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Lipomatous infiltration of the canine salivary gland.

Benign connective tumours of the canine salivary glands are rare. This report describes lipomatous infiltration of parotid or submandibular salivary glands in seven dogs in which the glands were enlarged as a result of infiltration by fat cells; they appeared to have been successfully treated by local excision. The precise cause of the lipomatous infiltration in the dogs is unclear but different causes of similar lesions in humans are discussed.

Animals↗

Parotid gland enlargement and xerostomia associated with labial sialadenitis in HIV-infected patients.

Infection with human immunodeficiency virus (HIV) may be associated with enlargement of the major salivary glands or symptoms of dry mouth. We term this condition HIV-associated salivary gland disease (HIV-SGD). In this report we describe 12 patients with HIV-SGD. Nine patients (one child, eight adults) had enlargement of the parotid glands, and three had xerostomia alone. Symptoms of dry mouth, dry eyes or arthralgia occurred in 11, five and five patients, respectively. Salivary flow rates were normal or slightly reduced in seven patients and severely reduced in five. Labial salivary gland (LSG) biopsy specimens from patients contained lymphocytic infiltrates in focal and other patterns, whereas specimens from three HIV-infected patients without salivary gland symptoms did not. The inflammatory infiltrates in LSG specimens showed a preponderance of T8-positive cells and a tissue T4/T8 average ratio of 0.66. The mean T4/T8 ratio of peripheral blood lymphocytes was 0.4. Serum antinuclear antibodies were present in one patient, but rheumatoid factor, SS-A, and SS-B antibodies were absent in all. Search for Epstein-Barr virus and cytomegalovirus in the LSG tissue of the six patients tested did not reveal evidence of antigens or DNA. HIV-SGD patients show a number of similarities to and differences from patients with Sjögren's syndrome (SS). The similarities include the oral and salivary features, histopathology and possibly changes in other organs. The differences include the lower salivary gland T4/T8 ratio and the absence of autoantibodies in serum. The causes of HIV-SGD as well as of Sjögren's syndrome are unknown.

Adult↗

Salivary excretory index--quantification of the ascorbic acid response in dynamic radionuclide sialography.

Dynamic radionuclide sialography (DRS) provides data about the aptitude of salivary glands to accumulate the tracer and to secrete the saliva. Visual interpretation of the t/a curves may be onerous when salivary glands uptake function is impaired. The purpose of the study has been to quantify the ascorbic acid (AA) response by means of salivary excretion index (SEI). DRS was performed in 10 healthy subjects and in 118 patients with various diseases of the parotid glands. Data acquisition (80 frames/15 s) started simultaneously with i.v. administration of 99mTcO4. Fifteen minutes later AA was given per os. Regions of interest were set over parotid glands. SEI was derived using the formula: SEI = (2b-a-c)/b, where a, b and c were cpm 3 minutes prior, in the moment when, and 3 minutes after AA was given. In 9 of 10 controls SEI was greater than 55 (mean = 63.2). Results in patients with Sjögren's and Mikulicz's syndrome and sialoadenitis, were significantly lower than in healthy subjects. Lowest results were found in patients with sialolithiasis. It may be concluded that SEI improves objective assessment of the AA response particularly in patients with minute or asymmetric disorders of salivary glands function.

Ascorbic Acid↗

Absolute indications for salivary gland scintigraphy with 99mTc-pertechnetate.

In recent years salivary gland scintigraphy has gained widespread acceptance as a useful means for evaluating salivary gland disorders. An absolute indication for this procedure exists when the ductal orifice of one or several major salivary glands cannot be found or cannot be cannulated. Clinical conditions in which this problem occurs include technical failure to probe and cannulate the duct, developmental anomalies, obstructive disorders, traumatic lesions and fistulae and the need of postsurgical information after glandular excision or after ligation or repositioning of a major excretory duct. The clinical value of scintigraphy in these conditions is demonstrated by means of case presentations.

Adult↗

Retromolar swelling.

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Diagnosis, Differential↗

[Autoimmune diseases of the salivary glands].

The structural and functional features of the salivary glands and their function associated with the immunocompetent system are described. The disturbance of such association, in the author's opinion, is conducive to the development of a peculiar tumour pathology (adenolymphomas) and autoimmune processes (Sjögren syndrome autoimmune parotitis). Based on the data from the literature two forms of this disease are distinguished: (1) a distinct nosological form developing as a result of various exo- and endogenous injuries, and (2) manifestations of other diseases, as a rule, of the autoimmune genesis accompanied by the secondary involvement of the salivary glands. The morphological picture in both forms is identical. It is suggested that in systemic involvement of the salivary, lacrimal and other glands and some autoimmune disease the term "Sjögren syndrome" be used, and the distinct disease be termed "autoimmune parotitis".

Adenolymphoma↗

[Biochemical aspects of human salivary gland secretions].

