The emergence of sialoendoscopy has fundamentally altered and has played a huge role in the diagnosis and treatment of salivary gland diseases. However, nationwide, the number of oral and maxillofacial surgeons skilled in the use of sialoendoscopy is very small, which limits its further promotion and application. No standardized training program is currently available for sialoendoscopy in domestic stomatology colleges, and the content and assessment standards of relevant training needs further improvement. Based on relevant clinical and teaching experience, this paper emphasizes the important role of clinical application and skill training for sialoendoscopy, with the aim of promoting the popularization and development of sialoendoscopic therapy.
Humans ; Endoscopy/methods* ; Clinical Competence ; Salivary Gland Diseases/diagnosis*

Necrobiotic xanthogranulomatous reaction is a multiorgan, non-Langerhans cell histiocytosis with an unknown etiology. Occurrence in the salivary gland is extremely rare. We recently identified a case of necrobiotic xanthogranulomatous sialadenitis in a 73-year-old Korean woman who presented with a painless palpable lesion in the chin. There was no accompanying cutaneous lesion. Partial resection and subsequent wide excision with neck dissection were performed. Pathological examination showed a severe inflammatory lesion that included foamy macrophages centrally admixed with neutrophils, eosinophils, lymphocytes, plasma cells, and scattered giant cells, as well as necrobiosis. During the 12-month postoperative period, no grossly remarkable change in size was noted. Necrobiotic xanthogranulomatous inflammation may be preceded by or combined with hematologic malignancy. Although rare, clinicians and radiologists should be aware that an adhesive necrobiotic xanthogranuloma in the salivary gland may present with a mass-like lesion. Further evaluation for hematologic disease and close follow-up are needed when a pathologic diagnosis is made.
Adhesives ; Aged ; Chin ; Diagnosis ; Eosinophils ; Female ; Follow-Up Studies ; Giant Cells ; Hematologic Diseases ; Hematologic Neoplasms ; Histiocytosis ; Humans ; Inflammation ; Lymphocytes ; Macrophages ; Neck Dissection ; Necrobiotic Disorders ; Necrobiotic Xanthogranuloma ; Neutrophils ; Plasma Cells ; Postoperative Period ; Salivary Glands ; Sialadenitis ; Skin ; Submandibular Gland

PURPOSE: Although Sjögren's syndrome (SS) is the most common disease causing xerostomia, autoimmune thyroid diseases can also affect the salivary glands. The aim of our study was to estimate the prevalence of thyroid diseases (TD) in subjects with symptoms of xerostomia and evaluate the efficacy of salivary gland scintigraphy (SGS) in the detection of TD in patients with SS and without SS.METHODS: We retrospectively reviewed the SGS findings of 173 subjects (men:women, 29:144) with symptoms of xerostomia. Ejection fractions (EF) in the parotid and submandibular glands were calculated. Thyroid disease was diagnosed on the basis of the results of the visual assessment of tracer uptake in the thyroid gland on SGS images as well as serological thyroid function tests.RESULTS: Based on the American-European Criteria, 94 patients were diagnosed with SS. Hashimoto's thyroiditis was diagnosed in 63 patients, subacute thyroiditis in 23, subclinical hypothyroidism in five, and Graves' disease in one. There were significant differences in the EF values of the parotid and submandibular glands between patients with TD and those with undetermined diagnoses.CONCLUSIONS: More than half of patients with xerostomia exhibited TD. Thyroid assessment by SGS is feasible, and SGS appears to be useful for the patients with xerostomia caused by TD. SGS may be the first imaging modality capable of evaluating both salivary gland function and thyroid gland status in patients with xerostomia. This strategy would make the requirement for additional workup for thyroid disease.
Diagnosis ; Graves Disease ; Humans ; Hypothyroidism ; Prevalence ; Radionuclide Imaging ; Retrospective Studies ; Salivary Glands ; Submandibular Gland ; Thyroid Diseases ; Thyroid Function Tests ; Thyroid Gland ; Thyroiditis ; Thyroiditis, Subacute ; Xerostomia

OBJECTIVETo investigate the value of 3D FIESTA sequence in magnetic resonance sialography (MRS) in the diagnosis of obstructive salivary diseases.

