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In 50 patients, the majority of them suffering from parotid diseases, serum isoamylases were determined (salivary S-type and pancreatic P-type). After sialography, there was in most cases a slight increase in isoamylase level. Salivary amylase does not seem to be a suitable marker for parotid neoplasms.
The value of high resolution real time ultrasound imaging in the preoperative differential diagnosis of focal disease of the parotid gland was evaluated in 35 cases. After description of the ultrasound imaging of the normal gland, the majority of benign and malignant tumours are demonstrated. Ultrasound patterns allow a good differentiation of mixed tumours, warthin's tumours and carcinomas. Differential diagnosis between mixed tumours on the one hand, mucoepidermoid and serous cell adenomas on the other can be difficult or even impossible. This holds true for pathologic lymphomas, too, whereas cysts can be distinguished very well. On the whole, the differentiation between benign and malignant tumours was correct in 28 out of 35 cases. Furthermore, in 21 cases the ultrasound pattern was in accordance with the result of the histologic examination. Compared with sialography, needle biopsy and CT scanning, ultrasonography is a reliable, safe and noninvasive method of high value in preoperative examination of parotid tumours.
In a retrospective study 101 patients who underwent surgery for a parotid mass were evaluated. The different diagnostic modalities (sialography, ultrasound, needle biopsy and frozen section) are described and discussed. Eighty-one tumors proved to be benign, of which 56 patients had a pleiomorphic adenoma, ten of them had a recurrent pleiomorphic adenoma, all after an enucleation, which again proved to be an inadequate operation for a parotid mass. The 20 malignant parotid tumors had a poor clinical outcome. Of the 18 patients with a malignant primary parotid tumor three showed a local recurrence and five metastatic disease within five years. The morbidity of parotid surgery is mainly due to post-operative facial nerve weakness (30%), which is mostly reversible, and the Frey syndrome (10%).
The incidence of adverse effects on radiotherapy in head and neck cancer is quite common. Some irradiation doses affecting parotid gland have been investigated. 38 irradiated cases and 12 non-irradiated cases constituting the control group have been included in the study. Histologic examination, sialography, scintigraphy and sialometry have been performed in all cases. The impairment of parotid gland is evident in the early stage and is aggravated with time. Glandular function is not reduced significantly by irradiation doses of 2000-3000 r. A marked functional reduction has been noted with irradiation doses of 5000-6000 r., and is variable in each individual. The reduced glandular function was particularly reduced in the early postirradiation period. The subsequent functional improvement is related to the remainder of less affected parenchyma, reduced inflammatory process and rapid growth of goblet cells in the walls of the outlet system compensating mucus deficit.
The results achieved by dynamic and static salivary gland scintigraphy in 272 patients over a ten year time (January 1976-December 1985) are reported. On the basis of a semi-quantitative assessment of time/activity curves, dynamic studies prove to be the most suitable method for studying functional disorders (phlogosis, facial paralysis, etc.). Harmlessness, easy execution and functional results are the main advantages of radioisotope techniques. Salivary gland scintigraphy has some limits in the study of space occupying lesions (SOL): however, ultrasounds, CT and sialography represent the methods of choice in this field of salivary gland pathology.
Investigation in 16 patients attending the stomatology outpatients clinic over the last 18 years has enabled definition of a particular radioclinical entity that has been named "idiopathic bilateral salivary megacanal". This generally parotid affection occurs in patients between 50 and 60 years, the onset usually being by an episode of sialodochitis. In addition to these inflammatory attacks there is the persistence of a bilateral "salivary ejaculation" from the ostia of the principal glands, sometimes after manual expression of a mucoid plug. Sialography shows dilatation of canals, the appearance being very suggestive for Stensen's duct, which becomes sinuous, enrolled and segmented. Dilatation is bilateral and affects the total length of the duct. The problem arises as to whether etiopathogenicity is from parietal canalar dysplasia or a constitutional anomaly of the nerve plexus comparable with that described in congenital megacolon. The latter hypothesis is plausible but requires confirmation from histopathology. The always benign course of the disease justifies conservative therapy only: oral antibiotics and canal massage several times a day, with a neostomy only when absolutely necessary.
