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A retrospective study of 6 cases of Stafne's static cavities is presented in a review of 1536 cases of maxillary cysts. We have found an incidence 4:2 for men. All cases have been detected casually. The sialography show a relationship between cavities and the submaxillary gland. The treatment was surgical in four cases and conservative in two.
It is well known that some patients with Sjögren's syndrome develop lymphoproliferative disorders. Approximately 60 cases of Sjögren's syndrome associated with malignant lymphoma, predominantly of B cell origin, have been reported in Japan. On the other hand, fourteen cases of non lymphoid malignant neoplasm, including six of thyroid cancer and four of gastric cancer, have been recently presented in Japanese literature. However, cases of double malignant neoplasms in Sjögren's syndrome are very rare. We reported a case of Sjögren's syndrome associated with breast cancer and B cell malignant lymphoma in the paper. A 53-year-old female was seen with eye pain, xerostomia, finger pain and right parotid swelling in January, 1985. Keratoconjunctivitis sicca was found. She had had eye pain and Raynaud's symptom during the past seven years. Sialectasia of grade III by Rubin and Holtz was seen in sialography. Schirmer's test was positive. Pathological finding of sialadenitis in minor salivary gland confirmed diagnosis of Sjögren's syndrome. Laboratory findings showed leukocytopenia and polyclonal hypergammaglobulinemia. Rheumatoid factor and antinuclear antibodies including SS-A antibodies were positive. Tuberculin test was negative. Ratio of CD 4 per CD 8 T lymphocytes was increased in peripheral blood. She had history of breast cancer. Radical mastectomy, followed by irradiation was performed in 1980. Arthralgia and parotid enlargement were transiently diminished by administration of small amount of prednisolone. She was readmitted because of progressive bilateral parotid swelling in April 1988. Pathological finding of the parotid was consistent with malignant lymphoma of diffuse, small cell type (lymphoplasmacytic). Immunoperoxidase staining revealed positive cytoplasmic IgM, k in lymphoma cells.(ABSTRACT TRUNCATED AT 250 WORDS)
Regressive changes of duct-ligated parotid glands in rabbits were examined by salivary gland scintigraphy with 99mTc O4-, subtraction sialography and soft X-ray radiography. Scintigram images were obtained with a pinhole collimator improved for small animal scintigraphy. Subtraction images were taken photographically. Contrast media were injected into extracted tissue for soft X-ray radiography. Radiological observations were carried out 3, 7, 14, 21, 28, 35 and 42 days after injection, and in the control rabbit. The images obtained by these three modalities were compared and discussed. Salivary gland scintigrams and subtraction sialograms clearly demonstrated the outlines of duct ligated parotid glands. Soft X-ray radiograms obtained from the extracted tissue showed the fine structure of the parotid glands. All of these images showed regressive changes in the duct-ligated parotid glands.
The AA. through the "transductal retrograde positive pressure" technique visualize the whole course of the tuba, after the injection of a radiopaque substance (lipiodol ultrafluide) in the external ear canal in those cases showing tympanic perforations or in subjects carrying transtympanic ventilatory tubes. The Hirtz incidence is the one recommended. They emphasize the importance of this radiologic study in order to detect either structural or functional changes in the tube, because a great deal of failures in tympanoplasties are due to tubal pathology. Lipiodol is in general well tolerated, apart from those mucous membranes showing an special sensibility. In sialographies its effects are beneficial. The AA. explain the "modus operandi" underlying that till now no accidents are reported. Logically when a salpingography is indicated the morbid middle ear require previous tomographies and T.A.C. records in axial and coronal incidences, in order to discover malformations, dehiscences of the Fallopian canal or in the tegmen tympani, labyrinthine fistulae, etc. The aware otologist can then proceed more judiciously.
Tumors of the parotis and surrounding tissues can be examined by CT, by CT-sialography ot by intravenous contrast medium injection. In five special cases in which we examined parotis and surrounding tissues we report on our experiences with the methods.
A 7-month-old Quarter Horse colt was examined because it had had a tortuous, distended vessel on the side of its head since birth. An abnormality of the parotid salivary duct was suspected on the basis of location and course of the vessel. Atresia of the duct near the parotid papilla was diagnosed by use of contrast sialography. Surgical transpositioning was attempted, but failed because of stricture formation. Chemical ablation of the salivary gland has been used to treat traumatic rupture of the duct. It proved to be an effective and practical method of resolving the problem in this case. Cosmetic outcome was excellent, and functional problems associated with loss of the gland were not observed.