METHODSEleven patients with obstructive salivary diseases underwent MRS, and three-dimensional (3D) reconstruction and virtual endoscopic images of the salivary gland ducts were obtained after MRS data post-processing for comparison with those of sialoendoscopy.

RESULTSThe diagnostic accuracy of MRS was 72.7% for obstructive salivary diseases. The virtual endoscopy provided a visual field highly consistent with that by sialoendoscopy.

CONCLUSIONMRS is capable of visualizing the tracts of salivary glands. MR virtual endoscopy can provide sufficient morphological and pathological data for preoperative assessment of salivary operations with sialoendoscopy.

Adult ; Constriction, Pathologic ; diagnosis ; Female ; Humans ; Imaging, Three-Dimensional ; methods ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Parotid Diseases ; diagnosis ; pathology ; Salivary Ducts ; pathology ; Salivary Gland Calculi ; diagnosis ; Salivary Gland Diseases ; diagnosis ; pathology ; Sialography ; methods ; Submandibular Gland Diseases ; diagnosis ; pathology ; Young Adult

Salivary duct lithiasis is a condition characterized by the obstruction of a salivary gland or its excretory duct due to the formation of calcareous concretions or sialoliths resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland. It most commonly involves submandibular gland (80 to 90%) and less frequently parotid (10 to 20%). The authors report 2 cases of parotid sialolithiasis. The first case involved a 46-year-old male patient complaining of the left parotid area pain and swelling, and presenting with a salivary calculus in the left parotid duct. When the patient was diagnosed, he refused surgical removal. The second case involved a 41-year-old male patient complaining of the right parotid area pain and swelling, and presenting with a salivary calculus in the right parotid duct. The sialolith was surgically removed under general anesthesia. In this paper, we also reviewed a series of concepts related to the etiology, diagnosis and treatment of sialolithiasis.
Adult ; Anesthesia, General ; Diagnosis ; Dilatation, Pathologic ; Humans ; Lithiasis ; Male ; Middle Aged ; Parotid Diseases ; Salivary Calculi ; Salivary Duct Calculi ; Salivary Ducts ; Salivary Gland Calculi* ; Salivary Glands ; Submandibular Gland

BACKGROUND AND OBJECTIVES: Fine-needle aspiration biopsy (FNAB) has been used as a diagnostic instrument in patients with salivary gland lesions. This article is aimed at defining the exact role of FNAB in the diagnostic workup of patients. MATERIALS AND METHOD: A retrospective study design was used to evaluate the accuracy of FNAB for salivary gland diseases. From January 1997 to June 2004, FNABs, confirmed histologically after surgery, were carried out on 419 patients with salivary gland diseases. Cytopathologic and histologic findings were categorized as malignant, suspicious, benign neoplastic, or nonneoplastic. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of FNAB were calculated using histologic diagnosis of the surgical specimen as the criterion standard. RESULTS: FNAB was performed in all of 419 salivary gland lesions undergoing surgical procedures. A total of 321 lesions were in the parotid gland and 98 in the submandibular gland. There were 417 FNAB specimens (99%) that were satisfactory for evaluation. The FNAB diagnosis of malignant or suspicious lesions had positive and negative predictive values of 77% and 91%, respectively. Fine-needle aspiration biopsy diagnosis of a benign neoplasm had positive and negative predictive values of 93% and 77%, respectively. A cytopathologic diagnosis of a nonneoplastic lesion was predictive in only 59% of the cases. CONCLUSION: Although an FNAB diagnosis of malignant or neoplastic major salivary gland disease is generally predictive of the final histologic diagnosis, the predictive value of a negative FNAB finding is low. A negative FNAB finding should not supersede clinical judgment in the management of a clinically suspected malignant or neoplastic lesion of the major salivary glands.
Biopsy* ; Biopsy, Fine-Needle* ; Biopsy, Needle ; Diagnosis ; Humans ; Judgment ; Parotid Gland ; Retrospective Studies ; Salivary Gland Diseases* ; Salivary Glands* ; Sensitivity and Specificity ; Submandibular Gland