Facial motor disorders, including facial paralysis, myokymia, dyskinesia, and hemifacial spasm, are common clinical problems in which radiographic evaluation plays a crucial role. Since every segment of the motor innervation of the face from the brain to the parotid gland can now be seen radiographically, radiologists must understand the normal anatomy, the common pathologic lesions at each level, and the clinical findings that help localize the abnormality so that the most sensitive and accurate radiographic approach can be planned. Though computed tomography alone allows for visualization of every segment, other methods such as cisternography, angiography, polytomography, sialography, and magnetic resonance imaging are complementary in specific disorders.
Zygomatic salivary mucoceles were diagnosed in 2 dogs. Ophthalmologic signs differed in both cases and reflected the position of the mucocele in relation to the orbit. Cytology of aspirated material and sialography were performed in both cases, but his enabled confirmation of the diagnosis in only one. Surgical excision of the zygomatic salivary gland, with drainage of the mucocele, was curative in both cases. Both dogs had a history of trauma to the head.
Twelve of 25 patients with mixed connective tissue disease complained of xerostomia and/or ocular symptoms of keratoconjunctivitis sicca. In addition to the clinical features of mixed connective tissue disease, all 12 patients had high titers of antibody to the ribonuclease-sensitive component of the extractable nuclear antigen. Eight parents had both clinical xerostomia and keratoconjunctivitis sicca, one had keratoconjunctivitis sicca and salivary gland enlargement, while three had xerostomia but no ocular complaints. Sjögren's syndrome was confirmed in all 12 patients by means of Schirmer's tests, Rose Bengal staining tests, salivary gland scintiscans, radionuclide excretion studies in saliva, parotid sialographies, and lip biopsies. At least three of these tests were abnormal in all patients.
Radiation protection requires that the so-called "on contact" (PARMA) projections be prohibited. They can be replaced by the short cone technique, which provides a sufficient enlargement to eliminate parasitic shadows on the unexamined opposite side, and is indicated for profile radiology of the TMA and profile parotid sialography examinations.
Non-neoplastic disorders of the parotid gland like chronic recurrent parotitis, asymptomatic gland enlargement or salivary fistulae present a therapeutic problem. Surgical removal of the gland is often difficult as scar tissue may be present in these benign diseases. Therefore alternative methods are suggested to eliminate parenchyma by inducing atrophy. This goal can also be attained by intraluminal duct occlusion. The principle consists of instillation of a resorbable protein solution into the duct system, a procedure similar to sialography injection. In animal experiments marked atrophy of parenchyma and complete reabsorption of the instilled substance within four weeks could be demonstrated histologically. The clinical experiences in 33 cases of major salivary gland diseases and three year follow up data are reported. The main advantages of the new method described are a simple technique, rapid onset of atrophy and preservation of facial nerve function.
Echotomography of the parotids in 88 patients was successful in detecting normal parotid morphology or inflammation of the parenchyma (parotitis) in 100 p. cent of such cases, and detecting the precise localization of tumors (adenopathies or intraparotid tumors) up to 3 mm in diameter in 93 p. cent of cases. Though cystadenomas do not provide a specific image, their appearance is typical. Positive diagnosis was possible in 85 p. cent of mixed tumors of 1 cm diameter or more, and in 5 out of 7 cases of malignant lesions. The diagnostic value of this examination is markedly limiting that of parotid sialography.
Labial salivary gland biopsy (LSG-B) along with Schirmer test and kerato-conjunctival staining with fluorescein dye was performed in 196 patients with suspected Sjogren's syndrome (SS). Of the 196 patients, 117 were found to have 2 or more lymphocytic focus scores (LFS/4mm2) on their LSG-B specimens. 92 of them having keratoconjunctivitis sicca (KCS) as well met the diagnostic criteria of SS. Among the cases (25) without KCS, 16 with another CTD were diagnosed as secondary SS. 9 cases were classified as probable primary SS in this study because they had clinical manifestations of SS. Of the 11 cases with KCS only, 6 with another CTD were diagnosed as secondary SS; 5 befitted primary SS for abnormal findings on sialography. We also found that lymphocytic infiltration in LSG-B was much more severe in primary SS than in secondary SS; this could be attributed to the use of immunotherapy for the accompanying CTD in secondary SS. There was good association in our study between the severity of lymphocytic infiltration and systemic involvement.
