Role of the Accessory Parotid Gland in the Etiology of Parotitis: Statistical Analysis of Sialographic Features

This retrospective study aimed to identify if the existence of the accessory parotid gland correlated with the etiology of parotitis. This may aid the development of better treatment strategies in the future. Sialographic features of cases with parotitis and healthy subjects were reviewed. The chi-square test was used to compare the incidence of accessory parotid gland between the groups. The Student's t test was used to compare the length of Stensen's duct, the length from the orifice to the confluence of the accessory duct, and the angle between the accessory duct and Stensen's duct between the groups. The incidence of accessory parotid gland in patients with parotitis was 71.8% (28/39), which was significantly higher than that in healthy subjects (P = 0.005). Patients with parotitis had a longer Stensen's duct than healthy subjects (P = 0.003). There was no significant difference in the length from the orifice to the confluence of the accessory duct or the angle between the accessory duct and Stensen's duct (P = 0.136 and 0.511, respectively) between the groups. The accessory parotid gland might play a role in the pathogenesis of parotitis. The existence of an accessory parotid gland is likely to interfere with salivary flow. Computational fluid dynamics analysis of salivary flow in the ductal system would be useful in future etiologic studies on parotitis.

Ultrasound and CT imaging features in a patient with salivary duct carcinoma of the parotid gland: a case report with literature review

The aim of this paper was to present the ultrasound (US) and computed tomography (CT) appearance of a patient with salivary duct carcinoma of the parotid gland. US showed a voluminous mass of the parotid gland, with multiple calcifications. Furthermore, it revealed regional multiple lymph nodes with malignant characters. Sonoelastography of the lesion and lymph nodes detected increased rigidity. Contrast enhanced CT scan of the neck completed the data description regarding the mass expansion and invasion of surrounding tissues. US and CT imaging features played a key role in establishing the malignant character of the mass and lymph nodes.

Human adipose tissue‑derived stem cells alleviate radiation‑induced xerostomia

Hyposalivation is an intractable side‑effect of radiotherapy for head and neck cancer. It is caused by the irreversible loss of acinar cells and decreased saliva secretion. However, this situation severely compromises the quality of life of affected patients. Currently, there is no effective treatment for this condition. In the present study, we developed a novel approach to regenerate the function of the irradiation‑damaged salivary glands using human adipose tissue‑derived stem cell (hADSC) intraglandular transplantation. ZsGreen‑labeled hADSCs were adoptively transferred into Sprague‑Dawley (SD) rat submandibular glands immediately following exposure to 18 Gy irradiation. A higher salivary flow rate (SFR) was observed in the hADSC‑treated group. Tissue improvement, including angiogenesis, anti‑apoptosis and anti‑fibrosis, was detected in the hADSC‑treated glands as compared to the untreated glands. Quantitative reverse transcription PCR (RT-qPCR) revealed a significantly higher expression of vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), cyclooxygenase‑2 (COX‑2) and matrix metalloproteinase‑2 (MMP‑2) in the hADSC‑treated rats. Furthermore, immunohistochemical analysis indicated that the hADSCs had differentiated into acinar and ductal cells in the rat submandibular glands. Thus, our results suggest that hADSCs are able to regenerate irradiation‑damaged salivary glands through glandular transplantation.

Dynamic magnetic resonance sialography as a new diagnostic technique for patients with Sjogren's syndrome

OBJECTIVE

To evaluate the clinical utility of dynamic magnetic resonance (MR) sialographic images as a diagnostic tool for patients with Sjögren's syndrome.

METHODS

The morphological findings and various kinds of functional parameters in volunteers on dynamic MR sialographic images were compared with those in five patients with definite Sjögren's syndrome.

RESULTS

On the MR sialographs of all five patients with Sjögren's syndrome, the so-called 'apple-tree appearance' was seen. The difference in two functional parameters using the dynamic MR sialographic data was elucidated between the two groups. The maximum area of the detectable ducts in the group of patients was significantly smaller (P < 0.001) than that in the group of volunteers. The ratio of change in the detectable ducts in the group of patients was significantly lower (P = 0.011) than that in the group of volunteers.

CONCLUSIONS

Our study suggests that dynamic MR sialographic data in addition to MR sialographic images might be useful for the diagnosis of Sjögren's syndrome.

Sjögren’s syndrome: a condition with features of chronic graft-versus-host disease: does duct cell adhesion or permeability play a role in pathogenesis?

Primary and Secondary Sjögren's syndrome are disease complexes characterized by periductal inflammatory cell infiltration of the salivary and lacrimal glands and manifest as dry mouth and dry eyes. Secondary Sjögren's syndrome may be associated with a connective tissue disorder. Additional extraglandular features in Sjögren's syndrome include a generalized inflammatory exocrinopathy that might be associated with abnormalities of both humoral and cellular mediated immunity. Similar inflammatory changes and extraglandular features, including an altered immune response, have been reported in patients developing graft-versus-host disease after bone-marrow transplantation and in patients with primary biliary cirrhosis. The periductal nature of the inflammatory response involving minor salivary and other glands raises the possibility of altered duct cell adhesion or permeability in playing a role in the aetiopathogenesis of Sjögren's syndrome. The paper pulls together evidence that could be interpreted in this light. Evidence for bacterial or viral factor(s) altering the antigenicity of the histocompartibility (HC) complex on ductal cells in Sjögren's syndrome patients is also described. A hypothesis is proposed for Sjögren's syndrome in which the principal feature is an alteration in salivary gland duct cell adhesion or permeability. A re-evaluation of current knowledge of these two conditions from a clinical and experimental context are interpreted in this light.

