><volume>21</volume><issue>6</issue><fpage>540</fpage><lpage>546</lpage><history><date date-type="received"><day>29</day><month>5</month><year>2013</year></date><date date-type="rev-recd"><day>11</day><month>7</month><year>2013</year></date><date date-type="accepted"><day>23</day><month>8</month><year>2013</year></date></history><permissions><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative
Commons Attribution Non-Commercial License which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the
original work is properly cited. </license-p></license></permissions><abstract><p>Asymptomatic mouth floor enlargements may be observed in edentulous patients. These
masses, which protrude from the mouth floor, may complicate the fitting of dentures
and require surgery. Whether this "entity" may be considered an anatomical variation
of the mouth floor or represent specific alterations in the sublingual gland is not
known. </p><sec><title>Objective</title><p>The aim of this work is to investigate the morphological and morphometric aspects
of the sublingual glands of edentulous patients with mouth floor enlargements and
compare the glands of these patients with the sublingual glands of human cadavers.
</p></sec><sec><title>Material and Methods</title><p>Microscopic evaluation was performed on human sublingual glands from edentulous
patients with mouth floor enlargements (n=20) and edentulous cadavers (n=20). The
patients and cadavers were of similar ages. The data were compared using
Mann-Whitney U, Fisher's exact and Student's t tests (p<0.05). </p></sec><sec><title>Results</title><p>Acinar atrophy, duct-like structures, mononuclear infiltrates, replacement of
parenchyma with fibrous/adipose tissue, mucous extravasation and oncocytosis were
similar between the groups (p>0.05). Only the variables "autolysis" and
"congested blood vessels" presented statistical difference between groups
(p=0.014; p=0.043). The morphometric study revealed that the volume densities of
acini, ducts, stroma and adipose tissue were similar between the groups
(p>0.05). </p></sec><sec><title>Conclusion</title><p>The microscopic characteristics of the sublingual glands in mouth floor
enlargements in edentulous patients correspond to characteristics associated with
the normal aging process. The glands are not pathological and represent an
age-related alteration that occurs with or without the presence of the mouth floor
enlargements.</p></sec></abstract><kwd-group><kwd>Salivary glands</kwd><kwd>Sublingual gland</kwd><kwd>Morphology</kwd><kwd>Anatomy</kwd></kwd-group><funding-group><award-group><funding-source>FAPESP</funding-source><award-id>05/60441-4</award-id></award-group></funding-group></article-meta></front><body><sec><title>INTRODUCTION</title><p>Asymptomatic mouth floor enlargements related to the sublingual glands (MFERSG) are
observed in inferior edentulous and partially edentulous patients<sup><xref ref-type="bibr" rid="r02">2</xref>,<xref ref-type="bibr" rid="r06">6</xref></sup>.
These masses, which protrude from the mouth floor and are covered by a normal-appearing
mucosa, may complicate the fitting of dentures and require pre-prosthetic
surgery<sup><xref ref-type="bibr" rid="r06">6</xref>,<xref ref-type="bibr" rid="r08">8</xref></sup> (<xref ref-type="fig" rid="f01">Figure 1</xref>).</p><fig id="f01" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Mouth floor enlargement in a 62-year-old woman</p></caption><graphic xlink:href="jaos-21-06-0540-g01"></graphic></fig><p>The aetiology of these enlargements is not known, and the terminology is often
unsuitable. Some of the names used to describe these enlargements include adenomatoid
serous hyperplasia<sup><xref ref-type="bibr" rid="r15">15</xref></sup>, swelling or
hypertrophy of the sublingual gland<sup><xref ref-type="bibr" rid="r03">3</xref></sup>,
mouth floor enlargement related to sublingual glands in edentulous and partially
edentulous patients<sup><xref ref-type="bibr" rid="r05">5</xref></sup> and idiopathic
hyperplasia of the sublingual gland in edentulous or partially edentulous