This paper consists the theorical review and the current concepts of the subject and the second includes the casuistry of the Stomatology Department of the Pulido Valente Hospital. From April 1989 to 1991 (2 years), a study was made on Sjögren Syndrome (Primary and Secondary) of multiple character with the particular co-operation of the Portuguese Institute of Rheumatology. With this paper we wish to point out the importance of the oral evaluation of the study of the plurisystemic diseases as well as to establish criterions of diagnosis for the Portuguese population. Eighty cases of suspected Sjögren's Syndrome have been assessed, 66 of which have been fully. The reason for the consultation was dry mouth, dry eyes and enlargement of parotid glands. The symptoms were isolated or in association with other pathologies after other causes had been excluded. We had to establish the salivary reference values for the Portuguese population in 22 healthy volunteers. The xerostomia was evaluated by the Sialochemistry, Sialography, Cintigraphy and biopsies of the lower lip and of the sublingual gland. The ophthalmologic examination took place in the Ophthalmology Department of Santo António dos Capuchos Hospital by means of Shirmer test, Rosa Bengala and B.U.T. In spite of Sjögren's Syndrome being, up to now, so remotely determined in connection with the treatment, these patients need medical care and Stomatology plays a fundamental role as far as the diagnosis and the therapeutic points of view are concerned. We maintain the notion that the Syndrome is not as infrequent as one would believe and the evaluation of the oral field is important to establish the degree of the disease and its treatment.
For the evaluation of diseases of salivary origin, ultrasound and/or sialography is recommended instead of MRI. In cases of salivary tumor, ultrasound may be helpful in delineating superficial tumors. For small tumors no further imaging is needed. When dealing with a large tumor or a tumor in the deep lobe of the parotid gland, MRI is the preferred imaging method. Not only does MRI provide a large variety of soft tissue signal differences, but also the multiplanar facilities are helpful in delineating the extent of the tumor, whether located in the submandibular, sublingual, or parotid gland. Skull base invasion is often well seen by MRI. Subtle changes may be missed and in those cases CT is recommended to exclude or prove destruction of the skull base. For the evaluation of patients presenting with a recurrent pleomorphic adenoma, MRI is recommended in all patients. MRI delineates the extent and number of recurrent tumors better than palpation in most cases. No other imaging technique is as accurate in depicting recurrent pleomorphic adenomas as MRI at present. The use of an intravenous contrast medium remains controversial whether for primary or recurrent disease.
PURPOSE: To clinically test a new type of parotid surgery termed functional superficial parotidectomy (FSP) to preserve the function of the residual gland. PATIENTS AND METHODS: Sixteen human parotid specimens were dissected, and 19 patients underwent FSP. RESULTS: It was shown that 91.4% of the main parotid ducts were found deep to the surface of the facial nerve. Physical examination, sialography, and scintigraphy showed that function of the residual gland was well preserved by FSP. CONCLUSION: A comparison of the main complications between FSP and conservative superficial parotidectomy showed a significant decrease (P < .01) of Frey's syndrome with FSP.
A retrospective analysis of the CT (n = 18) and MR (n = 4) examinations was performed in 21 patients with a histologically proven pleomorphic adenoma of the parotid gland. This group included 15 primary pleomorphic adenomas, 5 tumor recurrences and one carcinoma ex pleomorphic adenoma. There was a clear female predominance (15/21). On CT, pleomorphic adenoma usually presented as a well defined, round or oval-shaped tumor in the superficial part of the parotid gland, round or oval-shaped tumor in the superficial part of the parotid gland, showing an inhomogeneous captation pattern on contrast enhanced CT. CT sialography offered no complementary information. Although not specific for pleomorphic adenoma, the hyperintense appearance on spin-echo (SE) T2-weighted MRI was helpful in the detection of tumor masses, more specifically small recurrent tumor nodules.
The author presents a report on a group of 11 children with chronic recurrent parotitis, treated at the ENT department in Cadca. The author emphasizes the importance of sialography for establishment of the diagnosis of this disease and draws attention to therapeutic possibilities.