An unusual cause of obstructive sialadenitis

A case of bilateral recurrent submandibular sialadenitis is presented in a patient with decreased salivary flow. The condition was caused by trapping of the submandibular papillae between the lingual flange of the denture and the enlarged genial tubercles. Removal of these causes led to resolution of her symptoms. The value of plain radiography, sialography and scintigraphy is discussed.

Acceleration of rat salivary gland tissue repair by basic fibroblast growth factor

A model of atrophic rat submandibular gland was used to examine the ability of basic fibroblast growth factor (bFGF) to accelerate tissue repair. The gland duct was separated carefully from associated blood vessels and nerve, and ligated with a 8-0 suture under a surgical microscope. Two weeks after ligation, the glandular tissue showed severe atrophy and weight loss (to 26% of that in a sham-operated group). Thereafter, the ligature was removed and various amounts of bFGF, isoproterenol or saline were instilled retrogradely through the duct. Both isoproterenol and bFGF increased cell proliferation significantly. bFGF accelerated the proliferation of various cell types, including both acinar and ductal. The proliferative effects of bFGF peaked at a dose of 1 ng/gland. When bFGF (1 ng/gland) was administered to the atrophic gland, its weight increased to 125% of the glands in saline-treated control animals after 2 weeks. The effects of bFGF were also examined in normal submandibular glands: bFGF stimulated cell proliferation, but the effective concentration was at least 50 times higher than that required in the atrophic gland. The results from immunohistochemical tests against anti-FGF receptor-type 1 antibody demonstrated increased immunoreactivity in the damaged gland, which might be involved in the difference in the response to bFGF between damaged and normal glands. Overall, the results indicate that bFGF can accelerate tissue repair in salivary gland.

Buccinator window anomaly

Four patients, three women and one man, with a mean age of 32 years, presented with a history of recurrent parotid swelling. In the women the swelling was unilateral. All had previously undergone sialography using a hand injection technique and no structural abnormality was demonstrated. Sialography was repeated using a continuous-infusion pressure-monitored system. In all cases an initial very high filling pressure (>200 mmHg) was recorded followed by a rapid reduction in pressure and a more normal filling pressure pattern. The duct system and glands all appeared morphologically normal. Treatment with acrylic appliance therapy and an intraductal catheter was attempted with some success.

Sialoendoscopy: three years' experience as a diagnostic and treatment modality

PURPOSE

This article describes the use of endoscopy for treating sialolithiasis and compares this diagnostic method with other diagnostic methods.

PATIENTS AND METHODS

Forty-six major salivary glands suspected for obstructive pathology (26 males and 20 females aged 12 to 65 years) were treated using a rigid mini endoscope. The indications for sialoendoscopy were 1) screening the ductal system for any residual calculi after sialolith removal, and 3) determining the status of the major duct lumens.

RESULTS

Of the 46 endoscopies attempted, 5 were immediate failures as a result of technical problems. Of the remaining 41 patients, 32 had salivary stones, and nine had sialadenitis without evidence of sialolith formation. Within the former group (22 submandibular and 10 parotid), there were four patients in whom sialolithotomy was unsuccessful (three submandibular and one parotid). Of the 22 patients with submandibular sialolithiasis, seven (32%) were undetected by imaging methods (conventional radiography, sialography, and ultrasound). In the 10 parotid ducts, seven (70%) sialoliths were undetected. In the 28 patients who underwent successful calculus removal, no major post-operative complications were noted. Interesting findings noted during endoscopy were a sphincter-like mechanism in the ductal system, evidence of ductal wall changes associated with the presence of salivary stones, peculiar connection between calculi and the ductal wall, a salivary stone forming around a hair inclusion, and the presence of polyps projecting into the duct lumen.

CONCLUSIONS

Endoscopy is a minimally invasive technique for removal of calculi from the salivary glands as well as an excellent diagnostic procedure.

Diversion of salivary flow to treat drooling in patients with cerebral palsy

The authors performed six sialodochoplasties between 1991 and 1994 to treat drooling in six children who suffered from cerebral palsy. There were three boys and three girls, aged 13 to 22 years (mean, 16 years). All patients underwent parotid duct rerouting. The first four patients (group I) also underwent associated excision of submandibular ducts, and the last two patients (group II) benefited from rerouting of the submandibular ducts. In group I, results were considered good in two cases, fair in one case, and poor in one case. A fistula of the new Stenon duct appeared in one patient, which required excision and ligation followed by progressive involution of the parotid gland. Both group II patients had excellent and rapid results. The requirements leading to surgical decision are determined. The importance of physiotherapy is emphasized. Surgical techniques are described and discussed, as are objective criteria for the assessment of surgical results, namely salivary radioisotopic scanning.

Mucous retention cyst of the soft palate: a case presentation

This article describes a mucous retention cyst of the soft palate associated with an over-extended complete maxillary denture. The clinical and anatomical relevance of the fovea palatinae are discussed with respect to the posterior palatal seal and post-dam positioning.