Sialography of the transplanted submandibular gland.

Autologous transplantation of submandibular gland (SMG) is effective for severe keratoconjunctivitis sicca (KCS). Sialography is a method for morphological evaluation of the transplanted gland.We recruited 15 patients (15 eyes) with severe KCS who had successfully undergone SMG transplantation. Thirteen patients had normal transplanted SMGs, while two patients were suspected to have obstructive sialadenitis of the transplanted SMG. Sialography was performed in each patient with meglumine diatrizoate. Projections were applied immediately and 5, 7, and 10 min after contrast injection. The median dose of the contrast medium was 0.9 ml (range, 0.7-1.1 ml) for the full-size transplanted SMGs and 0.5 ml for the glands after reduction surgery. The acini and the ducts were clearly visible on sialograms. The contrast medium was completely excreted in 10 min in normal transplanted SMGs. The main duct had a regular shape in normal transplanted SMGs, while irregular dilation and stricture of the duct with delayed excretion of the contrast medium were found in the glands with obstructive sialadenitis. In conclusion, sialography is clinically feasible and valuable for the morphological evaluation of the transplanted SMG.

Obstructive sialadenitis of a transplanted submandibular gland: chronic inflammation secondary to ductal obstruction.

AIMS: To determine the pathological basis and clinical features of obstructive sialadenitis in transplanted submandibular glands (SMGs). METHODS: A total of 161 patients (174 eyes) with keratoconjunctivitis sicca underwent microvascular SMG transplantation. Patients were followed up at approximately 1 and 4 months and annually thereafter. Clinical data, including dry eye discomfort, symptoms of ductal obstruction, and Schirmer test, were recorded. Sialography was performed in six patients. In addition, SMG autotransplantation was performed in 22 rabbits. Salivary flow was recorded and the morphology of glands was examined at 6 months postoperatively by light microscopy. RESULTS: Among the patients, 16 out of 172 glands during the latent period (0-3 months) and 2 out of 154 glands with long-term follow-up (>1 year) showed obstructive sialadenitis. Typical manifestations were continuous small volumes of viscous secretions, recurrent gland swelling, decreased Schirmer test values, and irregular dilation of the main duct on sialography. The transplanted SMGs eventually showed no secretion in five cases. Of the 22 rabbit SMGs, 4 had obstructive sialadenitis. Morphological examination showed chronic inflammatory infiltration with salivary deposits. CONCLUSIONS: Obstructive sialadenitis of transplanted SMGs is a chronic inflammation secondary to ductal obstruction, which leads to insufficient ocular lubrication and potential treatment failure.

[Risk factors of alveolar bone loss of primary teeth].

OBJECTIVE: To study the risk factors of alveolar bone loss (ABL) of primary teeth in Chinese children. METHODS: Caries, restoration, food impact, pulp pathosis, calculus, and periodontal status were examined in 106 children aged 3-10 years old. Bite-wing radiographs of posterior teeth were scanned into computer. The distance from the cemento-enamel junction to alveolar bone crest was measured from the mesial surface of the first primary molar to the distal surface of the second primary molar using Adobe Photoshop 5.0 image analyzing system. ABL was recorded if the distance was more than 2 mm and the lamina dura was absent. All patients were divided into ABL group and non-ABL group. All data were analyzed by SPSS 10.0. RESULTS: Alveolar bone loss was found in 31 children (29%). Most of the affected areas were located at the proximal surface of primary molars. The mean of dmft and proximal dmft in ABL group were higher than those in non-ABL group (P < 0.01). Logistic regression also confirmed that proximal caries was high related factor. Inadequate restoration, and pulp pathosis were also related to alveolar bone loss in primary tooth. CONCLUSION: In children, alveolar bone loss was mainly associated with local factors such as proximal caries, inadequate restoration, and pulp pathosis. Caries and pulp pathosis might be treated in time. Children with bone loss should be re-examined regularly.