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PubMedDate not supplied

CT of parotid tumors.

Computed tomographic (CT) appearances of 18 surgically proven parotid tumors were studied. Digital radiography (GE, ScoutView) was performed to select the desired gantry angulations and then plain CT and CT combined with sialography were performed. Plain CT clearly showed parotid tumors in nine of the patients. CT combined with sialography was more helpful than plain CT for delineating the tumors in the other patients who had either tumors in high-density parotid glands for tumors low density. CT allows more accurate evaluation of tumor location and extent in the parotid gland than any other method and helps distinguish malignant from benign lesions. The normal CT appearances of the parotid region are necessary for precise interpretation of CT images in this region.

Adenoma↗
PubMed1994

[Imaging protocol in salivary pathology].

Numerous techniques have been used for imaging salivary glands including standard radiography, scintigraphy, sialography, echography, computed tomography and finally NMI. These different techniques each have their own indications or complementary role. We therefore developed a protocol for using the different imaging techniques according to the different salivary pathologies encountered. This protocol is given as an examination flow chart to be used in light of clinical findings. A large number of images selected by P. Laudenbach illustrate the typical pathologies encountered. Special emphasis is placed on sialography, an important imaging technique, unfortunately somewhat neglected.

Acute Disease↗
PubMed1994

[The x-ray changes in the parotid salivary glands of patients with Sjögren's disease].

The data obtained upon sialography of the parotid glands (PG) in 28 patients with Sjogren's disease (SD) were compared to clinical SD manifestations, PG regional circulation and histological picture of the labial salivary glands. 24 patients exhibited classical sialography characterized by sialoectasias, enlarged ducts, obscure outlines of the latter. 4 sialograms displayed the duct narrowing, noncontrast parenchyma outlines, unclear images of sialoectasias. Severe xerostomia, marked dryness of the vermilion border, rare enlargement of the salivary glands and parotitis recurrences occurred more frequently in patients with narrow efferent PG ducts. These changes are attributed to vascular sclerosis, devascularization, stromal sclerosis and parenchymal PG atrophy.

Adult↗
PubMed1994

[Sialo-ultrasonographic approach of primary tuberculosis of the salivary glands. Apropos of 3 cases].

Primary tuberculotic involvement of the salivary glands makes up two per cent of all cases of salivary gland tumefaction that we have had to explore with ultrasonography and sialography. The patients are generally young adults of a low socioeconomic status. Sialography is nonspecific, whereas ultrasonography can suggest the diagnosis in the presence of heterogeneous, hypoechogenic intraglandular lesions associated to adenopathies. An IDR with tuberculin is essential for the diagnosis before treatment.

Adolescent↗
PubMed1994

[Conventional roentgen diagnosis of the salivary glands. Still of clinical value or "traditional care"-].

This paper reviews the examination technique, normal findings, and pathological findings in conventional radiographic diagnosis of the salivary glands. The clinical importance of plain radiographs and sialography today despite the availability of modern imaging modalities is discussed. Of the ultrasound equipment is adequate and the examiner has enough experience in small-parts ultrasonography, application of conventional X-ray methods should be limited to confirmation of ultrasonographic suspicion of sialolithiasis or tumor-erosion of adjacent bone, especially the mandible (plain films), further imaging of extra- and intraglandular salivary duct abnormalities in chronic inflammatory salivary gland disease, and demonstrating salivary gland involvement in special entities, such as sialadenosis (pseudo)cystica in Sjögren-syndrome by sialography.

Humans↗
PubMed1980

Radiological appearances of parotid duct calculi.

A total of 42 patients presenting with recurrent unilateral parotid gland swelling was studied. Plain radiology of 38 patients with proved calculi showed that the lateral view is valueless. The anteroposterior view was positive in 58 per cent, and when coupled with an intrabuccal view 71 per cent of the calculi were radio-opaque. The overwhelming majority of calculi were visible as filling defects on sialography, while in 4 patients an area of narrowing with dilatation of the parotid duct proximal to it represented the site of the calculus. In the remaining 4 patients with the latter sign, repeat sialography showed normal appearances in 2, suggesting that the calculi had passed.

Humans↗
PubMed2002

[Indications and diagnostic sensitivity of CT and MRI in the otorhinolaryngology field].

