The role of salivary duct morphology in the aetiology of sialadenitis: statistical analysis of sialographic features.

Morphologic characteristics of salivary ducts may contribute to stagnation of saliva. The authors hypothesized that some features might contribute to development of submandibular and parotid sialadenitis. 106 digital subtraction sialograms (DSS) were retrospectively reviewed for: degree of sialadenitis, length of Wharton's and Stensen's ducts (SD), and angle of Wharton's duct (WD) genu. Student's t test was used for independent samples to statistically compare normal and sialadenitis groups. The effect of independent variables (age, gender, side, degree of sialadenitis) on the dependent variable (length or angle) were tested using regression analysis. Submandibular duct sialadenitis was mild (67%), moderate (8%), or severe (25%); parotid duct sialadenitis was mild (57%), moderate (18%), or severe (25%). Mean length of normal WD was 58.2 mm, and 56.3 mm with sialadenitis. Mean length of normal SD was 52 mm, and 53 mm with sialadenitis. The mean angle of WD genu was 115° in normal ducts, and 119° with sialadenitis. None of the independent variables affected variation in length or angle. There were no statistical differences in duct length or measured angle between normal and sialadenitis groups. There is a wide variation in salivary duct morphology but this does not appear to be associated with the cause of sialadenitis.

[A proposal for the classification of chronic sialadenitis of the major salivary glands with current diagnostic and treatment schedule]. / Nowe spojrzenie na klasyfikacje przewleklego zapalenia duzych gruczolów slinowych i algorytm postepowania.

UNLABELLED: Approximately 5% of patients visit the ENT doctors with major salivary gland complaints. Chronic sialadenitis is one of the major disorders that can cause salivary hypofunction and correct diagnosis and management is essential for its recovery. The classification of this pathological condition have changed in the past eight decades and nowadays was revised and modified, for new diagnostic (high resolution ultrasonography, CT and MR sialography and sonoelastography) and therapeutic methods (sialoendoscopy) were introduced. THE AIM OF THE STUDY: was to revive the past classifications of chronic inflammatory diseases of the major salivary glands and present the current one with implications for diagnostic and treatment schedule. MATERIAL AND METHOD: 20 patients with parotid and 44 with submandibular gland sialadenitis were treated in Otolaryngology, Head and Neck Surgery Department Poznan Medical University in the years 2007-2010. Two periods of time: 2007-8 and 2009-10 were compared, the turn point was December 2008, when sialoendoscopy was introduced. RESULTS: 25 out of 50 patients with parotid and 73 out of 95 with submandibular sialadenitis suffered from lithiasis. Surgical evacuation of the stone was performed in 10 cases in 2007-08, and in 4 between 2009 and 10. In this last period 94 sialoendoskopies was performed, in this number in case 38 submandibular and 7 parotid lithiasis. Stensens duct stenosis was diagnosed in 7 and Wharton duct in 12 patients. To conclude, authors underline that the prompt diagnosis is indispensible for the proper further treatment. The recommended treatment of chronic and obstructive sialadenitis obtains the novel technique, sialoendoscopy.

[Is bioptic assurance reasonable in patients with Sjögren's syndrome? From focus score to diagnosing vasculitides]. / Ist eine bioptische Sicherung beim Sjögren-Syndrom sinnvoll? Vom Focus-Score zur Vaskulitisdiagnostik.

Sjögren's syndrome is an autoimmune disease which targets the salivary and lacrimal glands in particular, causing sicca syndrome. Extraglandular manifestations are often seen. Chronic sialadenitis of the parotid gland is the most common symptom to be assessed for differential diagnosis. Common HE and Giemsa slices are histopathologically examined and graduated for lymphocyte infiltration (focus): grade 0: absent, grade 1: slight, grade 2: moderate non-focal infiltration, grade 3: 1 focus (> or =50 lymphocytes) per 4 mm2, grade 4: >1 focus. Grade 3 infiltrates correspond to a focus score of 1, which is one of four disease-classifying criteria acknowledged for diagnosis. Bioptic examination is also performed to rule out different (non-) immunologic sialadenitises, such as the necrotizing or epithelioid-like form (in sarcoidosis), and the extranodal marginal-zone lymphoma. Extraglandular manifestations of Sjögren's syndrome can also be safely diagnosed by histopathological examination. Emphases lie on vasculitides and myositides. Bioptic work-up, therefore, is not only reasonable but also an essential tool for diagnostics in Sjögren's syndrome.

Classification and management of chronic sialadenitis of the parotid gland.

Saliva has numerous oral functions and multiple functions in relation to digestion in the upper gastrointestinal tract. Chronic salivary hypofunction can lead to severe adverse health outcomes. Chronic sialadenitis is one of the major conditions that can cause salivary hypofunction. A correct diagnosis and management of chronic sialadenitis is essential for the recovery of salivary hypofunction. Chronic sialadenitis of the parotid gland is often seen in the clinic, sometimes also referred to as recurrent pyogenic parotitis, recurrent parotitis, non-obstructive parotitis, sialadenitis or obstructive parotitis, among other terms. The literature describes several different classifications and denominations for chronic sialadenitis of the parotid gland. These various classifications and denominations complicate the definition and diagnostic criteria, and if chronic sialadenitis of the parotid gland can develop into Sjogren's syndrome remains unclear. Treatment of this condition is also a challenging problem. Here, we review the presented classification and denomination of chronic sialadenitis of the parotid gland, proposing a classification based on the disease entities identified in a long-term follow-up investigation, and discuss the treatment principles for the condition.

