Juxtaoral organ of Chievitz: An innocuous organ to be known

Abstract

The Juxtaoral Organ of Chievitz is a normal anatomical structure located within the soft tissue in the buccotemporal fascia on the medial surface of the ascending ramus. This enigmatic vestigial structure is considered to be of neuroepithelial origin with no known function. As a matter of fact, JOOC is one of the most treacherous pitfalls in surgical pathology with respect to lesions in the head and neck area. Hence the basic aim of this short communication is to reveal the importance about this organ and enlighten the oral pathologist about this histopathological structure, thus preventing extensive and unnecessary investigations.

Juxtaoral organ: an anatomical finding to be considered

“…In our case the JOO appeared bilaterally, which agrees with what was described by Ito et al [10] and Sancheti et al [24], while the location and relations observed are consistent with what has been established in the literature [2,16,25], ruling out the possibility that it is an accessory parotid gland, as this presents a more superficial location and is relative to the parotid duct [21]. In our finding we observed a close proximity of the JOO to the roots of lower third molar, which could imply its exposure and/or damage during oral surgeries, although due to the little or no functionality that it seems to have, we consider that this damage might not be relevant to an individual's physiology.…”

The Juxtaoral Organ: From Anatomy to Clinical Relevance

“…It is generally described as 7–17 mm long and 1–2 mm wide [ 1 , 4 , 12 , 21 ]. In the cases in which the juxtaoral organ reaches 10 mm of diameter, this may be presumed to indicate a submucosal tumour or hyperplasia of the juxtaoral organ [ 10 ].…”

“…This organ was also described as in close proximity to the site used for inferior alveolar nerve block injection [ 24 ]. Other authors reported that the juxtaoral organ is located in the infratemporal region, at the level of the submucosa, in the retromolar trigone, medial to the medial pterygoid muscle and in relation with the pterygomandibular raphe [ 4 , 10 , 15 ]. Ramos-Vega and Roa [ 4 ] used, for the first time, head sections of a plastinated Asian male cadaver.…”

“…Some authors have demonstrated that the juxtaoral organ cell nests are immunohistochemically positive for vimentin, epithelial membrane antigen (weakly reactive), desmin, melan-A, a wide spectrum of cytokeratins and neuroendocrine markers (such as chromogranin, synaptophysin and neuron-specific enolase) [ 10 , 28 , 30 ]. The central epithelial cells are positive for cytokeratin 19 and the peripheral basal cells are positive for high molecular-weight keratin; however, no expression of S100 protein was observed [ 2 ].…”

“…Due to its topography, Salzer and Zenker proposed defining this anatomical structure as the ‘juxtaoral organ’, as it was later recognized in Terminologia Histologica: International Terms for Human Cytology and Histology (FICAT, 2008) and in the International Anatomical Terminology [ 9 ]. To date, this organ may be found with various other names, such as orbital inclusion, buccopharyngeal tract, ramus mandibularis ductus parotidei or buccotemporal organ [ 10 ]. Furthermore, Zenker speculated that the juxtaoral organ, due to its close relation with the buccal nerve, might have a mechanosensory function [ 11 ].…”