Sialendoscopy for the diagnosis and treatment of juvenile recurrent parotitis.

PURPOSE: The aim of the current study was to analyze the use of sialendoscopy for the diagnosis and treatment of juvenile recurrent parotitis (JRP), note possible complications, and the rate of disease recurrence. We believe that this cutting edge procedure may be very effective both for the diagnosis and treatment of JRP, with few complications and low rates of recurrence. PATIENTS AND METHODS: A retrospective descriptive case study was conducted on a sample of patients presenting with JRP. Data was collected from the patient's medical records. Diagnostic sialendoscopy was performed to identify and classify the ductal pathology, treated by interventional therapeutic sialendoscopy. We carefully noted all complications and the disease recurrence rates. RESULTS: The patient sample included 50 children presenting with JRP (33 M, 17 F; age range: 2 to 16 years). Seven children presented with bilateral parotitis, the remaining 43 with unilateral parotitis. The study was conducted from 2003 to 2012. There was a statistically significant association between sialendoscopic data and the actual outcome. Seven children underwent additional sialendoscopy because of recurrence. They were all in the group of children presenting with unilateral parotitis. DISCUSSION: Our results validate the expected outcome. Sialendoscopy is an accurate technique for the diagnosis of JPR, and an effective tool for the treatment of JRP, with a low rate of complications and recurrence.

[Cone beam 3D sialography: preliminary study]. / Sialographie 3D en cone beam: étude préliminaire.

INTRODUCTION: Stones, stenosis and inflammatory lesions are the main causes of mealtime syndrome. The aim of paraclinical exam is to find the cause of these obstructive symptoms. Ultrasound is often sufficient to confirm the lithiasic origin of salivary gland swelling. Non-lithiasic salivary obstructions are more difficult to diagnose. We studied the feasibility and quality of a new medical imaging device: three-dimensional (3D) sialography using the technique of cone beam with flat panel (CPCT). PATIENTS AND METHODS: Five patients were included, referred for diagnostic management of non-lithiasic salivary gland parotid colic. It was performed for each patient in the angiography room, conventional sialography and 3D CPCT. Images were compared to conventional sialography. RESULTS: None of catheterization failure or side effects were observed in five patients. 3D CPCT sialography enabled to view gland ducts until their fifth or sixth division. Compared to conventional sialography, 3D CPCT improves signal and contrast to noise ratio. DISCUSSION: This technique allows an anatomic resolution and signal/noise ratio unmatched. It also allows to reduce metallics artefacts. Its main drawback is those associated with ductal catheterization, exposure to ionizing radiation and potential allergy to iodinated contrast agents.

Agreement of aspiration tests using barium videofluoroscopy, salivagram, and milk scan in children with cerebral palsy.

To study the agreement between three tests for aspiration, barium videofluoroscopy, salivagram, and milk scan we studied 63 children with severe non-ambulant spastic quadriplegic cerebral palsy (CP) aged 14 months to 16 years (32 males, 31 females). The salivagram was most frequently positive (56%, 95% confidence interval 43 to 68%); the next most frequently positive was barium videofluoroscopy when aspiration was defined as the presence of either laryngeal penetration of material or frank aspiration (39%, 95% confidence interval 26 to 53%). The milk scan was rarely positive (6%, 95% confidence interval 2 to 16%). Agreement between the tests of aspiration was poor. The maximum agreement (kappa=0.20) was between aspiration as diagnosed with the salivagram and by barium videofluoroscopy. Positive tests for aspiration are frequent in children with severe CP. Frequency varies widely depending on the investigation used. There is poor agreement between tests used for the diagnosis of aspiration. This information is of importance in assessing the significance of test results.

[Simple and cost effective cannula for sialography: Technical note]. / Siyalografi için gelistirilmis basit ve ucuz kanül.

We developed a simple and cost-effective modified cannula for sialography. The cannulae were made from nineteen, twenty-one and twenty-three gauge winged infusion set which are generally used for injection of contrast material in radiological imaging. In this article, we intend to introduce this cannula and discuss its utility.

