Surgical pearl: removal of a large labial mucocele.
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BACKGROUND: The aim of this work was to determine morphometrical changes in lingual, labial and submaxillar salivary glands from alcoholic chronics. METHODS: Five samples of each type of gland were obtained from autopsies of chronic alcoholics and equal number of samples from individuals whose death cause was accidental (controls). Serous acini in von Ebner and submaxillar glands and mucous acini in labial and Blandin-Nühn glands were analysed. In the ductal system, intra and interlobular striated ducts were studied. A digital-image analyser was used to measure different parameters in the acini and ducts. RESULTS: Statistical analysis revealed that lingual and submaxillar salivary glands presented a significant acinar hypertrophy and hyperplasy. These changes were not observed in labial salivary glands. All studied glands showed significant structural modifications in the striated ducts. CONCLUSION: These results indicate that the significant variations together with the histological qualitative pattern could be useful as confident indicators for the differential histopathological diagnosis with other sialosis from different aetiology.
The formation of an orocutaneous fistula following ablative head and neck surgery is a common complication. Early fistula detection could permit prompt management, hopefully preventing further wound breakdowns. Amylase is quantitatively the most prominent enzyme in saliva. This study prospectively evaluated whether the amylase content of wound drainage could predict the formation of an orocutaneous fistula earlier than clinically evident. Patients undergoing procedures that required postoperative wound drainage represented the study population. Baseline serum and salivary amylase determinations were obtained. The drainage was assayed for amylase content twice daily. Wound amylase values were then correlated with the patient's clinical course. Results showed wound amylase had a downward trend in uncomplicated postoperative courses. An upward trend of wound amylase was correlated with early fistulization. No pattern was identified in patients with delayed fistulae.
Swellings of the submaxillary region are very frequent in otorhinolaryngology clinical practice. The authors of this study analyzed 106 cases of submaxillary gland excision under their observation, emphasizing their epidemiological, clinical and anatomopathological aspects which could be useful during the diagnostic and therapeutic phase of the submaxillary gland affections. They also made a comparison with the data already published on the same subject.
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The purpose of this review is to demonstrate the value of ultrasound in the assessment of salivary gland diseases. The technical preconditions, the ultrasound anatomy of the salivary glands and the examination procedure are described, and the ultrasound appearance of common and important salivary gland diseases (inflammation, calculi, and neoplasm) is discussed. In conclusion, the potentials and limitations of ultrasound in diagnosing the salivary glands are compared to other imaging modalities.
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This article discusses the anatomy, physiology, and pathology of the parotid, submandibular, and sublingual glands, which often are referred to as the major salivary glands. Overall, diseases of the salivary glands are relatively uncommon; however, as an organ system, they have the greatest diversity of pathology. Acute viral and bacterial inflammatory diseases are the most common salivary gland abnormalities; tumors are uncommon. The imaging approach to these lesions is discussed.
In the 30 years of laser history the oral cavity application has always played an important role. In the laboratory diagnostics the analysis of the saliva, tissues and hard dental tissues is performed by laser. In the clinical diagnostics the laser is used for examining the caries, dental matter, in orthodontics, in the surgical analysis of splanchnocranium and the teeth. The photodynamic treatment involves the diagnostic and therapeutic use of the lasers in the management of oral cavity cancers. The soft laser therapy is widely applied in diseases of the oral mucosa, parodontal and pain syndromes, temporomandibular articular diseases, dental inflammations, salivary gland diseases and in osseal healing processes. The surgical lasers are applied in the treatment of teeth, in preprosthetic surgery, salivary gland diseases, precancerous conditions, tumour surgery and in the surgery of hemophilic patients, respectively. In the 90s one cannot speak about modern oral surgery or dentistry without the application of lasers. Though in various fields the research is merely in initial phase (holography, caries-treatment, photodynamic therapy, etc.), the lasers are becoming an indispensable (treatment of precancerous conditions, hemophilic patients, diseases of the oral mucosa, etc.). The oral surgical use of lasers might bring about fundamental changes in diagnosis and treatment, becoming a new professional branch, opening up new vistas, representing "future" today. The invention of lasers in 1960 and their broad dissemination in oral surgery and dentistry since 1980 have resulted in basic changes in numerous diagnostic and therapeutic approaches. The medical use of lasers is of such an extent that it can well justifiably regarded as a new branch of science namely the laser medicine. This considerably relates to stomatology, too.
A review of 107 submandibular gland excisions was made to determine the relative frequency of neoplastic versus non-neoplastic disease. The results show a preponderance of non-neoplastic pathology. Benign tumors were found in 6% of glands, primary glandular and metastatic carcinoma in 3%. Timely treatment of a submandibular gland mass is indicated due to the relatively aggressive behavior of malignancies originating in this location.
We evaluated the role of quantitative indices derived from dynamic 99mTc-pertechnetate salivary scintigraphy in the differentiation between a group of patients with Sjögren's syndrome (SS), a group of patients without xerostomia, but with underlying autoimmune disorders, and a group of controls. Seventeen patients with SS (group A), 18 patients with autoimmune disorders (group B) and 15 controls (group C) underwent dynamic salivary gland scintigraphy. Functional indices for the parotid and submandibular glands were calculated and comparisons were made between the groups. There were no significant differences between the three groups in terms of the maximum accumulation (MA), maximum secretion (MS) and pre-stimulatory oral index (PRI). The uptake ratios (URs) for both the right and left parotid glands and the left submandibular gland in group A were significantly lower than those in group C, but no different from those in group B. The URs for the parotid glands in group B were significantly less than those in group C. The percentage uptake by the right parotid gland at 4 min (U4) was significantly lower in group A than in groups B or C, and lower than the percentage uptake by the left parotid gland at 4 min in group A. The rest of the U4 values and all of the uptakes at 14 min (U14) were not significantly different between the three groups. The time taken for the right parotid gland to reach peak activity (Tmax) was significantly less in group A than in the other groups, but other glands showed no significant differences. It can be concluded that MA, MS and PRI cannot be used to differentiate between the three groups. The URs in groups A and B were no different, but were significantly lower than those in group C. However, the extensive overlap between xerostomic patients and normal controls for all the quantitative indices calculated imposes a severe limitation on their discriminatory power.
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This report describes a case of necrotizing sialometaplasia (NS) in a patient diagnosed as having Buerger's disease with secondary Raynaud's phenomenon. The danger of misdiagnosing NS as a malignant lesion is emphasized. Possible causal relationships between the patient's medical condition and the lesion are discussed.
Salivary gland disease gives rise to salivary gland enlargement, pain, and prolonged xerostomia (dry mouth). Xerostomia is the most common long-standing problem for the majority of affected patients. There are many causes of dry mouth, with long-standing xerostomia being a particular problem in Sjögren's syndrome and after radiation to the head and neck region. Xerostomia is usually managed with saliva substitutes, but a large number of potential systemic therapies of long-standing xerostomia now exist. Some-particularly immunosuppressants-are of fundamental interest for the potential reduction of gland damage in Sjögren's syndrome but as yet are of limited clinical usefulness. Others, particularly pilocarpine and cevimeline, are, or have the potential to be, clinically useful in stimulating salivation by virtue of their action on cholinergic receptors.
An extremely rare case of a cutaneous fistula of the submandibular salivary gland is presented. The etiology of the fistula was a foreign body in Wharton's duct. We describe the clinical course, management and histo-pathological findings.