Of all malignant tumors, 4-5% affect the head and neck region. Computed tomography (CT) and magnetic resonance imaging (MRI) provide the means for us to determine the precise extent and depth of infiltration of space-occupying lesions, detect submucosal growth, stage lymph nodes preoperatively, and thus facilitate better preoperative planning. Thinner collimations of sections and shorter examination times are possible with modern multilayer spiral CT. Two-dimensional and three-dimensional images can be calculated from the volume specifications to assess the skull base (coronal and sagittal sections) and the midline crossover of tumors as well as staging of lymph nodes (coronal section). Examination of laryngeal and hypopharyngeal function as well as determination of tumor perfusion are also possible. Detection of tumors that do not absorb any contrast medium (approximately 15%) is more difficult with CT. In addition to providing a high degree of tissue contrast, MRI makes it possible to directly acquire images in any number of planes. In contrast to CT, metallic artefacts hardly come into play. Infiltration of the dura and the cerebrum can be depicted better with MRI than with CT. The long examination time with MRI carries the risk of movement artefacts. In the head and neck region, it is important to suppress fat in T2-weighted sequences and in T1-weighted sequences after administration of contrast media. Inflammations in the head and neck region are only exceptionally clarified with CT or MRI. It is imperative that CT be performed before functional endoscopic operations of the paranasal sinuses. Further indications for CT and MRI in cases of inflammation are the diagnosis of retrotonsillar and parapharyngeal abscesses and ensuing complications as well as the diagnosis of osteomyelitis. Since conventional sialography is contraindicated in acute inflammation in sialolithiasis, magnetic resonance sialography can be employed.

Humans↗
PubMed2004

MR imaging of salivary glands.

Diagnostic imaging of salivary glands has been revolutionized with the advent of cross-sectional imaging modalities like CT and MR imaging. In the era before CT, imaging of the salivary glands was relatively unrewarding and was used uncommonly by ear-nose-throat surgeons. Early diagnostic tests like plain films and sialography evaluated dilated parotid ducts and calculus disease within ducts or glands. Full evaluation of salivary glands, especially deep lobes of parotid gland and masses of minor salivary glands, was not possible by these methods, however. Imaging of the parotid glands has developed significantly since that time. CT and MR imaging greatly compliment physical and endoscopic examinations (and previous favorites like sialography) by direct visualization of previously blind areas of the salivary glands and extension of the disease process in surrounding tissue planes.

Journal Article↗
PubMed1999

Mucoepidermoid carcinoma arising in the accessory parotid gland.

A rare case of a 9-year-old female with mucoepidermoid carcinoma arising in the accessory parotid gland is reported. She had complained of a painless and round mass of the left cheek for a duration of 14 months. Sialography, ultrasonography, CT scan and MRI were performed preoperatively. Sialography revealed a small duct separating from the Stensen's duct. CT and MRI showed that the tumor with smooth outline was lying on the masseter muscle and detached from the main parotid gland. The preoperative diagnosis was an accessory parotid gland tumor. The tumor was removed without facial nerve injury via standard parotidectomy incision. The tumor was composed of mucous and epidermoid cells. The pathological diagnosis was low-grade mucoepidermoid carcinoma.

Carcinoma, Mucoepidermoid↗
PubMed1997

Reduction of radiation-induced xerostomia in nasopharyngeal carcinoma using CT simulation with laser patient marking and three-field irradiation technique.

PURPOSE: Tumor control and reduction of postirradiation xerostomia in patients with nasopharyngeal carcinoma (NPC) using the three-field irradiation technique based on the CT-based simulation with laser patient marking was investigated. METHODS AND MATERIALS: Seventy-eight patients with NPC were consecutively treated between 1983 and 1993. In 33 patients treated before 1987, target volume was determined using a conventional x-ray simulator with a reference of CT images, and the primary site was treated by the conventional parallel-opposed two-field technique (Group I). In 45 patients treated from 1987, target volume was determined using a CT simulator slice by slice, the treatment field was projected onto the patient's skin by a laser beam projector mounted on a C-arm, and the primary site was irradiated by a three-fields (anterior and bilateral) technique (Group II). In Group II, the shape of each field was determined using a beam's eye view to reduce the dose to the bilateral parotid glands. The three-field technique reduced the dose to the superficial lobe of parotid gland to about two-thirds of the dose given by the two-field technique. Radiation-induced xerostomia was evaluated by clinical symptoms and radioisotope sialography. RESULTS: The 5-year survival rate and disease-free survival rate were 46.6 and 31.2% in Group I, and 46.8 and 46.5% in Group II. A large variation in the volume of parotid glands were demonstrated, ranging from 9 cm3 to 61 cm3 among patients treated with CT simulation. Forty percent of the patients in Group II showed no or mild xerostomia, whereas all of the patients in Group I showed moderate to severe xerostomia (p < 0.01). The radioisotope sialography study showed that the mean secretion ratio by acid stimulation was improved from 3.8% in the Group I to 15.2% in the Group II (p < 0.01). CONCLUSIONS: CT simulation was useful to determine the size and shape of each field to reduce the dose to the parotid gland, of which size varies largely among individual patients. The three-field technique based on CT simulation with laser patient markings is suggested to result in superior complication-free survival in terms of salivary dysfunction than did the conventional two-field technique with x-ray simulatior for NPC.