[Comparative sonographic, x-ray and morphological studies of the salivary glands in Sjögren's syndrome]. / Sravnitel'nye sonograficheskie, rentgenologicheskie i morfologicheskie issledovaniia sliunnykh zhelez pri sindrome Shegrena.

AIM: To define diagnostic value of parotid gland (PG) sonography in Sjogren's syndrome (SS) as compared to sialography and morphological changes of labial salivary glands (LSG). MATERIALS AND METHODS: Examination of 50 females with primary (20 patients) and secondary (30 patients) SS consisted of clinical, ultrasonic, x-ray and morphological investigations. RESULTS: Sonographically, PG in SS is characterized by nonhomogeneity of parenchymal picture detected in 75% of patients with primary and 50% of patients with secondary SS. Moderate and severe nonhomogeneity of PG parenchyma was seen in the stage of marked manifestations of chronic parenchymatous parotitis. CONCLUSION: Relationship between PG sonographic image in SS and morphological changes in LSG need further study. PG sonography may help in combined examination of SS patients.

Advantage of appropriate K-edge filters for one-shot dual-energy subtraction sialography.

OBJECTIVES: To determine the optimal added filtration for use for one-shot dual energy subtraction sialography. METHODS: Test phantoms composed of bone and soft tissue materials were imaged with computed radiography using one-shot dual energy subtraction radiography. Eight different additional filter materials were compared with gadolinium contrast. Two numerical measures (absorption ratio and separation index) were used to compare the subtracted images obtained with the various filter/contrast combinations. The K-edge spectra were measured for each filter/contrast combination. A preliminary comparison of a 1.5 M iodine contrast medium with a 1.5 M gadolinium was performed using canine sialography. RESULTS: The gadolinium contrast/samarium filter combination had a larger separation index (P < 0.05). The same combination yielded better sialograms than iodine contrast. CONCLUSIONS: Samarium filter has an optimal k-edge for one-shot dual-energy sialography with gadolinium contrast.

[Sialography with direct multiple image enlargement and the processing of the sialograms on an analog computer]. / Sialografiia s priamym mnogokratnym uvelicheniem izobrazheniia i obrabotkoi sialogramm na analogovoi EVM.

To extend the potentialities of sialography, we used roentgenography with direct multiple amplification of the image by Reis microfocal portable x-ray diagnostic device and analyzed this image by analog UAR-1 computer operating in a high-frequency harmonization mode. The basic feature of such roentgenography is spatial stratification of the object shadow simultaneously forming its spatial image. High-frequency harmonization of an x-ray image essentially improved its contrast, this permitting detection of small formations poorly shown on sialogram, the contours of these formations and relationships between them. A total of 85 patients were examined using this method. Analysis of the resultant sialograms showed that using this method it is possible to assess the status of small structures of the gland, detect the changes in the pharyngeal process of the parotid gland. Sialogram direct projection is no longer needed.

[Conventional roentgen diagnosis of the salivary glands. Still of clinical value or "traditional care"-]. / Konventionelle Röntgendiagnostik der Speicheldrüsen. Immer noch klinischer Stellenwert oder "Traditionspflege"?

This paper reviews the examination technique, normal findings, and pathological findings in conventional radiographic diagnosis of the salivary glands. The clinical importance of plain radiographs and sialography today despite the availability of modern imaging modalities is discussed. Of the ultrasound equipment is adequate and the examiner has enough experience in small-parts ultrasonography, application of conventional X-ray methods should be limited to confirmation of ultrasonographic suspicion of sialolithiasis or tumor-erosion of adjacent bone, especially the mandible (plain films), further imaging of extra- and intraglandular salivary duct abnormalities in chronic inflammatory salivary gland disease, and demonstrating salivary gland involvement in special entities, such as sialadenosis (pseudo)cystica in Sjögren-syndrome by sialography.

Using the radionuclide salivagram to detect pulmonary aspiration and esophageal dysmotility.

