Diseases of the submandibular gland as demonstrated using high resolution ultrasound.

In this review the high resolution ultrasound appearances of the normal anatomy and pathology involving the submandibular gland are demonstrated. The submandibular gland is affected by a number of disease processes that may be difficult to distinguish clinically. Its superficial location makes it ideal for ultrasound evaluation and a useful adjunct to clinical examination. In the assessment of submandibular pathology ultrasound allows intraglandular and extraglandular lesions to be localized and differentiated. These lesions can be further characterized as being benign or malignant and the extent of any extraglandular extension determined. Ultrasound is the first-line investigation in the assessment of sialolithiasis due to its high specificity and sensitivity. In severe infective sialadenitis ultrasound can confirm the presence and guide drainage of abscesses. Ultrasound also has an important role in the assessment of chronic inflammatory disorders such as sarcoidosis and Sjogren's syndrome.

Establishing an accurate diagnosis of a parotid lump: evaluation of the current biopsy methods - fine needle aspiration cytology, ultrasound-guided core biopsy, and intraoperative frozen section.

The optimum technique for histological confirmation of the nature of a parotid mass remains controversial. Fine needle aspiration cytology (FNAC), which has traditionally been used, is associated with high non-diagnostic and false negative rates, and ultrasound (US)-guided core biopsy and frozen section have been explored as alternatives. US-guided core biopsy is more invasive than FNAC, but is safe, well-tolerated, and associated with improved diagnostic performance. Although frozen section offers better specificity than FNAC, it has a number of important drawbacks and cannot be considered as a primary diagnostic tool. US-guided core biopsy should be considered as the initial diagnostic technique of choice, and in units where the accuracy of FNAC is good it can be used when FNAC is equivocal or non-diagnostic.

A comparison of monopolar and bipolar electrical stimuli and thermal stimuli in determining the vitality of human teeth.

The sensory threshold was determined for 50 teeth in 31 patients using constant-current stimuli of 0.1, 1.0 and 10 ms duration at 10 Hz through both monopolar and bipolar electrodes. The teeth were also tested with a cold stimulus (ethyl chloride on cotton wool), then extracted, processed and examined by light microscopy. Histologically, 38 teeth were vital and 7 non-vital. The best prediction of vitality was from ethyl chloride (80% correct) or bipolar stimuli of 10 ms duration and up to 200 microA (73% correct). The remaining 5 teeth had vital radicular pulps and necrotic tissue coronally, but a comparison between the results of monopolar and bipolar stimulation did not permit the detection of this group. There was no correlation between the electrical threshold and presence of caries, restorations, pulp stones or diffuse pulpal mineralization.

Multiple idiopathic external resorption of teeth.

Three cases of multiple idiopathic external resorption are presented. The condition is characterised by the absence of any widespread inflammatory response both in the gingival tissues and within the dental pulp. The only curative treatment is exodontia.

A comparison of one hundred and fifty consecutive parotidectomies for tumours and inflammatory disease.

The demographic profile and complications are compared and contrasted for 150 consecutive parotidectomies. All patients were under the care of one surgeon (JDL) over a twenty-year period (1977-1997). The case records and contemporaneous database were analysed retrospectively. 111 (74%) procedures were performed for tumours and 39 (26%) for inflammatory disease. The incidence of unexpected permanent facial nerve palsy was 1.8% in the tumour group and zero in the inflammatory group. The overall unexpected palsy rate was 1.3%. Transient paralysis was more common in the inflammatory group than the tumour group (61.5% compared with 33.3%, P<0.02) and was more likely to be panfacial (48.7% compared with 17.1%, P<0.0002). The overall incidence of Frey's syndrome was less than 20% and both salivary fistulae and sialocoeles were infrequent.

Dermoid cyst of the parotid gland.

A dermoid cyst occurring within the parotid gland of a 37-year-old Chinese man is reported. The diagnostic difficulties, histopathological features and pathogenesis are considered.

Gadolinium an alternative contrast agent for sialography in patients with iodine sensitivity.

The use of iodinated contrast material in radiography is contraindicated in patients with known iodine sensitivity and such patients may present a management dilemma. The successful use of gadolinium in contrast sialography is described.

Combined treatment of adenoid cystic carcinoma of the salivary glands.

A retrospective review of the experience of a single surgeon over a 20-year period is presented. Fifteen patients with primary adenoid cystic carcinoma of the major (6) or minor (9) salivary glands underwent combined treatment with wide local excision and radical postoperative radiotherapy. The actuarial survival is 100% at 5 years and 62% at 10 and 15 years. The disease-specific survival is 100% at 5 years and 86% at 10 and 15 years. There were no loco-regional recurrences. Wide local excision and radical postoperative radiotherapy seems to be an effective treatment for adenoid cystic carcinoma of the salivary glands.

Surgical management of chronic parotid disease.

This is a retrospective review of a single surgeon's experience over a 20-year period, and covers the presentation, investigation, histology, management and complications of the surgical treatment of chronic parotid disease. There were 46 superficial parotidectomies (23 with ductal ligation); 3 required removal of calculi and there was one ductoplasty and one total parotidectomy. There were 28 cases of temporary palsy of the VIIth cranial nerve (55%, mean duration 4 months) and this was predominantly panfacial (79%). There were no cases of permanent palsy. Five patients who initially had a superficial parotidectomy required subsequent total parotidectomy for recurrent disease (11%). We have now adopted a policy of near total parotidectomy for the surgical treatment of chronic parotid disease.

Red man syndrome during administration of prophylactic antibiotic against infective endocarditis.

Red man syndrome (RMS) is the occurrence flushing, pruritus, chest pain, muscle spasm or hypotension during vancomycin infusion. It usually happens as a result of rapid infusion of the drug but may also occur after slow administration. The frequency and severity of this phenomenon diminish with repeated administration of vancomycin. A case is presented whereby RMS occurred while prophylactic antibiotic against infective endocarditis was administered.

Sonographic assessment of the submandibular space.

There is a wide variety of pathological processes which may present with swelling in the submandibular space. Although the submandibular gland is the most important structure in this region, there are a number of extraglandular causes of swelling which frequently mimic submandibular gland enlargement. In this review the use of high-resolution ultrasound in the assessment of the submandibular gland and adjacent structures is discussed and illustrated.