Salivary secretions fulfill some specific functions within the human organism, which are explained. The scientific research concerning these fluids dealt during the last years especially with the formation of these secretions within the glands. These investigations have been performed mostly in animal experiments. The results obtained are briefly summarized. For investigations in human salivary secretions, it was necessary to develop some new techniques for collecting the secretions from separate glands. The interpretation of sialo-chemical facts is often difficult as there are many factors, influencing the flow-rate and the composition of the fluids. These factors, as known up to now, are explained. In separate chapters, the inorganic and organic composition of human salivary secretions is described. Concerning the protein-composition of human saliva, there are some newer results as aspects, which are discussed. It must be the aim of a chemical analysis to discover the interrelation between the differences in salivary secretions and pathological conditions. Therefore changes of the salivary secretions in systemic diseases are reported as well as changes in the compositions of these fluids in pathological conditions of the glands themselves. According to the results from own experiments and from the literature, it should be possible in the future, to develop some new diagnostic methods by analysing the salivary secretions.

Humans↗

Subtotal parotidectomy in the treatment of chronic sialadenitis.

Chronic recurrent parotitis can be disabling, and often requires surgery for its resolution. Twenty-one patients with chronic sialadenitis treated by subtotal parotidectomy were studied. Two patients developed transient and one significant postoperative recurrent parotitis, and two patients had salivary fistulas. There were no instances of permanent facial nerve weakness. Parotidectomy in patients with severe chronic sialadenitis risks injury to the facial nerve. When the nerve is indistinguishable from surrounding scar, subtotal parotidectomy would appear to be preferable to total parotidectomy in select patients. Total parotidectomy is the procedure of choice for elimination of chronic sialadenitis when it can be performed with minimal risk to the facial nerve.

Chronic Disease↗

Salivary gland scintigraphy: the use of semiquantitative analysis for uptake and clearance.

OBJECTIVE: Quantitative analysis of (99m)Tc-pertechnetate salivary gland scintigraphy has been used in the evaluation of salivary gland function, but so far no one method can be considered optimal for this task. In this study, a semiquantitative method providing 2 functional parameters for objective assessment of salivary gland function by scintillation camera imaging was tested. METHODS: Twenty-one patients referred for (99m)Tc-pertechnetate thyroid scanning were studied. Two patients with salivary complaints were also included. Dynamic imaging of the anterior head using a scintillation camera was started after a bolus intravenous injection of 185 MBq (5 mCi) (99m)Tc-pertechnetate at 1 frame per 30 s for 30 min. At 15 min after injection, diluted lemon juice was administered orally. Analysis of the dynamic study included time-activity curves of 4 salivary glands (right and left parotid and right and left submandibular). Two parameters of function were defined: uptake rate, taken as the value of the initial slope of the time-activity curve, and washout fraction, which was the relative mobilizable radioactivity from each salivary gland after ingestion of the sialogogue. A parametric image of the washout fraction was also generated. RESULTS: The images showed gradual uptake in the parotid and submandibular glands. Washout was noted immediately after ingestion of the lemon juice. The pattern of the time-activity curve in all glands showed an early fast-rising part followed by a slow-rising component to nearly a plateau within 6-10 min after injection. The mean value of the uptake rate parameter was 0.10 +/- 0.09 cps/s. There was no significant difference between the parotid and submandibular glands or the right and left sides. Uptake in the parotid gland was 1.5-2 times that in the submandibular gland. The washout fraction was 1.40 +/- 1.60 for the parotid glands and 0.77 +/- 0.41 for the submandibular glands (P = 0.005). CONCLUSION: The quantitative analysis method including the uptake rate and the washout fraction parameters would enable objective assessment of salivary function and provide a reproducible means for follow-up of functional impairment in certain diseases.

Adolescent↗

Parotid swellings: report of 110 consecutive cases.

Parotid swellings are uncommon. Over a twelve-year period, 110 cases of parotid swellings were treated at the Department of Plastic Surgery, Hospital Kuala Lumpur, of which 97 cases were histologically proven to be parotid tumours. 75% of these tumours were benign tumours, and 80% of the benign tumours were pleomorphic adenomas. Among the malignant tumours, 6 cases were adenoid cystic carcinoma and 5 were carcinoma ex-pleomorphic adenoma. There were equal number of male to female patients, with an age range of 14 to 83 years. There is a positive correlation between the final histological diagnosis and FNAC results in 74% of cases. Surgical treatment of choice for benign parotid tumours was near-total parotidectomy whilst for malignant tumours was total radical parotidectomy with sural nerve graft.

Adolescent↗

Mucocele of the anterior lingual salivary glands (glands of Blandin and Nuhn): report of 5 cases.

The anterior lingual salivary glands (glands of Blandin and Nuhn) are mixed mucous and serous glands that are embedded within the musculature of the anterior tongue ventrum. Five cases of mucocele of the glands of Blandin and Nuhn are presented. These mucoceles on the anterior tongue ventrum were exophytic and resembled pyogenic granulomata, polyps, or squamous papillomata. In 2 cases, the onset of the mucocele was associated with trauma to the anterior tongue. All cases were mucus extravasation phenomena. A history of trauma and recovery of mucus with fine needle aspiration are helpful in the clinical diagnosis of mucocele of the glands of Blandin and Nuhn, as are the following characteristics of the mucocele: rapid onset, increase and reduction in size, bluish color, and fluid-filled consistency. During surgery, the glands that are deep in the tongue musculature are commonly left behind, resulting in persistence of the lesion. Careful clinical evaluation of these lesions and preoperative awareness of the surgical anatomy of the glands of Blandin and Nuhn may minimize the need for repeated surgical procedures.

Adult↗