Immunohistochemical evidence of nNOS and changes after intraglandular application of botulinum toxin A in cephalic salivary glands of adult rats

The purpose of our study was to investigate the possible influence of local injections of botulinum toxin A on the activity of neuronal nitric oxide synthase (nNOS) in cephalic salivary glands of adult rats. The role of nitric oxide (NO) as a possible neuromodulator of vascular regulation and in particular regulation of secretion in the upper respiratory and aerodigestive tract is discussed. We present immunohistochemical evidence of nNOS in the salivary glands of female adult Wistar rats, both in native (untreated) glands and after intraglandular injection of botulinum toxin A under general anesthesia. Other than in the untreated glands, there was a significant decrease in nNOS in the treated organs which became stronger with extended toxin exposure time. After our laboratory had already shown a decrease in acetylcholinesterase immunoreactivity after injection of botulinum toxin A into the cephalic salivary glands of the rat, the present study discusses a possible participation of NO in the regulation of secretion from these organs. As a conclusion, it might be assumed that the influence of botulinum toxin A on nNOS in the cephalic salivary glands of the rat is able to explain the sometimes longer duration of the toxin effect at the neuroglandular junction than at the motor endplate.     

Reduction of salivary flow with botulinum toxin: extended report on 33 patients with drooling, salivary fistulas, and sialadenitis

OBJECTIVES/HYPOTHESIS: The aim of the study was the evaluation of the clinical data of 33 patients who had had drooling attributable to various diseases, salivary fistulas, and sialadenitis and had been treated with injection of botulinum toxin type A (Botox). A controlled follow-up study documenting efficiency, possible side effects, and duration of the effect of treatment was also performed. STUDY DESIGN: Retrospective clinical evaluation. METHODS: Thirty-three patients with drooling attributable to head and neck carcinoma, neurodegenerative diseases, stroke, or idiopathic hypersalivation or with salivary fistula or chronic sialadenitis received injections of 20 to 65 U botulinum toxin type A into salivary glands under sonographic control. The entire salivary flow rate and the output per minute of the salivary analytes thiocyanate, total protein, alpha-amylase, acid phosphatase, kallikrein, and immunoglobulin A were measured at various times before and after injection. The patients were examined with regard to severity of their symptoms, including sonographic control investigation of their cephalic salivary glands. RESULTS: Twenty-six patients (79% of all patients) reported a distinct improvement of their symptoms after toxin injection. Seven patients noted a return of high salivation rates and requested a second injection after 4 to 7 months. Duration of toxin effect varied widely among individuals. In general, salivary flow rates and thiocyanate output dropped sharply within 1 week after injection and had increased again after a period of 12 to 16 weeks. Conversely, amylase outputs increased during this period, whereas the outputs of the other analytes remained roughly constant. Sonography did not reveal any major changes in salivary gland parenchyma, and side effects were not noted. CONCLUSION: Reduction of salivary flow in patients with drooling, salivary fistulas, or chronic sialadenitis by local injection of botulinum toxin type A into the salivary glands proved to be a dependable therapy for these disorders, as shown in the present extended report on 33 patients. Side effects were not observed. The effect of toxin application lasted for approximately 3 months. Based on their results, the authors recommend botulinum toxin injection as the therapy of choice in patients with the problem of drooling.     

Mixed tumor (pleomorphic adenoma) of head and neck. Typical and atypical patterns

Pleomorphic adenoma is a benign growth frequently encountered in major salivary glands, although minor salivary glands sometimes can be affected. In the latter non-specific clinical signs allows only the postoperative diagnosis. Nevertheless the existence of lesser salivary glands outside the oral cavity, and therefore pleomorphic adenomas, justify the specialist's need of its knowledge because of the difficulties arising in differential diagnosis. The AA. present a review of 22 cases in various sites treated in their Department in a 9 year-term.     

