MAJOR GLAND SIALECTASIS.
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Except for mumps, the benign lesions most frequently seen in the salivary glands of a child are parotitis, hemangioendotheliomas and mixed tumors. Carcinoma and sarcoma are uncommon. Rapid growth and pain are features of malignant change. Chronic parotitis usually subsides under conservative treatment. If operation is necessary, total parotidectomy is advisable. Scout x-ray films and sialangiographic examination are useful in differentiating an inflammatory lesion from a neoplastic growth.The treatment of choice for a non-inflammatory tumor is surgical excision, for most parotid tumors are radioresistant. Small masses should be completely excised for pathological evaluation. Since operation entails risk of damage to the seventh nerve, incisional biopsy may occasionally be indicated in the case of a large diffuse lesion for it is very likely to be benign and operation unnecessary. The risks of seventh nerve damage are magnified in a child as the anatomic structures are smaller and the nerve lies in a more superficial position.
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OBJECTIVE: To describe the nonsurgical removal of sialoliths and treatment of salivary duct strictures. DESIGN: Case series. SETTING: Two 200-bed general community hospitals. PATIENTS: Twelve consecutive patients from April 1985 to November 1994-8 with calculi, 3 with salivary duct strictures, and 1 with calculi and stricture. RESULTS: Successful nonoperative removal of calculi in 7 of 9 patients. All 4 sialodochoplasties were successful. All 10 patients with successful procedures had no recurrent symptoms. Seven patients have been symptom-free for 10 months to 10 years. Communication with 3 patients has been impossible recently, although these patients were symptom-free for at least 3 years. CONCLUSIONS: These methods of nonsurgical sialolith removal and sialodocoplasty were highly successful and should be used as the initial therapies for patients with these conditions.
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From personal observations, I review the genetic disorders of salivary gland development and function, including the lacrimo-auriculodentodigital (LADD) syndrome, autosomal dominant hypoplasia/agenesis of salivary and/or lacrimal glands, chronic recurrent sialadenitis, polycystic-dysgenetic disease of the parotids and salivary calculi.
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The anatomic structure of the mouse parotid gland was investigated by a sialographic method. The mouse parotid was infused with 0.4-0.6 micron grains of barium sulfate sol as an x-ray contrast medium and extirpated. The excised gland was flattened and imaged by using 10 or 25 k Vp x-rays. Twelve different strains of male mice 12 weeks old were investigated. It was found that the mouse parotid gland has the club-shaped major lobe and the accessory lobe and that the major lobe is further divided into three lobes: the superior lobe which extends underneath the ear, the middle lobe, and the inferior lobe which extends toward the submandibular gland. The accessory lobe began from the proximal part of Stensen's duct and extended to underneath the eye. The presence of the accessory lobe, the shape of the major lobe, and the branching pattern of the parotid duct tree were mouse strain dependent.