Diseases Of Major Salivary Glands Research Articles

Ultrasound Evaluations of Major Salivary Gland Pathology

No single sonographic feature is enough to distinguish gland disorders. Major salivary gland diseases are either localized or diffuse. Imaging must identify neoplastic from non-neoplastic diseases using Ultrasound, which is a non-invasive, low-cost, and accessible imaging method for the major salivary gland evaluation. Color Doppler in addition to B-mode ultrasound assesses gland enlargement and detects inflammatory, benign, and malignant gland enlargement. Moreover, this study aims to assess the diagnostic effectiveness of ultrasonography in diagnosis of major salivary gland pathology. Method: Ninety Major Salivary Gland swelling patients underwent preoperative ultra-sonography with a high-frequency linear probe. Echotexture, internal Calcification, focal lesion borders, lymphadenopathy, tumor shape, duct dilatation, and blood supply distribution were examined using color Doppler and B-mode Ultrasound. Result: A histological investigation of 62 tumors identified 18 malignant and 44 benign, with 68.2% of the benign group being pleomorphic adenoma and 61.1% of the malignant group being mucoepidermoid carcinoma. The rest of the cases, 28 cases were inflammatory, 50% of which were sialolithiasis. The sonographic features of malignant and benign differ significantly in echogenicity, posterior echo-enhancement, vascularity, morphology, and homogeneity and Calcification. All groups show considerable differences in duct dilatation, duct calcification, and homogeneity. Conclusion: Ultrasonography demonstrating excellent diagnostic efficacy in assessing salivary gland function, based on these results Ultrasonography may help reduce unnecessary biopsies especially in inflammatory cases.

Simultaneous application of ultrasound and sialendoscopy: experience in the management of stenosis and other non-sialolithiasis-related salivary gland disorders.

To assess the value of the simultaneous application of ultrasound and sialendoscopy (US+SE) in several salivary gland diseases not caused either by sialolithiasis or by tumours. US+SE are routinely used in patients with inflammatory, obstructive, and other non-tumorous major salivary gland diseases. In patients in whom US and SE as single investigation tools were not conclusive or not useful in the management of several non-sialolithiasis-related conditions (stenoses, ductal anomalies, ductal trauma, space-occupying paraductal lesions), both methods were used simultaneously for diagnosis and treatment. US+SE were used simultaneously in 44 patients for 56 indications. Stenosis was managed in 36 cases (81.8%) and in thirty-eight of the indications (67.9%) with simultaneous US+SE. The successful opening was achieved in 23 (63.9%), conservative and/or ablative treatment was indicated in 13 (36.1%), and further imaging was indicated in two (5.5%) of these cases. Post-traumatic or postinfectious complications were managed in 12 (27.3%) of all cases, and isolated ductal anomalies and paraductal space-occupying lesions were assessed in three cases (8.3%) each. In all instances, simultaneous US+SE clearly improved the management in diagnosis and/or therapy. Simultaneous application of US+SE provided additional information that proved to be valuable for diagnosis, planning, and treatment in several non-sialolithiasis-related conditions such as stenoses, ductal anomalies, ductal trauma, and space-occupying paraductal lesions.

SIALOENDOSCOPY- OUR PREMILINARY EXPERIENCE IN A PILOT STUDY

Obstructive sialadenitis is the most common non-neoplastic disease of major salivary glands. Previously many of these patients were undiagnosed cases of recurrent sialoadenitis and underwent unnecessary gland excision. In recent time with technical advancement sialendoscopy is increasingly used in both diagnosis and treatment of Salivary gland obstructive pathology. In this case series we are doing the retrospective study of our patients, in which sialendoscopy was done in last one year. Of 12 patients, 10 patients were having disease in submandibular gland, and 2 patients in parotid gland. All the patients were having obstructive pathology. In 5 patients stone removal was done by Dornia basket, and 3 patients required doing the papillotomy for stone removal. In 3 patients stone removal was not possible, due to large size of stone and required gland removal, and one patient was having stricture of submandibular duct, stenting failed, so gland removal was done. Obstructive sialadenitis can be managed purely endoscopically or in a combined modality, with success, which may avoid the gland removal

Clinico-Pathological Review Study of Neoplastic Diseases of Major Salivary Glands with Radiological Correlation

Clinico-Pathological Review Study of Neoplastic Diseases of Major Salivary Glands with Radiological Correlation

Sialendoscopic management of autoimmune sialadenitis: a review of literature.