Adolescent↗
PubMed1998

Scintigraphic evaluation of long-term salivary function after bilateral whole parotid gland irradiation in radiotherapy for head and neck tumour.

In 25 patients with head and neck tumour, in whom bilateral whole parotid glands were totally included in the irradiation volume, parotid gland function was estimated and compared with that of 58 non-irradiated parotid glands in 29 patients, by symptomatic grading and radioisotope (RI) sialography. Sequential follow-up by RI sialography has suggested that if the total dose to the parotid gland is less than 52 Gy or if the time-dose fractionation (TDF) value is less than 80, then partial recovery of salivary function can be expected 1 or 2 years after irradiation, even if patients show severe xerostomia during the first 6 months. Long-term recovery rarely occurs in parotid glands which have been irradiated at doses exceeding 55 Gy or with TDF values of 88 or higher. The 50% complication probability (ED50) was less than 33 Gy for subacute xerostomia during the first 6 months and 52.5 Gy for chronic xerostomia after 12 months, respectively. Although a prospective study will be required for confirmation, differences between the dose-response curves of xerostomia at subacute and chronic phases suggest a basis in different biological mechanisms.

Acute Disease↗
PubMed2003

[Salivary calculi--diagnosis and therapy].

The etiology for salivary gland stone formation, one of the most common salivary gland problems, is still unknown. In many cases the diagnosis is easy due to obvious clinical features, but for treatment considerations, imaging studies are very often necessary. Sonography or MR sialography have replaced sialography in the evaluation of patients with sialolithiasis. Besides traditional surgical procedures, new conservative treatment modalities like extracorporeal shock wave lithotripsy or interventional sialendoscopy are now available for the management of salivary gland stones.

Diagnostic Imaging↗
PubMed2002

Bilateral parotid-duct diversion using autologous vein grafts for the management of chronic drooling in cerebral palsy.

Chronic drooling is a major problem in patients with cerebral palsy and other neurological dysfunctions. Various treatments, ranging from speech therapy to radical surgery, have been used to overcome this distressing problem, with surgery the most consistently successful. In this study, we used a new surgical technique to manage severe drooling. This involved the dissection of both parotid-duct orifices, and their relocation, via a submucosal tunnel, into the tonsillar pillar using autologous vein grafts. Four patients were treated using this technique together with bilateral submandibular duct rerouting. The results were analysed by subjective judgements of drooling and retrograde sialography at 90 days postoperatively. In all cases, salivary flow was reduced and drooling was significantly improved. Retrograde sialography revealed no signs of obstruction or stricture formation in any of the cases. No postoperative complications occurred. These preliminary results suggest that the bilateral surgical transposition of Stensen's ducts into the tonsillar pillar using autologous vein grafts together with bilateral submandibular duct rerouting can provide effective control of chronic drooling.

Adolescent↗
PubMed2001

Possibility of sialographic sonography: a Doppler phantom study.

OBJECTIVES: The purpose of this study was to develop a new diagnostic method that has the merits of both sialography and sonography. STUDY DESIGN: Saline solution and various contrast media (Urografin 76%; 100%, 90%, and 67% Lipiodol Ultra-Fluide; 5% and 1% barium sulfate; and Levovist) were injected into thin tubes at a rate of approximately 0.001 to 0.1 mL/s. The relationship between the Doppler signal intensity and the kind, concentration, and velocity of the fluid was analyzed. RESULTS: Levovist, 90% and 67% Lipiodol Ultra-Fluide, and the barium sulfate solutions produced Doppler signals. The mixture of Lipiodol Ultra-Fluide and saline solution produced high signals at any concentration, in contrast with the barium sulfate solutions. Signals could be observed at any speed, from the speed of normal sialography down to 0.001 mL/s, and there was a proportional relationship between signal intensity and velocity for all fluids producing signals. CONCLUSION: The fact that we could obtain high signals with several fluids indicates potential clinical diagnostic usefulness of sialographic sonography.

Barium Sulfate↗
PubMed1994

Scintigraphic evaluation of sialadenitis.

