The prognostic value of selective neck dissection in early-stage major salivary gland carcinoma: a population-based analysis.

Objective: This population-based study aims to assess the survival benefits of selective neck dissection (SND) compared to neck observation in patients with T1/T2N0M0 major salivary gland malignancy (MSGC). Methods: We conducted a retrospective review of T1/T2N0M0 MSGC patients who underwent primary tumor surgical extirpation with or without elective neck dissection in the Surveillance, Epidemiology, and End Results database (SEER) from 2004-2015. The impact of SND and clinical variables on overall survival (OS) and disease-specific survival (DSS) was evaluated using Univariate and Multivariate Cox proportional hazards regression models. Kaplan-Meier survival curves were generated, and survival rates were assessed via the log-rank test. Results: Of 3778 post-operative T1-T2N0M0 MSGC patients, 2305 underwent elective neck dissection, while 1473 did not. Median follow-up was 106 months. Univariate and Multivariate analysis identified SND as a prognostic factor for OS in all the study population. After stratified analysis, we found that in the poorly high-grade (differentiated and undifferentiated) patients, the survival showed a significant OS and DSS benefit after receiving SND compared with the neck observations [HR for OS (95%CI): 0.571(0.446-0.731), P<0.001] and [HR for DSS (95%CI): 0.564(0.385-0.826), P=0.003], other than in the well differentiated or moderately differentiated subgroup. Especially, when the pathological is squamous cell carcinoma, the results show that the people underwent SND had better prognosis, not only in OS [HR (95%CI): 0.532(0.322-0.876), P=0.013], but also in DSS [HR (95%CI): 0.330(0.136-0.797), P=0.014]. The multivariate analysis also yielded encouraging results, compared with neck observation, receiving SND bought about a significant independent OS (adjusted HR, 0.555; 95% CI, 0.328-0.941; P=0.029) and DSS (adjusted HR, 0.349; 95% CI, 0.142-0.858; P=0.022) advantage in high grade squamous cell carcinoma MSGC patients. The Kaplan-Meier survival curves also demonstrated that adjusted SND still had significantly better OS(P=0.029) and DSS(P=0.022) than the observation group in patients with high-grade squamous cell carcinoma of MSGC. Conclusion: Poorly differentiated and undifferentiated T1/T2N0M0 major salivary gland malignancy treated with selective neck dissection demonstrated superior survival compared to neck observation, especially in the pathological subtype of squamous cell carcinoma. These findings suggest the potential benefits of multimodal therapy for appropriately selected patients, emphasizing significant clinical implications.

Parotidectomy for deep lobe pleomorphic adenomas is associated with higher rates of complications and recurrence.

BACKGROUND: Pleomorphic adenoma (PA) is a common parotid tumor, yet due to the relative rarity of deep lobe PA (DLPA), there is a paucity of information about its clinical presentation and surgical outcomes. METHODS: We reviewed the charts of patients with previously untreated parotid PA between the years 1990 and 2015. Clinical parameters and surgical outcomes were compared between superficial lobe PA (SLPA) and DLPA. RESULTS: The cohort comprised 147 cases of DLPA and 222 cases of SLPA. DLPA were larger (median 2.6 cm vs. 2.0 cm, p < 0.001), more often discovered incidentally on imaging (33%, n = 48) and had unique presentations (pharyngeal mass, dysphagia, otalgia). Postsurgical complications were more frequently observed in DLPA (41% vs. 30% in SLPA, p = 0.025), mainly transient facial nerve weakness. DLPA also showed higher recurrence rates (n = 6, 4.1% vs. n = 1, 0.4%, p = 0.016). CONCLUSIONS: Parotidectomy for DLPA carries a higher risk of complications and recurrence compared to SLPA.

Patterns and timing of recovery from facial nerve palsy after nerve-sparing parotid surgery: the role of neuromuscular retraining.

OBJECTIVES: Among the complications of parotid surgery, facial palsy is frequent and burdened by high functional and social impact for the patient. There are few data on the efficacy of facial neuromuscular retraining (FNR) in patients with facial palsy after parotid surgery, and no data exist on its impact in timing and extent of recovery. MATERIAL AND METHODS: A retrospective study was conducted on patients undergoing FN sparing parotid surgery and suffering from postoperative facial palsy. Among 400 patients undergoing surgery between July 2016 and May 2023, those with the preservation of the FN and onset of facial palsy were selected. Nerve function was evaluated during 2 years follow up using the House-Brackman (H&Bs) and Sunnybrook scales (SBs). RESULTS: A total of 46 patients undergoing partial or total parotidectomy were included. At discharge 18 patients (39,1%) had IV to VI grade paralysis according to the H&Bs and the mean SBs value was 54. At 2 and 6 months after surgery, the average value of Sunnybrook increased to 76.5 and 95.4 respectively. After 12 months no patients with IV to VI grade paralysis were represent in our cohort. Two years after surgery, only five patients (10.9%) had persistent grade II paralysis according to HBs. CONCLUSIONS: Our study supports the efficacy of FNR in the rehabilitation of facial paralysis after nerve-sparing parotidectomy. The greater functional improvement is achieved within the first 6 months of rehabilitation. A significant improvement is detected still after 18 months, supporting the importance of long rehabilitation for patients without complete recovery after the first year.

