Evaluation Of Salivary Gland Function Research Articles

Salivary gland condition before and after kidney transplantation: evaluation of salivary gland function in patients with end-stage chronic renal failure before and after kidney transplantation

The authors conducted a study of the state of the salivary glands in 50 patients with end-stage chronic renal failure. There was a pronounced violation of the function of the salivary glands (SG) in these patients by the type of xerostomy, which led to a change in the qualitative and quantitative indicators of mixed saliva. After the kidney transplant, the function of the SG improved, but did not fully recover. At the same time, there was an improvement in the hygienic condition of the oral cavity. Saliva cleanses the mucous membrane of the mouth from bacteria and food. It also immunoglobulins and lysozyme are involved in the formation of oral immunity. Saliva forms a food lump and makes it easier to swallow food. A decrease in salivation leads to digestive disorders and tooth decay. All patients with end-stage chronic renal failure showed a dysfunction in the work of the SG. A decrease in kidney function led to a change in the composition and nature of salivation. With saliva, toxic products were excreted, which normally were excreted only by the kidneys. Normalisation of salivation occurred after hemodialysis. Patients after kidney transplantation require long-term follow-up and preventive therapy for the salivary glands in order to improve and restore their function. Currently, there is no information in the literature about the state of SG in patients after kidney transplantation. This was the basis for this work.

Evaluation of Salivary Gland Function Using Diffusion-Weighted Magnetic Resonance Imaging for Follow-Up of Radiation-Induced Xerostomia.

ObjectiveTo investigate the value of diffusion-weighted magnetic resonance imaging (DW-MRI) as a noninvasive tool to assess salivary gland function for follow-up of patients with radiation-induced xerostomia.Materials and MethodsThis study included 23 patients with nasopharyngeal carcinoma who had been treated with parotid-sparing radiotherapy (RT). Salivary function was assessed by DW-MRI pre-treatment and one week and one year post-RT, respectively. The maximum apparent diffusion coefficient (ADC) of parotid glands (pADCmax) and the time to peak ADC of parotid glands (pTmax) during stimulation were obtained. Multivariate analysis was used to analyze factors correlated with the severity of radiation-induced xerostomia.ResultsThe ADCs of parotid and submandibular glands (1.26 ± 0.10 × 10−3 mm2/s and 1.32 ± 0.07 × 10−3 mm2/s pre-RT, respectively) both showed an increase in all patients at one week post-RT (1.75 ± 0.16 × 10−3 mm2/s, p < 0.001 and 1.70 ± 0.16 × 10−3 mm2/s, p < 0.001, respectively), followed by a decrease in parotid glands at one year post-RT(1.57 ± 0.15 × 10−3 mm2/s, p < 0.001) but not in submandibular glands (1.69 ± 0.18 × 10−3 mm2/s, p = 0.581). An improvement in xerostomia was found in 13 patients at one year post-RT. Multivariate analysis revealed 4 significant predictors for the improvement of xerostomia, including dose to parotid glands (p = 0.009, odds ratio [OR] = 0.639), the ADC of submandibular glands (p = 0.013, OR = 3.295), pADCmax (p = 0.024, OR = 0.474), and pTmax (p = 0.017, OR = 0.729) at one week post-RT.ConclusionThe ADC value is a sensitive indicator for salivary gland dysfunction. DW-MRI is potentially useful for noninvasively predicting the severity of radiation-induced xerostomia.

Massively Increased Caries Susceptibility in an Irf6 Cleft Lip/Palate Model

Patients with cleft lip/palate (CLP) have been reported, in some studies, to exhibit an increased prevalence of caries, although the underlying cause for this increase is unknown. In genetically defined mouse models, studies of postnatal sequelae associated with CLP have been hampered by neonatal lethality. Using a conditional targeting approach, we ablated the major CLP gene Irf6 only in the late embryonic oral epithelium (Irf6 cKO), bypassing the role of the gene in lip and palate morphogenesis and thus ensuring survival to adulthood. We report that Irf6 cKO mice present with 1) dysplastic salivary glands due to disruptions of epithelial junctional complexes, likely secondary to elevated activation of RHO GTPases, and 2) increased salivary cell proliferation. These changes result in significantly reduced saliva flow rate and buffering capacity and increased mucus acidity. A marked decrease in expression of CCL27, one of the major mucosal and skin cytokines, was found that correlated with increased bacterial colonization of the oral cavity with the cariogenic pathogen Streptococcus mutans and other bacteria. When placed on a high-sugar diet, Irf6 cKO mice show a 35-fold increase in presentation and severity of dental caries as compared with wild-type control mice. Strikingly, within the 8-wk test period, many molars extensively dissolved, and there was progressive loss of the alveolar bone, likely as a result of increased colonization of periodontal pathogens. These data provide the first mechanistic insight into the heightened caries susceptibility associated with CLP and indicate a direct role for the major CLP gene Irf6 in salivary gland development and a significant role in regulating oral immunity. Our data suggest that careful evaluation of salivary gland function and the implementation of early oral health preventive strategies are warranted to reduce the burden of dental care in this at-risk population.

