[Imaging protocol in salivary pathology]. / Protocole d'exploration en imagerie de la pathologie salivaire.

Numerous techniques have been used for imaging salivary glands including standard radiography, scintigraphy, sialography, echography, computed tomography and finally NMI. These different techniques each have their own indications or complementary role. We therefore developed a protocol for using the different imaging techniques according to the different salivary pathologies encountered. This protocol is given as an examination flow chart to be used in light of clinical findings. A large number of images selected by P. Laudenbach illustrate the typical pathologies encountered. Special emphasis is placed on sialography, an important imaging technique, unfortunately somewhat neglected.

[For practical salivary flowmetry. A weighing technic]. / Pour une débitmétrie salivaire pratique. Une technique pondérale.

No one method of salivary flowmetry has been found to be practical, reliable and fully significant. Consequently, the diagnosis of salivary gland failure remains uncertain and imprecise even though the diagnostic question is often raised. A simplified and effective weight measurement could be more widely used. Saliva is sampled easily with small compresses inserted into the sublingual groove and left in potion for 5 minutes without deglutition or mastication for a saliva collection and close as possible to the baseline level; then for 1 minute after mastication to collect stimulated secretion. The compresses are then weighted. The reliability of this method must be confirmed with a multicentric study.

[Salivary calculi]. / La lithiase salivaire.

Salivary calculi are frequent and revealed by very painful signs, which need an urgent therapy. These calculi are more often localized in the submaxillary gland, sometimes in the parotid gland, and unfrequently in the sublingual glands. Their clinical signs include an increased volume of the gland (salivary hernia), pain of infectious complication. Diagnosis is confirmed by standard x-ray and sialography, which also predicate the localization of the calculi. The treatment is symptomatic including antispasmodic, sympatholytic and parasympathomimetic drugs and washings of the canal with antibiotic solutions. After few months of this treatment, the surgical treatment is indicated if the calculi stays in the canal. Depending on the localization of the calculi, the access way will be either endobuccal or external.

[Late solitary and benign neurilemmoma of the pterygo-maxillary region]. / Neurilemmome solitaire ancien et bénin de la région ptérygo-maxillaire.

The neurilemmoma of the pterygoid fossa are very rare. The authors reports one case of a 32 years old man, with such a neoplasm, exteriorized on the lateral facial region (area of the glandula parotis) clinical and radiological data could not differentiate benign neurilemmoma or slow evolutive sarcoma and have justified a conservative latero facial approach of the neoplasm. The final diagnosis of ancient neurilemmoma was based on both light and electron microscopy morphology.

[Duct cysts of the parotid. Complications of dilated Stensen's duct]. / Kystes canalaires de la parotide. Complication des mégasténons.

The classification of parotid cysts is still uncertain and confusing, especially regarding true glandular cysts. In contrast, the pathogenesis of parotid duct cysts has generally been demonstrated by recognition of constitutional dysplastic dilatation and complicating stenotic phenomena.

[Magnetic resonance and salivary pathology. Identification of a lipoma of the parotid gland]. / Résonance magnétique et pathologie salivaire. Identification d'un lipome de la parotide.

Fatty tissue is easily identified by magnetic resonance imaging by the enhanced signal in sequences weighted T1 and a weak signal in those weighted T2. A lipoma of parotid was identified fortuitously during investigation of a cerebral tumor.

[Complications of the dilatation of Stensen's duct: stenosis and lithiasis]. / Complications des mégasténons: sténoses et lithiase.

A recent publication noted the apparent lack of serious complications of dilatation of salivary canals, based on a review of 16 cases. This is contested by the report of three cases of dilatation of Stensen's duct complicated by lithiasis and stenosis, with associated canalar pseudo-cysts. Surgical excision was required and allowed study of histopathology of this affection.

[Are orodental infectious foci responsible for bacterial pneumopathies? A statistical study]. / Les foyers infectieux bucco-dentaires sont-ils responsables des pneumopathies bactériennes? Etude statistique.

A statistical study compared a group of 38 patients with clinically and bacteriologically confirmed bacterial pneumonia with a control group of 33 subjects. Results facted to demonstrate any significant role for buccodental infection in the genesis of bronchopulmonary infections capable of inciting stomatologists to adopt drastic measures with respect to mortified teeth within the framework of pulmonary disease.

[Benign lympho-epithelial lesion (Blel) of the parotid. Godwin's tumor. A case with cystic ectasia and calcinosis]. / Lésion bénigne lympho-épithéliale (Blel) de la parotide. Tumeur de Godwin. Une observation avec ectasie kystique et calcinose.

We report a case of a benign lymphoepithelial lesion of the parotid gland known as Godwin's tumor. This swelling of the parotid gland, appears as a tumor clinically as well as in scintigraphy and echography. The individual features of this tumor are recognized only during the histological examination: massive infiltration of the lobules of the parotid by a proliferative lymphoid tissue with differentiation to germinal centers and atrophy of the glandular acini. The treatment consists of a superficial parotidectomy. The frozen section avoids a total parotidectomy. In our case, the histological picture is quite particular due to the extensive cystic ductal dilatation and the presence of some calcifications. This aspect permit us to bring together the BLEL and the pseudotumoral calcinosis of the parotid gland. Those two lesions, occur under a context of disfunction, and they could be associated to a Gougerot-Sjögren (GS) syndrome. The BLEL could be considered as the pseudotumoral form of an isolated GS which could be completed after many years with the apparition of auto anti-bodies. The BLEL evoluates as a benign tumor but it's correlation with a malignant lymphoma or a lymphoepithelial carcinoma is also possible. Therefore it is important to follow-up these patients clinically, hematologically and immunologically after their parotidectomy.