Bony Congenital Nasolacrimal Duct Obstruction: A Novel Phenotype of Aplasia of Lacrimal and Major Salivary Glands.

PURPOSE: Aplasia of lacrimal and salivary glands (ALSG) is a syndromic disorder characterized by aplasia of lacrimal and salivary systems. Reported ophthalmic manifestations of ALSG include aplasia of lacrimal glands, punctal agenesis, lacrimal sac mucocele, and membranous congenital nasolacrimal duct obstruction (CNLDO). Bony CNLDO, a rare clinical entity, has not been associated with any syndromic disorder. This study investigated the relationship between genetic mutations and bony CNLDO in 3 Chinese families with ALSG. DESIGN: Single-center observational case study. PARTICIPANTS: Three Chinese families with bony CNLDO, including 7 affected and 9 healthy family members. METHODS: Slit-lamp ophthalmic examination, comprehensive physical examination, orbital computed tomography (CT) imaging, cervicofacial magnetic resonance imaging, audiometry, and whole exome sequencing on periphery blood were performed. Variants were cross-referenced with 1000 control genomes and various population databases. Pathologic variants were identified using bioinformatic tools. MAIN OUTCOME MEASURES: Clinical examination, diagnostic imaging, whole exome sequencing, and bioinformatic analysis findings. RESULTS: Affected patients showed decreased tear production on the Schimer I test and reduced tear breakup time. Bony CNLDO was observed on CT, showing unilateral or bilateral bony termination at the middle or terminal segment of the nasolacrimal canal. Magnetic resonance imaging showed aplasia or absence of lacrimal, parotid, and submandibular glands. Physical examination revealed normal ears, digits, and facial morphology. Audiometry and dental assessment were conducted on the pediatric patients and yielded normal results. The clinical characteristics of patients aligned with a diagnosis of ALSG. Genomic analysis revealed 3 novel heterozygous missense mutations of the Fgf10 gene: c.316T→C, c.327C→G, and c.332T→G. The inheritance pattern was autosomal dominant with variable penetrance. These variants were not observed in 1000 control genomes and population databases. These variant positions also were shown to be highly conserved across various animal species. Mutated genes and proteins were predicted as deleterious with most computational models, with a few suggesting they may be benign. CONCLUSIONS: Bony CNLDO was identified as a novel phenotype of ALSG implicated by missense mutations of highly conserved residues in the Fgf10 gene. These cases broadened our knowledge of Fgf10-related phenotypes and prompted clinicians to consider syndromic associations in patients with bony CNLDO. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Análise da aplicabilidade da ultrassonografia no diagnóstico de sialolitíase nas glândulas salivares maiores / Analysis of the applicability of ultrasound in the diagnosis of sialolithiasis in the major salivary glands

Sialolitíase é caracterizada pela formação de estruturas calcificadas (sialolítos ou cálculos) nos parênquimas ou ductos das glândulas salivares maiores (GSM). Exames radiográficos ou de tomografia computadorizada (TC) podem ser utilizados na detecção dessas estruturas, embora apresentem limitações para a detecção de sialolítos pouco mineralizados, assim como para a diferenciação de tecidos moles. A ressonância magnética (RM) apresenta boa acurácia para o diagnóstico de alterações em GSM ou de cálculos salivares mineralizados ou não, porém, seu uso na prática clínica é limitado devido ao seu alto custo financeiro e a baixa disponibilidade. A ultrassonografia (US) tem sido descrita como uma ótima alternativa de exame por imagem para a avaliação das GSM, devido ao seu custo reduzido, obtenção de imagem em tempo real, boa resolução da imagem e pela não utilização da radiação ionizante. O objetivo deste trabalho é analisar a aplicabilidade da ultrassonografia na detecção de sialolitíase em GSM. Foi realizada uma revisão de literatura sobre o uso da US na avaliação de sialolitíase. Nesta revisão foram coletados dados sobre os autores, ano de publicação, tipo de estudo realizado, qual GSM foi avaliada, o valor diagnóstico da US (acurácia, sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo), principais características ultrassonográficas das sialolitíases, dados clínicos relevantes e outras informações adicionais. Cálculos salivares, únicos ou múltiplos, com tamanho maior que 2 mm, foram bem detectados pela US, assim como tampões mucosos não mineralizados. Cálculos menores que 1 mm foram mais difíceis de serem visualizados na US sendo a técnica de sonopalpação, associada com o uso de suco de limão ou ácido ascórbico intraoral importante nesses casos. A acurácia, sensibilidade, especificidade, valor preditivo positivo e valor preditivo e negativo foram satisfatórias. Eventuais alterações parenquimais foram bem visualizadas através da US. Dados clínicos e ultrassonográficos foram importantes no estabelecimento dos diagnósticos diferenciais. A ultrassonografia, portanto, pode ser considerada como um método de imagem adequado para a avaliação inicial das sialolitíases nas GSM, tanto em indivíduos adultos como em crianças.