SUMMARYAutoimmune diseases of major salivary glands include Sjögren's syndrome and a complex of disorders classified as immunoglobulin G4-related diseases. These pathologies are characterised by an autoimmune reaction mediated by T-helper lymphocytes that targets the ducts of exocrine glands in Sjögren's syndrome and glandular parenchyma in immunoglobulin G4-related diseases. Immunoglobulin G4-related diseases represent recently introduced multi-organ diseases that also involve the salivary glands. However, the morbid conditions once known as Mikulicz's disease and Kuttner's tumour were recently considered as two variants of immunoglobulin G4-related diseases affecting the major salivary glands ( immunoglobulin G4-related sialadenitis). This review briefly summarises the pathogenesis and clinical features of autoimmune diseases of the major salivary glands, focusing on the diagnostic and therapeutic role of sialendoscopy.

Sonography of Salivary Glands

Patients with salivary gland abnormalities present most commonly with painful or painless focal swelling, dryness of mouth or pain on eating certain type of food. The Sonography of Salivary glands needs to answer certain questions. Is there a focal mass? Is it benign or malignant? Is the lesion single or multiple? What is the location? Are there any Lymph nodes? US is accepted as the first imaging method for assessment of diseases of major salivary glands. Lesions in the deep lobe of parotid gland or behind the mandible are difficult to see. US needs to be complimented by MRI, and also when the tumors are large or appear to bulge into oral cavity or oropharynx. CT is considered better in assessment of inflammatory diseases of salivary glands. In acute inflammation, salivary glands are enlarged and are often hypoechoic. The glands may be inhomogeneous; may contain multiple small, oval, hypoechoic areas. In chronic inflammation, salivary glands are normal sized or smaller, hypoechoic, and inhomogeneous and usually do not have increased blood flow. Multiple small hypoechoic foci on a heterogeneous background. 60-90%Salivary calculi occur in the submandibular gland. Parotid calculi are relatively less commonUS and MR are the main modalities for detection of calculi and assessment of ducts. Bilateral glandular involvement. Parotid & Submandibular glands are commonly involved. Sometimes lacrimal glands are also involved. USG reveals heterogeneous echopattern, multiple round hypoechoic areas, reticulated pattern. Salivary gland neoplasms are not common. Most of them occur in Parotid glands (80-90%). Most of them are benign (70-80%). Neoplasm in submandibular gland is rare (10-20%) but almost 50% of them are malignant. The most common malignant neoplasms occurring in salivary glands are mucoepidermoid carcinoma and adenoid cystic carcinoma. Less than 30% of focal lesions in the parotid gland are malignant, whereas almost 50% of focal lesions in the submandibular gland are malignant. Ultrasound characteristics are Irregular shape, Irregular borders, Ill defined margins, and Hypoechoic inhomogeneous structure.

Head and Neck Sonography from the Viewpoint of a Surgeon

The ultrasound is the first-line imaging study for evaluation of the thyroid nodule. Comparing with other imaging studies, the ultrasound is the most sensitive and powerful imaging tool to detect the presence of the thyroid nodule and to distinguish between benign and malignant nodules. Besides, the ultrasound is very useful for follow-up of the thyroid nodule without surgery and those after surgery. The ultrasound is also a very promising imaging tool for other head and neck diseases, including major salivary gland diseases, cervical lymph nodes and other specific diseases. In terms of surgery, the ultrasound provides surgeons much more anatomical information of the thyroid nodule and other head and neck diseases beside differential diagnosis. Through the ultrasound, surgeons could know the extent of central and lateral lymph node metastasis, the anatomical relationship between the recurrent laryngeal nerve and the tumor, tracheal/thyroid cartilage and esophagus compression or invasion, and intrathoracic extension for thyroid tumors. The most amazing part of the ultrasound for head and neck surgery is that surgeons could know the best approach for head and neck surgery, especially revised surgery, and the potential risks/complications. In this speech, I will talk about the head and neck ultrasound and will more focus on the benefit of the ultrasound on head and neck surgery from the viewpoint of a surgeon, who is always doing the ultrasound by myself for patients, before and after surgery.

Giant submandibular sialolith in an old female patient: A case report and review of literature

Sialolithiasis or salivary gland duct calculus or salivary stones are the most common pathologies of the salivary gland. Sialolithiasis accounts for more than 50% of the major salivary gland diseases. Sialoliths are deposits obstructing the ducts of major or minor salivary glands or its parenchyma. Salivary stones larger than 15 mm are classified as giant sialoliths. Giant sialoliths measuring 35 mm or more are extremely rare, with approximately 18 cases published in literature all reported in male patients. The aim of this article is to present a case of a giant sialolith occurring in an old female patient and to communicate the results of a literature search on giant sialoliths.