patients<sup><xref ref-type="bibr" rid="r06">6</xref></sup>. Campos<sup><xref ref-type="bibr" rid="r02">2</xref></sup> (1996) initially described these
swellings as pathological entities and denoted them as "hyperplasia of the sublingual
glands" related to the absence of posterior teeth. The aging process may also contribute
to the etiopathogenesis of MFERSG<sup><xref ref-type="bibr" rid="r06">6</xref></sup>.</p><p>Iwaki Filho, et al.<sup><xref ref-type="bibr" rid="r06">6</xref></sup> (2006)
microscopically analysed specimens that were surgically removed from the enlarged mouth
floors of 19 patients. These enlargements exhibited acinar atrophy, an increase in the
number of duct-like structures and substitution of the glandular parenchyma with fat and
connective tissue. Azevedo, et al.<sup><xref ref-type="bibr" rid="r01">1</xref></sup>(2005) and Moreira, et al.<sup><xref ref-type="bibr" rid="r09">9</xref></sup> (2006)
identified similar characteristics as a result of the physiological aging process in
human sublingual glands that were obtained from necropsies. Moreira, et al.<sup><xref ref-type="bibr" rid="r09">9</xref></sup> (2006) identified a decrease in the total
volume of the sublingual glands during aging, which conflicts with the apparent volume
increase of the swellings.</p><p>Microscopic comparisons between the glands of MFERSG patients and those of inferior
edentulous individuals without the enlargements may explain the aetiology of these
enlargements. Whether this "entity" may be considered an anatomical variation of the
mouth floor after teeth loss or represent specific macroscopic and microscopic
alterations in the sublingual gland is not known. Therefore this study examined
sublingual glands in MFERSG patients and compared them with glands from edentulous
cadavers of similar ages who did not present the enlargements.</p></sec><sec sec-type="materials|methods"><title>MATERIAL AND METHODS</title><p>The Human Research Ethics Committee of the Bauru School of Dentistry - University of São
Paulo (process nº 010/2006) approved this study, and informed written consent in full
accordance with ethical principles was obtained from each patient. The São Paulo Death
Verification Service - University of São Paulo, where the glands of cadavers were
obtained, also approved the research. All experiments followed the guidelines of the
Helsinki Declaration.</p><p>The sample set included 20 human sublingual glands that were obtained from surgical
treatments MFERSG patients<sup><xref ref-type="bibr" rid="r06">6</xref></sup> (MFERSG
group). These patients were edentulous or partially edentulous and were referred by the
prosthodontist because they presented difficulties in fitting the mandibular dentures.
Analysis of the their medical history revealed only systemic diseases as anemia and
arterial hypertension. All patients had clinically normal parotid and submandibular
glands, which were submitted to examination, palpation and milking. Physical aspects of
the saliva such as volume, color and fluidity were absolutely normal<sup><xref ref-type="bibr" rid="r06">6</xref></sup>. The MFERSG patients underwent surgical
excision under local anaesthesia during pre-prosthetic procedures. The specimens
containing mucosa of the mouth floor and most part of the sublingual glands were
dissected by divulsion<sup><xref ref-type="bibr" rid="r06">6</xref></sup>.</p><p>Twenty other human sublingual glands were obtained from edentulous cadavers during
autopsies (Control group). Individuals with the following systemic disorders or base
diseases were excluded from the study, using the methods and the exclusion criteria of
Azevedo, et al.<sup><xref ref-type="bibr" rid="r01">1</xref></sup> (2005): lymphoma,
leukemia, mucoviscidosis, rheumatic diseases, Sjögren's syndrome, obesity, cachexia,
diabetes mellitus, alcoholic cirrhosis, collagen diseases, history of head or neck
cancer-related surgery, and history of cytotoxic drug administration or previous
radiotherapy of the head or neck during the last 3 months and macroscopic autolysis.