Sialolithiasis is characterized by the formation of calcified structures (sialoliths or stones) in the parenchyma or ducts of the major salivary glands (GSM). Radiographic or computed tomography (CT) examinations can be used to detect these structures, although they present limitations for the detection of poorly mineralized sialoliths, as well as for the differentiation of soft tissues. Magnetic resonance imaging (MRI) has good accuracy for diagnosing alterations in GSM or mineralized or non-mineralized salivary stones, however, its use in clinical practice is limited due to its high financial cost and low availability. Ultrasonography (US) has been described as an excellent imaging alternative for the evaluation of GSM, due to its reduced cost, real-time image acquisition, good image resolution and the non-use of ionizing radiation. The objective of this work is to analyze the applicability of ultrasound in detecting sialolithiasis in GSM. A literature review was carried out on the use of US in the evaluation of sialolithiasis. In this review, data were collected about the authors, year of publication, type of study carried out, which GSM was evaluated, the diagnostic value of US (accuracy, sensitivity, specificity, positive predictive value, negative predictive value), main ultrasound characteristics of sialolithiasis, relevant clinical data and other additional information. Salivary stones, single or multiple, larger than 2 mm in size, were well detected by US, as well as non-mineralized mucous plugs. Stones smaller than 1 mm were more difficult to visualize in the US, with the sonopalpation technique, associated with the use of lemon juice or intraoral ascorbic acid, being important in these cases. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value were satisfactory. Any parenchymal alterations were clearly visualized using US. Clinical and ultrasound data were important in establishing differential diagnoses. Ultrasonography, therefore, can be considered as a suitable imaging method for the initial assessment of sialolithiasis in GSM, both in adults and children.

UHFUS: A Valuable Tool in Evaluating Exocrine Gland Abnormalities in Sjögren's Disease.

Sjögren's Disease (SjD) is a chronic autoimmune disorder that affects the salivary and lacrimal glands, leading to xerostomia and xerophthalmia. Ultrasonography of Major Salivary Glands (SGUS) is a well-established tool for the identification of the salivary glands' abnormalities in SjD. Recently, a growing interest has arisen in the assessment of the other exocrine glands with ultrasonography: lacrimal glands (LGUS) and labial salivary glands (LSGUS). The objective of this study is to explore the practical applications of ultra-high frequency ultrasound (UHFUS) in the assessment of lacrimal glands and labial salivary glands. Indeed, UHFUS, with its improved spatial resolution compared to conventional ultrasonography, allows for the evaluation of microscopic structures and has been successfully applied in various medical fields. In lacrimal glands, conventional high-frequency ultrasound (HFUS) can detect characteristic inflammatory changes, atrophic alterations, blood flow patterns, and neoplastic lesions associated with SjD. However, sometimes it is challenging to identify lacrimal glands characteristics, thus making UHFUS a promising tool. Regarding labial salivary glands, limited research is available with conventional HFUS, but UHFUS proves to be a good tool to evaluate glandular inhomogeneity and to guide labial salivary glands biopsy. The comprehensive understanding of organ involvement facilitated by UHFUS may significantly improve the management of SjD patients.

Bilateral variation of the parotid gland in cadaver: a case report.

Bilateral variation of the parotid gland is an anatomically rare entity. In this study, we present a 91-year-old female cadaver with aplasia of the parotid gland on the left side of the face and hypoplasia of the parotid gland on the right side of the face. The accessory parotid glands on both sides were of normal size, while bilateral submandibular glands were found to be larger than normal. The surgical anatomy of the parotid gland is very important because this region of the face is a complex structure intertwined with important vessels and nerves. Patients with aplasia, atresia, agenesis, or hypoplasia of the parotid gland should be diagnosed early and proper treatment must be planned. Consequently, this case was found to be remarkable in terms of the coexistence of parotid gland aplasia and hypoplasia.

Reduced 123I-MIBG uptake in the parotid and submandibular glands in patients with Parkinson's disease identified using a quantitative semi-automatic method.

OBJECTIVES: To analyze 123I-metaiodobenzylguanidine (MIBG) uptake in the parotid and submandibular glands in patients with Parkinson's disease (PD) in comparison with controls, and to compare MIBG uptake between those glands and the myocardium. Furthermore, we aimed to identify the relationships between clinical features and MIBG uptake. METHODS: We recruited 77 patients with PD and 21 age-matched controls. We assessed MIBG scintigraphy in the major salivary glands and myocardium. We calculated the MIBG uptake ratio in the parotid glands/mediastinum (P/M), submandibular glands/mediastinum (S/M), and heart/mediastinum (H/M) using a quantitative semi-automatic method. We investigated the correlations between MIBG uptake and clinical features. RESULTS: The P/M and H/M ratios in the early and delayed phases were significantly reduced in PD patients compared to controls, while the delayed phase S/M ratio was reduced in PD patients compared to controls. The P/M ratio correlated with the S/M ratio, while neither the P/M nor S/M ratio correlated with the H/M ratio. Between PD patients and controls, sensitivity and specificity were 54.8% and 59.1% for the delayed phase P/M ratio, while sensitivity and specificity were 59.5% and 61.0% for the delayed phase S/M ratio, respectively. Furthermore, sensitivity and specificity for the delayed phase H/M ratio were 85.7% and 79.2, respectively. CONCLUSION: MIBG uptake in the parotid and submandibular glands was reduced in patients with PD. Furthermore, sympathetic denervation in the major salivary glands and myocardium might progress independently. Our findings suggest a new aspect of the pathological distribution of PD.