Sialoendoscopy in the diagnosis of parotid gland diseases

In the last two decades, a new minimally invasive technique for precise diagnosis of major salivary gland diseases has been introduced. This method is called salivary gland endoscopy or sialoendoscopy. The present survey outlines the emergence of this effective and safe procedure as well as its clinical applications in the diagnosis of the most common benign parotid gland diseases, i. e., chronic parotitis, including juvenile recurrent parotitis, and sialolithiasis causing major salivary gland obstructions.

PP104: A rare case of Sjogren’s syndrome presented as bilateral multifocal cystic major salivary gland disease

Purpose We present a rare case of a Sjogren’s syndrome presented as bilateral multifocal cystic major salivary gland disease. Material and methods A 38 year-old woman presented to the Oral & Maxillofacial dpt for examination of a progressing enlargement of her right preauricular area during the last six mounts period. A non painful, smooth discrete mass was obvious and palpated superficially of the right parotid. Regarding her medical history she reported recurrent, moderate episodes of dry keratoconjuctivitis and hypothyroidism due to Hasimmoto disease, well controlled by her endocrinologist. An USS examination of major salivary glands followed by an MRI scan were ordered. An FNA biopsy of the right parotid mass was suggested, followed by a sublabial glad biopsy. Results Both USS and MRI scan revealed multiple cystic lesions different in size within the major salivary glands, especially in parotids and diffuse enlargement of the parotid glands. Reports of FNA biopsy of the right parotid mass plus sublabial glad biopsy described diffuse lymphocyte infiltration of the glands with benign lymphoepithilial lesions. Conclusions Based mostly on the clinical and histological findings the diagnosis of Sjogren’s syndrome was carried out. Regarding the radiological findings we have to conclude that beyond the expected findings of dilated ducts, punctuate or globular collections and cavitary lesions, which characterize the disease, an appearance of multifocal cystic lesions bilaterally in major salivary gland, even rarely should be expected. Such findings should be under consideration for the differential diagnosis of diseases with benign lymphoepithilial lesions.

Sialendoskopie - Lernkurve und Verbreitung in deutschen HNO-Kliniken

Sialendoscopy is an established, minimal-invasive technique to diagnose and treat obstructive diseases of major salivary glands. Knowledge on learning curve and distribution in Germany is limited. MATERIAL UND METHODS: An 11 item questionnaire on Sialendoscopy was sent to all 159 German ent-hospitals. To determine the learning curve, all patients that underwent sialendoscopy during a 1-year-period after invention of sialendoscopy in our department were prospectively followed and evaluated. Sialendoscopy is currently performed in a minority (24%) of ent-departments in Germany. Denial was justified by technical problems, a lack of cost-benefit and small number of patients in descending order. A significant reduction of intervention time (61.0 ± 32.7 min to 43.2 ± 33.6 min, p=0.013) and less frequent aborted operations were noted after comparison of the first vs. the second half amount of interventions as indicators of a learning curve. Complications were not found to be significantly raised in the first half of interventions. The fact that sialendoscopy is provided in only a minority of ent-departments will in the future most likely be overcome by technical improvements. A learning curve has to be anticipated.

Sialendoscopy for the Management of Obstructive Salivary Gland Disease

To conduct a systematic review with meta-analysis to determine the efficacy and safety of sialendoscopy in the treatment of obstructive diseases of the salivary glands in adults. MEDLINE, EMBASE, and the Cochrane Library (no lower limit to October 2010). Reference lists were searched for identification of relevant studies. Prospective or retrospective studies of adult patients treated with interventional sialendoscopy for the management of salivary gland obstruction were selected. Outcome measures included rates of success (symptom-free and absence of residual obstruction), sialadenectomy, and complications. Non-English publications were excluded. Two independent review authors screened eligible studies, extracted relevant data, and resolved discrepancies by consensus when applicable. Weighted pooled proportion, 95% confidence intervals, and test results for heterogeneity are reported. Twenty-nine studies were included in the analysis. The weighted pooled proportion of success rates were 0.86 (95% CI, 0.83-0.89) for studies involving 1213 patients undergoing sialendoscopy alone and 0.93 (95% CI, 0.89-0.96) for the 374 patients undergoing sialendoscopy with a combined surgical approach. Outcomes following interventional sialendoscopy for radioiodine-induced sialadenitis were reported in 3 studies, and success rates were variable. Rates of sialadenectomy were low, and few major complications were reported. Findings from the present systematic review and meta-analysis suggest that sialendoscopy is efficacious, safe, and gland preserving for the treatment of obstructive major salivary gland disease.

