Quantitative Assessment of Salivary Gland Parenchymal Vascularization Using Power Doppler Ultrasound and Superb Microvascular Imaging: A Potential Tool in the Diagnosis of Sjögren's Syndrome

Background: Primary Sjögren's syndrome is a chronic inflammatory autoimmune disease. Minor salivary gland biopsy is the gold standard for the diagnosis of primary Sjögren's syndrome. Superb microvascular imaging, power Doppler ultrasound, and color Doppler of the salivary glands represent non-invasive, non-irradiating modality for evaluating the vascularity of the salivary glands in the diagnosis and follow-up of primary Sjögren's syndrome. Aims: To evaluate the efficacy of superb microvascular imaging and vascularity index in salivary glands for the sonographic diagnosis of primary Sjögren's syndrome. Study Design: Prospective case-control study. Methods: Twenty participants with primary Sjögren's syndrome and 20 healthy subjects were included in the study. Both parotid glands and submandibular glands were evaluated by superb microvascular imaging, power Doppler ultrasound, and color Doppler. The diagnostic accuracy of superb microvascular imaging was compared using these techniques. Results: In the patient group, the vascularity index values of superb microvascular imaging in parotid glands and submandibular glands were 3.5±1.66, 5.06±1.94, respectively. While the same values were 1.0±0.98 and 2.44±1.34 in the control group (p≤0.001). In the patient group, the vascularity index values of power Doppler ultrasound in parotid glands and submandibular glands were 1.3±1.20 and 2.59±1.82, respectively. While the same values were 0.3±0.32 and 0.85±0.68 in the control group (p≤0.001). The superb microvascular imaging vascularity index cut-off value for the diagnosis of primary Sjögren's syndrome in parotid glands that maximizes the accuracy was 1.85 (area under the curve: 0.906; 95% confidence interval: 0.844, 0.968), and its sensitivity and specificity were 87.5% and 72.5%, respectively. While the superb microvascular imaging vascularity index cut-off value for the diagnosis of primary Sjögren's syndrome in submandibular gland that maximizes the accuracy was 3.35 (area under the curve: 0.873; 95% confidence interval: 0.800, 0.946), its sensitivity and specificity were 82.5% and 70%, respectively. Conclusion: Superb microvascular imaging with high reproducibility of the vascularity index has a higher sensitivity and specificity than the power Doppler ultrasound in the diagnosis of primary Sjögren's syndrome. It can be a noninvasive technique in the diagnosis of primary Sjögren's syndrome when used with clinical, laboratory and other imaging methods.

Sialolipoma of the sublingual salivary gland in a dog ­ first report / Sialolipoma na glândula salivar sublingual em cão ­ primeiro relato

This report describes a 14-year-old Pit Bull dog presenting with a soft tissue swelling of 3-month progression in the right sublingual region. Histopathological analysis of the surgically resected specimen revealed large numbers of mature adipocytes and islets consisting of mucin-containing atrophic acini and dilated ducts surrounded by a thin fibrous capsule. Findings were consistent with sialolipoma of the sublingual salivary gland. To the authors' knowledge, this is the first case of sialolipoma affecting the sublingual salivary gland in dogs.(AU)

O presente relato descreve um cão Pit Bull, de 14 anos, com aumento de volume de consistência macia em região sublingual direita com evolução de 3 meses. Após excisão cirúrgica, a análise histopatológica revelou grande número de adipócitos maduros, tecido glandular composto por ductos dilatados e ácinos atróficos contendo mucina, circundados por fina cápsula fibrosa, achados compatíveis com sialolipoma da glândula salivar sublingual. Pelo conhecimento dos autores, este é o primeiro relato de sialolipoma acometendo glândula salivar sublingual em cão.(AU)

Effect of N-Acetylcysteine on Antioxidant Defense, Oxidative Modification, and Salivary Gland Function in a Rat Model of Insulin Resistance.

