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Sialography is one of the modalities that may offer a relatively simple diagnostic investigation in sarcoidosis. The present study revealed an abnormal sialogram of the parotid glands in 20 of 29 patients with pulmonary sarcoidosis. The radiographic parotid gland findings in sarcoidosis are discussed.
CT of the salivary glands can produce clinically significant information that may help in the selection of appropriate therapy. It is the method of choice for the examination of mass lesions in and about the salivary glands. The role of CT for the evaluation of calculi and other obstructions and sialectasis is not yet determined. Conventional sialography may still be the method of choice for these entities.
Two univitelline twin sisters developed Gougerot-Sjögren's syndrome at 30 years of age. Immunity disorders were more significant in the sister with the more severe disorder, as demonstrated by sialography and scintigraphy. Among the immunological tests practiced, emphasis is placed on antinuclear antibody assay in the saliva, the authors finding no mention of this test in the published literature. Of particular interest is the negative result of histological examination of the accessory salivary glands, this contrasting with the close relationship between immunity and sialographic disturbances. The identical nature of the two sisters was confirmed by a study of the HLA systems, but this did not demonstrate the presence of the B8 marker, classically correlated with Gougerot-Sjögren's syndrome.
A survey about different diagnostic parameters in salivary gland diseases is given. History, inspection, palpation, radiologic examinations by sialography and szintigraphy as well as sialometric and sialochemic findings are compared for their diagnostic value. Thereby by sialochemie and sialometrie a differentiation between sialadenitis and sialadenoses is possible in nearly all cases. Also in the differential diagnosis between benign and malignant tumors sialochemic findings are helpful.
The value of the individual examinations and tests that were carried out before and during surgery of tumors within the parotid was evaluated on the basis of a major number of surgical cases. Most indications for surgery were based, however, solely on the clinical examinations if the tumor was isolated in the parenchyma, well-differentiated and mobile. The radiological examinations are of importance only if a differential diagnosis is to be made to determine lithiasis, foreign bodies and sclerotic processes. It is of no relevance for pure tumor diagnosis. Sialography and scintigraphy are of a certain value for diagnostic purposes, both methods, however, are too vague in tumor diagnosis and may lead to wrong results. Still, frozen section and exploratory excision are the most reliable approaches for determining in vague cases the optimal extent of excision in accordance with the respective state of the growth. Needle biopsy was deliberately avoided in tumor patients since the danger of a propagation of tumor cells in certain types of tumor--in particular the pleomorphic adenoma--must not be neglected.
Various sets of criteria have been suggested in order to establish a diagnosis of Sjögren's syndrome (SS) in as much as evaluation of the salivary component is highly controversial. Our study was aimed at investigating both sensitivity and specificity of labial salivary gland biopsy (LSGB), as well as at comparing this method with other diagnostic procedures commonly employed in SS. LSGB was performed in 182 patients (174 female and 8 male, mean age 51.2) with xerostomia, dry eyes, parotid swelling and/or serological abnormalities such as positive rheumatoid factors, antinuclear antibodies, leukopenia and hypergammaglobulinemia. Diagnosis of SS was made according to the criteria recently proposed by Vitali et al. (1993). Severity of histologic changes was graded according to the Chisholm and Mason scoring system. Bioptic samples were considered abnormal when at least one focus of mononuclear cells/4mm2 was observed. The following parameters were also assessed in each patient: questionnaire of symptoms, Saxon test, sialography, salivary dynamic scintiscan, Schirmer-I-test, rose Bengal score, ANA, anti-SSA/SSB antibodies and rheumatoid factors. According to the above diagnostic criteria, 108 out of 182 patients had SS, 90 primary and 18 secondary. For 74 there were not enough data for a definite diagnosis of SS. In 9 cases (4 with and 5 without SS) LSGB was excluded because no glandular tissue was found in the specimens. Among the remaining 173, Grades 3 or 4 were found in 74 patients (71.2%) with SS and only in 1 case (1.4%) without SS. LSGB showed a very high specificity (98.6%) and a rather good sensitivity (72.5%). However, biopsy was crucial for diagnosis in only 11 cases (14.6%).(ABSTRACT TRUNCATED AT 250 WORDS)
The authors have revealed dilatation of the excretory ducts of salivary glands involved in sialolithiasis and of other salivary glands in a patient. A hypothesis on the primary etiological role of ductal ectasia in the development of sialolithiasis in case some other additional factors are present is put forward. The authors recommend resorting to computer-aided tomography and functional digital subtraction sialography of the salivary glands for the diagnosis of sialolithiasis and discuss the advantages of these methods in comparison with other ones.