Comparative Histology and Histochemistry of the Parotid Gland and Mandibular Gland in the Lowland Tapir (Tapirus terrestris Perissodactyla) and Aardvark (Orycteropus afer Tubulidentata).

In terrestrial mammals, the parotid and mandibular glands secrete different types of saliva into the oral cavity. Both glands were obtained from two female lowland tapirs (Tapirus terrestris) and one female aardvark (Orycteropus afer) from the Wroclaw Zoological Garden (Poland) and examined by light microscopy (hematoxylin and eosin, mucicarmine, periodic acid-Schiff, Alcian blue pH 1.0, Alcian blue pH 2.5, Alcian blue pH 2.5/PAS, and Hale's dialysed iron). Both the parotid glands observed in the lowland tapir and aardvark were compound alveolar serous secretory units, and in both species, the secretion was composed of neutral and acidic mucopolysaccharides (sialo and sulfated mucins). However, in both the lowland tapir and aardvark, a histological examination found the stroma of the mandibular gland was divided into very large lobes by poorly marked connective tissue. While many interlobar and striated ducts were found in the aardvark, very few were found in the lowland tapir. The mandibular gland was a branched tubular (mucous secretion) type in the lowland tapir, but it was a branched tubuloalveolar (mucous-serous) type in the aardvark. In all tested glands, the secretion was composed of neutral mucopolysaccharides, acid-sulfated mucosubstances, and sialomucins.

Prognostic models for estimating survival of salivary duct carcinoma: a population-based study.

PURPOSE: In a large salivary duct carcinoma (SDC) cohort, we aimed to investigate the clinical factors influencing their survival outcomes and to further establish prognostic models. METHODS: Data of patients with SDC were extracted from the Surveillance, Epidemiology, and End Results database (1975-2019). A retrospective analysis was conducted to explore the prognostic factors on overall survival (OS) and disease-specific survival (DSS), and corresponding nomograms were established. RESULTS: A steady upward trend in the incidence of SDC was observed over the past four decades. Totally, 399 patients (280 in the training set and 199 in the testing set) were enrolled. Advanced T stage, lymph node metastasis, distant metastasis, and surgery were associated with favorable OS and DSS. Besides, age > 80 years exhibited worse OS. The selected variables above were used to construct nomograms and online web calculators that could accurately predict patient survival. In addition, risk stratification systems were generated to identify low- and high-risk patients. As the risk level increased, the risk of both patient mortality and disease-specific mortality increased. CONCLUSIONS: The SDC incidence was low, but steadily increasing. The proposed prognostic models provided a robust and efficient approach to predict survival and risk stratification in SDC patients.

A Retrospective Cohort Study of Major Salivary Gland Tuberculosis: Our 13 Year Experience.

The tuberculous infection of major salivary glands is rare because they are relatively resistant to tubercle bacilli. The aim of this study is to present our 13 year experience on major salivary gland tuberculosis. The clinical, histopathological, microbiological and imaging records of 9 cases of major salivary gland tuberculosis were reviewed retrospectively. The cases diagnosed with either microbiological culture and/or polymerase chain reaction assay and/or Histopathological examination were included in the study. Descriptive statistics were used to summarize the data. There were 9 cases with tuberculous involvement of major salivary glands; parotid (n = 5), submandibular (n = 3), sublingual (n = 1). The most common local symptom was painless swelling present in 8 cases and constitutional symptoms were present in all the cases. The previous history of TB was present in 5 out of 9 cases. Surgical intervention was done in 2 cases of parotid TB for diagnostic purpose and therapeutic intervention was required in 1 patient. Patients responded well to medical therapy. Two patients with disseminated disease died. The major salivary gland is rare in both immunocompetent and immunocompromised patients. Diagnosis is difficult and requires high degree of suspicion especially in isolated cases. Medical management yields satisfactory results.

Salivary Gland Ultrasound in Primary Sjögren's Syndrome: Current and Future Perspectives.

Salivary gland ultrasound (SGUS) is the imaging modality of choice for the assessment of parotid and submandibular gland parenchyma. Being highly effective, non-invasive and easy to perform, SGUS has become increasingly popular among specialists in assessing salivary gland (SG) abnormalities, including those commonly found in primary Sjögren's syndrome (pSS). SGUS may be useful in the assessment of pSS and its complications, the most serious being the development of non-Hodgkin's lymphoma (NHL). SGUS may also be useful in the characterization and differential diagnosis of diffuse and focal abnormalities commonly associated with pSS, and may act as a guide for core-needle biopsy (CNB), an established, safe, and feasible technique, which provides enough viable tissue for the diagnosis and assessment of lymphoproliferative diseases of the SG. The combination of SGUS with other tools, such as sonoelastography and artificial intelligence (AI), could further improve the usefulness of SGUS in the management of pSS. In this perspective, we summarize current and future applications of SGUS in pSS.

Nomogram-Based Prediction of Overall and Disease-Specific Survival in Patients With Postoperative Major Salivary Gland Squamous Cell Carcinoma.