Data regarding the systemic involvement and cause of death were obtained from the
familiar and autopsy reports. The main causes of death included pulmonary edema,
bronchopneumonia, acute myocardial infarction, cerebral vascular accident, ischemic
heart disease, cerebral edema and congestive heart failure. The interval between the
time of death and autopsy ranged from 6:05 to 92:55 h, with a mean of 16:46 h. The
cadaver glands were completely removed with a portion of the overlying mucosa of the
mouth floor.</p><p>Specimens from both groups were age- and gender-matched when feasible. The age of both
groups ranged from 40 to 79 years (±59.5 years). Only inferior-posterior edentulous
cadavers were included because the enlargements are limited to edentulous
individuals<sup><xref ref-type="bibr" rid="r02">2</xref>,<xref ref-type="bibr" rid="r06">6</xref></sup>. However, the presence of clinical mouth enlargements in
this group was not detected. The specimens were fixed in 10% formalin and processed
using routine procedures. The slides were stained with hematoxylin-eosin (H.E.), and a
single pathology expert of the Bauru School of Dentistry performed the microscopic
examinations.</p><sec><title>Morphological study</title><p>The criteria for the morphological analysis were established in a previous
study<sup><xref ref-type="bibr" rid="r01">1</xref></sup> and the same
pathologist performed all examinations. Only three slices (anterior, middle and
posterior) were processed for histology regardless of the gland size. The slices were
scored using the following criteria: 1- acinar atrophy; 2- duct-like structures; 3-
mononuclear infiltration; 4- replacement of parenchyma by fibrous tissue; 5-
replacement of parenchyma by adipose tissue; 6- oncocytosis; 7- congested blood
vessels; 8- acinar autolysis; and 9- mucous extravasation (<xref ref-type="fig" rid="f02">Figure 2</xref>).</p><fig id="f02" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Sublingual glands of cadavers and MFERSG patients (hematoxylin & eosin
staining). a: Normal lobule (*) and atrophic acini (arrows). b: True duct
(excretory interlobular). c: Intense acinar atrophy, presence of duct-like
structures and intense substitution of the parenchyma by fibrous tissue. d:
intense replacement with fibrous and adipose tissue containing a few traces of
parenchyma (*). e: Periductal focal mononuclear infiltrate (IM). f: Diffuse
mononuclear infiltrate (*) and congested blood vessels. g: Acinar autolysis
(*). h: Oncocytosis (*) in ductal cells. i: Mucous extravasation (*)
MFERSG=mouth floor enlargements related to the sublingual glands</p></caption><graphic xlink:href="jaos-21-06-0540-g02"></graphic></fig><p>In this study, "acinar atrophy" was defined as a decrease in the size of the acinar
cells and/or the number of acini (<xref ref-type="fig" rid="f02">Figure 2a</xref>).
Many authors<sup><xref ref-type="bibr" rid="r01">1</xref>,<xref ref-type="bibr" rid="r02">2</xref>,<xref ref-type="bibr" rid="r05">5</xref>,<xref ref-type="bibr" rid="r09">9</xref>,<xref ref-type="bibr" rid="r13">13</xref>,<xref ref-type="bibr" rid="r16">16</xref>,<xref ref-type="bibr" rid="r17">17</xref></sup> prefer to denote doubtful structures as "duct-like
structures" because there is no guarantee that some of these structures are atrophic
acini or ducts. We considered duct-like structures those with shrunken seromucous
cells, granule depletion and widened lumens that are adjacent to ductal epithelial
cells and resemble intralobular non-striated ducts (<xref ref-type="fig" rid="f02">Figure 2c</xref>), which is consistent with the characterization used in our
previous study<sup><xref ref-type="bibr" rid="r01">1</xref></sup>. We excluded true
ducts, which were easily recognized in glands with normal parenchyma from the
variable "duct-like structures" because true ducts exhibited a dilated lumen lined by
cuboidal cells with central nuclei and an eosinophilic cytoplasm (<xref ref-type="fig" rid="f02">Figure 2e</xref>). The distinction between a duct and a
duct-like structure was impossible to discern in glands with advanced atrophy. True
ducts were excluded only when the distinction was clear. Therefore, only ambiguous
structures were included in the morphological study.</p><p>A degree of severity of the alterations in the glands was attributed to the
variables. The microscopic findings were classified as discrete when they were
observed in up to 1/3 of the section. The findings were moderate when 1/3-2/3 of the
section was involved and intense when more than 2/3 of the section was affected. The
severity degree was determined from the three slices of each gland to describe the
microscopic variables that globally represented the gland. Scores reflected the
microscopic characteristics and ranged from 0 to 3: 0- absent; 1- discrete; 2-
moderate; and 3- intense<sup><xref ref-type="bibr" rid="r01">1</xref></sup>.</p><p>The scores of the three slices of each gland were submitted to a conversion scale to
produce one representative score for each variable in each gland. The scores of the
three slices from each gland were added to produce one value that varied from 0 (if
all the initial scores were 0 - absent) to 9 (if all of the 3 initial scores were 3 -
intense). This value was submitted to the following conversion scale: the final score
was 0 if the sum was 0; 1 if the sum was 1-3; 2 if the sum was 4-6; and 3 if the sum
was 7-9.</p></sec><sec><title>Morphometrical study</title><p>A microscope with a 40x objective and an 8x Zeiss Kpl eyepiece containing a Zeiss II
integration grid with 10 parallel lines and 100 points that were symmetrically
distributed over a quadrangular area was used for these evaluations. We selected 51
histological fields <italic>per</italic> gland by systematic randomization<sup><xref ref-type="bibr" rid="r19">19</xref></sup>, and the points (Pi) that coincided
with the images of the following components were quantified: acini (serous, mucous or
mixed), ducts and duct-like structures, stroma (connective tissue, blood vessels,
septa, cells, nerves and inflammatory infiltrates), adipose tissue (quantified
separately because of the frequent substitution of the parenchyma) and others
(artefacts, points in the void and tissues not related to the gland, e.g. mouth floor
epithelium)<sup><xref ref-type="bibr" rid="r01">1</xref>,<xref ref-type="bibr" rid="r09">9</xref></sup>. The total number of points (PT) was also obtained.