Scintigraphic evaluation of salivary gland dysfunction in patients with thyroid cancer after radioiodine treatment.

PURPOSE: Sialadenitis is a well-recognized adverse effect of high-dose radioactive iodine treatment. This study was undertaken to determine whether Tc-99m pertechnetate salivary gland scintigraphy may be used for objective assessment of salivary gland function in patients with thyroid cancer treated with I-131. PATIENTS AND METHODS: The study group consisted of 71 patients (16 men, 55 women) with a mean age of 44 years (range, 16 to 73 years). Twenty-six (37%) patients were not given any radioiodine, and 18, 16, and 11 patients received doses of 100, 150, or 200 mCi (or higher), respectively. Parotid and submandibular glands were evaluated based on a four-grade scoring system. Correlation between the type of surgery, administered dose, time since therapy, subjective symptoms, and findings of salivary gland scintigraphy were evaluated. RESULTS: Subjective symptoms were questioned in 39 of the 45 patients who received radioactive iodine treatment. Fifty-four percent (21 of 39) of the patients reported xerostomia, of whom 86% (18 of 21) showed salivary gland dysfunction. Objective salivary gland dysfunction was observed in 69% (31 of 45) of patients. In 81% of the patients, the parotid glands were affected; in 13% of the patients, the submandibular glands were affected; and in 6%, both were affected ( < 0.000001). The frequency of salivary gland dysfunction showed a dose dependence to cumulative activity ( = 0.007). A greater complication rate was observed in patients with total thyroidectomy compared with subtotal surgery, although the correlation was not significant ( = 0.625). CONCLUSIONS: Parenchymal damage to the salivary glands induced by radioactive iodine treatment can be evaluated by salivary gland scintigraphy. The impairment is worse in the parotid glands and increases with the total dose.

Pathological features of lymphoid proliferations of the salivary glands: lymphoepithelial sialadenitis versus low-grade B-cell lymphoma of the malt type.

Lymphoid proliferations of the salivary glands can be either reactive or neoplastic. Reactive lesions include the lymphoepithelial sialadenitis (LESA; also known as myoepithelial sialadenitis [MESA]) of Sjogren's syndrome. Lymphomas of the salivary glands are predominantly B-cell type and include extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) type. The spectrum of histopathologic features of LESA/MESA includes 1) "fully benign lymphoid infiltrate," with or without an associated lymphoid follicular structure, without immunoglobulin (Ig) light chain restriction in B-cells, and without any features of aggressive behavior, and 2) "lymphoproliferative lesions," with or without areas of Ig light chain restriction in B-cells, with the usual presence of centrocyte-like cells. A more or less pronounced lymphoepithelial aggressiveness may be present without definite evidence of malignancy. B-cell clones are detected in over 50% of cases of LESA/MESA by molecular genetic methods, but this does not correlate with morphological or clinical evidence of overt lymphoma. On the other hand, "marginal zone B-cell lymphoma of the MALT type" of the salivary glands produces a dense lymphoid infiltrate diffusely involving the gland, with obliteration of acini. The centrocyte-like cells form broad "halos" around the epithelial cell nests and broad strands between lymphoepithelial lesions, often linking together several lymphoepithelial lesions. Further, lymphoma cells express monotypic surface Ig, and in the majority of the cases, the plasma cells are also monoclonal. In conclusion, the diagnosis of LESA/MESA versus marginal zone B-cell lymphoma of the MALT type still relies on the evaluation of morphological features. It seems that molecular genetic analysis has little or no practical role in the clinical diagnosis of salivary gland lymphoma in a setting of LESA/MESA and Sjögren's syndrome.

[Morphology and problems of the morphogenesis of cytomegalic sialadenitis]. / Morfologiia i nekotorye voprosy morfogeneza tsitomegalicheskogo sialoadenita.

Two varieties of nodular sialadenitis, acute nodular (15%) and chronic with exacerbation of the nodular type (19%), were distinguished basing on analysis of the material from 880 children dead from cytomegaly. Parotid glands were examined electron-microscopically in 2 cass of generalized and 6 cases of localized cytomegaloviral infection. Basing on the histoenzymochemical data published earlier, the etiological role of cytomegalovirus in the development of nodular infiltrates was substantiated and the functional activity of cytomegalic cells in virus reproduction and isolation shown. Diagnostic importance of nodular infiltrates was stressed. Morphological manifestations of cytomegalovirus reproduction were described.

Etiology and pathogenesis of the inflammatory diseases of the cephalic salivary glands.

The complexity of the inflammatory pathological processes in the salivary glands, especially in the parotid gland, requires subtle diagnostic techniques. A multitude of clinical, pathological and anatomical as well as laboratory investigation methods are now available. This permits to make a safe diagnosis in most cases. However, many questions concerning etiology and pathogenesis of the inflammatory diseases of the cephalic salivary glands remain unanswered. This impedes a specifically directed therapy with will have to be the aim of further clinical and theoretical research.