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Buccinator window anomaly.

Four patients, three women and one man, with a mean age of 32 years, presented with a history of recurrent parotid swelling. In the women the swelling was unilateral. All had previously undergone sialography using a hand injection technique and no structural abnormality was demonstrated. Sialography was repeated using a continuous-infusion pressure-monitored system. In all cases an initial very high filling pressure (>200 mmHg) was recorded followed by a rapid reduction in pressure and a more normal filling pressure pattern. The duct system and glands all appeared morphologically normal. Treatment with acrylic appliance therapy and an intraductal catheter was attempted with some success.

Adult↗

Recurrent parotitis.

(1) Recurrent parotitis is probably caused by a congenital abnormality of the salivary gland ducts with recurrent attacks of ascending infection, perhaps aided by dehydration. The parotid gland is predominantly affected probably because of its lower rate of secretion compared with the submandibular gland. (2) The condition mainly affects children between the ages of 3 and 6, with males being more commonly affected. The symptoms peak in the first year of school, and usually, but not invariably, begin to subside at puberty. By the age of 22, most patients are completely symptom-free. When the disease starts after puberty, females are predominantly affected. (3) Ultrasound is the appropriate initial investigation, and is usually supplemented by sialography. The sialography may itself cause a resolution of symptoms. (4) Treatment is conservative in the first instance, and an expectant policy is indicated. More aggressive treatment is justified only for those adults with persistent problems. This may be parotid duct ligation, parotidectomy, or tympanic neurectomy, depending upon the preference and experience of the treating physician.

Child↗

A case of buccal abscess; originating from an ectopic accessory parotid gland?

We report a case of an abscess from an 'ectopic' accessory parotid gland in the cheek demonstrated by sialography and computed tomography (CT). The accessory parotid gland was ectopically located anterolateral to the masseter muscle and isolated from the main parotid gland. The orifice and ductal system of the ectopic accessory parotid gland were separated from those of Stensen's duct. The abscess developed from this ectopic accessory gland, and the main parotid gland was free of inflammation. Using sialography and CT, we confirmed the presence of this ectopic accessory gland.

Abscess↗

Management of chronic parotitis: a review.

Chronic parotitis is an insidious inflammatory disorder, which is characterized by a recurrent, often painful, swelling of the gland or glands. Sialography remains the investigation of choice. Diagnostic siladenoscopy may complement or supersede sialography as the diagnostic procedure of choice, as more experience is gained in this technique and its use becomes more widespread. The management options are conservative or surgical, but controversy exists regarding the timing and method of surgical intervention. The surgical methods that have been described include injection of methyl violet - a sclerosing agent, ductal ligation, ductoplasty, tympanic neurectomy, and parotidectomy. Parotidectomy is considered the ultimate surgical option but because of its significant morbidity the exact technique and procedure that should be used remains contentious.

Anti-Inflammatory Agents↗

The anatomy of the facial nerve in relation to CT/sialography of the parotid gland.

The technique of computed tomography with simultaneous parotid sialography allows for accurate localisation of tumours within the parotid gland. The relationship of these tumours to the facial nerve, which divides within the gland, is of surgical significance. A study of the course of the facial nerve through the parotid gland in the cadaver was therefore undertaken in order to identify relevant landmarks for the CT prediction of its relationship to those tumours. The heads of five cadavers were sectioned in the Frankfurt plane into 1 cm slices which were then X-rayed. Individual slices were examined and the course of the facial nerve was plotted on the X-ray plate of the same slice. It was found that the nerve could be represented on a CT scan by an arc of radius 8.5 mm, the centre of which is the most posterior point of the ramus of the mandible. The arc extends from directly lateral to directly posterior to that point. Pre-operative visualisation of parotid tumours by simultaneous CT scan and sialography in conjunction with an appreciation of the course of the facial nerve through the parotid gland may allow for more precise presurgical planning.

Facial Nerve↗

Preoperative assessment of parotid masses: a comparative evaluation of radiologic techniques to histopathologic diagnosis.

A double-blind, retrospective analysis of 110 sequentially operated parotid masses compared the usefulness of preoperative radiologic evaluation to histopathologic diagnosis. The radiologic assessment included 25 sialograms, 162 computed tomography scans, and 10 nuclear magnetic resonance images. The diagnosis is influenced by the following four parameters of computed tomography: tumor borders, density, homogeneity, and enhancement. Well-defined borders, a homogeneous appearance, and high density strongly favor the diagnosis of a benign tumor or a low-grade malignancy (96.7%). Ill-defined tumor borders, heterogeneity, and high density indicate mainly a high-grade or recurrent malignancy (68.8%). Ill-defined borders, a heterogeneous appearance, and mixed density identify a lymphoepithelial lesion, lymphangioma, or sialoadenitis (100%). Sialography is cost effective in the evaluation of lymphoepithelial lesions. Computed tomography sialography offers no advantages over computed tomography with intravenous contrast. High-resolution computed tomography with intravenous contrast is highly sensitive for tumor detection (97%). Magnetic resonance imaging is complementary or superior to computed tomography (100%).