Volume density (VVi) was calculated using the equation VVi=Pi/PT, and expressed as a
percentage or a fraction of one<sup><xref ref-type="bibr" rid="r09">9</xref></sup>.</p></sec><sec><title>Statistical analysis</title><p>The results were analysed using the Sigma Stat Jadel<sup>TM</sup> Scientific software
for Windows (Jadel Corporation, Chicago, IL, USA). The variables with scores between
0 and 3 in the morphological study were analysed using the Mann-Whitney U test.
Percentage values were also calculated. The values for both groups in the
morphometric study were analysed using Student's t-test. The level of significance
was set at 5% for all tests.</p></sec></sec><sec sec-type="results"><title>RESULTS</title><sec><title>Morphological study</title><p>The results of the morphological analysis of both groups are detailed in <xref ref-type="table" rid="t01">Table 1</xref>. Only the autolysis and congested blood
vessels variables were significantly different between groups (p=0.014 and p=0.043,
respectively). Most of the glands (95%) from the MFERSG group and 65% of the glands
from the Control group exhibited congested blood vessels (<xref ref-type="fig" rid="f02">Figure 2f</xref>). Half (50%) of the glands from the MFERSG group
exhibited moderate or intense degrees of acinar autolysis, and 80% of the glands from
the Control group exhibited this characteristic (<xref ref-type="fig" rid="f02">Figure 2g</xref>).</p><table-wrap id="t01" orientation="portrait" position="float"><label>Table 1</label><caption><p>Group comparisons derived from the morphologic analysis</p></caption><table frame="hsides" rules="groups"><thead><tr><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1"><bold>Variable</bold></td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1"><bold>MFERSG group</bold></td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1"><bold>Control group</bold></td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1"><bold>p</bold></td></tr><tr><td rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"><bold>present (%)</bold></td><td align="center" rowspan="1" colspan="1"><bold>present (%)</bold></td><td rowspan="1" colspan="1"></td></tr></thead><tbody><tr><td style="background-color:#CCCCCC" rowspan="1" colspan="1">Acinar atrophy</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">95</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">85</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">0.758</td></tr><tr><td rowspan="1" colspan="1">Focai infiltrates</td><td align="center" rowspan="1" colspan="1">65</td><td align="center" rowspan="1" colspan="1">65</td><td align="center" rowspan="1" colspan="1">1.000</td></tr><tr><td style="background-color:#CCCCCC" rowspan="1" colspan="1">Diffuse infiltrates</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">50</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">30</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">0.142</td></tr><tr><td rowspan="1" colspan="1">Fibrous tissue</td><td align="center" rowspan="1" colspan="1">65</td><td align="center" rowspan="1" colspan="1">70</td><td align="center" rowspan="1" colspan="1">0.547</td></tr><tr><td style="background-color:#CCCCCC" rowspan="1" colspan="1">Adipose tissue</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">55</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">45</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">0.547</td></tr><tr><td rowspan="1" colspan="1">Oncocytosis</td><td align="center" rowspan="1" colspan="1">50</td><td align="center" rowspan="1" colspan="1">50</td><td align="center" rowspan="1" colspan="1">0.883</td></tr><tr><td style="background-color:#CCCCCC" rowspan="1" colspan="1">Autolysis</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">50</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">80</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">0.014<xref ref-type="table-fn" rid="t01-fn01">*</xref></td></tr><tr><td rowspan="1" colspan="1">Focal mucous extravasation</td><td align="center" rowspan="1" colspan="1">75</td><td align="center" rowspan="1" colspan="1">45</td><td align="center" rowspan="1" colspan="1">0.192</td></tr><tr><td style="background-color:#CCCCCC" rowspan="1" colspan="1">Diffuse