Background : The major salivary gland squamous cell carcinoma is a rare head and neck tumor, often accompanied by lymph node metastasis. Even if the patient undergoes surgery, the prognosis remains unsatisfactory. To explore the prognostic factors of postoperative major salivary gland squamous cell carcinoma to establish a prognostic risk stratification model to guide clinical practice. Methods: Patients' information was retrieved from the Surveillance, Epidemiology, and End Results database from 2004 to 2018. Optimal cutoff points were determined using X-tile software, and overall survival and disease-specific survival were calculated by the Kaplan-Meier method. Independent prognostic factors affecting the overall survival and disease-specific survival were identified by multivariate analysis, and corresponding 2 nomogram models were constructed. The discriminative ability and calibration of nomograms were evaluated by the Concordance index, area under curves, and calibration plots. Results: A total of 815 patients with postoperative major salivary gland squamous cell carcinoma were enrolled. The cutoff values for the number of lymph nodes were 2, and the cutoff values for the lymph node ratio were 0.11 and 0.5, respectively. Age, T stage, tumor size, lymph nodes, lymph node ratio, and radiotherapy were prognostic factors for overall survival and disease-specific survival. Nomograms for disease-specific survival and overall survival were established and showed favorable performance with a higher Concordance index and area under curves than that of the tumor-node-metastasis stage and Surveillance, Epidemiology, and End Results stage. The calibration plots of 1-, 3-, and 5-year overall survival and disease-specific survival also exhibited good consistency. What's more, patients were divided into low-, moderate-, and high-risk groups according to the scores calculated by the models. The overall survival and disease-specific survival of patients in the high-risk group were significantly worse than those in the moderate- and low-risk group. Conclusions: Our nomogram integrated clinicopathological features and treatment modality to demonstrate excellent performance in risk stratification and prediction of survival outcomes in patients with major salivary gland squamous cell carcinoma after surgery, with important clinical value.

A Novel Technique for the Evaluation and Interpretation of Elastography in Salivary Gland Involvement in Primary Sjögren Syndrome.

Ultrasound (US) of major salivary glands (MSG) evaluates echogenicity, border features and vascularization, with elastography, it can detect tissue elasticity and glandular fibrosis, related to inflammation in Primary Sjögren's syndrome (pSS). This study aimed to develop a novel technique by pixel analysis for evaluation and interpretation of elastography in MSG in pSS. A cross-sectional and observational multicenter study was conducted. The US of MSG performed in orthogonal planes in grayscale, Doppler, and shear-wave elastography. For elastography images of each gland were analyzed with the open-source program ImageJ to perform a pixel analysis. Statistical analysis was performed with the IBM-SPSS v25 program. Fifty-nine women with a mean age of 57.69 (23-83) years were recruited; pSS mean duration of 87 (5-275) months, and 12 healthy women without sicca symptoms as a control group with a mean age of 50.67 (42-60) years. Intragroup analysis showed p-values >0.05 between sicca symptoms, ocular/dryness tests, biopsy, US, and pixel analysis; correlation between Hocevar and pixel analysis was not found (rho < 0.1, p >0.5). MSG anatomical size was 41.7 ± 28.2 mm vs. 67.6 ± 8.8 mm (p ≤ 0.0001); unstimulated whole saliva flow rate was 0.80 ± 0.80 ml/5 min vs. 1.85 ± 1.27 ml/5 min (p = 0.016). The elastography values (absolute number of pixels) were 572.38 ± 99.21 vs. 539.69 ± 93.12 (p = 0.290). A cut-off point risk for pSS identified with less than 54% of red pixels in the global MSG mass [OR of 3.8 95% CI (1.01-15.00)]. Pixel analysis is a new tool that could lead to a better understanding of the MSG chronic inflammatory process in pSS.

The applicability of ultrasound in the diagnosis of inflammatory and obstructive diseases of the major salivary glands: a scoping review.

OBJECTIVES: The purpose of the present scoping review was to determine the contribution of ultrasound images in the diagnosis of inflammatory and obstructive diseases of the major salivary glands (MSGs). METHODS: A search of studies of ultrasonographic assessments of human samples was performed in several electronic databases and grey literature up to July 2021. The extracted data were the examined MSG; the diagnostic value of ultrasound (sensibility, specificity, positive- and negative predictive value, accuracy); features of lesions, including number, echogenicity, echotexture, form, margins, size, posterior acoustic aspect, and location; and related clinical information, such as swelling, palpation, sensible to pain, salivation, lymph nodes, recurrence, duration, and causes. RESULTS: After verifying the eligibility criteria, 90 articles focused on detecting inflammatory, and obstructive diseases of the MSG were gathered, with variable study designs and size samples. A wide variety of pathologies were assessed, including sialolitiasis (n = 45), acute sialadenitis (n = 30), chronic sialadenitis (n = 25), granulamatous diseases (n = 15), Kuttner's tumor (n = 11), juvenile recurrent parotitis (n = 9), abscess (n = 7), post-radiotherapy sialadenitis (n = 6), sialadenosis (n = 9), abscess (n = 7), IgG4-related disease sialadenitis (n = 5), HIV-sialadenitis (n = 4), obstructive sialadenitis (n = 3), iodinated contrast-induced sialadenitis (n = 2), and pneumoparotitis (n = 1). Most studies were case reports or series of cases. Few studies exhibited data about the accuracy of ultrasound in detecting MSG diseases. CONCLUSIONS: The present scoping review concluded that ultrasound aspects of different MSG pathologies are similar but contribute to their differential diagnosis and can be considered as a valuable initial method for assessing the MSG of adults and children.