Oxidative stress plays a crucial role in the salivary gland dysfunction in insulin resistance (IR). It is not surprising that new substances are constantly being sought that will protect against the harmful effects of IR in the oral cavity environment. The purpose of this study was to evaluate the effect of N-acetylcysteine (NAC) on oxidative stress and secretory function of salivary glands in a rat model of insulin resistance. Rats were divided into 4 groups: C-normal diet, C + NAC-normal diet + NAC, HFD-high-fat diet, and HFD + NAC. We have demonstrated that NAC elevated enzymatic (superoxide dismutase, catalase, and peroxidase) and nonenzymatic antioxidants (reduced glutathione (GSH) and total antioxidant capacity (TAS)) in the parotid glands of HFD + NAC rats, while in the submandibular glands increased only GSH and TAS levels. NAC protects against oxidative damage only in the parotid glands and increased stimulated salivary secretion; however, it does not increase the protein secretion in the both salivary glands. Summarizing, NAC supplementation prevents the decrease of stimulated saliva secretion, seen in the HFD rats affected. NAC improves the antioxidative capacity of the both glands and protects against oxidative damage to the parotid glands of IR rats.

Stafne Bone Cavity Complicated By Periapical Infection.

Stafne bone cavity (SBC) is an uncommon lesion of the mandible; and generally found incidentally on routine radiographic examinations. The radiographic differential diagnosis of SBC includes a variety of lesions including odontogenic cysts, benign tumors, or bone metastases. In the present case, a 22-year female patient was admitted with chief complaint of pain in the right mandibular molar area. On panoramic radiographic examination, a non-specific large radiolucent lesion related to mandibular molar teeth was detected and extra-oral surgical intervention was planned. However, on examination with cone-beam CT(CBCT), a SBC was suspected due to lack of lingual cortical plate; and intraoral surgical exploration confirmed the diagnosis showing a cavity with small inflamed salivary gland tissue. Examination with CBCTon suspicious jaw lesions helps avoid unnecessary extraoral surgical interventions.

Hiperplasia adenomatoide de glândulas salivares menores: relato de dois casos / Adenomatoid hyperplasia of minor salivary glands: a report of two cases

A hiperplasia adenomatoide de glândulas salivares menores é uma lesão benigna rara que pode ser confundida com outras neoplasias de glândulas salivares. Apresenta-se como um pequeno nódulo firme ou como massa exofítica, geralmente indolor, com mucosa de aparência normal, levemente avermelhada ou azul. Histologicamente, observa-se a presença de agregados acinares relativamente normais e lóbulos da mucosa em maiores quantidades, causando aumento do volume e, por vezes, dor. Relato do caso: São relatatos dois casos de hiperplasia adenomatoide de glândula salivar menor, sendo um em menino de 12 anos de idade, em mucosa bucal esquerda, e o outro em mulher de 44 anos de idade em mucosa labial; uma revisão dos relatos anteriores já descritos na literatura também é apresentada. O aparecimento clínico do tumor é indistinguível em comparação com neoplasia da glândula salivar; assim, o exame patológico é essencial para o diagnóstico definitivo desta patologia. Nos dois casos descritos, o tratamento escolhido foi o acompanhamento clínico após diagnóstico; não foram observadas alterações no período de 2 anos desde a primeira consulta...

Adenomatoid hyperplasia of minor salivary glands is a rare benign lesion that can be mistakenly diagnosed as other types of salivary gland neoplasms. It presents as a small firm nodule or as an exophytic mass, usually painless with normal mucosa, and slightly red or blue. Histologically, aggregates of relatively normal acinar lobule mucosa can be seen in larger amounts than expected, causing increased volume and sometimes pain. Case report: This article describes two cases of adenomatoid hyperplasia of minor salivary glands, the first in the left buccal mucosa of a 12 year-old boy and the second in the labial mucosa of a 44 year-old woman, and a review of previous reports of this pathology in English literature. The clinical appearance of the tumor is indistinguishable from salivary gland neoplasms and pathological examination is therefore essential for definitive diagnosis of this pathology. In both cases the treatment chosen after diagnosis was follow up and no changes were observed over 2 years from the first appointment...

Bilateral submandibular gland aplasia with hypertrophy of the sublingual glands of a patient with a cleft lip and palate: case report.

Aplasia of major salivary glands is a rare disorder with only a handful of cases reported in the literature. The cause of congenital absence of the salivary glands has not been determined, but it may be associated with ectodermal defects of the first and second branchial arches. Patients may be asymptomatic or may experience dysphagia, xerostomia, several periodontal disease, or multiple caries. There are few reports of patients with congenital gland aplasia with cleft lip and palate. We document the case of a 41-year-old patient with repaired unilateral cleft lip palate, bilateral submandibular gland aplasia, and compensatory hypertrophy of the sublingual glands. To the best of our knowledge, there are no previous reports that can be found in the literature with a combination of such findings.