Wegener’s granulomatosis of the major salivary glands

Wegener's granulomatosis is one of the anti-cytoplasmic autoantibodies (ANCA)-associated vasculitides. Although it typically affects the lungs and kidneys, the head and neck are also involved in most cases but the site usually affected is the upper airway. However, there are 35 cases with well-documented clinicopathological data in which Wegener's granulomatosis manifested in the major salivary glands, most commonly the parotid. Twenty-four patients presented with salivary signs and symptoms, in eight of whom there was no other presenting manifestation. These signs and symptoms may mimic infection or neoplasia and laboratory investigations, including ANCA serology and histopathology, may be non-specific; thus, in 21 of the 35 patients (60%) there was a delay in diagnosis. Amongst the 21 were 11 of the 14 (78.6%) patients who presented with unilateral parotid disease and three of the five who died. Three other patients suffered permanent pulmonary, two renal and five facial nerve damage. This article reviews the literature on major salivary gland involvement in Wegener's granulomatosis, which should be considered in the differential diagnosis of major salivary gland disease particularly if commoner causes have been excluded. A detailed medical history, and persistently inconclusive laboratory tests, could provide the clues that enable prompt diagnosis.

Imaging in major salivary gland diseases

Most of the salivary glands diseases are characterized only by a few distinct clinical patterns. Medical history and clinical examination are still considered of great relevance. However, in order to obtain a definite diagnosis, imaging techniques are required in most of the cases. Salivary glands ultrasonography (US) is the technique to be used as the first because US can easily differentiate calculosis, inflammatory diseases and tumors. Sonography is also frequently needed to perform needle aspiration or biopsy (FNAC). Sialography should be used essentially for assessing chronic sialoadenitis as well as Sjögren's syndrome. At present, Magnetic Resonance sialography should be preferred because of the greater sensibility in diagnosing inflammatory diseases of the salivary glands. It allows to evaluate both intraglandular oedema and nodules, so that incannulation of the salivary duct is not required. Computer Tomography (CT) and Magnetic Resonance imaging (MR) are useful when neoplasm are suspected, particularly if deep areas of the gland, which cannot be visualized by US, are involved. Sequential scintigraphy is currently employed for assessing the functional status of all the 4 major salivary glands and evaluating the chronic evolution of glandular damage.

Usefulness of ultrasonography and color Doppler sonography in the diagnosis of major salivary gland diseases

The algorithm for imaging of the salivary glands depends on the clinical scenario with which the patient presents to the clinician. Ultrasound has been increasingly used in recent years and thanks to high performance, easy to use apparatus, it can now be used for exploration of the salivary glands. This non invasive, painless and relatively inexpensive examination provides rapid visualisation of the salivary glands and is a useful adjunct to computed tomography and magnetic risonance imaging examination, particularly in tumour pathology. In recent years, publications have highlighted the potential uselfulness of salivary gland ultrasonography as a simple and non-invasive adjunctive test for the detection of gland involvement in Sjögren's syndrome (SS). SS is a chronic inflammatory disease of the salivary glands characterised by focal lymphocytic infiltrates that cause progressive destruction of the acinar structures. The findings of a previous study lead us to believe, in agreement with other examiners, that semiquantitative assessment of ultrasonographic images of the salivary glands is a sensitive and very useful means of evaluating salivary involvement in SS. Color Doppler sonography is a recently introduced method which makes it possible to evaluate intra- and perilesional vascularization and to perform a hemodynamic study of the area being explored. The color Doppler sonography can provide a useful adjunct to conventional ultrasound, increasing diagnostic accuracy in submandibular- parotid masses and to analyze physiologic changes that occur during salivary stimulation in normal subjects and the flow alterations that occur in diseased glands of SS patients. This article reviews the normal ultrasound anatomy of the salivary glands along with lithiasic, inflammatory, tumoral, and autoimmune disease such as SS.

Imaging of salivary glands

Ultrasound is the investigation of choice for major salivary gland disease, reserving other techniques for further assessment in the minority of cases.Sialolithiasis is the most common salivary gland pathology, affecting the submandibular ducts in 80% of cases. Digital subtraction sialography is indicated when ultrasound is inconclusive or normal despite a convincing clinical history. Mobile calculi <7 mm in size are amenable to image guided endoluminal extraction. Strictures may undergo endoluminal balloon dilatation.Diffuse multiglandular parenchymal disease is non-specific and can be caused by viral sialadenitis, Sjogren's syndrome, sarcoidosis or benign lymphoepithelial cysts in HIV.There is an increased risk of mucosa-associated lymphoid tissue (MALT) lymphoma of the salivary glands in Sjogren's syndrome and any dominant mass should be biopsied.A ranula is said to be plunging when it extends into the submental or submandibular triangles following rupture.All solitary salivary gland masses are neoplas...