Diffusion-weighted magnetic resonance imaging for evaluation of salivary gland function in head and neck cancer patients treated with intensity-modulated radiotherapy

Background and purposesPermanent xerostomia as a result of radiation-induced salivary gland damage remains a common side effect of radiotherapy (RT) of the head and neck. The purpose of this study was to evaluate the usefulness of diffusion-weighted magnetic resonance imaging (DW-MRI) in assessing the post-RT salivary gland function in patients with head and neck cancer (HNC). Materials and methodsIn this prospective study, 20 HNC patients scheduled for bilateral neck chemoradiotherapy (CRT) with weekly cisplatin went through diffusion-weighted magnetic resonance imaging (DW-MRI) and salivary gland scintigraphy (SGS) prior to and at a mean of six months after completing the treatment. The changes in apparent diffusion coefficient (ADC) before and after treatment were compared with ejection fraction (EF) measured with SGS and the radiation dose absorbed by the salivary glands. ResultsAs a result of gustatory stimulation with ascorbic acid, the ADC showed a biphasic response with an initial increase and subsequent decrease. This pattern was seen both before and after RT. Post-RT ADC increased as a function of RT dose absorbed by the salivary glands. A moderate statistical correlation between pre- and post-RT ADCs at rest and EF measured with SGS was found. ConclusionsDW-MRI seems a promising tool for detection of physiological and functional changes in major salivary glands after RT.

Value of diffusion-weighted imaging after transient taste stimulation in evaluation of salivary gland function before and after radiotherapy: a preliminary study

Objective To investigate the value of diffusion-weighted imaging (DWI) after transient taste stimulation in evaluating salivary gland function before and after radiotherapy (RT), as well as the correlation between apparent diffusion coefficient (ADC) and other evaluation methods. Methods A total of 30 patients with nasopharyngeal carcinoma (NPC) underwent dynamic DWI after taste stimulation before and after RT from 2010 to 2014. The characteristics of ADC changing curves for each salivary gland were analyzed. The paired t-test was used for comparison of the time to ADC peak, resting ADC, maximum ADC after stimulation, and maximum ADC increase rate. Pearson correlation analysis was used to investigate the correlation between ADC of the salivary gland and salivary flow rate, as well as the correlation of ADC of the salivary gland after RT with Common Terminology Criteria for Adverse Events (CTCAE) grade and visual analog scale (VAS) score. Results Before and after RT, ADCs of each salivary gland reached the peak value at the first scan after taste stimulation (30 s). The resting ADCs and maximum ADC after stimulation of each salivary gland increased significantly after RT (P=0.000, 0.000, 0.000 and 0.001.0.000, 0.000), while the maximum ADC increase rate after stimulation showed no significant differences between the salivary glands (P=0.213, 0.122, and 0.839). Before RT, the resting ADC of submandibular gland was positively correlated with salivary flow rate of all glands (r=0.364, P=0.048). Conclusions DWI after transient taste stimulation can effectively show the dynamic changes in ADCs of all salivary glands after RT for NPC and has a great potential in evaluating salivary hypofunction and dynamically monitoring functional changes of the salivary glands. Key words: Gustatory stimulation; Salivary glands; Diffusion weighted imaging; Magnetic resonance imaging; nasopharyngeal neoplasms/radiotherapy; Xerostomia

Value of magnetic resonance sialography in evaluation of salivary gland function in patients with nasopharyngeal carcinoma treated with radiotherapy

