Sialosis: 35 cases of persistent parotid swelling from two countries

Oral medicine considerations for the older patient

With the proportion of the world population aged over 60 years expected to nearly double to 22% by 2050, health care professionals are faced with the challenge of ensuring they are ready to address this demographic shift. As people age, they are more likely to develop comorbidities which have implications for their oral health. The effects of polypharmacy used to address these underlying health problems can also influence the oral health of older-aged patients. From a clinician's perspective, an awareness of the variety of conditions associated with old age, such as oral-mucosal disease, swellings and manifestations of underlying health conditions, are required to ensure appropriate referral, investigation and management, both in primary and secondary care settings. This article aims to provide the practitioner with an overview of orofacial and oral mucosal conditions commonly encountered with the older patient.

Xerostomia in patients with diabetes mellitus (pilot study)

Relevance. Saliva performs some essential functions indispensable for oral health. Patients with diabetes mellitus (DM) often complain of xerostomia. Long-term dry oral mucosa in diabetic patients adversely affects the quality of life and causes speech. chewing. swallowing. and taste problems; it leads to multiple caries and inflammatory periodontal diseases.Aim. To evaluate the detection rate and determine the x erostomia nature in patients with DM.Materials and methods. The interview and survey included 251 patients aged 18-82 y.o. with Type 1 DM. latent auto-immune diabetes in adults and Type 2 DM. The patients informed the study of DM duration. current therapy duration. xerostomia presence and nature. The patients’ records provided information about the established diagnosis. age. glycohemoglobin (HbA1c). body mass index (BMI). and prescribed DM therapeutic regimen. The data were statistically analysed using the StatTech v. 2.4.8 software. Results. 134 (53.4%) patients complained of a transient dry mouth associated with blood sugar levels increase; 6 (2.4%) patients noted dry mouth if blood sugar levels decreased; 30 subjects (12.0 %) and 10 subjects (4.0 %) reported constant and stress-associated dry mouth. respectively (р > 0.05). Patients over 80 declared dry mouth associated with blood sugar decrease more often than patients aged 45-64 and 65-80 y.o. (р = 0.002*; р45-64 – over 80 = 0.012; рover 65 – over 80 < 0.001); 21.1% of patients aged 65-80 noted permanently dry mouth (р = 0.028). Patients with persisting xerostomia (permanent dry mouth and stress-associated dry mouth) had statistically significant. higher BMI of 33 (31-37) kg/m2 (р = 0.019) and 36 (34-41) kg/m2 (р = 0.002). respectively. The higher glycohemoglobin level increase was more statistically significant in patients with DM. who reported dry mouth associated with glucose increase. The evaluation of xerostomia nature vs to diagnosis. sex. DM duration. drug therapy scheme. and smoking did not reveal any statistically significant differences.Conclusion. Xerostomia presents an additional problem for patients with DM. Patient education and the selection of individual products for oral care by dentists may improve oral health parameters in the long run.

Development of head and neck pathology in Europe

This review gives a brief history of the development of head and neck pathology in Europe from a humble beginning in the 1930s to the explosive activities the last 15 years. During the decades before the introduction of immunohistochemistry in the 1980s, head and neck pathology grew as a subspeciality in many European countries. In the late 1940s, the Institute of Laryngology and Otology with its own pathology laboratory was founded in London, and in 1964 the World Health Organization (WHO) International Reference Centre for the Histological Classification of Salivary Tumours was established at the Bland-Sutton Institute of Pathology, also in London. International collaboration, and very much so in Europe, led to the publication of the first WHO Classification of Salivary Gland Tumours in 1972. In the 1960s, a salivary gland register was organised in Hamburg and in Cologne the microlaryngoscopy was invented enabling microscopic endoscopic examination and rather shortly afterwards a carbon dioxide laser attached to the microscope became established and laryngeal lesions could be treated by laser vaporisation. During the last three decades, the use of immunohistochemistry supplemented with cytogenetic and refined molecular techniques has greatly facilitated the pathological diagnostics of head and neck lesions and has had a huge impact on research. Collaboration between different European centres has drastically increased partly due to establishment of scientific societies such as the Head and Neck Working Group (HNWG) within the European Society of Pathology and the International Head and Neck Scientific Group (IHNSG). A very large number of European pathologists have contributed to the 2nd, 3rd and 4th WHO books, and are involved in the upcoming 5th edition. Accredited educational meetings and courses are nowadays regularly arranged in Europe. Numerous textbooks on head and neck pathology have been written and edited by European pathologists. The increased collaboration has created larger series of tumours for research and new entities, mainly defined by their genetic abnormalities, are continuously emerging from Europe, particularly regarding salivary gland neoplasms and "undifferentiated" sinonasal tumours. These findings have led to a better and more precise classification and open the possibilities for new treatment strategies.

Bilateral Submandibular Gland Aplasia: An Unusual Cause of Sublingual Swelling—The Role of Imaging in Patient Management

There are very limited reports of aplasia of bilateral submandibular glands. We report the case of a 55-year-old male who presented with nontender palpable sublingual masses. On computed tomography and magnetic resonance imaging, bilateral submandibular gland aplasia and compensatory hypertrophy of bilateral parotid and sublingual glands were seen with herniation of hypertrophied sublingual glands through the bilateral mylohyoid muscles presenting as palpable sublingual region masses. Additional finding of bilateral accessory parotid glands was also noted. Prolapsed hypertrophied sublingual glands should be considered in patients presenting with bilateral sublingual masses to avoid unnecessary invasive procedures. We suggest radiological evaluation of such cases prior to any intervention.

