# Salivary Gland Disorders in Pediatric Patients: A 20 Years' Experience
## 4 Discussion
### Obstructive Disorders  
Among the obstructive diseases, cannula was the most common diagnosis within the major salivary glands. These benign obstructive lesions, which present as painless mobile masses in the floor of the mouth and/or neck, can be managed with different approaches: a trans-oral surgical excision, a marsupialization or a trans-oral excision of the sublingual gland [9; 10; 11]. In our report analysis, 85.7% of our patients have been treated through sublingual gland removal and the remaining 14.3% through marsupialization. Despite in the literature some findings reporting a female prevalence (29%) and a 7% possibility of relapse [9], our data indicate a prevalence of 78.6% in females and a 100% success rate. In agreement with [PERSON] et al. [11], we believe that the main goal of pediatric ranula management is radical sublingual gland excision, since it allows for closing the mucus extravasation with low complication rates.  
\begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline  & \multicolumn{1}{c}{**Adenocarcinoma**} & \begin{tabular}{c} **Pleomorphic** \\ **Adenoma** \\ \end{tabular} & \begin{tabular}{c} **Adenoid** \\ **Cystic** \\ **Carcinoma** \\ \end{tabular} & \begin{tabular}{c} **Mucoepidemoid** \\ **Carcinoma** \\ \end{tabular} & \begin{tabular}{c} **Leukemia** \\ **C** \\ \end{tabular} & \begin{tabular}{c} **Schwanoma** \\ **Tumor** \\ \end{tabular} & \
\begin{tabular}{c} **Inflammatory** \\ **Moyofibphasic** \\ **Tumor** \\ \end{tabular} \\ \hline \multirow{3}{*}{
\begin{tabular}{c} **Total patients (n)** \\ **Sex (n)** \\ **Age (mean \(\pm\) SD)**  
The second most common finding was sialolithiasis. This condition implicates the formation of stones that may be located within major salivary glands' ducts or in the glands' parenchyma. The obstruction can lead to inflammation caused by destructive salivary enzymes and superimposed bacterial infections causing sialadenitis or, in rare cases, abscess formation. sialolithiasis is very uncommon in children and adolescents; the literature reports sporadic cases of calculi both in the [PERSON] and in the [PERSON]'s duct with a prevalence in males [12; 13]. Our data showed impairment of the submandibular gland with a slight prevalence in the female sex (63.6%). Some authors found a positive family history among patients with sialolithiasis, highlighting the hereditary nature of salivary stones [6; 14]. Sialogogues, the direct massage of distal stones out of the duct, and techniques involving interventional sialography, lithotripsy, sialoendoscopy and various surgeries were proposed as treatment choices for sialolithiasis [14]. Our patients were predominantly treated through intraoral surgical excision of the calculi (72.7%), but also through sialoendoscopy, a minimally invasive and versatile procedure that can preserve the gland with the recovery of its functions and without the risk of nerve damage [15]. When sialoendoscopy was carried out, after the dilation and the lavage of the duct, cortisone was injected; the post-operative phase was managed by administering antibiotics along with the gland massages. Some authors compared the efficacy of sial endoscopic lavage to antibiotic therapy, suggesting a faster regression of the symptoms through the lavage [16]. Regarding antibiotic therapy, the administration of antibiotics is not a causal therapy and should be limited to cases of acute bacterial superinfection. In acute episodes with no signs of bacterial superinfection, the first-line treatment should be analgesics, sialogogues and sufficient hydration.  
Regarding the minor salivary gland disorders affecting the tongue and the lower lip, mucocele was the most common diagnosis made. Our findings agree with the literature [17; 18; 19]. In the long-term, all the patients surgically treated for mucocele presented no signs of relapse, demonstrating that correct and prompt treatment can be resolutive.