mucous extravasation</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">10</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">15</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">0.758</td></tr><tr><td rowspan="1" colspan="1">Congested blood vessels</td><td align="center" rowspan="1" colspan="1">95</td><td align="center" rowspan="1" colspan="1">65</td><td align="center" rowspan="1" colspan="1">0.043<xref ref-type="table-fn" rid="t01-fn01">*</xref></td></tr><tr><td style="background-color:#CCCCCC" rowspan="1" colspan="1">Ducts/duct-like structures</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">85</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">85</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">0.192</td></tr></tbody></table><table-wrap-foot><fn><p>Mann-Whitney U Test (p<0.05);</p></fn><fn id="t01-fn01"><label>*</label><p>Statistically significant; MFERSG= mouth floor enlargments related to the
sublingual glands</p></fn></table-wrap-foot></table-wrap><p>Acinar atrophy was observed in both groups (<xref ref-type="fig" rid="f02">Figure
2a</xref>). Atrophy was present in 95% of the glands in the MFERSG group, with
discrete, moderate and intense degrees in 55, 25 and 15% of the glands, respectively.
Atrophy was present in 85% of the glands in the Control group, with discrete,
moderate and intense degrees observed in 30, 40 and 15% of the glands, respectively.
No significant difference in acinar atrophy was observed between the groups (p=0.758)
(<xref ref-type="table" rid="t01">Table 1</xref>). The presence of duct-like
structures was observed in 85% of the sublingual glands from both groups (p=1.000)
(<xref ref-type="fig" rid="f02">Figures 2c</xref> and <xref ref-type="table" rid="t01">Table 1</xref>).</p><p>The mononuclear infiltrates consisted primarily of lymphocytes, with few plasma cells
and macrophages. No polymorphonuclear infiltrates were observed in any of the
analysed specimens. Discrete or moderate focal infiltrates were observed in 65% of
the glands in both groups (p=1.000) (<xref ref-type="fig" rid="f02">Figure
2e</xref>). Diffuse infiltrates were observed in 50 and 30% of the glands in the
MFERSG and Control groups, respectively (p=0.142) (<xref ref-type="fig" rid="f02">Figure 2f</xref> and <xref ref-type="table" rid="t01">Table 1</xref>).</p><p>Moderate or intense replacement of the glandular parenchyma with fibrous tissue was
observed in 65 and 70% of the sublingual glands in the MFERSG and Control groups,
respectively (p=0.547) (<xref ref-type="fig" rid="f02">Figure 2c</xref>, <xref ref-type="fig" rid="f02">2d</xref> and <xref ref-type="table" rid="t01">Table
1</xref>). The replacement of the glandular parenchyma with adipose tissue was
observed in 55 and 45% of the glands in the MFERSG and Control groups, respectively
(p=0.547) (<xref ref-type="fig" rid="f02">Figure 2d</xref> and <xref ref-type="table" rid="t01">Table 1</xref>).</p><p>No gland exhibited a severe degree of oncocytosis, but discrete oncocytosis (<xref ref-type="fig" rid="f02">Figure 2h</xref>) was observed in approximately 50% of
the glands of both groups (p=0.883). Both groups primarily exhibited focal mucous
extravasation (<xref ref-type="fig" rid="f02">Figure 2i</xref>), and no significant
difference between groups was observed (p=0.192) (<xref ref-type="table" rid="t01">Table 1</xref>).</p></sec><sec><title>Morphometric study</title><p>The volume densities of acini, ducts, stroma, adipose tissue, parenchyma (acini and
ducts) and total stroma (stroma and adipose tissue) in both groups are presented in
<xref ref-type="table" rid="t02">Table 2</xref>. No statistically significant
differences in these variables were observed between the groups.</p><table-wrap id="t02" orientation="portrait" position="float"><label>Table 2</label><caption><p>Means and standard deviations (mean ± sd) of various volume densities in both