Nomograms-based prediction of overall and cancer-specific survivals for patients diagnosed with major salivary gland carcinoma.

BACKGROUND: Major salivary glands carcinoma (MSGC) is a relatively rare cancer with diverse histological types and biological behavior. The treatment planning and prognosis prediction are challenging for clinicians. The aim of the current study was to establish a reliable and effective nomogram to predict the overall survival (OS) and cancer-specific survival (CSS) for MSGC patients. METHODS: Patients pathologically diagnosed with MSGC were recruited from Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training and validation groups (7:3 ratio). Univariate, multivariate Cox proportional hazard models, and least absolute shrinkage and selection operator (LASSO) regression were adopted for the selection of risk factors. Nomograms were developed using R software. The model performance was evaluated by drawing receiver operating characteristic (ROC), overtime C-index curves, and calibration curves. Harrell C-index, areas under the curves (AUC), and Brier score were also calculated. The decision curve analysis (DCA) was conducted to measure the net clinical benefit. RESULTS: A total of 11,362 patients were identified and divided into training (n=7,953) and validation (n=3,409) dataset. Sex, age, race, marital status, site, differentiation grade, American Joint Committee on Cancer (AJCC) stage, T/N/M stage, tumor size, surgery, and histological type were incorporated into the Cox hazard model for OS prediction after variable selection, while all predictors, except for marital status and site, were selected for CSS prediction. For 5-year prediction, the AUC of the nomogram for OS and CSS was 83.5 and 82.7 in the training and validation dataset, respectively. The C-index was 0.787 for OS and 0.798 for CSS in the validation group. The Brier score was 0.0153 and 0.0130 for OS and CSS, respectively. The calibration curves showed that the nomogram had well prediction accuracy. From the perspective of DCA, a nomogram was superior to the AJCC stage and TNM stage in net benefit. In general, the performance of the nomogram was consistently better compared to the AJCC stage and TNM stage across all settings. CONCLUSIONS: The performance of the novel nomogram for predicting OS and CSS of MSGC patients was further verified, revealing that it could be used as a valuable tool in assisting clinical decision-making.

Aplicabilidade da ultrassonografia no diagnóstico de doenças inflamatórias e obstrutivas das glândulas salivares maiores: revisão de escopo / Applicability of ultrasonography in the diagnosis of inflammatory and obstructive diseases of the major salivary glands: scoping review

Alterações em glândulas salivares maiores (GSM) ocorrem em adultos ou crianças. Sialoadenites agudas ou crônicas são alterações inflamatórias que podem estar ou não associadas à infecção. Sialolitíases se caracterizam pela presença de calcificações (sialolitos) nos ductos ou parênquima glandular. Radiografia e tomografia computadorizada (TC) podem detectar sialolitos, mas possuem limitações relacionadas ao grau de mineralização ou para a caracterização de algumas alterações em tecidos moles. A ressonância magnética (RM) detecta alterações em GSM e sialolitos mineralizados ou não, porém possui alto custo e baixa disponibilidade que inviabilizam seu uso na rotina de atendimento. Ultrassonografia (US) é uma alternativa viável de exame para avaliação das GSMs, devido ao baixo custo, facilidade de aquisição de imagem em tempo real, boa resolução, e não utilização de radiação ionizante. O objetivo da presente revisão de escopo foi verificar a aplicabilidade da US na detecção de alterações em GSMs acometidas por sialoadenites ou sialolitíase. Foi realizada busca nas bases de dados eletrônicas PubMed, Web of Science, EMBASE e SCOPUS, que resultaram na seleção de 2277 referências. Após a leitura de títulos e resumos, 92 artigos contemplaram os critérios de elegibilidade desta revisão. Foram coletados dados sobre os autores, data de publicação, tipo de estudo, condição/alteração/patologia avaliada, GSM, valor diagnóstico da US, características ultrassonográficas das lesões, dados clínicos e informações adicionais. US pôde detectar alterações em GSM, com exceção do lobo profundo das parótidas. O Doppler colorido permitiu avaliar o padrão de vascularização dos tecidos alterados, auxiliando no estabelecimento de diagnósticos diferenciais. Sialolitos, únicos ou múltiplos, maiores que 2 mm foram bem detectados, inclusive tampões mucosos não mineralizados. Sialolitos menores que 1 mm foram melhor visualizados utilizando a técnica de sonopalpação e administração de ácido ascórbico ou suco de limão. Alterações glandulares causadas por sialoadenites agudas ou crônicas foram visualizadas através da US. A associação entre características ultrassonográficas e dados clínicos foi útil no estabelecimento de diagnósticos diferenciais. A ultrassonografia foi considerada como o método de escolha para avaliação inicial de alterações em GSM, tanto em adultos como crianças.