Clinical Trials as Topic↗

Sialographic and ultrasonographic analyses of major salivary glands.

Seventy patients with major salivary gland diseases (60 parotis, 10 submandibular) were examined both with sialography and ultrasonography. The clinical and histopathological results were compared with radiological interpretations. Sialography was found to be 60% accurate for the diagnosis of salivary gland tumors and cysts and 63% for the diagnosis of inflammatory diseases. Ultrasonography diagnosed 95% of the tumors and 63% of inflammatory diseases accurately.

Adolescent↗

[The salivary glands during rheumatoid arthritis].

Salivary gland lesions were studied in 65 non-selected, confirmed rheumatoid polyarthritis patients. The investigations included a careful clinical study, the Schirmer test, sialography, sequential scintigraphy with Technetium 99, and a histological study of the sublingual glands. Tests were also made for salivary gland anti-epithelium antibodies. The frequency of sialography and scintigraphy anomalies is emphasized. In different degrees, two of of three patients presented anatomical or functional anomalies of the salivary glands. These disturbances were not related to the duration, the functional severity, or the treatment of the disease or to the presence of anti-salivary gland antibodies. On the other hand, there was a clear relation with both the presence of anti-nuclear antibodies and an increase in the serum gammaglobulin levels. The limits of the Gougerot syndrome are discussed and it is proposed that there is a need for a second nosological class grouping the minor scintigraphic and sialographic anomalies related to rheumatoid arthritis that has been suggested by several authors.

Adult↗

[Current opinion on diagnosis of primary Sjögren's syndrome].

For many years, Sjögren's syndrome was a purely descriptive diagnosis of symptoms such as xerostomia and dry eye (sicca syndrome). The different classification criteria proposed for Sjögren's syndrome comprise a rather variable spectrum of diagnostic possibilities, at one extreme of which we find an array of exclusively objective parameters while, at the other extreme, the objective parameters and patients' symptoms balance out. Improved accuracy in the diagnosis of Sjögren's syndrome can be attained only through the combination of a symptoms questionnaire, histopathology, scintigraphy or sialography or evaluation of the unstimulated salivary flow and specific autoantibodies. In these last few years, further methods have been proposed to increase diagnostic accuracy: the analysis of various salivary constituents, saliva and tear ferning tests, the search for new autoantigens and, above all the use of ultrasonography and magnetic resonance imaging. Color-power Doppler and magnetic resonance sialography have recently been proposed as promising techniques to improve sensitivity and diagnostic specificity. This study discusses the data present in the literature and personal experience regarding diagnostic methods in a group of 350 patients affected by primary Sjögren's syndrome.

Autoantibodies↗

[Parotid tumors: a diagnostic and therapeutic protocol in 81 surgical cases].

AIM: In the last five years we cured 81 patients divided in two groups: the first was managed inordinately, the second according to a diagnostic and therapeutic protocol. METHODS: The first 23 patients were differently evaluated, before surgery, by means of traditional sialography, US, CT, CT sialography, MR, larger bore needles and FNAB. Neoplasm enucleations, atipic resections, superficial and total conservative parotidectomies were performed. The following 58 patients were evaluated and cured according to a diagnostic and therapeutic protocol. RESULTS: Diagnostic and therapeutic time were shortened, patients endurance improved and cost lowered. DISCUSSION: We think that many diagnostic procedures are useless and delay operation that, if possible, must be performed according to principles of radical extirpation.

Adenoma, Pleomorphic↗

[Chronic obstructive parotitis: a report of 92 cases].

This article presents 92 cases (117 diseased parotid glands) of chronic obstructive parotitis with studies by clinical, sialographical, sequential quantitative scintigraphy methods and with investigation of the treatment. The nature of this disease is that various local factors cause obstruction of saliva flow resulting in recurrent swelling of parotid, in which the main feature in sialography is irregular dilatation of the main duct and branch duct. Sialographical manifestations can be divided into four types. Conservative, operative therapy and injection into diseased gland with 1% methyl violet are introduced to treat this disease. Long follow-up findings show that type I in sialography can be cured by conservative method, but other types to not respond to this method and should be treated by other methods, such as parotidectomy. We have used 1% methyl violet to treat cases who have swelling of parotid after conservative therapy. It is considered to be a simple, practical and good method and should only be used in this disease. There are no other side effects except swelling of parotid for a few weeks. Especially it can be used to treat the anterior part of main duct left over by parotidectomy, which still gives off purulent discharge.