Sjögren's syndrome (SS) is thought to be uncommon in children. We studied the clinical manifestations and laboratory findings of 12 pediatric patients with SS, all of children did not have sicca symptoms but have lymphocytic infiltration of salivary glands, abnormal sialograms or abnormal results of scintigraphy compatible with typical SS. Seven cases had primary SS and five were secondary SS and had other autoimmune disorders (three cases with systemic lupus erythematosus, one case with dermatomyositis, and the other with mixed connective tissue disease). All patients were female. The mean age at onset of symptoms, including other autoimmune manifestations, was 12.2 years (range 9-15 years). The initial symptoms were some systemic manifestations (fever, exanthema, arthralgia, etc.) and various autoimmune phenomena (butterfly rash, Raynaud's phenomenon, proteinuria, weakness of muscles, etc.). On the other hand, no patients complained sicca symptoms. Laboratory studies in our patients revealed elevated levels of IgG (92%), antinuclear antibody (92%), rheumatoid factor (58%), anti-SS-A antibody (75%). These findings were similar to those found in adult patients with sicca symptoms previously reported in literature. From these studies, we suggest that lip biopsy, sialography and/or salivary gland's scintigraphy should be carried out in patients who had abnormal laboratory findings as mentioned above, irrespective of absence of sicca symptoms, in order to diagnose SS at early period.
In this work, we describe a diagnostic iter in case of salivary gland neoplasia suspicion: 1) direct radiography, 2) ultrasound (US), 3) sialography, 4) computed tomography (CT), 5) cytodiagnosis, 6) scintigraphy. But we particularly speak about US and CT, because of their daily use in diagnostic radiology. Ultrasound is considered a first examination for its high resolution, low invasiveness, low costs and it is easy and smart. While CT is considered a second examination because it permits staging of the salivary neoplasia and a complete patient inquiry. We presented two clinical cases: a submandibular sarcoma and a parotid carcinoma, describing their US-CT diagnosis: we can confirm that these techniques are often sufficient for a correct localisation of neoplasia and for a therapy program.
This study presents a study on 23 patients with chronic obstructive parotitis (COP) in whom the sialographic changes are related to the clinical and histopathological features. The sialographic changes are divided into 4 types. The stimulated parotid flow rate (SPFR) is normal in sialography Type I patients, while SPFR is significantly reduced in Type II, III, and IV patients, as compared with healthy persons. The changes under light microscope consist of irregular dilatation and chronic inflammation of main and branching ducts with saliva deposits in the enlarged luminal system. Ultrastructural changes include degeneration of ductal epithelial cells, marked proliferation of periductal fibrous tissue, and moderate electron-dense deposits in the lumen of the dilated peripheral ducts. The extent of the histopathologic changes largely parallel the severity of the sialographic changes. These findings indicate that COP is a common inflammatory disease and that the sialographic classification reflects the severity of the disease.
Our goal was to establish the practical usefulness of combinations of tests (saliva flow rate, SFR; salivary lysozyme, Lys; salivary lactoferrin, Lf; sialography, SG; salivary gland scintigraphy, SGS; and labial salivary gland biopsy, SGB) for the oral component of Sjögren's syndrome (SS). These tests were applied to 40 patients with primary SS (group A, defined by the presence of keratoconjunctivitis sicca, a positive response to two of three selected questions for xerostomia and the presence of two of four autoantibodies), 16 patients with secondary SS (group B), 16 patients with connective tissue disease but no evidence of secondary SS (group C) and 14 normal controls (to establish the threshold of the six tests). SFR was decreased in 68, 56 and 19% of the patients in groups A-C respectively [sensitivity (sens) 68%, specificity (sp) 81%, positive predictive value (PPV) 90% and negative predictive value (NPV) 50% for primary SS]. Lys was elevated in 3, 0 and 0% of the patients in groups A-C (sens 3%, sp 100%, PPV 100% and NPV 66%). Lf was reduced in 58, 69 and 25% of the patients in groups A-C (sens 58%, sp 75%, PPV 82% and NPV 53%). SG was positive in 74, 27 and 13% of the patients (sens 74%, sp 87%, PPV 93% and NPV 41%). SGS was positive in 75, 63 and 25% of the patients (sens 75%, sp 75%, PPV90% and NPV 45%). SGB was abnormal in 95, 94 and 25% (sens 95%, sp 75%, PPV 90%, NPV 14%).(ABSTRACT TRUNCATED AT 250 WORDS)
The most common conditions affecting the salivary glands are calculi, inflammation and tumours. Plain radiography may be useful, especially in showing calculi. Sialography is the examination of choice for inflammatory diseases, whereas ultrasonography, computed tomography and magnetic resonance imaging are particularly useful in evaluating masses in the salivary glands. Radionuclide studies are sometimes helpful in evaluating inflammatory or tumoral diseases. Each technique has its place, and the methods are often complementary. In this review article the authors present the techniques that they use in evaluating diseases of the salivary glands.
