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Moore J, Simpson MTW, Cohen N, Beyea JA, Phillips T. Approach to sialadenitis. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:531-536. [PMID: 37582587 PMCID: PMC10426371 DOI: 10.46747/cfp.6908531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
OBJECTIVE To provide family physicians with a practical evidence-based approach to the management of patients with sialadenitis. SOURCES OF INFORMATION MEDLINE and PubMed databases were searched for English-language research on sialadenitis and other salivary gland disorders, as well as for relevant review articles and guidelines published between 1981 and 2021. MAIN MESSAGE Sialadenitis refers to inflammation or infection of the salivary glands and is a condition that can be caused by a broad range of processes including infectious, obstructive, and autoimmune. History and physical examination play important roles in directing management, while imaging is often useful to establish a diagnosis. Red flags such as suspected abscess formation, signs of respiratory obstruction, facial paresis, and fixation of a mass to underlying tissue should prompt urgent referral to head and neck surgery or a visit to the emergency department. CONCLUSION Family physicians can play an important role in the diagnosis and management of sialadenitis. Prompt recognition and treatment of the condition can prevent the development of complications.
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Affiliation(s)
- Jonah Moore
- Medical student in the Faculty of Health Sciences at Queen's University in Kingston, Ont.
| | - Matthew T W Simpson
- Assistant Professor in the Department of Family Medicine at Queen's University
| | - Natasha Cohen
- Assistant Professor in the Department of Surgery at Queen's University
| | - Jason A Beyea
- Assistant Professor in the Department of Surgery at Queen's University
| | - Timothy Phillips
- Assistant Professor in the Department of Surgery at Queen's University
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Moore J, Simpson MTW, Cohen N, Beyea JA, Phillips T. Approche de la sialadénite. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:e159-e164. [PMID: 37582592 PMCID: PMC10426354 DOI: 10.46747/cfp.6908e159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Objectif Proposer aux médecins de famille une approche pratique fondée sur des données probantes pour la prise en charge de patients souffrant de sialadénite. Sources de l’information Une recension a été effectuée dans les bases de données MEDLINE et PubMed pour trouver des recherches publiées en anglais sur la sialadénite et d’autres troubles des glandes salivaires, ainsi que des revues et des lignes directrices pertinentes, publiées entre 1981 et 2021. Message principal La sialadénite désigne une inflammation ou une infection des glandes salivaires; elle peut être causée par un large éventail de processus de nature infectieuse, obstructive et auto-immune. L’anamnèse et l’examen physique jouent un rôle important pour orienter la prise en charge, tandis que l’imagerie est souvent utile pour établir un diagnostic. Des signaux d’alerte comme la formation suspectée d’un abcès, des signes d’obstruction respiratoire, une parésie faciale et la fixation d’une masse aux tissus sous-jacents devraient inciter à faire une demande de consultation urgente en chirurgie de la tête et du cou, ou à recommander une visite au service d’urgence. Conclusion Les médecins de famille peuvent jouer un rôle important dans le diagnostic et la prise en charge de la sialadénite. Une reconnaissance et un traitement rapides du problème peuvent prévenir la survenance de complications.
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Affiliation(s)
- Jonah Moore
- Étudiant en médecine à la Faculté des sciences de la santé de l'Université Queen's à Kingston (Ontario).
| | - Matthew T W Simpson
- Professeur adjoint au Département de médecine familiale de l'Université Queen's
| | - Natasha Cohen
- Professeure adjointe au Département de chirurgie de l'Université Queen's
| | - Jason A Beyea
- Professeur adjoint au Département de chirurgie de l'Université Queen's
| | - Timothy Phillips
- Professeur adjoint au Département de chirurgie de l'Université Queen's
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Sarode GS, Sarode SC, Gophane R, Kumari N. The role of saliva in taste dysfunction among cancer patients and the neglected pre-treatment causes. Oral Oncol 2022; 134:106128. [PMID: 36174457 DOI: 10.1016/j.oraloncology.2022.106128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Gargi S Sarode
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune 411018, Maharashtra, India
| | - Sachin C Sarode
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune 411018, Maharashtra, India
| | - Renuka Gophane
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune 411018, Maharashtra, India.