OBJECTIVETo evaluate the value of sialoendoscopy in the diagnosis and treatment of chronic obstructive sialadenitis (COS).

METHODS25 patients (34 sides) who complained of recurrent swelling in the salivary gland region were selected for study from Jan. 2003 to Jun. 2003 at the Department of salivary gland diseases, School of Stomatology, Wuhan University, including 19 parotid cases (27 sides) and 6 submandibular gland cases (7 sides); 16 females and 9 males. And their age range was 17 - 77 years, with an average of 43.72 years. Before sialoendoscopy, 22 parotid cases underwent sialography, and 3 submandibular gland sialoliths cases received an additional standard mandibular occlusal film examination.

RESULTSConventional radiographs revealed that 3 cases had submandibular gland radiopaque stones, and 22 had COS. Dilatation of main duct of parotid and submandibular gland were also found in the radiographs. Sialoendoscopy showed: proliferative fibrous materials in the duct; stenosis or dilatation of duct; vasodilatation, erythema on the wall of the duct; mucoid plugs and pyogenic plugs; irregular lumen shape; radiopaque and radiolucent stones.

CONCLUSIONSSialoendoscopy may be a safe, effective, and minimal invasive method in the diagnosis and treatment of COS.

Adolescent ; Adult ; Aged ; Chronic Disease ; Endoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Salivary Gland Diseases ; diagnosis ; therapy ; Young Adult

BACKGROUND AND OBJECTIVES: Tuberculosis of salivary gland is a rare disease but it must be considered in the context of the patient presenting the salivary gland mass. The purpose of this study is to investigate the clinical characteristics of a major salivary gland tuberculosis by determining the diagnostic usefulness of the radiographic, histopathologic, microbiological and molecular biologic evaluations. SUBJECTS AND METHOD: Eight patients diagnosed as having major salivary gland tuberculosis between June 1998 and June 2004 were treated at three tertiary referral centers. Medical records, including imaging, microbiological tests, M. tuberculosis polymerase chain reaction (PCR), and histopathology results were retrieved retrospectively and the literature was reviewed. RESULTS: Parotid glands and submandibular glands were involved in five (62.5%) and three (37.5%) cases, respectively. Neck CT demonstrated typical findings of salivary gland tuberculosis in three patients (37.5%). Fine needle aspiration cytology (FNAC) revealed chronic inflammation in six of seven patients (85.7%), two of which showed caseous necrosis, strongly suggesting tuberculosis (2/6, 33.3%). Five of the eight patients (62.5%) required resection of the affected gland and three (37.5%) received open biopsy. PCR was performed in half of the cases, all of which were affirmative. No significant difference was found between surgically resected and non-resected groups in terms of treatment results or morbidity. All patients received anti-tuberculous chemotherapy for 8 to 12 months with no disease recurrence. CONCLUSION: Tuberculosis of the salivary gland is mostly a medically curable disease entity. In cases with high index of suspicion, FNAC coupled with PCR may become an effective and alternative diagnostic tool for salivary gland tuberculosis. This diagnostic approach should be considered before surgical intervention for the differential diagnosis of salivary gland tumor.
Biopsy ; Biopsy, Fine-Needle ; Diagnosis* ; Diagnosis, Differential ; Drug Therapy ; Humans ; Inflammation ; Medical Records ; Neck ; Necrosis ; Parotid Gland ; Polymerase Chain Reaction ; Rare Diseases ; Recurrence ; Retrospective Studies ; Salivary Glands* ; Submandibular Gland ; Tertiary Care Centers ; Tuberculosis*