Abnormalities of the salivary glands from the clinical viewpoint

Malformations of the salivary glands may be an occult cause of sialadenitis, fistulae, tumours, or xerostomia. Diseases of the salivary glands occurring at atypical sites may result from several forms of dystopia of the glands, or from the presence of accessory or aberrant salivary glands, causing considerable problems in differential diagnosis and therapy.     

Sialocysts of the parotid glands

Sialocysts of salivary glands are outnumbered greatly by pseudocystic lesions, exemplified by mucoceles. In the major salivary glands, sialocysts are preponderantly lesions of the parotid glands, where they are classified as 1) salivary duct cysts, 2) lymphoepithelial cysts, or 3) dysgenetic or congenital cysts. All arise from salivary ducts and have no relation with the branchial apparatus.     

Hyalinizing clear cell carcinoma of the base of the tongue

Clear cell carcinoma of the salivary glands is a rare tumour that represents less than one per cent of all salivary tumours. They are divided into a biphasic, epithelial-myoepithelial carcinoma and a monophasic pattern which may be myoepithelial or ductal in origin. The latter is accompanied by prominent fibrohyaline stroma and has been described recently as hyalinizing clear cell carcinoma (HCCC). Most of the HCCC occur in the oral cavity, and are associated with minor salivary glands, unlike the biphasic pattern which is more common in the major salivary glands. In the oral cavity, the commonest site is the palate followed by the lips and the buccal mucosa. Its occurrence in the oropharynx and the larynx is extremely rare.     

High-resolution real-time sonography in salivary gland diseases. II: Salivary gland tumors

74 non-selected patients with suspected tumors of the major salivary glands were examined by high-resolution real-time sonography (7 MHz). The different tumors presented with characteristic but nonspecific echomorphological features. Cysts of the salivary glands, intraglandular lymphadenitis, and paraglandular lesions can be distinguished from real tumors of the salivary glands. In case of uncertain palpatory findings the demonstration of an intact echographic texture pattern proves the absence of a tumor. No false negative ultrasound tumor diagnoses were encountered (sensitivity 100%). In salivary-gland neoplasms high-resolution real-time sonography completes the clinical findings and provides important informations about size, number and type of space occupying lesions.     

Studies on the radioprotective potency of amifostine on salivary glands of rats during fractionated irradiation: acute and late effects

The purpose of this study was to evaluate the radioprotective potential of amifostine on the salivary glands of rats with respect to the acute and late effects. The head and neck area of WAG/RijH rats was irradiated with (60)Co-gamma rays (60 Gy/30f for 6 weeks). Amifostine (250 mg/m(2) body surface) or an equal volume of physiologic saline was applied intravenously 15 min before each irradiation. In the course of treatment the salivary glands were examined histopathologically. Body weight was measured sequentially during irradiation. A cytoprotective effect of amifostine on the acute toxicity of salivary glands could not be detected under fractionated irradiation. However, late effects such as fibrosis and necrosis of the glands 6 months after irradiation were less developed in the amifostine group. The weight loss of the amifostine-treated animals during fractioned irradiation was higher than in the irradiated group. Amifostine has a significant cytoprotective effect on the late toxicity of irradiated salivary glands. However, the acute toxicity of the glands during radiotherapy cannot be reduced.     

Nizatidine enhances salivary secretion in patients with dry mouth

OBJECTIVE: It was reported that salivary secretion increased in 30 volunteers with administered nizatidine. The aim of the present study was to investigate whether or not nizatidine enhances salivary secretion and improves the function of salivary glands in patients with dry mouth. METHODS: Both basal and stimulated salivary secretions were measured before and after the administration of nizatidine for a month in 18 healthy adult volunteers and 38 patients with dry mouth. In 6/38 patients, salivary gland scintigraphy was performed. RESULTS: After the administration of nizatidine for a month, salivary secretions significantly increased in the control and dry mouth patient groups compared to the pretreatment baseline. In addition, 25 of 38 dry mouth patients showed subjective improvements of oral dryness. In 3/4 patients, the function of salivary glands was improved on salivary gland scintigraphy. CONCLUSION: Nizatidine may reactivate salivary gland cells and be useful in the treatment of patients with dry month.     