Salivary gland scintigraphy using 99Tcm sodium pertechnetate and a 20-min dynamic data acquisition with a sialogogue at 10 min was employed as the primary imaging modality in sialadenitis in 32 patients. Paired asymptomatic glands within the study group were used to establish control values for a number of computer-derived functional parameters. The shape of the activity-time curve was described as: H = hyperactive, N = normal, M = median, S = sloped, F = flat, O = obstructed. Of seven patients who had ductal stones on plain films, two passed stones prior to sialography and had normal curves, whole the remaining five patients had Type O curves. Parametric evidence of gland dysfunction was identified in an additional seven symptomatic glands, six being hyperactive; histology identified an acute inflammatory infiltrate in the only excised gland in this group. Glandular hypofunction was identified in one case, in which histology revealed extensive fibrosis and glandular atrophy. Type M and S curves were found in 28 glands, 75% of which were asymptomatic. Only one gland was indicated as hypoactive by calculated parameters, and this showed a Type S curve. Scintigraphy and plain films represent the least invasive and, we feel, the most suitable primary method of investigating sialadenitis. Conventional contrast sialography may be reserved for cases with no identifiable stone but an obstructed curve. The use of functional parameters and curve morphology to determine gland dysfunction other than obstruction is non-specific, probably insensitive and is unlikely to alter clinical management. We propose an algorithm for the investigation of sialadenitis.

Adolescent↗
PubMed2004

Juvenile recurrent parotitis: a new method of diagnosis and treatment.

OBJECTIVE: Juvenile recurrent parotitis (JRP) is a nonobstructive, nonsuppurative parotid inflammation in young children. Causative factors, such as local autoimmune manifestation, allergy, infection, and genetic inheritance, have been suggested, but none of them has been proved to date. Until now, treatment of JRP was divided into conservative observation and antibiotic treatment, and no preventive therapy was available. METHODS: Twenty-six cases symptomatic JRP in children were diagnosed and treated with a combined endoscopic approach. Sialography and sialoendoscopy were performed bilaterally in all children. The treatment modality was composed of lavage, ductal dilation, and hydrocortisone injection. RESULTS: Sialography showed multiple sialectasis in the affected gland and in the contralateral one as well. Dilations and strictures were noticed in the main duct, and kinks could be identified in 31% of the glands. The main endoscopic finding was a white appearance of the ductal layer without the healthy blood vessel coverage. Recurrence of the symptoms occurred in only 2 (8%) children. CONCLUSIONS: The endoscopic technique provides the possibility of a correct diagnosis and treatment. In this article, we present a new treatment modality of irrigation and dilation under direct vision by endoscopically guided miniature surgical instruments.

Adolescent↗
PubMed2001

[Imaging in major salivary gland diseases]

Most of the salivary glands diseases are characterized only by a few distinct clinical patterns. Medical history and clinical examination are still considered of great relevance. However, in order to obtain a definite diagnosis, imaging techniques are required in most of the cases. Salivary glands ultrasonography (US) is the technique to be used as the first because US can easily differentiate calculosis, inflammatory diseases and tumors. Sonography is also frequently needed to perform needle aspiration or biopsy (FNAC). Sialography should be used essentially for assessing chronic sialoadenitis as well as Sjögren's syndrome. At present, Magnetic Resonance sialography should be preferred because of the greater sensibility in diagnosing inflammatory diseases of the salivary glands. It allows to evaluate both intraglandular oedema and nodules, so that incannulation of the salivary duct is not required. Computer Tomography (CT) and Magnetic Resonance imaging (MR) are useful when neoplasm are suspected, particularly if deep areas of the gland, which cannot be visualized by US, are involved. Sequential scintigraphy is currently employed for assessing the functional status of all the 4 major salivary glands and evaluating the chronic evolution of glandular damage.

Journal Article↗
PubMed2003

Malignant mucoepidermoid tumor arising in the accessory parotid gland: a case report.

PURPOSE: The head and neck surgeon's fascination with parotid surgery arises from the gland's spectrum of histopathological presentations, as well as the diversity of its morphological features. A mass arising in the mid-cheek region may often be overlooked as a rare accessory lobe parotid neoplasm. This report serves to revisit the topic of accessory parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of salivary fistula, facial nerve paralysis, and recurrence are avoided. CASE REPORT: We report a case of mucoepidermoid carcinoma which was assessed pre-operatively as arising from the accessory parotid gland of a 11-year-old female. She had complained of a painless and round mass of the left cheek for a duration of 12 months. Sialography, ultrasonography, CT scan and MRI were performed preoperatively. Sialography revealed a small duct separating from the Stensen's duct. CT and MRI showed that the tumor with smooth outline was lying on the masseter muscle and detached from the main parotid gland. The preoperative diagnosis was an accessory parotid gland tumor. The tumor was removed without facial nerve injury via standard parotidectomy incision. The tumor was composed of mucous, intermediate and epidermoid cells. The pathological diagnosis was low-grade mucoepidermoid carcinoma. CONCLUSIONS: Accessory parotid gland neoplasms are rare and may present as innocuous extraparotid mid-cheek masses. A high index of suspicion, prudent diagnostic skills (including fine-needle aspiration [FNA] biopsy followed by computed tomography [CT] imaging), and scrupulous surgical approach (extended parotidectomy-style incision and limited peripheral nerve dissection when possible) are the keys to successful management of these lesions.

Carcinoma, Mucoepidermoid↗