Recurrent parotid enlargement.
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Details of 2 patients with idiopathic bilateral parotid duct strictures are presented. The possible aetiology and treatment are discussed.
High resolution computed tomography (CT) has been of extraordinary value in all areas of the head and neck. Previous communications have indicated its effectiveness in the evaluation of the temporal bone and soft tissues of the neck. This current communication illustrates and discusses the anatomy and pathology of the salivary glands and oral cavity as seen on CT.
Of 58 patients whose parotid glands were extirpated because of a chronic parotitis, 90% could be cured. The rate of success of this operation is reduced to 70-80% if its is based on those 31 patients alone who showed the typical symptoms of a chronic-recurrent parotitis. The incidence of persisting facial pareses is about twice as high as after removal of non-inflamed parotid glands. This figure is based on seven patients suffering, with one exception, from only slight disorders of innervation in the region of the angle of the mouth. In our opinion total parotidectomy is the method of choice for the treatment of chronic parotitis, if all attempts at conservative treatment have failed. We attribute our failures to remaining glandular parenchyma that was both inflamed and still secretory-active. To further improve the rate of success of parotidectomy, its combination with procedures suitable for occlusion of the duct system is proposed. In this way one should succeed in completely eliminating any secretory-active gland tissue.
Four children are reported with a chronic caseating granulomatous infection on the intraparotid lymph nodes most likely due to atypical mycobacteria. The sialogram showed one or more masses within the parotid gland.
Salivary and serum concentrations of beta 2-microglobulin, salivary levels of the immunoglobulins, and salivary flow (as measured by a gravimetric method) were assessed in 34 patients and 11 controls. Of the 34 study patients, 16 had a primary form of Sjögren's syndrome (pSS) and 18 had sicca syndrome. The salivary and serum concentrations of beta 2-microglobulin and salivary levels of IgA and IgG were much higher in the patients with pSS than in controls or those with sicca syndrome (p < 0.001). Similarly, the salivary IgM levels of patients with pSS were higher (although at a lower degree of statistical significance) as compared to those of patients with sicca syndrome (p < 0.01) or controls (p < 0.05). No correlation was observed among the salivary flow and the salivary IgG and IgM levels, while there was a negative relationship (p < 0.01 with salivary IgA levels in all 45 patients considered as a whole. In 12 patients with pSS, the coefficient of correlation between the salivary gland biopsy focus score and the salivary (but not serum) concentration of beta 2-microglobulin was highly significant (p < 0.001). A similar relationship was observed with the IgG (p < 0.001) and IgM (p < 0.05) levels, but not IgA. In the diagnosis of pSS, the salivary IgA level demonstrates high sensitivity and low specificity. In contrast, serum and salivary concentrations of beta 2-microglobulin, salivary IgG, and to a lesser degree, salivary IgM have high specificity and positive predictive value.(ABSTRACT TRUNCATED AT 250 WORDS)
Although associations of Sjögren's syndrome (SS) with malignant affections are well known, an association with chronic myelomonocytic leukemia (CMML) is infrequent. Our report concerns an 80-year-old woman with chronic polyarthrosis, hospitalized for an anemic syndrome, who also complained of buccal dryness. Clinical examination showed simply parotid swelling and discrete splenomegaly. The diagnosis of SS appeared to be primary. The hemogram, myelogram and bone biopsy indicated CMML. During SS, the possibility of occurrence of a lymphoproliferative syndrome is well documented, and other malignant affections are much less likely to be found in the absence of immunosuppressive treatment. The particular case of SS and associated CMML detected at the same time suggests either the favorable role of monocytic proliferation on immunity or a stem clonal anomaly affecting monocytes and B lymphocytes.
Deep injuries to the parotid region may result in trauma to vital structures: i.e., the parotid gland and duct and the facial nerve and its branches. While there is no doubt concerning primary microsurgical reconstruction of injuries to the facial nerve clinical approaches for treating disruptions of the parotid duct have been controversial. A case report is presented of a secondarily reanastomosed parotid duct following complete transection. The microsurgical technique and its indications are discussed.
The accessory parotid gland, a little-known and seldom-mentioned anatomical variant, is a nodule of normal salivary tissue separate from the main parotid gland, located on the masseter muscle and connected to the Stensen duct at that level. It can be the site of both congenital and acquired lesions.
PURPOSE: To evaluate the results of balloon dilatation of salivary duct stenosis and to discuss the technique and its limitations. METHODS: Balloon dilatation of 30 salivary duct stenoses (24 parotid, 6 submandibular) was carried out in 29 patients over a 5-year period. Duct dilatation was performed with a 3-mm-diameter balloon on a 0.035-inch wire passed into the salivary duct under fluoroscopic guidance. The follow-up period ranged from 1 month to 5 years. RESULTS: In 25 patients balloon dilatation was technically successful in 26 of 30 ducts (87%). Ninety-six percent of parotid duct dilatations and 50% of submandibular duct dilatations were technically successful. Early clinical follow-up after parotid duct dilatation showed that 57% of patients were asymptomatic, 39% showed an improvement in symptoms, and 4% showed no improvement in symptoms. Following technically successful submandibular duct dilatation (3 cases), 1 patient showed complete resolution of symptoms and 1 showed no change in symptoms. No follow-up was available for 1 patient. No significant complications were seen. The longer-term results are presented. CONCLUSION: Balloon dilatation of salivary duct stenosis is a simple, safe, and clinically effective method of relieving obstructive symptoms of parotid duct stenosis.
Sjögren's syndrome is a chronic inflammatory systemic autoimmune disease mainly affecting the exocrine and, particularly, the salivary and lacrimal glands. The condition usually occurs in adults. In 1994, the criteria for this syndrome were redefined in a multicenter European study. In children, Sjögren's syndrome is a rare and probably underdiagnosed disease. To date, Sjögren's syndrome in children has only been described in case reports and in the comparative presentation of various study results. So far, no study of a comparative classification into primary and secondary Sjögren's syndrome has been carried out in a patient population of any size. Sjögren's syndrome should be considered in the differential diagnosis of children with recurrent parotitis, keratoconjunctivitis sicca, or pronounced and early tooth decay associated with xerostomia. In this study of 23 children and adolescents under the age of 16 with the clinical symptoms and laboratory findings of Sjögren's syndrome, we differentiate between primary and secondary Sjögren's syndrome. The value of the individual methods of assessing the oral and the ophthalmological components and the manifestation of the underlying rheumatic condition are discussed on the basis of the EULAR criteria. The EULAR diagnostic criteria are of limited applicability in children because reliable anamnestic data are frequently lacking. Another problem in diagnosing Sjögren's syndrome is the short-term detection of serological alterations and clinical symptoms. Even if young patients do not completely fulfill the required criteria, Sjögren's syndrome can be assumed or confirmed in the presence of positive testing for oral and ocular manifestations and recurrent salivary gland enlargement.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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