groups</p></caption><table frame="hsides" rules="groups"><thead><tr><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1"><bold>Variable</bold></td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1"><bold>MFERSG group</bold></td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1"><bold>Control group</bold></td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1"><bold>p</bold></td></tr><tr><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"><bold>mean ± sd (%)</bold></td><td align="center" rowspan="1" colspan="1"><bold>mean ± sd (%)</bold></td><td align="center" rowspan="1" colspan="1"></td></tr></thead><tbody><tr><td style="background-color:#CCCCCC" rowspan="1" colspan="1">Acini</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">33.76±18.84</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">35.07±14.91</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">0.752</td></tr><tr><td rowspan="1" colspan="1">Ducts</td><td align="center" rowspan="1" colspan="1">8.40±3.36</td><td align="center" rowspan="1" colspan="1">9.62±5.11</td><td align="center" rowspan="1" colspan="1">0.444</td></tr><tr><td style="background-color:#CCCCCC" rowspan="1" colspan="1">Stroma</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">42.85±9.25</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">39.27±8.58</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">0.209</td></tr><tr><td rowspan="1" colspan="1">Adipose tissue</td><td align="center" rowspan="1" colspan="1">14.99±14.86</td><td align="center" rowspan="1" colspan="1">16.03±13.96</td><td align="center" rowspan="1" colspan="1">0.794</td></tr><tr><td style="background-color:#CCCCCC" rowspan="1" colspan="1">Parenchyma</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">42.16±18.26</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">44.70±16.74</td><td align="center" style="background-color:#CCCCCC" rowspan="1" colspan="1">0.649</td></tr><tr><td rowspan="1" colspan="1">Total stroma</td><td align="center" rowspan="1" colspan="1">57.84±18.26</td><td align="center" rowspan="1" colspan="1">55.30±16.74</td><td align="center" rowspan="1" colspan="1">0.649</td></tr></tbody></table><table-wrap-foot><fn><p>MFERSG= mouth floor enlargments related to the sublingual glands</p></fn></table-wrap-foot></table-wrap></sec></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>Our results demonstrated that the morphological patterns in the sublingual glands of
edentulous patients with mouth floor enlargements were very similar to those of the
sublingual glands of edentulous cadavers without enlargements, despite both groups were
age/gender-matched. Macroscopically, the mouth floor of the cadavers' group was normal,
despite the absence of posterior teeth. It is not possible to affirm when and why these
enlargements appear, even because many edentulous patients do not present this
condition.</p><p>No differences in acinar atrophy, duct-like structures, distribution of mononuclear
infiltrates, replacement of parenchyma with fibrous or adipose tissue, oncocytosis or
mucous extravasation were observed between groups. However, the sublingual glands of
enlarged mouth floors exhibited more congested blood vessels and less acinar autolysis
than the glands from the cadavers.</p><p>It is known that autolysis increases proportionally over time during the course of
<italic>post-mortem</italic> changes but it should not occur <italic>ex vivo</italic>if the material is fixed immediately<sup><xref ref-type="bibr" rid="r10">10</xref></sup>. We agree with Nery, et al.<sup><xref ref-type="bibr" rid="r10">10</xref></sup> (2010) who stated that this phenomenon might be a result of
surgical dissection trauma during glandular removal. Regarding the variable "congested
blood vessels", it was more frequent in MFERSG patients. We believe that it is a result
of the greater surgical manipulation that is required <italic>in vivo</italic>.</p><p>Importantly, the ages of both groups were matched in the present investigation and the
average age of the entire sample group was 59.5 years, which is representative of an
elderly population. Consequently, age-related microscopic changes were detected in the
majority of glands from both patients and cadavers. The aging process likely begins with
acinar atrophy followed by the presence of duct-like structures and ends with the
replacement of the parenchyma with fibrous and/or adipose tissue<sup><xref ref-type="bibr" rid="r01">1</xref></sup>. These aging alterations have been