Objective To investigate the feasibility of magnetic resonance sialography (MRS) in the evaluation of salivary gland function in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy. Methods The MRS images of parotid and submandibular glands were collected in resting and stimulated states among 32 patients with nasopharyngeal carcinoma before and after radiotherapy. The visibility of the salivary ducts and radiation-induced xerostomia were evaluated, and the relationship between radiation-induced acute xerostomia grade and MRS score was analyzed. Comparison of the visibility and score between two groups was made by paired t test, and the correlation between acute xerostomia grade and MRS score was determined using the Spearman rank correlation method. Results Both the visibility of salivary duct and MRS score were significantly reduced after radiotherapy (P=0.000, P=0.000). There were significant differences in the variation of MRS scores of the parotid (DPS) and submandibular glands (DSS) from the resting state to the stimulated state between patients with severe and non-severe acute xerostomia (P=0.009; P=0.005). There were no significant differences in MRS scores of the parotid and submandibular glands in resting and stimulated states between patients with severe and non-severe acute xerostomia (P=0.881, P=0.305, P=0.327, P=0.229). The Spearman correlation analysis showed that the acute xerostomia grade was negatively correlated with DPS and DSS (R=-0.472, P=0.006; R=-0.482, P=0.005). Conclusions MRS score is correlated with xerostomia grade. MRS can be used to evaluate the salivary gland function in patients with nasopharyngeal carcinoma treated with radiotherapy. Key words: Xerostomia; Magnetic resonance sialography; Salivary gland; Nasopharyngeal neoplasms/radiotherapy

Diffusion-weighted MR imaging of salivary glands with gustatory stimulation: comparison before and after radiotherapy

Xerostomia is the most prominent complication in patients with head and neck carcinoma after radiotherapy (RT). Diffusion-weighted magnetic resonance imaging (DWI) with gustatory stimulation may contribute to the evaluation of salivary gland function. To investigate the value of DWI for quantifying physiological changes of the parotid gland during gustatory stimulation in patients before and after RT. Magnetic resonance imaging (MRI) was performed in 28 consecutive patients with nasopharyngeal carcinoma before and after RT and clinical xerostomia was also assessed. A DWI sequence was performed once at rest and continually repeated seven times during stimulation with ascorbic acid. Apparent diffusion coefficient (ADC) maps for parotid glands at different time points and the range of increase with stimulation were calculated. Paired two-tailed Student t tests were used to compare the ADC values before and after stimulation, and before and after RT. Before RT, the ADC showed an initial increase (P < 0.001) and then fluctuated during stimulation. After RT, as the clinical xerostomia changed from Grade 0 to Grade 2, the mean ADC at rest increased compared with the pre-RT value (P < 0.001). A similar response to stimulation was observed, but the range of increase between the maximum ADC during stimulation and the baseline value at rest was higher post-RT than pre-RT (P = 0.022). The minimum ADC during stimulation was higher than the baseline value post-RT (P = 0.028), but there was no difference pre-RT (P = 0.603). DWI combined with gustatory stimulation seems to display the physiological changes of the parotid gland following RT and may be a potential tool for non-invasively assessing salivary gland function.

Salivary Gland Involvement in Chronic Graft-Versus-Host Disease: Prevalence, Clinical Significance, and Recommendations for Evaluation

Although xerostomia is a commonly reported complaint in patients with chronic graft-versus-host disease (cGVHD), criteria for evaluating the prevalence and characteristics of salivary gland involvement have not been well defined in this patient population. Previous studies also have made no distinction between salivary and mucosal oral cGVHD. We systematically evaluated signs and symptoms of sicca in a large cohort of patients with cGVHD (n = 101) using instruments widely used to study Sjogren's syndrome. Xerostomia was reported in 60 (77%) patients reporting ocular and 52 (67%) patients reporting oral complaints [corrected]. The salivary flow rate was < or =0.2 mL/min in 27%, and < or =0.1 mL/min in 16%. Histopathological changes, consisting of mononuclear infiltration and/or fibrosis/atrophy, were present in all patients with salivary dysfunction. Importantly, there was no correlation of salivary and oral mucosal involvement in cGVHD. Patients with cGVHD-associated salivary gland involvement had diminished oral cavity-specific quality of life and lower body mass index. Salivary gland involvement is a common and clinically distinct manifestation of cGVHD. Formal evaluation of salivary function using standardized criteria is needed, and this could be incorporated as an outcome measure in clinical trials of cGVHD.

