Sjogrens Syndrome

Sjogren's syndrome is an inflammatory autoimmune disease that manifests as a chronic, slowly progressive disease characterized by keratoconjunctivitis sicca and xerostomia. Since 1965, it has been defined as a triad of dry eyes, dry mouth, and rheumatoid arthritis or other connective tissue diseases (Daniels 1991). This process may evolve from an exocrine organ-specific disorder to an extraglandular multisystem disease affecting the lungs, kidneys, blood vessels, and muscles (Table 6.1). These...

Mikuliczs Disease And The Benign Lymphoepithelial Lesion

The pathologic entity known as the benign lym-phoepithelial lesion was once referred to as Miku-licz's disease. The German surgeon Johann Mikulicz first described the benign lymphoepithelial lesion in 1888 in a report of a single case of lacrimal gland involvement (Daniels 1991). The lacrimal gland enlargement was followed by enlargement of the submandibular and parotid glands, as well as minor salivary gland tissue. The term Mikulicz's disease was subsequently applied to a variety of cases of...

Diagnostic Imaging of Salivary Gland Pathology

Normal Volume Parotid Gland

Introduction Imaging Modalities Computed Tomography (CT) CT Technique Advanced Computed Tomography Magnetic Resonance Imaging (MRI) MRI Technique Spin-Echo T1 Spin-Echo T2 Gradient Recalled Echo Imaging (GRE) Fluid Attenuation Inversion Recovery (FLAIR) Dynamic Contrast Enhanced Magnetic Resonance Imaging Other Magnetic Resonance Imaging Techniques Ultrasonography (US) US Technique Radionuclide Imaging (RNI) Positron Emission Tomography (PET) Positron Emission Tomography Computed Tomography...

References

Al-Qahtani K, Hier MP, Sultanum K, Black MJ. 2006. The role of submandibular salivary gland transfer in preventing xerostomia in the chemoradiotherapy patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101(6) 753-756. Ananthakrishnan N, Parkash S. 1982. Parotid fistulas A review. Br J Surg 69 641-644. Anne PR, Machtay M, Rosenthal DI et al. 2007. A phase II trial of subcutaneous amifostine and radiation therapy in patients with head and neck cancer. Int J Radiat Oncol Biol Phys 67(2)...

Submandibular Gland Tumors

Submandibular Incision With Name

As in all salivary gland tumors surgery is the primary modality of treatment. When the diagnosis is established preoperatively as benign PA by FNAB, then an extracapsular excision of the sub-mandibular gland is indicated (Figures 9.6 and 9.7). Pleomorphic adenomas should be treated in the same manner as for the parotid gland (see chapter 8). There is some evidence that the capsule of PAs in the submandibular gland is thinner than in the parotid (Webb and Eveson 2001), and it is important to...

Adenoid Cystic Carcinoma Parotid Mr

Parotid Acinic Cell Carcinoma Pet Scan

CT scan of large superficial lobe tumor in 22-year-old woman. Figure 8.11c. Complete parotidectomy. The facial nerve was not involved. The reported survival related to stage varies between authors, which may reflect differences in therapy as well as different patterns of histopathol-ogy. Luukkaa, Klemi, and Leivo et al. (2005) found Figure 8.11b. Clinical appearance the tumor has no signs of malignancy. Figure 8.11b. Clinical appearance the tumor has no signs of malignancy. Figure...

Diagnosis

Images Scans The Neck With Lump

The diagnosis of a tumor of the parotid gland will be dependent upon the history, clinical examination, imaging, and fine needle aspiration biopsy (FNAB). In most cases the history will be of a painless slow-growing lump that the patient had been aware of for some months or even years, and that was noticed initially when shaving, washing, or applying makeup. Occasionally the patient will report a rapidly growing mass, but this is not always a malignancy, as a long-standing retroman-dibular...

Sialosis

Sialosis, also known as sialadenosis, represents a bilateral enlargement of the parotid gland that is multifactorial in its etiology (Table 6.3). It is not commonly associated with an autoimmune phenomenon, as is the case for Sjogren's syndrome and sarcoidosis, although it can easily be confused with these two pathologic processes due to its clinical presentation (Figure 6.14). Quite commonly, sialo-sis is caused by nutritional disturbances such as alcoholism, bulimia, or in the rare case of...

Diagnosis Of Sarcoidosis With Salivary Gland Biopsy

Natural Medicine For Sarcoidosis

As with Sjogren's syndrome diagnoses with salivary gland biopsies, early stage disease is perhaps more readily diagnosed with a parotid biopsy rather than a minor salivary gland biopsy. It has been pointed out that cases of sarcoidosis that do not clinically produce parotid enlargement nonetheless show involvement at the microscopic level (Marx 1995). In this review, the labial biopsy was positive in 38 of cases while 88 of parotid biopsies were positive for sarcoidosis. The lesions of...

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Teeth With Divergent Roots

Computerized tomograms were obtained that identified destruction of bone by the cancer. Figure 10.12d. The maxillectomy specimen delivered. Figure 10.12f. The large ablative defect. Figure 10.12h. At 1 year postoperatively, the patient showed no signs of recurrent disease. Figure 10.12f. The large ablative defect. Figure 10.12h. At 1 year postoperatively, the patient showed no signs of recurrent disease. The surgical treatment of polymorphous low-grade adenocarcinoma of the upper...

