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PubMed1987

[Computed tomography and diagnosis of salivary gland diseases].

A study was carried out to compare routine sialography and combination sialo-CT. The results in 36 patients with afflictions of the parotid and submandibular region are discussed. In addition to tumors, regarded as primary indications, inflammatory disorders were also considered. The diagnosis made by routine sialography is regularly confirmed by computed sialography (CTS), which is often an important complementary means. Visualization of the deep parotid lobe and parapharyngeal space (third plane) is very important for making the diagnosis and planning therapy.

Humans↗
PubMed1985

A comparative analysis of the clinical, sialographic, and pathologic findings in parotid disease.

In review of the clinical and sialographic ability to predict parotid pathology, it was found that the clinical exam was consistently more accurate. Sialographic findings and histopathology were compared in 119 patients who underwent 120 sialograms and subsequent parotidectomies. Sialography alone was able to diagnose a malignant tumor in only 8 per cent (1/13) of the cases. The sialogram proved most helpful for the clinician in the management of patients when the diagnosis was calculus, obstruction, or sialectasia. On the other hand, mass lesions in or adjacent to the parotid, diffuse enlargement of the gland, or conditions such as masseter muscle hypertrophy are probably better evaluated with newer CT techniques in conjunction with sialography or without sialography.

Adolescent↗
PubMed2004

Diagnosis and therapeutic management of iatrogenic parotid sialocele.

Salivary gland sialoceles are relatively common and may be a complication of trauma with a penetrating salivary gland injury or may be a complication of salivary gland surgery. The development of new diagnostic tools such as magnetic resonance sialography and endoscopic techniques has led to further improvements in the clinical and diagnostic assessment of this condition, and botulinum toxin therapy has recently been described in the management of parotid sialoceles. We here report the case of a 41-year-old patient with an unusually complicated parotid sialocele following an unsuccessful attempt to remove a stone located in the distal third of Stensen's duct. Magnetic resonance sialography and sialoendoscopy were used in order to obtain an adequate diagnostic assessment. The patient underwent extracorporeal lithotripsy that led to partial symptom regression. After the development of a parotid abscess, he received antibiotics and a botulinum toxin type A injection that induced spontaneous drainage and disappearance of the symptoms. Magnetic resonance sialography and sialoendoscopy are promising new diagnostic techniques for better noninvasive management of iatrogenic sialoceles.

Adult↗
PubMed1982

Computed tomography in the diagnosis of parotid gland tumours.

Twenty patients with swelling of the parotid region have been examined by computed tomography (CT). CT correctly demonstrated a mass in eleven patients and correctly excluded a mass in nine patients. Five patients had primary parotid neoplasms, all of which showed higher attenuation values than normal salivary tissue. The other masses included cystic hygroma, branchial cyst, carotid sheath hamartoma and metastases in the region of the gland. Neither intravenous nor intraglandular contrast medium was necessary for diagnosis. CT is superior to sialography in demonstrating the total extent of a mass, particularly when there is involvement of the deep lobe of the gland or the parapharyngeal space. The appearance at CT following sialography with oily contrast media suggest that oil persists in the gland despite apparent complete clearing at sialography. CT should be regarded as the investigation of choice in patients with clinical features suggesting a mass in the region of the parotid.

Adenoma↗
PubMed2001

The role of MRI in facial swelling due to presumed salivary gland disease.

50 consecutive patients presenting with facial swelling thought clinically to be due to salivary gland disease underwent MRI. Examinations were interpreted by one radiologist without access to previous investigations. Records were reviewed to determine the reliability and role of MRI in patient management, and the contribution of other prior or subsequent investigations. MRI findings were verified against operative findings, percutaneous biopsy or clinical follow-up (periods ranging from 8-58 months). A mass was found in 27 patients; in 11 of these patients, disease was extrinsic to the salivary gland. MRI diagnosis of tumour was correct in all patients and MRI was a reliable investigation for planning surgical resection. No mass was found in 23 patients, 8 of whom had normal appearances. Evidence of salivary duct dilatation was seen in 12 patients and fatty infiltration was seen in 3. MRI findings appeared correct in all patients. Prior investigation was undertaken in 29 patients, including orthopantomography, ultrasound and sialography; none provided additional information. Sialography was carried out in three patients after MRI and concurred with MRI in all cases. MRI was an adequate basis for management in all patients and therefore appears to be an effective first line investigation of facial swelling. It is reasonable for patients to undergo preliminary investigation for dental sepsis, this being the most common cause of facial swelling. Further study is required to determine whether MRI can completely replace invasive sialography.