BACKGROUND AND OBJECTIVES: Obstructive lesion of salivary glands by salivary duct calculi and stenosis is the main inflammatory disease of major salivary glands. Recently, the sialendoscopy has been introduced for the diagnosis and intervention of salivary ductal disease. The purpose of this study is to assess the efficacy of the sialendoscopy for the treatment of inflammatory salivary gland diseases. SUBJECTS AND METHOD: Diagnostic and interventional sialendoscopy were performed in 19 patients (7 parotid glands, 12 submandibular glands), who had salivary duct calculi or recurrent sialadenitis without calculi from 2003 Sep. to 2004 Jun. Diagnostic sialendoscopy was performed for obstructive lesions and evaluation of ductal status. Interventional sialendoscopy was performed for the removal of salivary duct calculi and dilatation of duct stenosis in cases with calculi and stenosis. RESULTS: Diagnostic sialendoscopy was performed in all cases successfully. Sixteen glands had obstructive lesions and 3 glands had sialadenitis with no evidence of obstruction. Only one case with salivary duct calculi was failed. The remaining 10 calculi were removed with microforceps and basket with or without laser fragmentation. The average size of sialoliths was 5.2 mm and multiple stones were found in 2 cases. Five cases with stenosis of parotid and submandibular gland duct were dilated with balloon catheter or endoscopy sheath successfully. In the remaining 3 glands with no obstruction, the finding of ductal inflammation was identified. No major complications were noted. CONCLUSIONS: Diagnostic sialendoscopy is a new and minimal invasive technique for complete exploration of ductal system and evaluating salivary duct disease. Interventional sialendoscopy allows the extraction of salivary duct calculi in most cases and the dilatation of stenotic duct. This technique might be useful in preventing open gland surgery in well indicated cases.
Calculi ; Catheters ; Constriction, Pathologic ; Diagnosis* ; Dilatation ; Endoscopy ; Humans ; Inflammation ; Parotid Gland ; Salivary Duct Calculi ; Salivary Ducts ; Salivary Gland Calculi ; Salivary Gland Diseases* ; Salivary Glands* ; Sialadenitis ; Sialography ; Submandibular Gland

Low-grade B cell mucosa-associated lymphoid tissue (MALT) lymphoma makes up 8% of non-Hodgkin's lymphomas. It has been characterized by a prolonged clinical course and persistent disease at the site of origin. Most patients with low-grade B cell MALT lymphoma occur in the stomach, orbit, intestine, lung, thyroid, salivary gland, skin, soft tissues, bladder, kidney, and central nervous system. The diagnosis of MALT lymphoma can be established by a characteristic finding of infiltration of small lymphocytes that are monoclonal B cell and CD5 negative. Bone marrow involvement seems uncommom but has been developed. Waldenstr m's macroglobulinemia (WM) is usually defined as bone marrow infiltration of lymphoplasmacytoid lymphocytes with a high level of circulating macroglobulin IgM. Lymphadenopathy and splenomegaly occurs in 20~40% of WM. It is very hard work to do differential diagnosis between disseminated low-grade B cell MALT lymphoma and WM with organ involvement by a bone marrow examination. We reprot one case of low grade mediastinal MALT lymphoma with bone marrow involvement and a high level of serum monoclonal IgM with clinical appearance of WM.
Bone Marrow ; Bone Marrow Examination ; Central Nervous System ; Diagnosis ; Diagnosis, Differential ; Humans ; Immunoglobulin M ; Intestines ; Kidney ; Lung ; Lymphatic Diseases ; Lymphocytes ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Lymphoma, Non-Hodgkin ; Mediastinum* ; Orbit ; Salivary Glands ; Skin ; Splenomegaly ; Stomach ; Thyroid Gland ; Urinary Bladder ; Waldenstrom Macroglobulinemia*