Hereditary and Congenital Conditions

Aplasia of one or all of the major salivary glands is a rare condition that may present with severe xerostomia, rampant caries, candidiasis, pharyngitis, and laryngitis. In addition, dental chipping (Mandel 2006) and recurrent herpes labialis (Heath, McCleod, and Pearce 2006) have been described as presenting signs of salivary gland aplasia. The condition may occur as part of a recognized syndrome, associated with other congenital anomalies, or as an isolated phenomena. Aplasia of the lacrimal...

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Fused PET CT confirms positive node in the parotid gland. Figure 11.15d. Incision allows wide access down to level III of the neck. Figure 11.15e. Postoperatively the patient has no nerve weakness. Figure 11.15e. Postoperatively the patient has no nerve weakness. O'Brien, McNeil, and McMahon et al. (2002), two recent studies have been published. One series of 67 patients from New Zealand found again that the extent of parotid disease was an independent prognostic factor and that...

Parotid Gland Tumour Mri Radiology

Dirty Fat Sign

Axial CT scan (a) and corresponding PET scan (b) at the level of the parotid gland. Note the asymmetric slightly higher uptake on the right corresponding to partially resected parotid gland on the left, confirmed by CT. into the substance of the gland. The parotid duct emanates from the superficial anterior part of the gland and is positioned along the superficial surface of the masseter muscle. Along the anterior aspect of the masseter muscle the duct turns medially, posterior to...

Clinical Manifestations Of Sjogrens Syndrome

Most patients with Sjogren's syndrome develop symptoms related to decreased salivary gland and lacrimal gland function. Primary Sjogren's syndrome patients generally complain of dry eyes, often described as a sandy or gritty feeling under the eyelids. Other symptoms such as itching of the eyes, eye fatigue, and increased sensitivity to light can accompany the primary symptoms. Many of these symptoms are due to the destruction of corneal and bulbar conjunctival epithelium and come under the...

The Cellular Classification Of Salivary Gland Neoplasms

Salivary gland neoplasms are noted for their histological variability. Reflecting the anatomy of these glands, benign and malignant salivary gland neoplasms may arise either from epithelial, mesenchymal, or lymphoid origins. The complexity of the classification and the rarity of some of these tumors, some of which display a wide spectrum of morphological patterns within the same tumor and the existence of hybrid lesions, challenge the surgical pathologist with a difficult task in...

Surgical Management

Superficial Parotid

The basic surgical procedure is the superficial parotidectomy in which the superficial lobe of the parotid is removed, preserving the facial nerve unless it is directly infiltrated by the tumor. The author's usual incision is the modified Blair or lazy S. The skin flap is elevated in a plane through the subcutaneous fat superficial to the parotid capsule (Figure 8.4). Recently the use of a face lift incision has been advocated to improve esthetic results of the scar (Honig 2005 Menin-gaud,...

Yamamoto Cranioacupuncture Paris

Infected Salivary Gland Scan

Axial PET scan corresponding to the case illustrated in Figure 2.76. The mass in the right parotid gland (arrow) is hypermetabolic. Also note two foci of intense uptake corresponding to inflammatory changes in the tonsils. Figure 2.78. Axial contrast enhanced CT scan through the parotid glands demonstrating a large mass of heterogenous density and enhancement partially exophytic from the gland. Metastatic squamous cell carcinoma from the scalp was diagnosed. Figure 2.78. Axial...

Tumors of Salivary Gland Lymph Nodes

Lymph Node Tumor Forehead

Primary lymphoma of the salivary glands is rare. Eighty percent of lymphomas of the salivary glands are found in the parotid gland and 20 in the submandibular gland, with only case reports of sublingual and minor gland involvement (Eraso, Lorusso, and Palacios 2005) (Figure 11.10). Other authors have found a higher incidence of submandibular involvement (39 ) (Dunn, Kuo, and Shih et al. 2004). In 121 parotid tumors 8.3 were lymphomas (Shine, O'Leary, and Blake 2006), and in 51 submandibular...

Diagnosis Of Sjogrens Syndrome With Salivary Gland Biopsy

Parotid Incision Biopsy

Incisional biopsy of minor salivary glands was introduced as a clinical diagnostic procedure for Sjogren's syndrome in 1966. Many studies since that time have examined the value of this biopsy procedure (Marx, Hartman, and Rethman 1988). One study graded inflammation in labial salivary gland biopsy specimens from patients with various rheumatologic diseases and in postmortem specimens (Chisolm and Mason 1968). A grading scheme of lymphocytes and plasma cells per 4 mm2 was established and has...

Clinical Manifestations Of Sarcoidosis

Sarcoidosis Submandibular Gland

Sarcoidosis occurs most commonly in American blacks and northern European Caucasians. It is eight times more common in American blacks than American Caucasians (Hellmann 1993). Women are affected slightly more frequently than men. Patients with sarcoidosis generally present with one of the following four problems respiratory symptoms such as dry cough, shortness of breath, and chest pain (40-50 ) constitutional symptoms such as fever, weight loss, and malaise (25 ) extrathoracic inflammation...