Obstrução respiratória causada por mucocele salivar faríngea em um cão / Respiratory obstruction caused by salivary mucocele pharyngeal in a dog

Conforme Dunnig (2007) não é recomendado o tratamento apenas por aspiração ou drenagem, devido à ocorrência de recidiva em poucos dias. A relevância clínica deste caso está relacionada à viabilidade da cricotireoidotomia para melhora da angústia respiratória e a utilização da técnica de marsupialização como tratamento eficaz, pois não ocorreu recidiva no caso relatado, embora a realização dessa técnica possa apresentar comprometimento da via aérea superior e possibilidade de disfunção da deglutição em caso de recidiva.

Incidencia de tumor de glándula parótida / Parotid gland tumor incidence

La patología tumoral de las glándulas salivares representa el grupo más heterogéneo y complejo de los procesos tumorales de cabeza y cuello. Su prevalencia en la literatura mundial es descrita en un 5% de todas las neoplasias de cabeza y cuello. El tumor de glándula parótida es el más frecuente presentándose en un 75% de los tumores de glándula salivares. Su evolución es asintomática, descrito en la sexta década de la vida, manifestándose con aumento de volumen de la zona, siendo más frecuentes los tumores benignos. Se realiza estudio retrospectivo y descriptivo en base a historia clínica. La población correspondió a 6 individuos, 66,66% al sexo masculino y un 33,33% al femenino. El tumor se localizó en un 83,3% a nivel de la glándula parótida derecha. El resultado anatomopatológico concluyó en un 50% de frecuencia para adenoma pleomórfico, Un 33,3% para quiste benigno y un 16,6% para linfoma no Hodgkin. Fueron encontrados 6 casos compatibles con el diagnóstico clínico y anatomopatológico de tumor de glándula parótida con predisposición en el sexo masculino y pacientes menores de 40 años. Las técnicas quirúrgicas empleadas para la resección del tumor fueron la parotidectomía total y subtotal. Los hallazgos anatomopatológicos correspondieron en un 50% para el adenoma pleomórfico, 33,3% para el quiste benigno. Presentándose en un porcentaje elevado en relación a la literatura el linfoma no Hodgkin con 16,6%.

The tumor like pathology of the salivary glands represents the most heterogeneous and complex group of the tumor like processes of head and neck. Its prevalence in worldwide literature is described in a 5% of all the tumors of head and neck. The tumor of parotid gland is most frequent appearing in a 75% of the salivary gland tumors. Its evolution is asymptomatic, described in the sixth decade of the life, pronouncing itself with increase of volume of the zone, being more frequent the benign tumors. Retrospective and descriptive studyon the basis of clinical history is realized. The population corresponded to 6 individuals, 66.66% to male sex and 33.33% to female. The tumor located in 83.3% concerning the right parotid gland. The anatomical pathology result conclude in a 50% of frequency for pleomorphic adenoma, a 33.3% for benign cyst and 16.6% for lymphoma non Hodgkin. We was found 6 compatible cases with the clinical diagnosis and anatomical pathology of tumor of gland parotid with predisposition in masculine sex and patient minors of 40 years the used surgical techniques for the resection of the tumor were parotidectomy total and subtotal. The ended results of the biopsy findings corresponded in a 50% for the pleomorphic adenoma, 33.3% for the benign cyst. Appearing in a percentage lifted in relation to literature lymphoma non Hodgkin with a 16.6%.

Bilateral aplasia of the major salivary glands and unilateral atresia of lacrimal duct.

Aplasia of the major salivary glands, especially the parotid gland, is a rare disorder. Up to now, few cases have been reported. Clinically, patients may present with xerostomia, irritable eyes, severe dental caries, or asymptomatic manifestations.According to clinical and radiologic findings, we reported a case of a 20-year-old girl with bilateral aplasia of the major salivary glands and unilateral atresia of the lacrimal duct and made telephone follow-up 1 year later.