Adenoma, Pleomorphic↗
PubMed1986

Natural history of patients with recurrent parotitis and punctate sialectasis.

The clinical features of 68 patients (26 children and 42 adults) who suffered recurrent attacks of parotitis and in whom sialography had revealed punctate sialectasis of the affected gland is described. The sex incidence was equal in those patients in whom symptoms commenced during childhood (younger than 15). When symptoms commenced later in life, however, there was a marked preponderance of females (female:male = 7.5:1). Bilateral sialography in 16 patients with unilateral symptoms revealed punctate sialectasis in the asymptomatic gland in 11 (69 per cent) of patients. Neither the presence of the sicca syndrome nor auto-antibodies had a significant predictive value as to the outcome of the disease. Five-year follow-up of 52 patients revealed that 56 per cent of adults and 64 per cent of children had shown spontaneous improvement of symptoms with symptomatic treatment alone. In 40 per cent of adults and 4 per cent of children, however, the persistence or worsening of symptoms necessitated parotidectomy. We believe that these results of conservative management indicate that, at least in the first instance and particularly in children, conservative management is justified and that the use of radiotherapy or steroids (with their attendant morbidity) is unnecessary.

Adolescent↗
PubMed1987

Acute suppurative parotitis in outpatients: microbiologic and posttreatment sialographic findings.

The presenting clinical features of twenty-seven cases of acute suppurative parotitis seen in the Oral Medicine Unit, Glasgow Dental Hospital, between 1975 and 1985 are reviewed. The microbiologic findings plus the management and subsequent findings on sialography after recovery are summarized. Of the microorganisms isolated, alpha-hemolytic streptococci predominated, with many other bacteria similar in range to those reported in previous studies. Microbiologically, the drug of choice was erythromycin, closely followed by ampicillin. Sialography in the posttreatment phase demonstrated a local salivary gland abnormality in 70% of patients, and 22% of patients had a generalized salivary gland disorder. On the basis of these findings, a management regime for patients with acute suppurative parotitis is suggested.

Acute Disease↗
PubMed1989

Sonographic examination of sialolithiasis.

Ultrasound examination for sialolithiasis was carried out in ten cases, and the findings were compared with those from sialography. Salivary stones were recognized as high-level reverberation echoes accompanied by posterior acoustic shadows in eight cases, whereas in the remaining two they appeared only as hyperechoic masses. In a case of sialolithiasis of the parotid gland that was difficult to detect by simple radiographic examination, a salivary stone was detected by both sialographic and ultrasonographic examination. Clearly separated salivary stones were also easily detected in each case by the ultrasonographic method, but multiple, gathered calculi were not precisely detected. The smallest sialolith that could be detected was approximately 2 x 3 mm in size. The rate of detection of salivary stones by using the ultrasonographic method was as high as that from using sialography. Because the examination is simple and noninvasive, its use to evaluate sialolithiasis is probably indicated more frequently, especially when there is acute infection in the gland.

Adolescent↗
PubMed2004

Quantitative ultrasonography and magnetic resonance imaging of the parotid gland: can they replace the histopathologic studies in patients with Sjogren's syndrome?

OBJECTIVE: To assess the diagnostic value of parotid gland quantitative assessment using ultrasound (US) as well as magnetic resonance imaging (MRI) in patients with Sjogren's syndrome (SS) and to evaluate the possibility of using such modalities as a predictor of the histopathologic score of salivary gland biopsy in this group of patients. METHODS: Sonographic and MRI studies were performed on the parotid glands of 47 patients diagnosed to have primary SS, 20 healthy control subjects of matched sex and age, and 20 subjects with sicca symptoms but without any evidence of SS. The patients and the control subjects were scored according to the structural changes seen in both radiologic modalities. In addition, sialography and labial gland biopsy were done for all patients as well as the control subjects and scored according to the degree of affection. RESULTS: Parenchymal inhomogenity (PIH) was seen in 93.6% of the patients studied by US, while nodular pattern was seen in 97.8% in the MRI study. The US and MRI results correlated significantly with the histopathologic score of the minor salivary glands (r = 0.82, 0.84, respectively) as well as sialography score (r = 0.69, 0.60, respectively). There was good agreement between US and MRI findings (r = 0.87) in both SS cases and control subjects. CONCLUSION: US and MRI are equally sensitive tools for the diagnosis of salivary involvement in patients with SS. Quantitative assessment of US and MRI images seem to represent an advance in the diagnosis of SS as they offer a good prediction of the pathology score of the salivary gland. MRI seems unnecessary as a routine diagnostic tool and should be considered as the second option in case of normal US.

