[Histochemical aspects in the course of dental infection of the salivary glands].
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Many hypotheses have been advanced to try to explain the mechanism involved in reflex secretory dysfunctions. The use of dynamic isotopic techniques and their application in clinical research enable a more precise approach to be made to assist in solving the problem. Using several examples of dysfunction of various etiologies, the authors demonstrate the existence of an excretory blocking effect from parasympathetic inhibition.
The authors review the etiological, and therapeutic data obtained from a statistical study of a homogenous group of 50 patients after submandibular gland resections. The operation was conducted for calculi in the gland in 56% of cases, infections in 24% and for other causes in the few remaining cases, including 4% with glandular tumors. From the technical point of view, the two cutaneous approaches with section of the vessels and simple enucleation were able to be employed in 76% and 24% of the cases respectively; the ease with which cleavage was obtained being the main factor whatever the etiology. Wharton's duct must be systematically and completely removed when calculi are present. The indications for therapy can be summarized as follows: -- systematic operation on any suspicious tumor for which the etiology is not rapidly discovered, -- determining factors for operation are also infections, recurrences, and a posterior localization of the calculi, -- postoperative complications are minor and consist mainly of paresis of the VIIth cranial nerve, which always regressed in this series.
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Fine needle aspiration biopsy of the major salivary glands was performed on 160 patients. In 146 patients with satisfactory samples, the cytologic diagnosis was correlated with clinical follow-up and histologic findings. There were 122 benign lesions, including 47 tumors. There were 24 malignant lesions, 10 of which were primary and 14 metastatic. The overall accuracy was 98%. The sensitivity of the technique was 87.5%. There was no false-positive diagnosis. There were three false-negative diagnoses due to sampling errors and inexperience during the initial period of the study. This study documents that needle aspiration biopsy cytology of the salivary glands is accurate, simple, rapid, inexpensive, well tolerated and harmless to the patient.
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The results of 171 salivary gland fine-needle aspirates, with subsequent histologic correlation, were compared with those from previous head and neck series and analyzed for diagnostic accuracy. Cytologically, 118 cases were diagnosed as benign; 51, malignant; and two, insufficient for diagnosis. The false-negative rate was 4.7%, and the false-positive rate was 3.5%. Pleomorphic adenoma, mucoepidermoid carcinoma, chronic sialadenitis, and malignant lymphoma were the lesions most frequently misdiagnosed. Corresponding frozen sections (available in 38 cases) showed an exact correlation with the final surgical pathologic diagnosis in 58% of the cases, with no false-positive diagnoses but an 11% false-negative rate.
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