demonstrated in the human parotid, submandibular, palatal, labial and sublingual
glands<sup><xref ref-type="bibr" rid="r03">3</xref>,<xref ref-type="bibr" rid="r05">5</xref>,<xref ref-type="bibr" rid="r09">9</xref>,<xref ref-type="bibr" rid="r12">12</xref>-<xref ref-type="bibr" rid="r14">14</xref>,<xref ref-type="bibr" rid="r16">16</xref>-<xref ref-type="bibr" rid="r18">18</xref></sup>. Azevedo, et al.<sup><xref ref-type="bibr" rid="r01">1</xref></sup>(2005) demonstrated that these microscopic alterations are minimal or absent in the
sublingual glands of cadavers under the age of 30 years.</p><p>The increasing appearance of duct-like structures with age represents the final process
of acinar atrophy, and the distinction between a duct and a duct-like structure can be
difficult<sup><xref ref-type="bibr" rid="r01">1</xref>,<xref ref-type="bibr" rid="r03">3</xref>,<xref ref-type="bibr" rid="r05">5</xref>,<xref ref-type="bibr" rid="r09">9</xref>,<xref ref-type="bibr" rid="r12">12</xref>-<xref ref-type="bibr" rid="r14">14</xref>,<xref ref-type="bibr" rid="r16">16</xref>,<xref ref-type="bibr" rid="r17">17</xref></sup> due to the generalized regressive
processes of the glandular parenchyma. Therefore, authors prefer to denote these
structures as "duct-like structures"<sup><xref ref-type="bibr" rid="r01">1</xref>,<xref ref-type="bibr" rid="r03">3</xref>,<xref ref-type="bibr" rid="r05">5</xref>,<xref ref-type="bibr" rid="r09">9</xref>,<xref ref-type="bibr" rid="r13">13</xref>,<xref ref-type="bibr" rid="r16">16</xref>,<xref ref-type="bibr" rid="r17">17</xref></sup>. Whether the appearance of these structures and the increase in
their number with age are the result of a regressive process that begins with acinar
atrophy or whether they are true ducts with a proliferation capacity is not known.
Additional research to clarify these issues is required.</p><p>No significant differences in the volume densities of acini, ducts, stroma and adipose
tissue were observed between the groups in our study. The sublingual glands exhibited a
minor quantity of parenchyma in relation to the total stroma volume (stroma and adipose
tissue) in both groups. This observation is consistent with that of Moreira, et
al.<sup><xref ref-type="bibr" rid="r09">9</xref></sup> (2006) who demonstrated
that the volume of acini decreases with age but that the volume of ducts, stroma and
adipose tissue increases. These authors also found that the glandular volume decreases,
on average, 33.78% during the aging process, which indicates that the sublingual glands
are not responsible for the mouth floor enlargements.</p><p>Our data demonstrated that the sublingual glands in mouth floor enlargements in
edentulous patients were not morphologically and morphometrically different from the
glands of edentulous cadavers without enlargements and both sets of glands exhibited
age-related changes. Therefore, the aging process cannot explain the etiopathogenesis of
the mouth floor enlargements in edentulous individuals. Moreira, et al.<sup><xref ref-type="bibr" rid="r09">9</xref></sup> (2006) showed that sublingual glands do
not increase in size with age despite the enlargements. Conversely, the total volume of
the glands decreases<sup><xref ref-type="bibr" rid="r09">9</xref></sup>. We agree that
the intrinsic biologic characteristics of the sublingual glands are not responsible for
the enlargements although these glands occupied almost the entire specimen that was
submitted for microscopic examination. In both groups, a portion of the mouth floor
mucosa was excised during the surgical procedure and, microscopically, this epithelium
was normal. We do not believe that the surrounding tissues are responsible for the
enlargements. The enlargements may arise from local external factors that are already
known, such as the absence of posterior-inferior teeth and the degree of alveolar ridge
resorption<sup><xref ref-type="bibr" rid="r02">2</xref>,<xref ref-type="bibr" rid="r04">4</xref>,<xref ref-type="bibr" rid="r06">6</xref></sup>. However, these
factors are not sufficient to account for the etiopathogenesis in all cases because many
edentulous with severe bone resorption in the alveolar margin do not exhibit MFERSG.