| | - Nidhi Kumari
- Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune 411018, Maharashtra, India
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Damage to Oral Mucosae Induced by Weekend Alcohol Consumption: The Role of Gender and Alcohol Concentration. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The damage caused by chronic alcohol consumption is frequently reported, but the effects caused by weekend recreational consumption, which is much more frequent than even daily consumption, have not, to our knowledge, been reported. The metabolism of ethanol, once consumed, starts from the mouth, and the biotransformation process follows different routes. In this study, the effect of weekend alcohol consumption on the oral cavity was observed. Methods: Thirty male and female rats were divided into six groups (n = 5), with control groups (male/female) and groups administered with 5% and 40% ethanol solution ad libitum consumption 2 days a week for 3 months. After treatment, the animals were sacrificed, an incisional slice of the cheek and back of the tongue was obtained, and the tissues were processed according to the histological technique and routine staining (hematoxylin-eosin, H&E). Samples were observed using light microscopy. Results: Histological changes were observed in samples of tongue and cheek mucosa including different levels of keratinization of the surface layer. Epithelial dysplasia, acanthosis, and chronic inflammation were also observed. The vascularization level also increased because of the ethanol-induced damage. The results were very similar between female and male groups. Conclusion: Weekend alcohol consumption for a period of 3 months causes oral-cavity tissue alterations that could contribute to tumor growth and the development of cancer in the oral cavity.
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Sorkina O, Zaitseva O, Khudyakov A. The effect of long-term alcohol intoxication on the morphological structures and enzymatic activity of rat salivary glands. Alcohol 2022; 99:23-33. [PMID: 34883230 DOI: 10.1016/j.alcohol.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/27/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To study changes in the morphological structures and enzymatic activity of the submandibular salivary gland (SMG) and parotid salivary gland (PG) in rats after prolonged alcohol intoxication. METHODS Sexually mature male Wistar rats consumed 20% ethanol (6.9 g/kg/day) for 180 consecutive days. The PG and SMG were collected for morphometric and histochemical analyses (nonparametric Mann-Whitney U test, p < 0.05). RESULTS After exposure to ethanol for 180 days, the PG showed a change in the shape of the acini and the secretory cells that formed them, uneven expansion of the interlobular excretory ducts, and moderate fatty infiltration in the stroma. After exposure to ethanol for 180 days, the SMG showed fatty infiltration and stromal edema, and changes in acinar cells, intercalated ducts, and striated ducts. There was a significant decrease in the relative and absolute weight of the SMG. The number of mast cells in the PG and SMG and their degranulation index increased 2-fold after exposure to ethanol. All mast cells were highly active. After ethanol exposure, the activity of alkaline phosphatase increased significantly in the myoepithelial cells of the SMG and PG; the activity of NADPH oxidase increased only in the acini SMG, and the activity of succinate dehydrogenase remained at the control level in the acini of both glands. In the ducts of these glands, the activity of other enzymes did not change. CONCLUSIONS Changes in the morphological structures, morphometric parameters, and enzymatic activity of the rat salivary glands after 180 days of ethanol intoxication are shown for the first time. The most pronounced changes were found in the SMG.
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Affiliation(s)
- Olga Sorkina
- Chuvash State University, 428015, 15 Moskovsky Prospect, Chuvash Republic, Cheboksary, Russia
| | - Oksana Zaitseva
- Institute of Physiology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, FRC Komi SC UB RAS, 167982, 50 Pervomayskaya str., Komi Republic, Syktyvkar, Russia.
