Case of Suspected Sialodochitis Fibrinosa (Kussmaul's Disease).

Here we report a case of Kussmaul's disease, or sialodochitis fibrinosa. This rare disease is characterized by recurrent swelling of the salivary glands, which then discharge clots of fibrin into the oral cavity. An 80-year-old man with a history of allergic rhinitis visited our department with the chief complaint of pain in the bilateral parotid gland area on eating. An initial examination revealed mild swelling and tenderness in this region, and indurations could be felt around the bilateral parotid papillae. Pressure on the parotid glands induced discharge of gelatinous plugs from the parotid papillae. No pus was discharged, and there were no palpable hard objects. Panoramic X-ray showed no obvious focus of dental infection, and there was no calcification in the parotid gland region. Magnetic resonance imaging revealed segmental dilatation of the main ducts of both parotid ducts, with no signs of displacement due to sialoliths or tumors, or of abnormal saliva leakage. Two courses of antibiotic therapy resulted in no improvement. During treatment, gelatinous plugs (fibrin clots) obstructing the left parotid duct were dislodged by massage, which prevented further blockage by encouraging salivary outflow. The obstruction persisted in the right parotid duct, however. Therefore, the distal portion of the right parotid duct was partially resected and the opening into the mouth enlarged, which, in combination with massage, prevented further obstruction. The pain and swelling of the parotid gland and discharge of gelatinous plugs improved, with no further recurrence at 12 months postoperatively. This case is presented along with a review of the relevant literature.

Salivary Duct Carcinoma of the Parotid: Outcomes with a Contemporary Multidisciplinary Treatment Approach.

OBJECTIVE: Salivary duct carcinoma (SDC) is a rare and aggressive malignancy for which an optimal treatment algorithm is lacking. We endeavored to assess the current treatment outcomes for SDC with a multimodality treatment approach combining surgery with adjuvant radiotherapy ± concurrent chemotherapy. STUDY DESIGN: Case series with chart review. SETTING: A National Cancer Institute-designated comprehensive cancer center. SUBJECTS AND METHODS: The clinical record of 17 patients with salivary duct carcinoma were analyzed to assess locoregional control, recurrence-free survival, and overall survival. RESULTS: All SDC cases (n = 17) were managed with surgical resection, followed by adjuvant radiotherapy (47.1%) or concurrent chemotherapy and radiotherapy (52.9%). Median patient follow up was 37 months. An aggressive disease course was generally observed, with 3-year recurrence-free survival and overall survival of 34.4% and 35.5%, respectively. The majority of recurrences were distant. Intensification with adjuvant concurrent chemotherapy was not associated with improved outcomes on univariate survival analysis. CONCLUSION: For salivary duct carcinoma, a multimodality treatment approach is associated with acceptable locoregional control rates but poor distant control and overall survival. Novel systemic therapies may be needed to optimize clinical outcomes.

Conservative management of bilateral pneumoparotitis with sialendoscopy and steroid irrigation.

Pneumoparotitis is a rare condition related to retrograde airflow into the ductal system of the gland and secondary infections. Although counselling is enough in the majority of cases, persistent problems require surgery. Sialendoscopy and ductal irrigation with steroids have never been described as a treatment option. We present the case of a 61-year-old man with recurrent bilateral parotid swellings who had three episodes of sialadenitis on the right side within 2 years. Massage of the glands revealed air bubbles coming out from both papillae. A previous CT scan confirmed the presence of air in both parotid glands. The patient underwent sialendoscopy and irrigation of the ductal system with prednisolone. Ductal irrigation with steroids in three additional sessions led to a significant improvement of symptoms 6 months later. Sialendoscopy and irrigation with steroids could be another treatment modality in cases of recurrent pneumoparotitis avoiding major surgery.

Evaluation of protective effect of propolis on parotid salivary glands in gamma-irradiated rats.

OBJECTIVE AND BACKGROUND: One of the most significant side effects of radiotherapy for head and neck cancers is xerostomia as a result of salivary gland damage. Considering pharmaco- logical effects of propolis, we evaluated its protective effect on salivary glands subjected to radiotherapy of head and neck cancer patients. MATERIALS AND METHODS: Twenty-one male albino rats (8-11 W, 190 ± 5 gm) were divided into three groups of seven animals. Scintigraphy was performed in all the groups. Then groups 1 (S) and 2 (SR) received normal saline injections and group 3 (PR) received propolis injection over 3 days. After that groups 2 and 3 were exposed to gamma radiation and all the rats underwent scintigraphic assessment on third day and 70th day after irradiation. The lips and tongues of rats in groups 2 and 3 were examined for mucositis daily in first 10 days. At the end, the parotid glands of all rats were examined histologically. RESULTS: Scintigraphy results of third and 70th day after irradiation showed statistically significant differences between PR and SR as well as SR and S. However, there was no significant difference between the PR and S groups. Histopathologic assessment demonstrated significant difference between SR, PR and S. CONCLUSION: These results suggest that propolis has protective effects on salivary gland function in animal models whilst it did not prevent radiation-induced histologic changes in tissues. Further investigations are needed to elucidate mechanisms of propolis actions. Clinical significance: Regarding to the results of this study, propolis may be useful in reduction xerostomia due to radiation to salivary glands and may be helpful for head and neck cancer patients.

