International Journal of Pediatric Otorhinolaryngology, 21 ( 1993) 159- 162 159

0 1993 Elsevier Scientific Publishers Ireland Ltd. All rights reserved. 016%5876/93/$06.00

PEDOT 00906

Ectopic salivary gland tissue in the palatine and

lingual tonsil

A.R. Banerjeea, J.V. Soarnesb, J.P. Birchall”, C. Reid” and R.J. Bray’

‘Department of E. N. T, Freeman Hospiral, Newcastle Upon Tyne. bProfessor of Oral Parhology. The Den-
tal School, Framtington Place, Newcastle Upon Tyne NE2 48 W and ( Consullant Plastic Surgeon and
Clinical Director in Plastic, Surgery and Consultant Anaesthetist, Department of Plastic Surgery Royal
Victoria Infirmary, Newcastle Upon Tyne (UK)

(Received 16 September 1992)

(Accepted 25 October 1992)

Key words: Palatine; Lingual; Tonsil; Ectopic: Salivary gland

Abstract

A case is reported of a child born
branchial arch in whom there was
horseshoe-shaped mass of what was
was performed but histopathological
them to be almost entirely made up
with a developmental field defect of the first
partial obstruction of the oropharynx by a
thought to be tonsillar tissue. ‘Tonsillectomy’
examination of the excised specimens showed
of salivary gland tissue.

Introduction

Ectopic salivary glands are known to occur throughout the oral cavity and are so
common in some areas that they have been referred to as ‘minor’ rather than ectopic
[2]. These are glands which on histological examination exhibit a ductal system
rather than simply being aberrant salivary tissue 161.The palatine tonsils have been
documented as containing microscopic salivary glands but the almost total replace-
ment of tonsillar tissue by ectopic salivary gland has not previously been described.

Case report

In January 1989 a ten-month-old boy was admitted to the Plastic Surgery Depart-
ment of the Royal Victoria Infirmary for investigation and repair of what was
diagnosed provisionally as a soft palate cleft.
Correspondence to: A.R. Banerjee, Department of E.N.T., Freeman Hospital, Newcastle Upon ‘b-e. UK.
160

Since birth he had failed to thrive and had been admitted to hospital several times
with feeding difficulties and recurrent chest infections. A tentative diagnosis of
Pierre-Robin Syndrome made shortly after birth was modified to ‘a developmental
defect of the first branchial arch’ by a clinical geneticist who examined the child. The
child was found to exhibit micrognathia, microglossia and what appeared to be a
cleft soft palate. There was no stridor and the voice and cry were normal.
At operation, after a gaseous induction of anaesthesia, intubation proved impossi-
ble because of severe narrowing of the oropharyngeal isthmus thus obscuring the lar-
ynx from view. However, an airway could be maintained by pushing the mandible
anteriorly. An examination under anaesthetic revealed no evidence of a cleft palate,
the apparent defect being due to abnormal pharyngeal anatomy (Fig. 1.). An ENT
opinion was therefore sought. Further examination under anaesthetic, with the
fashioning of a tracheostome to allow safe anaesthesia, revealed the apparent soft
palate cleft to be in fact abnormal palatoglossi, the edges of which came together
to form a curtain between uvula and tongue. The soft palate was normal.
By inserting an endoscope between the palatoglossi, normal tonsils were seen. The
tip of the epiglottis was identified but the rest of the larynx could not be seen. In
place of the lingual and palatine tonsils was found a horseshoe of lymphoid tissue
lying in front of the curcumvallate papillae which considerably narrowed the
oropharyngeal isthmus. This was excised and sent for histopathological examina-
tion. A later examination under anaesthetic showed fibrosis in the area of the excised

Fig. I. Intraoral view of patient age 2 years.

Fig. 2. Photomicrograph of salivary tissue excised from the right palatine tonsil showing serous acini and
normal ductal system. (Haematoxylin and eosin. Mag. x 158).

tissue with no regrowth of salivary tissue. The parotid and submandibular salivary
ducts were identified and saliva was seen emenating from the parotid ducts, The
uvula was excised to increase the size of the oropharyngeal isthmus but was found
to contain no abnormal tissue on histopathological examination.

Histopathology
Examination of multiple blocks of tissue excised from the site of the right palatine
tonsil revealed apparently normal salivary gland tissue consisting of serous acini
(Fig. 2). The tissue from the left palatine tonsil bed was similar and consisted mainly
of serous acini, but a few lobules of normal mucous acini and some underlying ton-
sillar tissue and muscle were included. Both histological specimens showed normal
ductal systems.

Discussion

An ectopic salivary gland is defined as a normal gland in an abnormal position

[6]. Lucas (1972) [2] classified eight groups of minor salivary glands including the
tonsillar glands and it has therefore been argued that descriptions of ectopic salivary
glands occurring in these sites are wrongly classified as salivary heterotopia [3].
Samy et al. (1968) [4] found ectopic salivary glands in the tonsils to be consistently
of the mucus rather than serous type.
162

Unfortunately, these definitions have not been used in all descriptions of salivary
tissue anomalies and so the incidence of ectopic as opposed to aberrant salivary tis-
sue reported in the literature cannot be accurately ascertained. However, Sanderson
(1952) [5] reported a case of aberrant salivary tissue excised from the left tonsillar
bed after tonsillectomy and in a review of the literature found a further twelve cases
of salivary tissue reported as occurring in the tonsillar fossa. Detailed histological
descriptions were not included in many of these reports but this suggested that the
majority were probably ectopic rather than aberrant. Sinha et al. (1987) [7] reported
a case of ipsilateral absence of tonsil and microtia with an ectopic salivary gland oc-
curring on the posterior ipsilateral tongue. The relation of the ectopic salivary gland
to the circumvallate papillae was not mentioned.

Summary

A case is reported of a ‘horseshoe’ of ectopic salivary tissue almost totally replac-

ing the palatine tonsils and being continuous across the tongue anterior to the cir-
cumvallate papillae. Histological examination revealed areas of serous and
seromucinous acini in contrast to previous descriptions of ectopic salivary glands of
the palatine tonsils [3]. Normal ductal systems were present. This occurred in a child
with a development defect of the first branchial arch. There has been no similar case
report.

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