Management Options for Sialadenosis

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.

Imaging of Submandibular and Sublingual Salivary Glands

The submandibular and sublingual salivary glands are major salivary glands with a wide spectrum of pathologic conditions. The corresponding spaces along the floor of mouth have complex anatomy, best evaluated with cross-sectional imaging. The spectrum of diseases in these regions varies from simple infection to advanced malignancy, not just from the gland itself but also from the surrounding structures. The most common abnormalities in these spaces are inflammatory and infectious, and computed tomography is currently the most common imaging modality used. The anatomy of these spaces is much better depicted with MR; however, all the modalities have their unique roles.

Imaging of Inflammatory Disorders of Salivary Glands

Sialadenitis is among the most common conditions that affect the salivary glands. Inflammation of the salivary glands occurs as the end result of a variety of pathologic conditions, including infectious, autoimmune, and idiopathic causes. Clinically, inflammation of the salivary gland causes pain and localized swelling. The presentation may be acute or chronic, and can be recurrent. Because there is significant overlap of underlying disease mechanisms and clinical presentations, radiologic evaluation often plays a significant role in evaluation. This article is a brief review of sialadenitis, including disease mechanisms, causes, and the practical imaging of the salivary glands.

Sialosis: Cytomorphological significance in the diagnosis of an uncommon entity

A diffuse, chronic, usually bilateral, noninflammatory, nonneoplastic enlargement of major salivary glands is termed as Sialosis or Sialadenosis. It is an extremely uncommon cause for enlargement of the parotid gland. We hereby present a case of a 45-year-old female patient having a swelling at the left preauricular region. The swelling was gradually increasing in size since 6 months. On clinical examination, the swelling was 3 cm × 3 cm, mobile, and nontender. On ultrasonography, it was suggestive of benign parotid lesion or parotitis with cervical lymphadenopathy. On fine needle aspiration cytology, it was suggestive of sialadenosis. This is an extremely rare salivary gland lesion with specific cellular features. It is very important to distinguish sialadenosis from other causes of enlargement of the parotid gland as treatment modality differs.

Sialosis, Gout Induced or Idiopathic? Case Report

Sialosis is observed in relation to diabetes, alcoholism, and malnutrition. An assumed relation between gout and sialosis is probably based on confusion that originated from the therapeutic use of phenylbutazone for gout and the sialadenitis that the medication caused. This report describes a case of sialosis in a patient with a longstanding history of gout that was idiopathic in origin.

Rare Parotid Gland Diseases

The differential diagnosis for "rare" parotid gland diseases is broad and encompasses infectious, neoplastic, autoimmune, metabolic, and iatrogenic etiologies. The body of knowledge of parotid gland diseases has grown owing to advances in imaging and pathologic analysis and molecular technology. This article reviews rare parotid diseases, discussing the respective disease's clinical presentation, diagnosis, imaging, pathogenesis, treatment, and prognosis.

Bilateral Parotid Swelling in Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is recognized by the presence of polycystic ovaries, irregular menstruation, and increased androgen levels. Many patients have insulin resistance or impaired glucose tolerance and an associated development of type 2 diabetes mellitus. A patient with PCOS is presented whose cosmetic concerns centered on the prolonged existence of substantial bilateral parotid swelling. The pathophysiology, diagnosis, and therapy of sialosis are discussed.

Salivary gland disorders

Patients with salivary gland disease present with certain objective and/or subjective signs. An accurate diagnosis for these patients requires a range of techniques that includes the organized integration of information derived from their history, clinical examination, imaging, serology, and histopathology. This article highlights the signs and symptoms of the salivary gland disorders seen in the Salivary Gland Center, and emphasizes the methodology used to achieve a definitive diagnosis and therapy.

Morphometrical study of minor salivary gland in xerostomic patients with altered lipid metabolism

OBJECTIVE

To evaluate the correlation between dyslipidemia in patients with oral dryness and the development of non-specific histopathological findings in their labial salivary gland biopsies.

METHODS

Thirty seven patients suffering from oral dryness (18 patients with dyslipidemia and 19 age-matched patients with normal lipid blood levels) underwent labial salivary gland biopsy. Total acinar area (TAA), acinar cell number, acinar lumen area (ALA), duct lumen area (DLA), area occupied by cells in acinus (AoCA), and area of one acinar cell (OAC) were calculated.

RESULTS

A significantly (P < 0.05) increased AoCA, OAC, and DLA in labial glands from patients with impaired lipid metabolism, compared to controls, were found.

CONCLUSION

A positive relationship between dyslipidemia and morphological changes in labial salivary glands was obtained.

Ultrasound in sialadenitis

The salivary glands are located superficially and are therefore easily accessible to ultrasound (US) examination, particularly if a high-frequency probe designed for small parts is used. Hence, US examination of these organs is widely applied particularly in non-neoplastic pathologies. In this way, it is possible to obtain adequate images without the use of ionizing radiation or complex instrumentation such as magnetic resonance imaging. However, US examination requires an expert clinical knowledge and familiarity with the normal and pathological US anatomy of the area. Limitations and pitfalls linked to US examination of this area should also be kept in mind.

An Algorithm Approach to Diagnosing Bilateral Parotid Enlargement

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.

Sonographic and CT findings of sialadenosis in a child with leukemia

Sialadenosis is characterized by asymptomatic bilateral enlargement of the parotid glands. It is uncommon, especially in children. Diagnosis and analysis of sialadenosis based on imaging modalities have been rarely reported. Here, we report a case of sialadenosis in a child with leukemia, in which the diagnosis was made based on sonography and CT findings.