Coenzyme Q10 in salivary cells correlate with blood cells in Fibromyalgia: improvement in clinical and biochemical parameter after oral treatment.

OBJECTIVE: We have determined Coenzyme Q(10) (CoQ(10)) levels in salivary cells (SCs) and mononuclear blood cells (BMCs) from Fibromyalgia (FM), and we study the influence of oral CoQ(10) supplementation on cells levels and clinical symptoms. METHODS: CoQ(10) was determined by high-performance liquid chromatography (HPLC). Ten patients were supplemented daily with 300 mg of CoQ(10) during 3 months. RESULTS: CoQ(10) were reduced in both cell models. Oral supplementation showed an improvement in clinical symptoms and restored levels. CONCLUSIONS: Patients with FM showed an important dysfunction in CoQ(10) levels and might benefit from oral supplementation.

Effect of estrogen therapy, soy isoflavones, and the combination therapy on the submandibular gland of ovariectomized rats.

The objective of this study was to evaluate the effect of estrogen deficiency, estrogen therapy, and soy isoflavones on the salivary glands in female rats. Ninety-six animals were ovariectomized, and 24 were sham-operated. Among the ovariectomized rats, 24 received 17ß-estradiol; 24 received isoflavone extract; 24 received a combination therapy of both; and 24 received water as placebo. The submandibular glands were histomorphometrically analyzed. As a result, the ANOVA test revealed that the hormonal deficiency affected the acini and the ducts of ovariectomized rats, reducing their percentage compared to the sham group. All treatments caused an increase in ducts and acini compared to the placebo group. It was concluded that the estrogen deficiency may be related to salivary gland function due to a reduction in the quantity of salivary acini and ducts secondary to ovariectomy. The estrogen therapy, soy isoflavone therapy, and the combination of both are effective in reducing the effects of ovariectomy on the salivary glands.

[Diagnostic and therapy of salivary gland diseases: relevant aspects for the pathologist from the clinical perspective]. / Diagnostik und Therapie von Speicheldrüsenerkrankungen: Relevantes für den Pathologen aus Sicht der Klinik.

Significant progress in the diagnosis and therapy of salivary gland diseases has been made in recent years. The new technique of diagnostic and interventional sialendoscopy has made an important contribution and is indicated in every case of obstructive sialadenitis. The number of open resections of salivary glands due to stones will clearly decrease in the future in favor of endoscopic removal. Due to recent publications on the appropriate extent of salivary gland resection in benign tumors, more and more specimens with reduced cuffs of healthy salivary gland tissue will be sent to the pathologists. Ultrasound will stay the procedure of first choice for imaging of salivary gland diseases in Germany. In combination with fine-needle aspiration cytology high sensitivity and specificity for the assessment of salivary gland tumors can be achieved. Diffusion-weighted magnetic resonance imaging (MRI) is a new imaging tool and the power of distinction of pleomorphic adenoma from malignant tumors is promising. The use of botulinum toxin for salivary glands diseases is increasing. Intraglandular injections have been shown to induce salivary gland atrophy in animal experiments. The availability of biologicals is currently yielding new aspects for the treatment of Sjögren's disease.

Morphological changes of parotid glands following adjuvant arthritis and ibuprofen treatment in rats.

Drug administration and numerous systemic diseases may cause morphological changes of the parotid gland. The aim of this study was to investigate the possible relationship between experimental adjuvant arthritis following ibuprofen treatment and morphological alterations of the parotid glands in rats. Freud's adjuvant was injected intradermally into the plantar surface of the hind paw of the animals to induce experimental arthritis. Ibuprofen was administrated per os (17 mg/kg/day). Both adrenals and parotid glands were isolated and their absolute and relative weights were evaluated. A full histological examination of parotid glands took place. The diameter of the foot as well as the serum levels of rheumatoid factor was measured. In conclusion, both experimental adjuvant arthritis and ibuprofen treatment induce morphological changes of the parotid tissues, which are related to macro- and micro-structure of the gland.

Experimental study on necrotizing sialometaplasia of the palate in rats. Role of local anesthetic injections.

The effect of local anesthetic injections in the palate of rats was studied by light microscopy and immunohistochemistry with antibody to proliferating cell nuclear antigen (PCNA). The results of this study suggest that local anesthetic injections could be one of the causes of necrotizing sialometaplasia.