Lithiasis of a minor salivary gland. Apropos a case]

Sialolithiasis of minor salivary glands is generally considered to be extremely rare, particularly in younger persons. In addition, the symptomatology of this entity is not always typical and, for this reason, clinical misdiagnosis is possible. A case of sialolithiasis of minor salivary glands of the cheek in a 20 year-old woman is reported. The clinical diagnosis is verified by the histopathological examination after surgical excision of the lesion.     

Sequenced scintigraphy: A morphological and functional study of the salivary glands

The use of scintigraphy in sequenced registration shows that there are three fundamental stages in the intraglandular turnover of the radio-nuclide: 1. At very early stage (between 3 min. and 15 min.), the major salivary glands could be clearly distinguished; 2. At the stage immediately following (between 20 min. and 35 min.), both the parotid and submaxillary glands were already less well defined; while in the mouth projection zone, quite intense radioactivity, connected with a progressive accumulation of the radionuclide in the minor salivary glands, was seen; 3. Within an hour after injection, maximum captation took place in the minor salivary glands, while both the parotid and the submaxillary glands were hardly distinct. These three stages are strictly related to the three phases of behavior of the radionuclide in each salivary gland: arrival, accumulation, dismissal. Then, each documented variation from the normal pattern will indicate a determined functional anomaly related to defined disease of the salivary glands. The sequenced scintigraphy offers a functional study of the salivary glands from which it is possible to obtain many elements of practical clinical utility.     

Radioprotective effectiveness of amifostine on the salivary glands of the rat during fractionated irradiation

BACKGROUND: The aim of this study was to evaluate the cytoprotective potency of amifostine during a fractioned irradiation of salivary glands but also on the tumor response of rhabdomyosarcomas R1H in rats. METHOD: The head-neck-area of male WAG/RijH rats and the tumor in the flank were irradiated with 60Co-gamma-rays (60 Gy/30 f/6 weeks). Amifostine (250 mg/m2) was applicated 15 min before irradiation. The control group was treated with an equal volume of physiologic sodium chloride. The salivary glands were exstirpated and examined histopathologically. Tumour volume was measured, the body-weight of rats determined. RESULTS: A dose dependent radiosialadenitis developed in all salivary glands. Amifostine had no influence on the response of R1H tumours to radiation. The animal weight loss in the amifostine group was higher as compared to control group. CONCLUSIONS: No cytoprotective effects on acute toxicity of salivary glands of rats could be detected under irradiation with synchronous application of amifostine. In addition, no effects on tumor response were observed. The general animal constitution decreased by additional medication of amifostine.     

Heterotopic salivary tissue

Salivary tissue can be present in the head and neck outside the usual locations of the major and minor salivary glands. This can be in the form of accessory salivary glands, in association with branchial cleft anomalies, or, less commonly, as heterotopic salivary gland tissue (HSGT). Heterotopic salivary gland tissue is defined as salivary tissue outside of the expected locations of major, minor, and accessory salivary glands with absence of clinical or histologic features of branchial cleft anomalies. Here we present the case of a 13-year-old girl who presented with a draining sinus of the lower neck, which was excised and, on histologic analysis, was consistent with HSGT. We include photographs and histologic images. A review of the literature on heterotopic salivary tissue in the neck is then presented including discussion of the presentation, clinical features, important considerations, and recommendations for management.     