A case of temporal arteritis (TA) associated with polymyalgia rheumatica (PMR) and subclinical Sjögren's syndrome (sub SjS) was presented in this paper. A 76 year-old-male was admitted with headache, fever and weight loss in April 1987. Myalgia of upper extremities and of thighs developed during the past two months before admission. He also had noticed bilateral wrist pain. Physical examination revealed slight cord-like thickening of left temporal artery with tenderness. Cerebral angiography disclosed narrowing of frontal and parietal branches of left temporal artery. Temporal artery biopsy was consistent with TA. Diagnosis of PMR was made by Bird's diagnostic criteria. Although sicca symptoms were not seen, sialography revealed moderate sialectasis. Pathological finding of salivary gland was compatible with sub SjS. Possibility of occult lymphoma was eliminated by CT scanning or myelogram. Laboratory evaluation disclosed slight anemia, leukocytosis and thrombocytosis. Blood chemistry showed no abnormal finding except for hyperfibrinogenemia. Serological studies indicated positive C-reactive protein and slight elevation of alpha 2 and beta globulin fractions of serum protein. Either rheumatoid factors, antinuclear antibodies, anti-smooth muscle antibodies, cryoglobulin or circulating immune complexes were not detected. The HLA-B8 and DR3, frequently detected in TA and SjS, were not identified. Tuberculin test was negative. These results suggested that immunological aberration not caused by genetic factors but by senescence would induce presence of TA associated with both PMR and sub SjS.
In this work, we studied the therapeutic clinical efficacy and the immunoregulating effect of methisoprinol in 4 cases of primary SS and one case of secondary SS. After 12 weeks of treatment, no significant clinical improvement was detected in the glandular histology, in Schirmer's test and sialography. On the other hand, we have observed the following alterations: immunological changes characterized by an increase in the total population of T-lymphocytes (OKT3), a normalization and thereby a diminution in IgM, an increase in T-helper subpopulation (OKT4) in four cases and in T-suppressor subpopulation in one case. A noticeable fact was the best immunological response of the patient showing a negative histology, a functional alteration of the parotid and a short evolution of the syndrome. These findings support the hypothesis that methisoprinol can be an efficient coadjuvant in the treatment of primary Sjögren's syndrome in early stages when there is only functional alteration but no glandular atrophy.
Chronic and usually odontogenic inflammations of the masticatory muscles may be, due to anatomical conditions and inconspicuous inflammatory symptomatology, difficult to differentiate from tumours in this region. The differential diagnosis of both affections is based on the clinical course, sialography and CT examination which along with modern ATB treatment significantly modify hitherto used surgical therapy.
Traditionally, incisional bone biopsy has been required in order to establish and confirm a diagnosis of Paget's disease (Osteitis deformans) of the mandible and/or maxilla. This article presents a case report of a patient who refused such biopsy. The patient was referred with a three year history of intermittent mandibular pain, accompanied by occasional swelling of the adjacent soft tissues. Although several health professionals had been consulted, no diagnosis had been established. Furthermore, an incisional biopsy had apparently been performed in the area of the left mandible, as reported by the patient, with no conclusive results. On examination, the patient refused all proposed repeat biopsy, but did agree to a full laboratory workup which included: routine blood studies; nuclear medicine bone studies of total body regions including the head and neck, followed by sialography of the submandibular salivary glands. A definitive diagnosis of Paget's disease was reported on 99-m-MDP-technetium bone scans of the mandible. The patient was subsequently treated with the appropriate medication which resulted in a remission of the disease over the three year follow-up period. The histopathological diagnosis was never confirmed because of the patient's repeated refusal to be biopsied.
The various techniques available for the investigation of salivary gland disease are described and their clinical applications discussed. Sialography and scintigraphy are most helpful in cases of recurrent glandular swelling, and CT or MRI in the evaluation of tumors.
On the basis of two cases, one a fistula and the other a cyst of the first brachial cleft with chiefly parotid manifestations, a review of the embryology is given which explains the anatomical features. The elements in their clinical diagnosis, complemented by fistulography and sialography are compared with operative findings, the essential steps in which are as follows: 1) Identification of the facial nerve which by necessity overlies the lesions. 2) Partial resection of the superficial lobe of the parotid. 3) The essential resection of the external auditory meatus, the keystone of radical cure of these cysts and fistulae.