Alterations in major salivary glands (GSM) occur in adults or children. Acute or chronic sialoadenitis are inflammatory alterations associated or not with infections. Sialolithiasis is characterized by the presence of calcifications (sialoliths) in the ducts or glandular parenchyma. Radiography and computed tomography (CT) can detect sialoliths, but they have limitations related to the grade of mineralization or for the characterization of some alterations in soft tissue. Magnetic resonance imaging (MRI) detects alterations in GSM and mineralized or not mineralized sialoliths, but it has a high cost and low availability that make its use in routine care unfeasible. Ultrasonography (US) is a viable alternative exam for evaluating GSMs, due to its low cost, easy real-time image acquisition, good resolution, and no use of ionizing radiation. The objective of this scope review was to verify the applicability of US in detecting alterations in GSMs affected by sialoadenitis or sialolithiasis. A search was performed in the electronic databases PubMed, Web of Science, EMBASE and SCOPUS, which resulted in the selection of 2277 references. After reading the titles and abstracts, 92 articles met the eligibility criteria for this review. Data on authors, publication date, type of study, condition/alteration/pathology evaluated, GSM, diagnostic value of US, ultrasound characteristics of the lesions, clinical data and additional information were collected. US could detect alterations in GSM, with the exception of the deep parotid lobe. Color Doppler allowed us to assess the vascularization pattern of altered tissues, helping to establish differential diagnoses. Single or multiple sialoliths larger than 2 mm were well detected, including non- mineralized mucus plugs. Sialoliths smaller than 1 mm were better visualized using the sonopalpation technique and administration of ascorbic acid or lemon juice. Glandular alterations caused by acute or chronic sialoadenitis were visualized through US. The association between ultrasound characteristics and clinical data was useful in establishing differential diagnoses. Ultrasonography was considered the method of choice for the initial assessment of alterations in GSM, both in adults and children.

Aplicabilidade da ultrassonografia no diagnóstico de doenças inflamatórias e obstrutivas das glândulas salivares maiores: revisão de escopo / Applicability of ultrasonography in the diagnosis of inflammatory and obstructive diseases of the major salivary glands: scoping review

Alterações em glândulas salivares maiores (GSM) ocorrem em adultos ou crianças. Sialoadenites agudas ou crônicas são alterações inflamatórias que podem estar ou não associadas à infecção. Sialolitíases se caracterizam pela presença de calcificações (sialolitos) nos ductos ou parênquima glandular. Radiografia e tomografia computadorizada (TC) podem detectar sialolitos, mas possuem limitações relacionadas ao grau de mineralização ou para a caracterização de algumas alterações em tecidos moles. A ressonância magnética (RM) detecta alterações em GSM e sialolitos mineralizados ou não, porém possui alto custo e baixa disponibilidade que inviabilizam seu uso na rotina de atendimento. Ultrassonografia (US) é uma alternativa viável de exame para avaliação das GSMs, devido ao baixo custo, facilidade de aquisição de imagem em tempo real, boa resolução, e não utilização de radiação ionizante. O objetivo da presente revisão de escopo foi verificar a aplicabilidade da US na detecção de alterações em GSMs acometidas por sialoadenites ou sialolitíase. Foi realizada busca nas bases de dados eletrônicas PubMed, Web of Science, EMBASE e SCOPUS, que resultaram na seleção de 2277 referências. Após a leitura de títulos e resumos, 92 artigos contemplaram os critérios de elegibilidade desta revisão. Foram coletados dados sobre os autores, data de publicação, tipo de estudo, condição/alteração/patologia avaliada, GSM, valor diagnóstico da US, características ultrassonográficas das lesões, dados clínicos e informações adicionais. US pôde detectar alterações em GSM, com exceção do lobo profundo das parótidas. O Doppler colorido permitiu avaliar o padrão de vascularização dos tecidos alterados, auxiliando no estabelecimento de diagnósticos diferenciais. Sialolitos, únicos ou múltiplos, maiores que 2 mm foram bem detectados, inclusive tampões mucosos não mineralizados. Sialolitos menores que 1 mm foram melhor visualizados utilizando a técnica de sonopalpação e administração de ácido ascórbico ou suco de limão. Alterações glandulares causadas por sialoadenites agudas ou crônicas foram visualizadas através da US. A associação entre características ultrassonográficas e dados clínicos foi útil no estabelecimento de diagnósticos diferenciais. A ultrassonografia foi considerada como o método de escolha para avaliação inicial de alterações em GSM, tanto em adultos como crianças.

Alterations in major salivary glands (GSM) occur in adults or children. Acute or chronic sialoadenitis are inflammatory alterations associated or not with infections. Sialolithiasis is characterized by the presence of calcifications (sialoliths) in the ducts or glandular parenchyma. Radiography and computed tomography (CT) can detect sialoliths, but they have limitations related to the grade of mineralization or for the characterization of some alterations in soft tissue. Magnetic resonance imaging (MRI) detects alterations in GSM and mineralized or not mineralized sialoliths, but it has a high cost and low availability that make its use in routine care unfeasible. Ultrasonography (US) is a viable alternative exam for evaluating GSMs, due to its low cost, easy real-time image acquisition, good resolution, and no use of ionizing radiation. The objective of this scope review was to verify the applicability of US in detecting alterations in GSMs affected by sialoadenitis or sialolithiasis. A search was performed in the electronic databases PubMed, Web of Science, EMBASE and SCOPUS, which resulted in the selection of 2277 references. After reading the titles and abstracts, 92 articles met the eligibility criteria for this review. Data on authors, publication date, type of study, condition/alteration/pathology evaluated, GSM, diagnostic value of US, ultrasound characteristics of the lesions, clinical data and additional information were collected. US could detect alterations in GSM, with the exception of the deep parotid lobe. Color Doppler allowed us to assess the vascularization pattern of altered tissues, helping to establish differential diagnoses. Single or multiple sialoliths larger than 2 mm were well detected, including non-mineralized mucus plugs. Sialoliths smaller than 1 mm were better visualized using the sonopalpation technique and administration of ascorbic acid or lemon juice. Glandular alterations caused by acute or chronic sialoadenitis were visualized through US. The association between ultrasound characteristics and clinical data was useful in establishing differential diagnoses. Ultrasonography was considered the method of choice for the initial assessment of alterations in GSM, both in adults and children.