Adenoid cystic carcinoma of the salivary glands: a 20-year review with long-term follow-up

The behavior of adenoid cystic carcinoma (ACC) of the salivary glands has been shown to be unpredictable in terms of local and distant spread and mortality. We retrospectively studied 35 operations in 34 patients who had had a pathologic diagnosis of ACC of the salivary glands and who had been treated over a 20-year period and followed for a minimum of 10 years. We analyzed the effect that different factors had on outcomes. The site of origin appeared to be an important factor in survival rates; survival among patients with tumors that had originated in the parotid gland was fairly good, while survival among those with tumors that originated in the minor salivary glands was significantly worse. TNM staging was another significant factor in survival. Other poor prognostic indicators were local spread, nodal positivity, distant metastasis, and local and regional recurrence. Radiation and chemotherapy did not appear to be beneficial for patients with advanced disease. We recommend radical surgery with complete resection for all patients with ACC of the salivary glands and a careful assessment of the neck in patients with minor salivary gland tumors.     

The value of sonography in salivary gland tumors

In a prospective study, 178 patients with tumours of the salivary glands were examined both clinically and by ultrasound. All patients have since been operated upon, and the diagnosis was confirmed histologically. The diagnostic accuracy of clinical examination is compared with that of ultrasound. Every tumour of the salivary glands could be diagnosed by ultrasound. In the benign group, an exact diagnosis of the tumour type was possible in 83% of cases. In the malignant group an exact diagnosis was only possible in 57% of cases. Furthermore, it is possible with ultrasound to recognise multiple and bilateral tumours, to determine whether a tumour is intra- or extraglandular, and to show the nature of the tumour (cyst, abscess, central necrosis) to a much greater extent than with clinical examination alone. In addition, a fairly good assessment of the cervical and intraglandular lymph nodes is obtained. We believe that ultrasound is of great importance in the diagnosis of tumours of the salivary glands.     

Schwellungen der Glandulae submandibularis und parotis

Swelling of single or multiple major salivary glands can be caused by various local or systemic diseases. In differential diagnosis, congenital cystic or vascular malformations should be considered, as well as infectious or tumorous alterations. Salivary duct obstructions due to sialolithiasis or stenosis can cause salivary gland enlargement. Multiple systemic diseases can have manifestations in the parotid or submandibular glands. As therapy varies from cause to cause, knowledge of the different potential diagnoses is crucial.     

Adenocarcinoma of the salivary glands. The pathohistology and subclassification of 77 cases

Seventy-seven adenocarcinomas of the salivary glands recorded in the Salivary Gland Register between 1965 and 1984 were analysed and classified histopathologically. The following results were obtained: 1. 2% of all salivary gland tumours and 10% of all malignant epithelial salivary gland tumours were allotted to the group of adenocarcinomas. The age peak lies in the 7th to 8th decade. 60% occurred in women, 58.5% were localized to the parotid gland, 28.5% to the minor salivary glands (palate, lips, and cheek), 11.5% to the submandibular gland and only 1.5% to the sublingual gland. 2. Solid, tubular and papillary adenocarcinomas can be distinguished. Additional criteria are microcysts, mucus production and grade of differentiation. 3. The solid adenocarcinoma (13%) is predominantly localized in the parotid gland and characterized by a low differentiation, invasive growth and metastases. 4. 62.5% of tubular adenocarcinomas (52%) are localized in the parotid gland, 27.5% to the minor salivary glands and 10% to the submandibular gland. Most of the tumours are highly differentiated. A distinct mucus production is present in 40% of the cases. Microcysts are very frequent. 5. Papillary adenocarcinomas (28.5%) are localized in almost 50% of cases to the minor salivary glands, 45% to the parotid and only 5% to the submandibular gland. Microcysts and mucus production can be observed in 50% of the cases. 6.5% of the cases have a mixed tubular papillary structure. 6. In differential diagnosis, thyroid gland carcinomas and metastases of other adenocarcinomas must be distinguished, the former by negative result of the thyroglobulin reaction, and absent mucus production. 7. Adenocarcinomas arise from the salivary duct system. Solid or tubular adenocarcinomas imitate stages of the embryonal development of the salivary ducts.