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The authors performed xerosialography on 41 patients with various diseases of the salivary glands. In 38 patients this provided positive information. Each of eight submandibular sialograms was abnormal; of the 33 parotid examinations, three benign salivary tumours could not be demonstrated radiologically. Xeroradiography is a useful method for the examination of the major salivary glands. It is superior to the traditional film method.
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In connection with 141 cases of parotid tumours, 21 adenopathies of the parotid region and 22 cases of parotitis, the authors define the role of ultrasonography in the exploration of the salivary glands. Use of simple criteria permits differentiation of benign from malignant tumours with a good degree of sensitivity (79.8% in our series). This score allows ultrasonography to be offered as the first complementary examination when dealing with a tumefaction of the parotid region. When ultrasonographic findings evoke a malignant lesion, a CT scan seems necessary to evaluate any extension in depth. In contrast, ultrasonography does not appear justified in cases of parotitis or lithiasic pathologies.
Salivary retention and recurrent sialadenitis as a result of ductal stenosis is an uncommon condition that presents difficult management problems. Ductal dilation with small angioplasty balloons is recognized to be of low morbidity and can eliminate the possible need for surgical intervention. This case report is interesting in that the successful treatment of parotid duct stenosis was accompanied by the resolution of a spectrum of autonomic symptoms that had seriously compromised the patient's quality of life.
Primary Sjögren's syndrome seems to be the most common of the chronic systemic inflammatory connective tissue diseases, according to epidemiological investigations. Basic and clinical research, including treatment within this group, is increasing while simultaneously there is increasing confusion and uncertainty about the classification criteria for Sjögren's syndrome. Within the last three decades nine different classification criteria sets have been introduced including the recent US-European classification criteria set. The diagnostic criteria used in daily practice seem to differ even more and many forget that the function of both the lachrymal glands and the salivary glands should be diminished. Consequently many rheumatologists prefer to diagnose patients according to classification criteria. The advantages and disadvantages of the various classification criteria for primary Sjögren's syndrome are dealt with but it is stressed that the majority of these will exclude former/present smokers (from the diagnoses)--more than half of the population!
This article provides a brief overview of the various orofacial presentations of Sjögren's syndrome. The paper summarises the clinical features of patients with xerostomia, and alludes to differential diagnosis, investigative procedures and therapeutic modalities for the oral component of Sjögren's syndrome.
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Nine patients with thyroid cancer were treated with reserpine in an attempt to reduce radiation exposure to the salivary glands from 100-150 mCi doses of I-131 therapy to thyroid remnants or metastases. Three control patients were not treated with reserpine but did receive 100-150 mCi of I-131. Parotid/background ratios of activity after radioablative doses of I-131 in patients not treated with reserpine were significantly higher than the patients treated with reserpine, and this was also true seven days after the radioablative dose. Combined therapy with reserpine, chewing gum, lemon candies, and hydration is suggested for the prevention of sialadenitis and xerostomia due to large doses of radioiodine.
That the radionuclide "milk" scan is insensitive for aspiration has been demonstrated. Here the authors review their experience with the radionuclide salivagram in its ability to detect aspiration in children. Tc-99m sulfur colloid, 0.5 to 1.0 mCi in less than 1 mL, is instilled into the mouth and sequential supine posterior images of the thorax are obtained for an hour with delayed images until the oropharynx is cleared of radiotracer. Fourteen studies have been performed in 13 patients aged 1 month to 6.5 years. There are scintigraphic findings consistent with aspiration in 4 of 14 studies (28%); dysmotility (prolonged retention of activity in the esophagus) in 7 of 14 studies (50%); and normal studies in 3 of 13 patients (22%). Eight of 13 patients had milk scans; all were negative for aspiration. One patient studied twice had aspiration on the first examination, and dysmotility on the second study. It is concluded that the salivagram can detect aspiration of oral secretions, is superior to the milk scan in detecting aspiration, and can demonstrate esophageal dysmotility.
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A method for measuring the fractal dimension of radiographic images was devised by the modified pixel dilation (PD) method, and its accuracy was examined by two types of image analyzers: one controlled by a minicomputer and based on the hexagonal array of the pixels, and the other controlled by a personal computer and based on the square array of the pixels. It was shown that the fractal dimensions measured by using the image analyzers for three curves (straight line, Koch curve, and Sierpinski gasket) were deviated by less than 2.1% from the theoretical dimension. The time required for the measurements fell within 10 seconds by the minicomputer-controlled image analyzer, and within 12 minutes by the personal computer-controlled image analyzer, which contrasts to the 30 minutes or more required for measuring fractal dimensions by other available methods. Analysis of the ductal patterns in sialograms by this method indicated that the fractal dimensions were significantly different between normal parotids and parotids with Sjögren syndrome. The modified PD method can be used for measuring the fractal dimension of ductal patterns in sialograms. The measurements may serve as numerical gradings of the progression of disease.
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Twenty-six cases of parotid hemangiomas seen at the Montreal Children's Hospital are reviewed. This lesion is by far the most common tumor of the parotid gland in children. In recent years, our treatment of this condition has gradually shifted toward conservatism, reserving surgical excision for the unusual case where the lesion does no show spontaneous resolution.
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