Also, the cadavers, who were edentulous or partially edentulous, did not present the
swellings clinically. We speculated that the accommodation of soft tissues after teeth
loss, which varies according to individual elasticity, associated with the tongue
movements, might also contribute to the MFERSG. Therefore, the enlargements may be a
clinical manifestation of an adaptation to the current anatomical situation since the
placement of a dental prosthesis in the lower posterior region may result in the
disappearance of the swelling.</p><p>The mouth floor enlargements in edentulous patients are not described in academic books,
but surgical interventions are frequent. Commonly, surgeons treat and describe these
enlargements as a hyperplasia or a hypertrophy. However, the pathologists often describe
the microscopic images as a sialodenitis, which is normally observed in the salivary
glands during the aging process<sup><xref ref-type="bibr" rid="r01">1</xref>,<xref ref-type="bibr" rid="r09">9</xref></sup>. The terms "hyperplasia" and
"hypertrophy" are wrong, since they represent, respectively, an abnormal increase in the
number of normal cells in normal arrangement in an organ or tissue and an enlargement of
an organ or part resulting from an increase in the size of the cells. The sialodenitis
represents an infectious or inflammatory disorder of the salivary gland that includes
focal infiltrates and can be a relatively frequent finding in salivary glands
biopsies<sup><xref ref-type="bibr" rid="r11">11</xref></sup>. As well as the
present study, an investigation in patients with MFERSG<sup><xref ref-type="bibr" rid="r06">6</xref></sup> showed that all these terms are incorrect. The sublingual
glands in the enlargements do not show these kinds of alterations but show microscopic
changes compatible with the aging process<sup><xref ref-type="bibr" rid="r01">1</xref>,<xref ref-type="bibr" rid="r09">9</xref></sup>. We suggest that
pathologists provide a descriptive microscopic report that emphasizes the possibility of
age-related changes in the sublingual gland in MFERSG patients. The final diagnosis will
depend on clinical, surgical and microscopic information.</p><p>The microscopic characteristics of these glands rule out the diagnosis of Sjögren
Syndrome. First of all, the clinical findings are essential to diagnose this autoimmune
disorder and patients or cadavers with this disease were excluded from this study. In
this investigation, the mononuclear infiltrate basically consisted of lymphocytes,
eventually showing some plasma cells and macrophages. The presence of a discrete, focal
and periductal mononuclear infiltrate probably corresponds to IgA-secreting plasma cells
and duct-associated lymphoid tissue<sup><xref ref-type="bibr" rid="r01">1</xref></sup>.
Ductal obstruction in adult life might explain the increase of the mononuclear
infiltrate with age. Azevedo, et al.<sup><xref ref-type="bibr" rid="r01">1</xref></sup>(2005) found that the presence of a mononuclear infiltrate was associated with the
process of acinar atrophy. The infiltrate became diffuse as the process of parenchymal
replacement progressed. When replacement of the parenchyma was complete, the infiltrate
disappeared, a finding also reported by Vered, et al.<sup><xref ref-type="bibr" rid="r17">17</xref></sup> (2001).</p><p>The nomenclature of these volume alterations in the mouth floors in edentulous patients
is variable and not well defined. In this study, we used the same terminology adopted by
Iwaki Filho, et al.<sup><xref ref-type="bibr" rid="r06">6</xref></sup> (2006). The term
"enlargement" is justified because it is nonspecific and represents an increased volume
in the mouth floor but not specifically in the sublingual gland. This term does not
refer to a disturbance in cell growth or size. Therefore, we suggest that the best
nomenclature for these enlargements is "non-pathological enlargements of the mouth floor
in edentulous individuals". Academic books should present these enlargements as normal
variations of the anatomy of the mouth floor. Surgical treatment should be indicated
only when the enlargement impairs denture fitting.</p></sec><sec sec-type="conclusions"><title>CONCLUSION</title><p>The present study demonstrated that the microscopic characteristics of the sublingual
glands in mouth floor enlargements in edentulous patients correspond to characteristics
associated with the normal aging process. The sublingual glands do not represent
pathological changes; they represent an age-related alteration that occurs with or
without the presence of the mouth floor enlargements.</p></sec></body><back><ack><title>ACKNOWLEDGEMENTS</title><p>The authors would like to thank FAPESP (grant 05/60441-4) for financial support. We
would also like to thank the professors and employees of the Department of Biological
Sciences of the Bauru School of Dentistry and Dr. José Roberto Lauris, Dr. Tânia Mary
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