Fine-needle aspiration biopsy of salivary gland lesions in a selected patient population.

To report the role of selective use of preoperative fine-needle aspiration biopsy (FNAB) in patients with major salivary gland lesions at a tertiary care cancer center. Retrospective review of FNAB results compared with final histologic diagnosis as the criterion standard. An academic tertiary care cancer center. A consecutive series of 258 patients who underwent FNAB of major salivary gland lesions between 1996 and 2000, of whom 169 had surgical resection. Predictive value, sensitivity, specificity, and accuracy. FNAB was performed in 169 (37%) of 463 salivary gland lesions undergoing surgical procedures. A total of 126 lesions were in the parotid gland and 44 in the submandibular gland. Seventy-nine lesions (46%) were malignant. There were 150 FNAB specimens (89%) that were satisfactory for evaluation. The FNAB diagnosis of malignant or suspicious lesion had positive and negative predictive values of 84% and 77%, respectively. Ten of 20 false-negative FNAB results were low-grade lymphoma on final histologic assessment. Fine-needle aspiration biopsy diagnosis of a benign neoplasm had positive and negative predictive values of 83% and 88%, respectively. A cytopathologic diagnosis of a nonneoplastic lesion was predictive in only 47% of cases. Fifteen (47%) of 32 lymphocyte-predominant FNAB specimens were lymphoma on final histologic assessment. Ten (20%) of 49 patients with history of a solid, non-head and neck malignancy had evidence of distant metastasis to the salivary gland by histologic and/or cytopathologic assessment. An FNAB diagnosis of malignant or neoplastic major salivary gland disease is generally predictive of final histologic diagnosis. The predictive value of a negative FNAB finding is low, and should not supersede clinical suspicion. Cytologic findings of a lymphocyte-predominant lesion should prompt further workup to rule out lymphoma.

The clinical picture of benign lympho-epithelial lesion.

The histopathological diagnosis 'benign lympho-epithelial lesion' characterizes the major salivary gland disease in Sjögren's syndrome. It is not known if all cases with microscopically diagnosed benign lympho-epithelial lesion are variants of Sjögren's syndrome. The present clinical investigation showed that in 19 patients with the microscopical diagnosis of lympho-epithelial lesion, 84% fulfilled all criteria of Sjögren's syndrome. The rheumatoid factor and/or antinuclear factor was found in 84% and M-component was present in 16%. Sialography revealed sialectasis in all parotid glands. Salivary gland enlargement was found in 79%, and keratoconjunctivitis sicca in 89% of the patients. Systemic disease was found in 32%. The disease in the 2 patients with M-component took a malignant course, culminating in immunoblastic sarcoma and myelomatosis. The clinical diagnosis 'autoimmune sialadenitis' is proposed for the oral and salivary gland component is Sjögren's syndrome.

Cervicofacial Mycobacterial Infections Presenting as Major Salivary Gland Disease

Mycobacterium tuberculosis and atypical mycobacterium are well-known causes of cervical lymphadenopathy, most often presenting without symptoms of systemic infection. These organisms may also directly involve the parenchyma of the major salivary glands and their periglandular or intraglandular nodes. The diagnosis of mycobacterial infections of the major salivary glands, compared to cervical lymph nodes, is equally--if not more--difficult to make. The differential must include the same spectrum of inflammatory and neoplastic diseases as well as lesions unique to the salivary glands. Selected cases are presented and discussed to show that principles established for the treatment of cervical mycobacterial infections must also be applied to major salivary gland infections. In particular, cutaneous fistulas may result from incisional biopsy or incision and drainage of the involved gland. Partial parotidectomy or submaxillary gland excision may be required, followed by multidrug, antituberculous chemotherapy for one to two years. Culturing of the organisms is extremely difficult, and the diagnosis of either mycobacterium tuberculosis or atypical mycobacterial infection must be based on a combination of history and clinical examination, skin testing, histopathology, acid-fast stains, culture, and response to surgery and antituberculous chemotherapy.

Sialographic findings in diseases of major salivary glands

Sialographic findings in diseases of major salivary glands