Large German Multicenter Experience on the Treatment Outcome of 207 Patients With Adenoid Cystic Carcinoma of the Major Salivary Glands.

INTRODUTION: We aimed to evaluate treatment outcome of combined radiotherapy (RT) including photon intensity modulated radiotherapy (IMRT) and carbon ion boost for adenoid cystic carcinomas (ACCs) of the major salivary glands, the currently available largest German collective for this cohort. MATERIALS AND METHODS: Overall, 207 patients who were irradiated with combined RT between 2009 and 2019 at Heidelberg University Hospital were analyzed retrospectively for local control (LC), progression-free survival (PFS) and overall survival (OS) using Kaplan-Meier estimates. The majority of patients received postoperative RT (n=176/207, 85%) after previous surgery in large German hospitals mainly Mainz, Freiburg, Mannheim and Heidelberg University Hospitals and 15% received primary RT (n=31/207). RESULTS: After a median follow-up time of 50 months, 84% of the patients were still alive (n=174/207). Disease progression occurred in 32% of the patients (n=66/207) while local recurrence was diagnosed in 12% (n=25/207), and distant relapse in 27% (n=56/207). Estimated 5-year LC, PFS and OS rates were 84%, 56% and 83% for OS, respectively. In multivariate analysis, we could identify two prognostic subgroups: one subgroup resulting in decreased LC, PFS and OS rates and another subgroup having an additional survival disadvantage in PFS and OS. Patients with a macroscopic tumor disease (yes vs. no; p<0.001 for LC, p=0.010 for PFS and p=0.040 for OS) treated in a definitive setting (vs. postoperative setting; p=0.001 for LC, p=0.006 for PFS, p=0.049 for OS) and tumors of upper T stage (T1-4; p=0.004 for LC, p<0.001 for PFS, p<0.001 for OS) showed significantly more local relapses and a decreased PFS and OS. Upper Age (p<0.001 for both PFS and OS), lower Karnofsky Performance Score (<80% vs. ≥80%; p<0.001 for both PFS and OS) and solid histology (vs. non-solid; p=0.049 for PFS and p=0.003 for OS) were in addition associated with worse survival outcome. Toxicity was moderate with 18% late grade 2 and 3 toxicity. CONCLUSIONS: Combined RT results in superior LC rates compared to photon data with moderate toxicity. In multivariate analysis, upper T stage, the existence of a macroscopic tumor before RT and definitive RT setting were identified as major prognostic factors affecting LC negatively.

Radioiodine-Induced Salivary Gland Damage Detected by Ultrasonography in Patients Treated for Papillary Thyroid Cancer: Radioactive Iodine Activity and Risk.

Background: An important side effect of radioactive iodine (RAI) therapy in patients treated for papillary thyroid cancer (PTC) is chronic sialadenitis. Neck ultrasonography (US) easily recognizes radioiodine-induced salivary gland abnormalities. The objectives of this study were to determine the prevalence of US-detected sialadenitis caused by RAI and to identify the risk factors associated with this damage. Methods: This nonconcurrent cohort study includes all PTC-operated patients who were treated with RAI between 2007 and 2017 and were systematically evaluated with preoperative and follow-up neck US that included targeted exploration of the major salivary glands. Patients with pre-existing salivary gland diseases were excluded. The anatomical damage (diminished glandular volume, wavy contours, hypoechogenicity, and heterogeneity) was qualitatively assessed and compared with the preoperative study. RAI activity, sex, age, and preparation method were evaluated as risk factors using univariate and multivariate analyses with logistic regression. Results: Enrolled in this study were 570 patients who received a median RAI activity of 3700 MBq (100 mCi). On US, we found 143 patients (25.1%) with damage in at least one of their salivary glands: all had parotid damage (77 bilaterally) and 14 (9.8%) also had submandibular gland damage (7 of them bilaterally). The multivariate analysis indicated that the risk of sialadenitis was significantly (p < 0.01) correlated with both RAI activity and sex (14.1% of males vs. 28.5% of females). However, the main risk factor was RAI activity; no injury was detected in 156 patients who received 1110 MBq (30 mCi) and 1850 MBq (50 mCi) of RAI. In the groups of patients receiving 3700 MBq (100 mCi), 5550 MBq (150 mCi) and ≥7400 MBq (≥200 mCi), atrophy was found in 21%, 46.9%, and 77.7% of patients, respectively. Age and preparation method were not related to an increased risk of atrophy in this study. Conclusions: Chronic sialadenitis is common and affects approximately one fourth of patients who receive 3700 MBq (100 mCi) or higher RAI activity. The main risk factor for this injury is the total RAI activity administered. By using the lowest effective activity possible, irreversible anatomical damage in salivary glands can be minimized. US is an excellent tool to diagnose post-RAI atrophy.