Evaluación ultrasonográfica de las glándulas salivales y el piso de la boca / Ultrasound assessment of salivary glands and floor of mouth

Características principales de las glándulas salivales, y descripción de evaluaciones sonográficas adecuadas para optimizar su estudio, y detectar las patologías más frecuentes en el piso de la boca

Enfermedad de Mikulicz: reporte de un caso / Mikulicz disease: a case report

La enfermedad de Mikulicz, descrita por Johann von Mikulicz-Radecki en 1888, constituye una patología benigna que compromete de manera simétrica las glándulas lagrimales y salivares. Su causa es desconocida; sin embargo, se ha asociado con el síndrome de Sjõgren, pero la patogénesis de ambas entidades es distinta. En el síndrome de Mikulicz se ha observado un aumento de la concentración sérica de IgG4 e infiltración linfocitaria en las glándulas salivales y lagrimales. En cuanto al tratamiento, se ha demostrado una adecuada respuesta a los glucocorticoides, sobre todo en estadios tempranos de la afección. Se presenta el caso de una paciente femenina de 31 años, con un curso de siete años de evolución, caracterizado por crecimiento indoloro y progresivo de las glándulas lagrimales y submaxilares, sin xerostomía ni xeroftalmia. El estudio histopatológico evidencia infiltración linfoproliferativa benigna compatible con enfermedad de Mikulicz.

Mikulicz’s disease was described by Johann Von Mikulicz-Radecki in 1888, it is a benign condition that involves symmetrically lacrimal and salivary glands, its etiology is unknown. It has been associated with Sjogren’s syndrome, being the pathogenesis of both diseases different. It has been observed in Mikulicz syndrome an increased serum IgG4 and infiltration of abundant plasmatic cells in lacrimal and salivary glands. It has shown an adequate response to glucocorticoids especially in early stages of the disease. We report a case of a female patient 31 years old, with an evolution of 7 years of painless, progressive growth of the lacrimal glands and submaxillary gland without xerostomia or xerophthalmia. Histopathological examination shows benign lymphoproliferative infiltration compatible with Mikulicz disease.

Dacryocystorhinostomy precipitating keratoconjunctivitis sicca in aplasia of lacrimal and major salivary glands (ALSG).

We report a 16-month-old girl referred for bilateral epiphora and sticky eyes since birth. Examination revealed a refluxible left lacrimal sac mucocele, agenesis of the left lower punctum, and agenesis of both puncta on the right side. Complete bony obstruction was noted on probing of the left nasolacrimal duct. At 4 years of age, she underwent left external dacryocystorhinostomy (DCR) with silicone intubation because of chronic dacryocystitis. Her epiphora and stickiness improved significantly in the first postoperative year, but she subsequently developed dryness of the left eye, dry mouth, and dental caries. CT and MRI scans revealed the absence of the lacrimal and salivary glands. The clinical signs and symptoms improved with plugging the left upper punctum and topical lubricants. Aplasia of the lacrimal and salivary glands may present with symptoms of congenital lacrimal obstruction, and failure to make an early diagnosis will result in inappropriate lacrimal surgery and dry eye.

Complete congenital agenesis of all major salivary glands: a case report and review of the literature.

Congenital agenesis of the salivary glands is uncommon. There are documented cases of partial or unilateral aplasia of the major salivary glands associated with the lacrimal puncta, but very few reports of the absence of all major salivary glands. We report the case of a 10-year-old girl with xerostomia and extensive teeth caries. Physical examination and imaging showed total and bilateral aplasia of the parotid, submandibular, and sublingual glands, with no involvement of the minor salivary glands or the lacrimal puncta. We describe the clinical presentation, important aspects in diagnosing partial forms of the condition, and patient management.

A Stafne bone defect in the anterior mandible--a diagnostic dilemma.

Stafne bone defects are nonprogressive yet nonhealing bone cavities situated near the angle of the mandible. Rare locations include the anterior mandible and the ramus. In most instances, salivary gland tissue can be found in these defects, which are of unclear pathogenesis. The case of a unilateral Stafne bone defect in the anterior mandible is presented. A 46-year-old man presented in an oral-maxillofacial practice with two panoramic radiographs, taken in 2001 and 2008, showing a progressive radiolucent region overlying the apices of the lateral incisor, canine, and first premolar in the left mandible. The patient did not report any symptoms or pain in the region of the radiolucency. The differential diagnosis was odontogenic cyst or neoplastic lesion. Following surgical exploration, histology showed inflamed connective tissue, fatty tissue, striated muscle, bony fragments, and salivary gland tissue but no cystic or neoplastic lesion.

[The lacrimo-auriculo-dento-digital syndrome (LADD): case report and literature review]. / Síndrome lacrimo-auriculo-dento-digital (LADD): relato de caso e revisão da literatura.