That the radionuclide "milk" scan is insensitive for aspiration has been demonstrated. Here the authors review their experience with the radionuclide salivagram in its ability to detect aspiration in children. Tc-99m sulfur colloid, 0.5 to 1.0 mCi in less than 1 mL, is instilled into the mouth and sequential supine posterior images of the thorax are obtained for an hour with delayed images until the oropharynx is cleared of radiotracer. Fourteen studies have been performed in 13 patients aged 1 month to 6.5 years. There are scintigraphic findings consistent with aspiration in 4 of 14 studies (28%); dysmotility (prolonged retention of activity in the esophagus) in 7 of 14 studies (50%); and normal studies in 3 of 13 patients (22%). Eight of 13 patients had milk scans; all were negative for aspiration. One patient studied twice had aspiration on the first examination, and dysmotility on the second study. It is concluded that the salivagram can detect aspiration of oral secretions, is superior to the milk scan in detecting aspiration, and can demonstrate esophageal dysmotility.

Quantitative evaluation of sialograms.

RATIONALE AND OBJECTIVES: The authors developed and evaluated a quantitative analytic method for interpreting clinical sialograms. METHODS: Images were obtained by digital subtraction sialography and transformed into binary form. The duct width of the image was calculated and represented as a normalized histogram. The effects of the volume of contrast medium injected and of the inclination angle of the objects on the histogram were examined. RESULTS: In model studies, the normalized histogram was affected insignificantly by these factors. Clinical sialograms of 18 patients with normal results, 12 patients with parotitis, and 5 patients with Sjögren syndrome were preliminarily analyzed by the histogram method and four representative parameters of the histogram. Discriminant analysis showed a relatively high correct-predictive rate in the distinction between patients with normal and abnormal results. CONCLUSIONS: This method reduces the effect of observer variation in diagnosing sialograms, and improves diagnostic accuracy for assessing the presence of inflammatory diseases of the parotid gland.

Technical report: wire guided sialography.

An improved technique for performing sialography in difficult cases is described. This is based on the passage of a cannula into the salivary duct ostium over a thin, flexible, blunt guide-wire.

Clinical application of computerized continuous-infusion pressure-monitored sialography.

The clinical application of computerized continuous-infusion pressure-monitored sialography using an aqueous contrast medium during the investigation of 296 salivary glands is described. A comparison between the pressure changes and the sialographic features revealed a significant (P less than 0.001) correlation between raised filling pressure (greater than 60 mmHg) and the presence of an obstructive lesion (stricture, mucous plug, sialolith). Occasionally a raised filling pressure was observed although the associated sialography films were normal. The sensitivity of the technique was 86.4%. It is concluded that the monitoring of pressure changes occurring during sialography can alert the clinician to the presence of high filling pressure and may also provide additional evidence of obstructive changes within salivary glands.

[Sialography with digital image processing screens]. / Sialographie mit digitalen Bildspeicherfolien.

We recorded 45 sialograms on digital screens and discuss the use of a digital recording, processing and screening system for the diagnosis of inflammation, tumours and stones of the major salivary glands. Thirty-three investigations of a total of 33 parotid sialograms and 12 submandibular sialograms were analysed. A ductal examination with small volumes of soluble contrast media, permitting painless examination, was possible in all cases due to excellent homogeneous optical density, satisfactory detail and good contrast.

[Optimization of the radiographic technic in parotid sialography. Experimental findings and clinical evaluation of the selection of the film-screen combination]. / Ottimizzazione della tecnica radiografica nella scialografia parotidea. Rilievi sperimentali e valutazione clinica sulla scelta della combinazione film-schermo.

A suitable choice of film-screen combination is certainly the essential condition for achieving diagnostically reliable results together with the benefit of a low dosage for the patient. In parotid sialography, the choice of one particular film-screen combination depends on the different thickness of various glandular areas and on the particular anatomical site of the gland which inevitably causes the superimposition of the thinnest canalicular ducts with the adjacent areas. We have therefore performed an experimental-clinical study in order to evaluate the combination which can guarantee the most elevated diagnostic increase. The analysis of the results shows useful indication as far as the use of mammographic systems is concerned. These allow more diagnostic information together with a sufficiently low dosage for the patient.