Aged↗
PubMed2006

[What's useful in maxillo-facial surgery imaging: advantages and disavantages of examination modalities (first part)].

Widespread use of multislice volumic CT and rapid 3D reconstructions as well as MR sequences allowing high-resolution tissue characterization have greatly improved the efficiency of face and neck imaging. Panoramic radiography nevertheless remains highly contributive. Sonography has now replaced the standard sialography for the diagnosis of salivary lithiasis. The quality of MR sialography remains subject to sufficiently salivation into the salivary ducts, but without long-lasting retention increasing protein content. Plain radiographs of the face are now out of date.

Bone Diseases↗
PubMed1990

Bacterial colonization of the parotid duct in xerostomia.

Salivary flow rate and bacterial colonization of the parotid main duct were investigated in 17 patients referred for sialography and in 10 healthy controls. Cultures in the controls were negative whilst the patient group revealed bacterial colonization of the main duct, especially in those with the lowest flow rates. The implications of this finding in patients at high risk of endocarditis who will be undergoing sialography are discussed.

Adolescent↗
PubMed1998

Sonographic analysis of recurrent parotitis in children: a comparative study with sialographic findings.

OBJECTIVE: The sonographic features of recurrent parotitis in children were studied to clarify a relationship between sonographic and sialographic findings in this disease. STUDY DESIGN: Twenty-one glands (7 on follow-up) were examined by 7.5 MHz ultrasonography and sialography. Echo intensity level, distribution of the internal echoes, and size of hypoechoic areas were compared with the size of punctate shadows on the sialograms. Twenty other histopathologic specimens were analyzed to investigate the entity of hypoechoic areas. RESULTS: Sonography showed hypoechoic, heterogeneous internal echoes, the level of which increased as the punctate shadows enlarged. Hypoechoic areas, all of which were larger than the sialographic punctate shadows, were observed in 62% of the glands. Histopathologic analysis suggests that these hypoechoic areas represent dilated peripheral ducts with lymphocytic infiltration. Sonography was likely to detect changes over time more sensitively than sialography. CONCLUSIONS: Sonography should be performed as the test of first choice, both in the primary and follow-up stages, in cases of recurrent parotitis in children.

Adolescent↗
PubMed1999

Primary sialoangiectasia--a diagnostic pitfall in Sjögren's syndrome: case report.

A case of primary sialoangiectasia, which in this case was initially misdiagnosed as Sjögren's syndrome, is described. Other diseases, including HIV infection, psoriatic arthritis, and acute parotitis, may cause glandular changes similar to the changes found in the syndrome. Therefore, sialography must be combined with other methods of assessment of the oral cavity when suspicion is high for Sjögren's syndrome. Properly applied, sialography provides essential information regarding the severity of glandular damage and the progression of the disease.

Diagnosis, Differential↗
PubMed2001

Diagnosis and treatment of strictures and kinks in salivary gland ducts.

PURPOSE: This article describes the use of sialoendoscopy for diagnosis and treatment of strictures and kinks in the major salivary glands ducts. PATIENTS AND METHODS: Thirty-four salivary glands with obstruction were diagnosed as having ductal kinks or strictures. Strictures were diagnosed by sialography and sialoendoscopy, kinks were diagnosed mainly by sialography, whereas endoscopy was used to rule out other pathology and to locate the kink. There were strictures in 25 salivary glands (14 male and 11 females; aged 25 to 60 years), 14 in the parotid and 11 in the submandibular gland, and kinks in 9 salivary glands (5 males 4 females; aged 40 to 55 years). Seven kinks were found in the submandibular gland and 2 in the parotid. Treatment of strictures was performed by dilatation procedures with saline under pressure, balloon techniques, and forced manipulation. After these procedures, a polyethylene stent was inserted for 2 weeks. Kinks were treated by advancement ductoplasty and balloon contouring to overcome the acute angle. RESULTS: Twenty of 25 cases of stricture became completely asymptomatic in a follow-up of 8 to 36 months after treatment. In 4 cases, further revisional dilatation was needed, and in 1 case treatment failed and the gland had to be removed. All 9 cases of kinks became completely asymptomatic in a follow-up of 6 to 24 months after treatment. CONCLUSION: Strictures and kinks should be considered when salivary gland obstruction is present without sialolithiasis.