Levy-Hollister or lacrimo-auriculo-dento-digital (LADD) syndrome is a rare entity with autossomic dominant inheritance occuring as an isolated form or affecting many family generations. Diagnosis is based on the identification of the lacrimal drainage system abnormalities with reduction or absence of tear production and bone, teeth, salivar glands and outer ear abnormalities. A 13 year-old male patient has been followed at the Hospital Servidor Público Estadual in São Paulo due to dry eye since his first year of life. Due to the occurrence of early ocular manifestations in patients with Levy-Hollister or lacrimo-auriculo-dento-digital syndrome, ophthalmologists must be aware to recognize and control this syndrome.

Síndrome lacrimo-auriculo-dento-digital (LADD): relato de caso e revisão da literatura / The lacrimo-auriculo-dento-digital syndrome (LADD): case report and literature review

A síndrome de Levy-Hollister ou lacrimo-auriculo-dento-digital (LADD) é uma síndrome rara, de herança autossômica dominante, podendo ocorrer de forma isolada ou em várias gerações de uma mesma família. O diagnóstico é feito por meio da identificação de anormalidades do sistema lacrimal, como redução ou ausência de produção de lágrimas, alterações ósseas, dentárias, de glândulas salivares e orelha externa. Trata-se de uma criança, de 13 anos, em acompanhamento no Hospital do Servidor Público Estadual de São Paulo desde os cinco meses de idade, com quadro clínico compatível com a síndrome, apresentando quadro de olho seco. Devido ao fato das manifestações oculares ocorrerem precocemente, sendo o oftalmologista um dos primeiros profissionais a ser procurado, o mesmo deve ter conhecimento da síndrome, a fim de diagnosticar e acompanhar adequadamente o indivíduo acometido.

Levy-Hollister or lacrimo-auriculo-dento-digital (LADD) syndrome is a rare entity with autossomic dominant inheritance occuring as an isolated form or affecting many family generations. Diagnosis is based on the identification of the lacrimal drainage system abnormalities with reduction or absence of tear production and bone, teeth, salivar glands and outer ear abnormalities. A 13 year-old male patient has been followed at the Hospital Servidor Público Estadual in São Paulo due to dry eye since his first year of life. Due to the occurrence of early ocular manifestations in patients with Levy-Hollister or lacrimo-auriculo-dento-digital syndrome, ophthalmologists must be aware to recognize and control this syndrome.

Presentación de un caso de tejido salival heterotópico cervical asociado con un quiste branquial / A case of salivary heterotopic tissue associated with branchial cyst

Las masas cervicales en los adultos jóvenes responden a adenopatías inflamatorias, malformaciones congénitas o menos frecuentemente a neoplasias. El tejido salival heterotópico es la presencia de tejido salival en un lugar anormal. Cuando tiene ubicación cervical puede encontrarse asociado con anomalías branquiales, al parecer por la relación que tienen ambos durante su embriogénesis. Por lo poco frecuente de esta asociación y no encontrarse publicado ningún caso en la literatura nacional, se decide la presentación del caso de una paciente joven con una masa cervical, con diagnóstico presuntivo de quiste branquial, que al intervenirla quirúrgicamente, se constata formación de aspecto glandular asociado con la lesión quística, con confirmación histopatológica de tejido salival heterotópico cervical asociado con quiste branquial. Se exponen además las posibles teorías de esta asociación según autores revisados en la literatura mundial y se confirma la importancia de tener en cuenta este diagnóstico ante una tumoración cervical para poder planear el tratamiento quirúrgico adecuado(AU)

In adult people cervical masses account for inflammatory adenopathies, congenital malformations or in a lesser degree to neoplasms. Heterotopic salivary tissue is the presence of salivary tissue in an abnormal place. When it has a cervical location may to be associated with branchial anomalies apparently by its relation (both) during the embryogeny. Due to the non-frequent of this association and the no publication of any case in national literature, we decide a case presentation of the case of a young patient with a cervical mass presumptively diagnosed with branchial cyst and in surgical intervention we noted a glandular development associated with the cystic lesion with histopathology confirmation of cervical heterotopic salivary tissue linked to branchial cyst. We showed also the potential theories of this association according the authors reviewed in world literature and we confirmed the significance of to take into account this diagnosis in case of a cervical tumor to plan the appropriate surgical treatment(AU)