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The authors describe a case of adenomatoid hyperplasia of a minor salivary gland. On the basis of the literature, they discuss the clinical, diagnostic and therapeutic aspects and dwell upon the value of the histologic examination as the only way to achieve a correct diagnosis, because the lesion cannot be clinically discriminated from the tumoral lesions.
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This discussion is a brief review of the current status of sialography and salivary gland scanning in the diagnosis of salivary disorders. Both techniques are in current use; the contrast sialogram is most useful in evaluating recurrent inflammatory disorders, and the radiosialogram finds its greatest value in evaluating patients with suspected neoplasms. These examinations should not be used in lieu of a histologic diagnosis in tumor cases except when a smooth margined radiopositive lesion corresponding with a clinically evident Warthin tumor is noted; in this case a presumptive diagnosis of a benign neoplasm may be established. The utilization of these radiographic techniques depends upon the facilities available, the needs of the particular patient, and the experience and clinical judgment of the salivary gland surgeon.
AIM: The aim of this study was to evaluate possible deterioration of salivary gland function due to radioiodine therapy with low activities using standardized quantitative salivary gland scintigraphy (qSZ). In addition, the prevalence of sialopathies was estimated in patients with thyroid dysfunction. METHODS: Prior to routine thyroid scintigraphy qSZ was performed after i.v. injection of 36-126 MBq 99mTc-pertechnetate, and both uptake and excretion fraction were calculated as a measure of parenchymal function and saliva excretion, respectively 312 healthy patients served as reference for a normal data base. 144 patients underwent qSZ prior to and 3 months after radioiodine therapy. Results of qSZ in another 674 thyroid patients were evaluated for determining the prevalence of salivary gland dysfunction. RESULTS: Normal uptake was 0.45 +/- 0.14% and 0.39 +/- 0.12%, and normal excretion fraction amounted to 49.5 +/- 10.6% and 39.1 +/- 9.2% in parotid and submandibular glands, respectively. Despite salivary gland stimulation with ascorbic acid during radioiodine therapy a significant activity-related functional impairment of 14-90% could be measured after application of 0.4-24 GBq of 131I. Prevalence of pretreatment sialopathies was 77/674 = 11.4% in single glands, and there was a global salivary gland functional impairment in 52/674 = 7.7%. CONCLUSION: Together with thyroid scintigraphy qSZ is an easy to perform examination without additional radiation burden. It can be recommended in all patients prior to and after radioiodine therapy both in order to quantify and to document possible parenchymal impairment induced even by low activities of 131I.
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There are numerous methods described in the literature for sialocele treatment. Surgical modalities usually involve an operation with possible facial nerve injury, with the risk of a general anesthetic, and with prolonged hospitalization to be considered. Among non-surgical modalities radiation and laissez-faire are of questionable efficacy. Propantheline bromide, which medically interrupts the parasympathetic control of salivary secretion, has proved a safe, effective means of rapid sialocele control.
Fine-needle aspiration is increasingly used in community practices for the diagnosis of salivary gland lesions, and it often renders an unequivocal diagnosis. This chapter discusses in detail the technical considerations of FNA, non-neoplastic and inflammatory conditions, benign neoplasms, common malignant neoplasms, and rare malignant neoplasms.
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Intraoral minor salivary gland carcinomas are relatively uncommon. The glands are concentrated in the mucosa of the mouth but occur over a wide area in the head and neck region. Little is known about the etiologic factors responsible for these tumors. Histologically, most salivary gland tumors are similar to those occurring in the parotid gland, but are more likely to be malignant. The most common presentations is an asymptomatic submucosal mass on the palate in a patient in the fifth or sixth decade, although it can occur in any age group. Neck node metastases occur in about one fourth of these patients. Surgical resection is the treatment of choice; irradiation may be a useful adjunctive method of palliation. Multiple recurrences over a long period of time are the rule, with 5 year survival for all malignant lesions being 44.5 per cent. The survival decreases another 10 per cent for each succeeding 5-year period of follow-up.
Morphological changes of tissues in patients with macrocheilia or so-called "double lip" are described. These changes refer this abnormality to teratomas. Surgical treatment of the condition is discuss.
Cheilitis glandularis is reported in two farmers with characteristic clinical and histopathological features. Both patients were treated with vermilionectomy. The prognosis was good.
The case is pointing to two remarkable facts: 1. Sjögren's syndrome may also be proceeding--without demonstrating any inflammatory rheumatic symptoms--with an isolated pulmonary fibrosis, as it had been evident in another case mentioned. 2. In certain circumstances, it may be considerably difficult to differentiate, with reliable certainty, the morphological changes in the salivary gland from those of a malignant lymphoma. Besides, also in literature there are reports concerning malignant degeneration turning into malignant lymphomata [1,8] in cases of Sjögren's syndrome.
Disorders of the salivary glands range from common inflammatory and functional conditions, to rare types of neoplasms. An overview and update of selected, common non-neoplastic and neoplastic conditions is presented.
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The vast field encompassed by the non-tumorous diseases of the salivary glands poses difficult problems for their diagnosis and therapy. In order to facilitate comprehension of the pathological processes and the therapeutical possibilities for their treatment, physiological and biochemical aspects of salivary gland function are presented in the introduction. There are also mentioned in detail most of the diagnostic methods clinically applied today and stress is laid on their respective diagnostic values. In contrast to the opinion of many authors, exploratory excision and puncture are shown to be very important diagnostic tools in salivary gland pathology. The specific application of these methods is often the only means for a reliable diagnosis. The classification of the diseases follows Seifert's (1971) proposal. The chronic diseases of the salivary glands are specifically mentioned with the chronic recurrent and the chronic myoepithelial sialoadenitis taking first place. The sialoses are presented in a larger chapter. An attempt was made to correlate clinical and experimental results, to establish working hypotheses concerning the development of sialoses, to suggest therapeutical possibilities and, last not least, to give an idea of the many clinical and patho-anatomical difficulties to be overcome for a satisfactory understanding of such pathological processes. Finally, various forms of salivary gland fistulas and their treatment are mentioned. The long list of references merely gives an approximation of the abundance of publications dealing with the problems of this field.