Adult↗
PubMed2001

Experimental microsurgery of salivary ducts in dogs.

The results achieved by experimental microsurgical suturing of salivary ducts in dogs are presented. Nine partial lesions and one complete transection of the ducts were made on parotid and submandibular ducts. Four to seven interrupted microsutures were used for each lesion. The operations were successful in seven out of 10 cases, as observed by sialography. Histologically, granulation tissue compressing the ducts was observed after suturing the lesions. Four venous graft transplantations were performed and none were successful. After venous graft transplantation, the transplant was not apparent histologically, raising doubt as to the potential success of this technique. The use of stenting is discussed based on a summary of the published literature. Those reports indicate that long-term stenting can benefit the outcome of salivary duct repair. The use of dogs as a model for experimental salivary duct operations has been shown to be valuable in assessing various surgical techniques. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗
PubMed1981

Parotid gland sarcoidosis and the CT sialogram.

The clinical and radiographic presentation of salivary gland sarcoid is presented. Computed tomographic sialography is a more sensitive method for detecting the multiple discrete granulomas of sarcoid than is conventional sialography. This appearance is distinctly different from that of the autoimmune salivary diseases with which it can be clinically confused. The differential diagnosis of salivary sarcoid is presented.

Adult↗
PubMed1999

Salivary gland involvement in patients with chronic pancreatitis.

The salivary glands are structurally similar to the exocrine pancreas and may be involved in the course of diseases of autoimmune origin (sclerosing cholangitis, ulcerative rectocolitis, primary biliary cirrhosis). For a not-yet-quantified proportion of chronic pancreatitis (CP) cases, a possible autoimmune pathogenesis has been postulated. The aim of the study was to assess the frequency of salivary ductal system abnormalities in patients with CP. Fifty-one patients with CP consecutively admitted to our center were studied (44 men, seven women; mean age, 48.2 +/- 10.8 years). The mean duration of disease was 11.7 years (range, 1-37 years); 44 (86%) of 51 patients had pancreatic calcifications, 25 (49%) of 51 diabetes, 25 (52%) of 48 steatorrhea, and 32 (63%) of 51 underwent pancreatic surgery. As a control group, we studied 10 patients of whom four with liver cirrhosis (three alcoholic and one posthepatitis; three men, one woman; mean age, 57 +/- 12.5 years), and six with temporomandibular pain (five men and one woman; mean age, 42 +/- 10.3 years). The patients were given parotid sialography, the findings being read by two independent observers. In two CP patients, parotid sialography was unsuccessful. Fifteen (31 %) of 49 patients and none of the 10 control patients exhibited abnormalities of the glandular ducts compatible with chronic inflammation of the salivary ducts (p = 0.039). None of the CP patients had salivary intraductal calcifications. Findings of parotid ductal abnormalities are frequent in the course of CP and may indicate a common pathogenetic mechanism, even of an immune type.

Adult↗
PubMed2005

Sialoendoscopic and irrigation findings in chronic obstructive parotitis.

OBJECTIVES/HYPOTHESIS: To study the sialographic changes related to sialoendoscopic and irrigation fluid findings in chronic obstructive parotitis. STUDY DESIGN: The sialographic changes were classified according to previous studies and related to sialoendoscopic and irrigation fluid findings. METHODS: This study included 26 patients with a long history of parotid swelling. All patients were examined by radiography and sialography and were diagnosed as having chronic obstructive parotitis without sialolithiasis. Sialoendoscopy was used to observe the ductal system and perform an irrigation treatment. The irrigated liquid was centrifuged, and the fluid deposits were stained and observed using light microscopy. RESULTS: In all cases, sialoendoscopic examination showed the ductal system was filled with fiber-like substances and hyperemia of the ductal wall. Although a few of the thin and short fiber-like substances were found in the chronic obstructive parotitis patients with sialographic type I and type II changes, many thick and long wadding or lumpy fiber-like substances were revealed in chronic obstructive parotitis patients with sialographic type III and IV changes. Microstones were found in two chronic obstructive parotitis patients with sialographic type III changes, which were stained and identified using light microscopy. Irrigation fluid examination showed that the fiber-like substance was composed of desquamative duct epithelial cells, neutrophils, lymphocytes, and acidophils. Also, some epithelial cells were found in two microliths. CONCLUSIONS: Sialoendoscopy can provide direct and more detailed observation of the ductal system compared with sialography. Fiber-like substances in the lumen of the ductal system are considered one of the obstructive factors associated with chronic obstructive parotitis.

Chronic Disease↗