In the oral cavity and oropharynx, the predominant disease is cancer, which arises, in most cases, from the oral mucosa. Therefore, radiologists have a minor role in the detection of the disease but help to define the exact extent of the lesion and have an important role in therapeutic planning. Computed tomography and magnetic resonance imaging are the imaging modalities of choice. In the salivary glands, nonmodalities are numerous and include computed tomography, magnetic resonance imaging, sialography, sonography, and scintigraphy. The role of radiologists is to select the best study to determine the nature of the lesion and its extent and consequences. The choice of first study is primarily based on physical examination.
Parotid enlargement in childhood is a diagnostic challenge to all physicians. A frame of reference has been established wherein the disease spectrum involving the child's parotid glands can be outlined in a stepwise manner. In some instances after sialography, specific hematologic tests, and cultures the diagnosis will remain obscure until a biopsy is performed. Protracted conservative management should be instituted prior to the consideration of ablative surgical procedures.
Our experience in the management of 20 patients with recurrent parotitis (RP) as an isolated symptom is reported. The clinical manifestations in all patients were pain, infection and swelling of the parotid gland on at least three separate occasions. The presence of obvious tumor or specific inflammation were exclusion criteria. Three patients benefited from radiological interventional treatment: two stones were removed from the main duct with a Dormia basket and one parotid duct stricture was dilated with a balloon catheter. The role of conventional or digital sialography and interventional radiology procedures in the diagnosis and management of RP is discussed. We proposed this approach as a therapeutic alternative to surgery, which is more aggressive and carries a risk of facial nerve damage.
Twenty patients with various parotid gland enlargement were selected from outpatient dental clinic. The classical sign of the parotid enlargement is swelling which may by localized as inflammatory, cystic, neoplastic or associated with systemic diseases as diabetes mellitus, sjogren's syndrome and may occur after ingestion of certain drugs or metals. These heterogeneous pathological swellings have great morphological variation that need various diagnostic imaging modalities to be visualized. The favoured modality has been evolved from plain radiography, to sialography, scintigraphy, ultrasonography and to computed tomography. The application and limitation of each modality were presented.
A 64-year-old woman with mild bilateral parotid gland swelling and bilateral lower extremity purpura was admitted for evaluation of xerostomia and pancytopenia. The patient had an increased erythrocyte sedimentation rate, pancytopenia, and positive tests for antibodies to nuclear antigen, SS-A, and SS-B. Impaired cell-mediated immunity was also present. Bone marrow aspiration showed a hypoplastic marrow with an increased percentage of lymphocytes. A positive Schirmer's test and keratoconjunctivitis were also noted. A diagnosis of primary Sjögren's syndrome was made by sialography and histological salivary gland findings. Therapy with prednisolone improved the pancytopenia. Addition of the patient's peripheral blood mononuclear cells to cultures of bone marrow mononuclear cells derived from a healthy volunteer dose dependently inhibited colony formation, including mixed hemopoietic colonies. On the other hand, addition of the patient's serum failed to inhibit colony formation by normal bone marrow mononuclear cells. These results suggested that one of the causes of pancytopenia in primary Sjögren's syndrome might be mediated by the inhibition of mononuclear cells to the hemopoietic progenitors.
BACKGROUND: Mucoepidermoid carcinoma of Stensen's duct is a rare neoplasm, with only five cases reported in the literature. METHODS: We report another case of mucoepidermoid carcinoma of Stensen's duct and review the literature. RESULTS: Stensen's duct neoplasms tend to be symptomatic at an early stage by causing an obstruction of the parotid duct. New imaging techniques such as MR sialography and sialoendoscopy are very helpful in diagnosis and patient management. CONCLUSIONS: Although the rarity of this condition prevents definitive conclusions about the optimal treatment, we propose that Stensen's duct neoplasms should be treated like similar neoplasms occurring in the parotid gland tissue, taking into consideration clinical stage, tumor grade, and surgical margins.