| | - Andrey Khudyakov
- Institute of Physiology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, FRC Komi SC UB RAS, 167982, 50 Pervomayskaya str., Komi Republic, Syktyvkar, Russia
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Oral Health and Liver Disease: Bidirectional Associations—A Narrative Review. Dent J (Basel) 2022; 10:dj10020016. [PMID: 35200242 PMCID: PMC8870998 DOI: 10.3390/dj10020016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 12/04/2022] Open
Abstract
Several links between chronic liver disease and oral health have been described and are discussed in this narrative review. Oral manifestations such as lichen planus, ulcers, xerostomia, erosion and tongue abnormalities seem to be particularly prevalent among patients with chronic liver disease. These may be causal, coincidental, secondary to therapeutic interventions, or attributable to other factors commonly observed in liver disease patients. In addition, findings from both experimental and epidemiological studies suggest that periodontitis can induce liver injury and contribute to the progression of chronic liver disease through periodontitis-induced systemic inflammation, endotoxemia, and gut dysbiosis with increased intestinal translocation. This has brought forward the hypothesis of an oral-gut-liver axis. Preliminary clinical intervention studies indicate that local periodontal treatments may lead to beneficial liver effects, but more human studies are needed to clarify if treatment of periodontitis truly can halt or reverse progression of liver disease and improve liver-related outcomes.
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Abstract
Sialadenosis (sialosis) is a chronic, noninflammatory, nonneoplastic, bilateral, often painless enlargement of the salivary glands, most frequently affecting the parotid glands. Approximately 50% of cases are associated with an underlying disease process. The pathogenesis of sialadenosis is unknown but likely results from an autonomic neuropathy. The key to management is diagnosis and management of any poorly controlled underlying medical process.
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Affiliation(s)
- Andrew B Davis
- Otolaryngology Department, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| | - Henry T Hoffman
- Otolaryngology Department, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Haber PS, Kortt NC. Alcohol use disorder and the gut. Addiction 2021; 116:658-667. [PMID: 32511812 DOI: 10.1111/add.15147] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/14/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023]
Abstract
Acute and chronic gastrointestinal problems are common in the setting of excessive alcohol use, and excessive alcohol use is associated with injury to all parts of the gastrointestinal tract. There is mounting evidence of gastrointestinal injury and increased cancer risk even from moderate alcohol consumption. The major causes of alcohol-related morbidity and mortality within the gastrointestinal system are liver disease, pancreatitis and gastrointestinal cancer. Other alcohol-related intestinal dysfunction is common but not life-threatening, leading to diarrhoea, malabsorption and nutritional deficiencies. This review describes non-neoplastic and neoplastic alcohol-related disorders of the gastrointestinal tract, omitting the liver, which has been reviewed elsewhere.
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Affiliation(s)
- Paul S Haber
- Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia.,University of Sydney, Sydney, NSW, 2050, Australia
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Abstract
Signs and symptoms representative of a systemic condition can manifest in the oral cavity and orofacial region. Such conditions may be previously diagnosed, or the orofacial manifestation may be the presenting sign of an acute or chronic systemic condition not previously diagnosed. Pathologic processes in the mouth, jaws, and contiguous structures could have a direct and indirect impact on the patient's overall systemic condition. Moreover, systemic conditions may result in compromised function of the orofacial region or impact patients' oral health profile. This article reviews selected systemic conditions that present or impact on the oral cavity and orofacial region.
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Affiliation(s)
- Joel J Napeñas
- Department of Oral Medicine, Atrium Health's Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA.