Adolescent↗

[The proteincomposition of human parotid saliva in acute and chronic parotitis. Quantitativ densitometry of single protein-fractions in comparison to normal secretions].

By means of acrylamidgelectrophoresis parotid secretions of patients with acute and chronic parotitis were examined. Thereby significant changes in protein patterns of electrophoretic separation were found. Especially two bands are described in detail. One in the cathodal near gel region, the isoamylases, and the otherone in the anodal part of the gel, identified as albumin. In rest and under stimulation these bands show signficant changes compared to normal secretions. Furthermore information about the capacity of the parotid gland parenchyma is won by observing the changes of amylase bands in rest and under stimulation in chronic parotitis without actute exacerbations. The amylase shows a remarked decreased secretion in chronic parotitis under stimulation corresponding to parenchymalteration. The same happens with the albuminexcretion as parameter for ductlesions. In chronic parotitis albmuninexcretion goes parallel to duct changes in sialography. Therefore by discelectrophoretic separation of native parotid saliva a helpful mean for diagnostic use is given, besides sialography and scintigraphy.

Acute Disease↗

[Diagnostic imaging of the salivary glands in children and adolescents].

In children and adolescents, imaging of the salivary glands is a valuable supplement to clinical examination in various diseases. The choice of the most appropriate radiological technique depends on patient compliance, the necessity of avoiding radiation exposure as far as possible, and the tentative diagnosis made on the basis of the clinical examination. Ultrasonography (US) is the method of choice for the detection of both acute inflammatory disease and masses in the salivary gland and the adjacent tissue. US can also be implemented as a screening method for calculi, though sialography is superior for this purpose. Sialography is the only technique that allows diagnosis and evaluation of the degree of chronic inflammation. Computed tomography and magnetic resonance imaging are required for more deeply located neoplasms of the parotid region.

Adolescent↗

Recurrent parotitis in children. A report of 102 cases.

This article presents 102 cases of recurrent parotitis in children with studies of clinical findings, sialographic manifestations, dynamic functions of the parotid gland examined with radionuclide, laboratory findings and follow-up studies of 28 cases with sialography. The following conclusions are reached: 1. Retrograde infection induced by the mumps virus and upper respiratory infection seem to play a major role in the etiology of recurrent parotitis. Familial abnormalities are potential factors. Incomplete immune functions of the children are factors related to the pathogenesis, and following growth and development of the immune system, this disease will undergo remission; 2. Sequential scintigraphy shows normal uptake and retarded excretion function of the parotid; 3. Long-term follow-up studies demonstrate that the patients are free from symptoms for many years, but the punctate dilatation in sialography may diminish, disappear, or be unchanged; and 4. If the disease is not cured in childhood, it may continue into adulthood and healing will take place eventually. Relationship with Sjogren's syndrome has not been revealed.

Adolescent↗

Computed tomography of parotid masses.

Fifty-six patients with parotid masses, benign tumors in 22, malignant tumors 26 and other diseases 8, were examined by CT scan, which can differentiate intrinsic from extrinsic parotid lesions, especially deep lobe from parapharyngeal tumors and typical benign tumors from malignant ones, but may fail to differentiate aggressive benign tumors from low-grade malignant ones. CT sialography was done to detect the relation between the trunk of the facial nerves and tumor according to the band of normal parotid tissue between the tumor and posterior border of the mandibular ramus, and incremental dynamic CT with intravenous bolus injection of contrast medium to detect the relation between the tumor and carotid sheath. We conclude that the images of CT sialography are much better than those of plain CT and intravenous enhancement CT.

Adenocarcinoma↗

[Sialographic findings in inflammations of the salivary glands (author's transl)].

The greatest part of all diseases of salivary glands are caused by inflammations. The differential diagnosis to other diseases, e.g. tumors, if of great importance. The sialography has hereby developed to an important diagnostic measurement. There is a discussion about the technique of the sialography and its simple performance as well as the high effectiveness of this X-ray examination. The X-ray morphology of different kinds of inflammations is various. The acute inflammations are characterized by narrowing of ducts, the subacute inflammations by the pathological staining of the parenchyma, and the chronic by the increased changes of the Stenon's or Wharton's duct, respectively of ducts with superior range.

Abscess↗

[Present role of diagnostic imaging in the study of extensive pathology of the parotid gland].

After the introduction in diagnostic imaging of CT and US beside sialography (SG), today it is possible completely evaluate the ductal system as well as the parenchima of the parotid gland. The authors examine the results and limitations of these new imaging modalities, outlining their role in the evaluation of parotid masses. Echography, because of high sensitivity, seems to be the method of choice for the first approach to this pathology, while sialography and CT can be successful in some circumstances: the first allows to easy outline the inflammatory involvement of the gland, while CT seems to be essential for the study of deeply situated tumors and for a complete spatial evaluation.

Diagnosis, Differential↗