Evaluation of salivary gland function after treatment of head-and-neck tumors with intensity-modulated radiotherapy by quantitative pertechnetate scintigraphy

Purpose To evaluate salivary gland function after inversely planned stereotactic intensity-modulated radiotherapy (IMRT) for tumors of the head-and-neck region using quantitative pertechnetate scintigraphy. Methods and materials Since January 2000, 18 patients undergoing IMRT for cancer of the head and neck underwent pre- and posttherapeutic scintigraphy to examine salivary gland function. The mean dose to the primary planning target volume was 61.5 Gy (range 50.4–73.2), and the median follow-up was 23 months. In all cases, the parotid glands were directly adjacent to the planning target volume. The treatment planning goal was for at least one parotid gland to receive a mean dose of <26 Gy. Two quantitative parameters (change in maximal uptake and change in the relative excretion rate before and after IMRT) characterizing the change in salivary gland function after radiotherapy were determined. These parameters were compared with respect to the dose thresholds of 26 and 30 Gy for the mean dose. In addition, dose–response curves were calculated. Results Using IMRT, it was possible in 16 patients to reduce the dose for at least one parotid gland to ≤26 Gy. In 7 patients, protection of both parotid glands was possible. No recurrent disease adjacent to the protected parotid glands was observed. Using the Radiation Therapy Oncology Group/European Organization for the Research and Treatment of Cancer scoring system, only 3 patients had Grade 2 xerostomia. No greater toxicity was seen for the salivary glands. The change in the relative excretion rate was significantly greater, if the parotid glands received a mean dose of ≥26 Gy or ≥30 Gy. For the change in maximal uptake, a statistically significant difference was seen only for the parotid glands and a dose threshold of 30 Gy. For the end point of a reduction in the parotid excretion rate of >50% and 75%, the dose–response curves yielded a dose at 50% complication probability of 34.8 ± 3.6 and 40.8 ± 5.3 Gy, respectively. Conclusion Using IMRT, it is possible to protect the parotid glands and reduce the incidence and severity of xerostomia in patients. Doses <26–30 Gy significantly preserve salivary gland function. The results support the hypothesis that application of IMRT does not lead to increased local failure rates.

Scoring analysis of salivary gland scintigraphy in patients with Sjögren’s syndrome

The purpose of the present study was to evaluate the validity of a scoring system based on excretion rate of salivary gland scintigraphy in patients with Sjögren's syndrome (SjS). Total scintigraphic scores were compared with the results of the Saxon test. One hundred and twenty-four subjects who were clinically diagnosed with SjS and 11 normal ones underwent salivary gland scintigraphy and the Saxon test. In salivary gland scintigraphy, the difference between maximum and minimum counts after stimulation using vitamin C divided by maximum counts was defined as the excretion rate. We then defined a scoring system with 4 grades: severe dysfunction = 3 (excretion rate < 25%), moderate dysfunction = 2 (25% < or = excretion rate < 40%), mild dysfunction = 1 (40% < or = excretion rate < 50%) and normal function = 0 (50% < or = excretion rate). The summation of the total scintigraphic score (0-12) of all 4 salivary glands was used as a semi-quantitative index indicating total salivary gland function, and total scintigraphic scores were compared with the results of the Saxon test. A significant inverse linear correlation (R2 = 0.95) was observed between total scintigraphic scores and mean values of the Saxon test within a range of abnormal scintigraphic scores (> or = 4). The scoring system developed in the present study is a clinically available, objective, and reproducible method for evaluation of salivary gland function in patients with SjS.

Sjögren's syndrome. Additional diagnostic tools.

SJOGREN'S SYNDROME is characterized by dryness of the mucous membranes and conjunctiva (sicca syndrome), and episodes of salivary gland enlargement. The syndrome has most frequently been associated with connective tissue diseases, especially rheumatoid arthritis, and lymphomas or a combination of all three clinical problems in the same patient. The involved salivary glands demonstrate infiltration by lymphoid cells and various degrees of intraductal proliferation. In this case report, the palatal minor salivary glands, which have been infrequently described1were biopsied for histologic confirmation of the diagnosis of Sjogren's syndrome, obviating the danger of facial nerve paralysis, fistulous tract formation, or visible surgical scar as may occur with the parotid gland biopsy site. Evaluation of salivary gland function is often a difficult and tedious procedure. Technetium Tc 99m, an artificial radioactive element, is concentrated in normal salivary gland tissue and can be used to perform radioactive scintiscans of these organs. The patient