| | - Michael T Brennan
- Department of Oral Medicine, Atrium Health's Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232, USA
| | - Sharon Elad
- Division of Oral Medicine, Hospital Dentistry, Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Avenue, Rochester, NY 14620, USA
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Karapantzou C, Jakob M, Canis M. Neurotoxin injection in benign submandibular gland hypertrophy: A first choice treatment. Laryngoscope Investig Otolaryngol 2020; 5:217-220. [PMID: 32337352 PMCID: PMC7178459 DOI: 10.1002/lio2.363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/12/2020] [Accepted: 02/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Various benign clinical entities with a symptomatology of hypertrophic submandibular glands like sialadenitis, sialadenosis, sialolithiasis, or an ageing neck have been described. Botulinum toxin type A is an elegant tool in the management of these conditions. METHODS This article is an original article, describing the Munich Concept of treating persistent submandibular swelling with Botulinum Toxin Type A from aesthetic and functional aspect. To shrink the affected tissue, 15 Units of Botox or Xeomin are applied in a single injection technique and under ultrasound guidance into the glands. Therefore, the 100 Units vial is being diluted with 3.5 of NaCl. RESULTS Intraglandular injections, using a specific dilution and dosage of the neurotoxin preparations, are very effective in the management of these swellings, offering safe and long-lasting results, with a high satisfaction rate. Our working group treated in the last 18 months 23 patients with benign, bilateral submandibular gland hypertrophies, which did not have any major complications. CONCLUSION As there is not yet described an ideal therapeutic strategy for the management of this symptomatology, we suggest, based on our experience, a concept with very promising results from functional and cosmetic aspect.
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Affiliation(s)
- Chrisanthi Karapantzou
- Facial Rejuvenation OfficeORL Clinic, Ludwigs‐Maximillians‐University MunichMunichGermany
| | - Mark Jakob
- ORL University DepartmentLudwig‐Maximillians University MunichMunichGermany
| | - Martin Canis
- ORL University DepartmentLudwig‐Maximillians University MunichMunichGermany
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Guan G, Won J, Mei L, Polonowita A. Extensive adipose replacement of the parotid glands: an unusual presentation of sialadenosis. A Case Report and Literature Review. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/ors.12442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G. Guan
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry University of Otago North Dunedin New Zealand
| | - J. Won
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry University of Otago North Dunedin New Zealand
| | - L. Mei
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry University of Otago North Dunedin New Zealand
| | - A. Polonowita
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry University of Otago North Dunedin New Zealand
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McCann S, le Chevoir M, Lacorcia L, Wernham B, Mansfield CS. Cricopharyngeal dysphagia and phenobarbitone-responsive sialoadenosis in a Miniature Poodle. Aust Vet J 2017; 95:232-236. [PMID: 28653385 DOI: 10.1111/avj.12595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/24/2016] [Accepted: 09/29/2016] [Indexed: 11/29/2022]
Abstract
CASE REPORT An 11-year-old male neutered Miniature Poodle was investigated for ptyalism, weight loss and anorexia. Cricopharyngeal dysphagia was diagnosed using fluoroscopy, and non-inflammatory salivary disease was diagnosed using a combination of cytology and computed tomography. The dog was successfully managed with phenobarbitone. CONCLUSION To the authors' knowledge this is the first time acquired cricopharyngeal dysphagia and phenobarbitone-responsive sialoadenosis have been described together.
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Affiliation(s)
- Sam McCann
- Translational Research and Animal Clinical Trial Study (TRACTS) group, Faculty of Veterinary and Agricultural Science, 250 Princes Hwy, Werribee 3030, Victoria, Australia
| | - M le Chevoir
- Translational Research and Animal Clinical Trial Study (TRACTS) group, Faculty of Veterinary and Agricultural Science, 250 Princes Hwy, Werribee 3030, Victoria, Australia
| | - L Lacorcia
- Translational Research and Animal Clinical Trial Study (TRACTS) group, Faculty of Veterinary and Agricultural Science, 250 Princes Hwy, Werribee 3030, Victoria, Australia
| | - Bgj Wernham
- Translational Research and Animal Clinical Trial Study (TRACTS) group, Faculty of Veterinary and Agricultural Science, 250 Princes Hwy, Werribee 3030, Victoria, Australia
| | - C S Mansfield
- Translational Research and Animal Clinical Trial Study (TRACTS) group, Faculty of Veterinary and Agricultural Science, 250 Princes Hwy, Werribee 3030, Victoria, Australia
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Yeluru A, Cuthbert JA, Casey L, Mitchell MC. Alcoholic Hepatitis: Risk Factors, Pathogenesis, and Approach to Treatment. Alcohol Clin Exp Res 2016; 40:246-55. [PMID: 26842243 DOI: 10.1111/acer.12956] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/02/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alcoholic hepatitis (AH) is an inflammatory disorder of the liver characterized clinically by jaundice, hepatomegaly, and abdominal pain, and histologically by macrovesicular steatosis and necroinflammation. METHODS This clinical review will cover what is known about the pathogenesis, clinical presentation, current treatments, and novel therapies for AH. RESULTS The pathogenesis and treatment of AH remain areas of active research. Although abstinence is the cornerstone of therapy for all stages of alcoholic liver disease, corticosteroids have shown modest short-term benefits in treatment of severe AH. CONCLUSIONS Improved understanding of the pathogenesis of AH has expanded the range of potential treatments for this devastating disease. Several novel therapies are also currently in various stages of testing through clinical trials.