A 53-year-old female, who had been having xerostomia and xerophthalmia for two years, was admitted in November 1984, because of subfever and malaise. Laboratory examination revealed pancytopenia with appearance of blasts, mild hypergammaglobulinemia, and elevated titers of ANA, anti SS-A and anti SS-B. Bone marrow aspirate showed increased myeloblasts. Schirmer's test and Rose Bengal's test were both positive, and sialography showed apple tree like appearance. Pathological findings of biopsied lip mucosa showed remarkable infiltration of lymphocytes. The patient was diagnosed acute myelocytic leukemia and Sjögren's syndrome. In spite of recovery of peripheral blood after combination chemotherapy (BHAC-DMP), a disturbance of consciousness appeared and she died of its progression. It was suspected clinically that she was suffered from progressive multifocal leukoencephalopathy (PML). It is sometimes reported that patients with Sjögren's syndrome develop malignant lymphoma, but it is very rare that Sjögren syndrome develop AML.
Clinical features of Sjogren's syndrome were found in 31 percent of 32 patients with SLE. Eight patients had features of KCS while four had xerostomia. Subclinical abnormalities were found in six other patients tested with sialography and labial salivary gland biopsy and there were abnormalities in 65 percent of SLE patients in whom labial salivary gland biopsy was performed. The prevalence of Raynaud's phenomenon and renal disease in SLE patients with and without Sjogren's syndrome were similar but four of the five patients with SLE and an erosive arthritis had symptomatic Sjogren's syndrome.
On the basis of 15 cases, the authors define their attitude to traumatic lesions of the parotid salivary system. In the first place, such lesions must be accurately diagnosed by careful examination and catheterisation of the papilla. This simple manoeuvre makes it possible to avoid emergency sialography. Secondly, treatment varies according to the type of lesion: with a lesion of the facial nerve, suture or nerve graft in the case of loss of substance; with a minimal parenchymatous lesion, observation is necessary after the avoidance of surgery or drainage; with a severe parenchymatous lesion, parotidectomy is necessary, with exploration of the facial nerve.
Sonography of the salivary glands is a valuable diagnostic tool in acute and chronic sialadenitis, sialadenoses, lymphadenopathies and tumours lesions. A new examination technique is presented: ultrasound-guided fine needle biopsy. We report on our experience in 308 patients with parotid and in 47 patients with submaxillary gland diseases examined between 1982 and 1987. The diagnostic accuracy and limitations of sonography are discussed compared with sialography, computed tomography and magnetic resonance imaging.
Non Hodgkins lymphoma (NHL) is reported to be at least 40 times more common in Sjögren's syndrome (SS). Diagnosis may be difficult as blood and bone marrow haematology can remain normal, with no evidence of a serum paraprotein band or Bence-Jones proteinuria by routine electrophoresis. Using the technique of isoelectric focusing in agarose, followed by immunofixation, monoclonal free light chains can be found in the urine of 44% and 74% respectively of patients with NHL and B cell chronic lymphocytic leukaemia, but not in normal individuals. Three patients, two with typical severe primary SS and the third with several features of SS including abnormal sialography and reduced tear secretion, developed B cell NHL of parotid and/or lung. Using the above method on concentrated urine specimens, monoclonal free light chains of the same class as that demonstrated on the tumour cells were found to be present in each patient's urine. In one patient the level of urinary free light chains was monitored and found to correlate with disease activity. Using similar techniques no monoclonal light chains could be found in the urine from a further 10 cases of primary SS and 18 cases of SS secondary to rheumatoid arthritis, all of whom had no clinical evidence of lymphoma. Screening of SS patients' urine by the method described for monoclonal urinary free light chains may provide an early diagnostic clue to the development of lymphoma and be a means of tumour monitoring.
Clinically, the parotid gland and associated parapharyngeal space can be assessed better using selective diagnostic imaging as an adjunct. It increases the effectiveness of management and the pretreatment staging of disease. This paper reviews the available specific imaging modalities (conventional x-ray films, contrast sialography, computed tomography, magnetic resonance imaging, ultrasonography, angiography and radionuclide scanning), their current indications and potential limitations.