Treating oral ranula: another case against blanket removal of the sublingual gland.

There are a number of occasions when ranula-like lesions of the oral floor can develop that do not originate from the sublingual gland, or that arise from the gland with no tendency towards recurrence. The author advises that the unconditional removal of the sublingual gland should not be the standard treatment for all ranulas, and present four case reports to illustrate these and describe how they should be treated. All the patients were treated successfully with conservative management and retained normal functioning sublingual glands. Except for the management of plunging ranulas, caution and a close examination of the origin of the lesion are prudent before considering excision of sublingual glands for all ranula-like lesions.

Bonded arch bars to manage traumatic injuries to the teeth and alveolar bone.

A simple, rapid, painless, and bloodless method of successfully treating avulsed and partially avulsed teeth with or without associated dentoalveolar fractures is presented for management by the general practitioner in the office. It is a bonding technique with the key elements being a prefabricated malleable mesh backed arch bar in combination with any light curing composite procedure that is standard in the individual's office.

Bonded arch bars in oral and maxillofacial surgery. An update.

From 1987 to 1992, 127 cases that involved maxillomandibular trauma, reconstruction, and various oral surgical procedures were managed with arch bars bonded to the teeth. The aim of this article is to present the method of application of the arch bar and to report the results of management with this technique stressing its use with 99 trauma patients.

Marsupialization for treatment of oral ranula: a second look at the procedure.

Simple marsupialization to manage oral ranula has fallen into disfavor because of excessive failures and the high incidence of iatrogenically caused cervical ranula that may follow this procedure. With the simple addition of packing the entire pseudocystic cavity with gauze after its unroofing, the rate of recurrence is minimized. It is recommended that oral ranula be treated initially by marsupialization with packing and, if recurrence occurs, then the offending sublingual gland should be excised.

Extraoral parotid sialolithotomy.

The extraoral approach to duct surgery for the removal of parotid stones can be a simple procedure once the stone is accurately located in relation to the skin surface. The combination of sialography and sonography can provide this information. A case report demonstrates the step-by-step approach to diagnosis, localization, and surgery for the management of such extraglandular sialoliths.

Direct bonding of arch bars in the management of maxillomandibular injuries.

The shortcomings of the conventional arch bars for the treatment of maxillomandibular injuries are described. A mesh-backed arch bar bonded to the teeth is recommended as a means of overcoming these problems.

Clinical utilization of sialochemistry in Sjögren's syndrome.

Sialochemistry was performed on the stimulated parotid secretion of a group of patients with Sjögren's syndrome (SS) having a Grade 4 lymphocytic infiltrate of their minor labial salivary glands and a normal control group. Parameters examined included flow rate, and concentration of sodium, potassium, chloride, urea, calcium, phosphate, total protein, IgA, IgG. albumin, amylase and lactoferrin. Although all SS patients had virtually no parotid secretion in the absence of stimulation, with a gustatory stimulation, 40% of the patients with SS had a relatively normal parotid flow rate, when compared with the control group. The SS patients, regardless of flow rate, exhibited a highly significant (p less than 0.01) elevation in the concentration of sodium, chloride, IgA, IgG, and lactoferrin and a significant (p less than 0.05) increase in albumin concentration, when compared with the control group. The phosphate level was significantly lower (p less than 0.01) in SS patients than in the control group. The elevated IgA in SS was almost all 11S, in contrast to parotitis where 7S was a major contributor. In view of the variation in flow rate in SS patients chemical quantitation of selected salivary components can be a valuable aid in the differential diagnosis of this disease and in monitoring patients over time.

Sialochemistry in chronic recurrent parotitis: electrolytes and glucose.

The concentration of parotid fluid electrolytes and glucose was measured in: (a) a subject during an acute exacerbation of chronic recurrent parotitis and then at various stages of recovery following treatment with corticosteroids; (b) a group of seven patients seen during an acute exacertation and then when clinical symptoms had subsided; and (c) a group of 22 patients studied at various stages of parotitis. During acute exacerbations sodium and chloride concentrations were markedly elevated despite the very low flow rate and potassium was only half the normal salivary level. Phosphate concentration was also extremely low; glucose was very high. During recovery flow rate gradually increased while sodium, chloride and glucose levels fell. Potassium returned quickly to normal while the phosphate level rose very gruadually. The pattern of flow rate and sialochemistry during recovery was essentially the same for all patients. The pattern of flow rate and sialochemistry during recovery was essentially the same for all patients. In most subjects there was a residual effect, and elevated sodium and chloride and a decreased phosphate relative to flow rate. The degree of change from normal appeared to be a good indication of residual pathology within the gland. Sialochemistry should be useful to the clinician in the diagnosis and treatment of chronic recurrent parotitis.

Salivary immunoglobulins in diseases affecting salivary glands.

Inflammatory disorders of the salivary glands cause marked abnormalities in secretion of immunoglobulins. The changes are reversible, however, in a relatively short period of time. More subtle changes in immunoglobulin transport are present in such diseases as Sjogren's syndrome and diabetes. No changes are discernable in alcoholic cirrhosis. Apparently salivary gland basement membranes are much more resistant to derangement than plasma membranes and the secretory IgA system can continue to operate in the face of numerous affronts. If nothing else these findings suggest that vaccination procedures in the region of the salivary glands may produce an inflammatory response, but it would be readily reversible. In addition, one could anticipate a functioning s-IgA system even in salivary glands with alterations in electrolyte transport. It is difficult to anticipate the situation in immunologically compromised patients, such as those on hemodialysis. Fortunately these patients represent a small population and for them at least, caries is a relatively minor concern.