[Godwin's tumor and Gougerot-Sjögren syndrome. Apropos of 2 cases]. / Tumeur de Godwin et syndrome de Gougerot-Sjögren. A propos de deux cas.

Two new cases of pseudo-tumoral parotid benign lymphoepithelial lesion serve as the basis for a review of the clinical aspects of "Godwin tumour". This is a pseudo-tumoral parotid swelling of non-characteristic clinical appearance which has the radiological findings of a systemic type sialogram ("punctate marks" and diffuse parenchymatous spots). Histopathological examination shows lesions affecting the whole gland but predominant in the swollen area, sometimes surrounded by a connective tissue pseudo-capsule. These lesions are the same as those seen in Sjögren's syndrome. There are virtually no humoral immunological abnormalities such as auto-antibodies nor inflammatory laboratory abnormalities. Whilst the diagnosis of this rare condition may be considered in the presence of any isolated parotid swelling with a sialogram of systemic type, the diagnosis of a benign lymphoepithelial lesion, eliminating a lymphoma, can be made only by histopathological examination of the parotidectomy specimen. These lesions could be the pseudo-tumoral form of isolated, so-called primary, Sjögren's syndrome. Some of these isolated syndromes become more complete after several years with the appearance of auto-antibodies. Clinical, immunological and haematological surveillance of these benign lymphoepithelial lesions is thus necessary during the years following parotidectomy.

[Oral and cutaneous lesions in Crohn's disease. A case report]. / Lésions buccales et cutanées au cours de la maladie de Crohn. A propos d'une observation.

Cutaneous and buccal manifestations of Crohn's disease are common. They are diagnostically helpful either by their specificity or from a biopsy which whilst access is easy offers less satisfactory results with buccal lesions. Stomatological clinical aspects are varied, most commonly of aphthoid or vesicular stomatitis type (as in the case reported here).

[Idiopathic bilateral salivary megacanals. Apropos 16 cases]. / Mégacanaux salivaires bilatéraux idiopathiques. A propos de 16 observations.

Investigation in 16 patients attending the stomatology outpatients clinic over the last 18 years has enabled definition of a particular radioclinical entity that has been named "idiopathic bilateral salivary megacanal". This generally parotid affection occurs in patients between 50 and 60 years, the onset usually being by an episode of sialodochitis. In addition to these inflammatory attacks there is the persistence of a bilateral "salivary ejaculation" from the ostia of the principal glands, sometimes after manual expression of a mucoid plug. Sialography shows dilatation of canals, the appearance being very suggestive for Stensen's duct, which becomes sinuous, enrolled and segmented. Dilatation is bilateral and affects the total length of the duct. The problem arises as to whether etiopathogenicity is from parietal canalar dysplasia or a constitutional anomaly of the nerve plexus comparable with that described in congenital megacolon. The latter hypothesis is plausible but requires confirmation from histopathology. The always benign course of the disease justifies conservative therapy only: oral antibiotics and canal massage several times a day, with a neostomy only when absolutely necessary.

[Chondromyxoid fibroma of the temporomandibular joint. Apropos of a case report]. / Fibrome chondromyxoïde de l'articulation temporo-mandibulaire. A propos d'une observation.

A 32-year-old woman presented with a chondromyxoid fibroma of the right temporomandibular joint. The tumor is rarely observed but this case emphasizes the need for complete radiological investigation of this joint in patients with clinical symptoms localized to this region.

[The accessory salivary glands in Sjögren's syndrome. Histological and ultrastructural study. Correlations with sialographic changes in the principal glands]. / Les glandes salivaires accessoires dans le syndrome de Sjögren. Etude histologique et ultrastructurale. Corrélations avec les modifications des sialographies dans les glandes principales.

139 salivary gland biopsies have been studied in patients with Sjögren's syndrome. Histologically, we classified labial salivary gland injuries (127 cases) in 3 groups based on striated duct distension: first, some tubular ectasia with few interstitial lymphoid cells; second, much ectasia associated with many lymphoid cells and early pericanalar sclerosis; third, intensive ectasia, scarce lymphocytes, severe peri and intralobular sclerosis and extensive destruction of acini. This grading is positively correlated with that of parotid biopsies and also with abnormalies on 60 parotid sialographic radiogramms performed simultaneously. Histoenzymological and ultrastructural studies demonstrate, at an early stage of the disease, epithelial and myoepithelial alterations in striated ducts, with tubular ectasia. Simultaneously, an intensive regeneration from intercalated ducts takes place. Nevertheless that regeneration fails to repair myoepithelial cells. Furthermore, young myoid cells, leaving tubular walls, migrate in interstitial tissue and are responsible for accumulation of membranoid material and later of collagen sclerosis.

[A giant-cell tumor of the mandibular condyle]. / Tumeur à myéloplaxe du condyle mandibulaire.

The authors present a case of a giant cell tumor of the mandibular condyle, which is a very rare condition. Clinical history and symptoms suggested a disease of the ear. There was a destruction of the cortex of the condyle an invasion of the joint cavity, and an erosion of the adjacent temporal bone.