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Affiliation(s)
| | - Jennifer A Cuthbert
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Lisa Casey
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Mack C Mitchell
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
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Krishnamurthy S, Vasudeva SB, Vijayasarathy S. Salivary gland disorders: A comprehensive review. World J Stomatol 2015; 4:56-71. [DOI: 10.5321/wjs.v4.i2.56] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/25/2015] [Accepted: 04/14/2015] [Indexed: 02/06/2023] Open
Abstract
Salivary glands are complex in nature. They could be either tubulo acinar, merocrine or exocrine glands secreting mainly saliva. Salivary gland is one of the main soft tissue structures in the maxillofacial area. Saliva is a clear, slightly acidic muco serous fluid that coats the teeth, mucosa and thereby helps to create and maintain a healthy environment in the oral cavity. Salivary glands may be affected by a number of diseases: local and systemic and the prevalence of salivary gland diseases depend on various etiological factors. The glands may be infected by viral, bacterial, rarely fungal or its ductal obstruction which may cause painful swelling or obstruction, affecting their functions. The salivary gland may also be affected by a various benign and malignant tumours. This review article briefly describes about the various salivary gland disorders, diagnostic techniques and their management including the recent advances and the future perspective.
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Dinis-Oliveira RJ, Magalhães T, Moreira R, Proença JB, Pontes H, Santos A, Duarte JA, Carvalho F. Clinical and forensic signs related to ethanol abuse: a mechanistic approach. Toxicol Mech Methods 2013; 24:81-110. [PMID: 24274640 DOI: 10.3109/15376516.2013.869782] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Chen S, Paul BC, Myssiorek D. An Algorithm Approach to Diagnosing Bilateral Parotid Enlargement. Otolaryngol Head Neck Surg 2013; 148:732-9. [DOI: 10.1177/0194599813476669] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective This contemporary review aims to categorize the disease entities that cause bilateral parotid enlargement and to develop a question-based algorithm to improve diagnosis of bilateral parotid masses. Data Sources A PubMed search for bilateral and parotid showed 818 results. Of these, 68 relevant studies were reviewed to compile a list of disease processes that can cause bilateral parotid enlargement. Review Methods A total of 22 diseases entities were reviewed. The disease processes were initially grouped into 6 categories based on etiology: sialadenosis, infection, neoplasm, autoimmune, iatrogenic, and miscellaneous. For each lesion, the incidence, history, and physical examination were compiled in a matrix. Conclusion After reviewing the matrix, it was clear that grouping diseases based on specific history and physical findings limits the differential diagnosis. The most important factors included disease incidence, timing of onset, nodular or diffuse, pain, and overlying skin changes. With this algorithm, the differential diagnosis can be limited from 28 to 7 or fewer likely diagnoses for a given presentation. Implications for Practice Bilateral parotid disease has a wide differential diagnosis with an expanding number of available tests. An algorithm, based solely on data obtained from the history and physical examination in the first patient encounter, may reduce the differential and aid the clinician in deciding on further workup and treatment. Following the algorithm presented here should allow the clinician to arrive at a diagnosis rapidly without ordering unnecessary tests and wasting resources.
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Affiliation(s)
- Si Chen
- Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Benjamin C. Paul
- Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - David Myssiorek
- Department of Otolaryngology–Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
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