Phleboliths and salivary calculi.
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The parotid gland function and structure was studied in 30 patients with biopsy-proven alcoholic cirrhosis and in 43 age- and sex-matched alcoholic and nonalcoholic control subjects. Mean simulated parotid saliva flow rate was significantly (p less than 0.05) lower in patients with alcoholic cirrhosis as compared with alcoholic and nonalcoholic control subjects. A similar reduction was observed in mean basal parotid saliva flow rate in patients with alcoholic cirrhosis that reached statistical significance (p less than 0.05) in comparison with nonalcoholic control subjects. In addition, the concentration of sodium, bicarbonate, and total proteins in stimulated parotid saliva was significantly (p less than 0.005) lower in patients with alcoholic cirrhosis as compared with the two groups of control subjects. Sialograms in 6 patients with alcoholic cirrhosis did not reveal any obstructive lesion in the primary parotid duct or its branches. Histology of salivary tissue revealed an increase in the interstromal fatty infiltration, edema, and fibrosis without evidence of inflammatory reaction in 5 patients as compared with the control subjects. These data provide evidence for marked parotid gland dysfunction in patients with alcoholic cirrhosis presumably due to metabolic derangement and altered parotid gland structure.
This prospective study investigated the outcome for non-operative management of parotid duct injuries in 19 patients with injury confirmed by the methylene blue method. Nine (47 per cent) healed without complications. Short-term salivary fistulas complicated seven (36.8 per cent) wounds and a sialocele occurred in four (21.1 per cent). All complications resolved without the need for operative intervention. Acute surgical repair of damaged ducts can no longer be recommended, since conservative management of parotid duct trauma is both safe and effective; simple surgical procedures exist for the management of the rare long-term disorders.
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Radiolucent calculi are discussed. Three cases are presented, with a sialographic interpretation of each. Recent studies show that radiolucent calculi in general and parotid gland sialolithiasis in particular occur more frequently than was previously believed.
The literature relative to developmental submandibular gland defect of the mandible is reviewed, and an interesting case is presented. Evaluation for more serious systemic disease which may manifest radiolucencies in the region of the angle of the mandible is made.