Interobserver and intraobserver variability in the radiological assessment of sialolithiasis using cone beam computed tomography

Background Data regarding the inter- and intraobserver variability in the radiological assessment of sialolithiasis using cone beam computed tomography are missing in the current literature. This study assessed the inter- and intraobserver variability in the radiological assessment of sialolithiasis using cone beam computed tomography (CBCT).Material and Methods In 107 patients, 130 salivary glands (65 parotid and 65 submandibular) with clinical signs of obstruction were assessed by four independent observers; 2 residents OMFS and 2 experienced OMFS. The observers analyzed the CBCT images and determined the absence or presence of one or more salivary stones in the affected gland. This procedure was repeated after three months.Results Interobserver agreements showed kappa values of 0.84 for the parotid gland, and 0.93 for the submandibular gland. Intraobserver agreements for the whole group reported kappa values between 0.83 - 0.95. There was no significant difference between residents and experienced OMFS.Conclusions Due to the good inter- and intraobserver agreement, CBCT appears to be a reproducible imaging modality for detecting salivary stones in patients with signs and symptoms of obstructed parotid and submandibular glands. Key words:Salivary gland calculi, cone-beam computed tomography, observer variation.     

Sialendoscopy for sialolithiasis in children: 4-8 years follow up

Sialolithiasis is rare in children, there are no guidelines for its treatment, and there are few, if any, long term follow-up studies. We report a retrospective review of medical records of children who were treated for sialolithiasis by sialendoscopy between 1 January 2007 and 31 December 2011, and who have been followed up for 4-8 years. Personal and clinical details, including age, sex, symptoms, whether the lithiasis was parotid or submandibular, the technique of sialendoscopy and complications, were recorded. Twenty-six children (30 sides) were successfully treated by sialendoscopy between 2007 and 2011 (mean (range) age 12 (3-17) years). Stones were removed from the parotid gland in four patients and the submandibular gland in 22. The main indication for sialendoscopy was swelling of the salivary gland during meals. Twenty-six procedures were done endoscopically. Twelve were treated with a wire basket alone, 10 by the combined approach, and laser was used in eight. Four patients developed complications, but without long-term effects. During follow-up of 4-8 years there were no recurrent swellings. We conclude that endoscopic treatment of stones in childhood is an efficient and conservative option for salivary glands, has few complications and no clinical recurrence at medium to long-term follow-up.     

Diagnosing salivary stones

Sialolithiasis, or the formation of sialoliths or salivary stones, typically occurs in the ducts of the submandibular and parotid glands of middle-aged adults. Pain and swelling are often among the first signs and symptoms. Obstructive sialadentitis, epidemic parotitis (mumps) and salivary gland tumors, should all be included in the differential diagnosis for sialolithiasis.     

Virtual endoscopic view of salivary gland ducts using MR sialography data from three dimension fast asymmetric spin-echo (3D-FASE) sequences: a preliminary study

OBJECTIVES: We performed magnetic resonance (MR) sialography of parotid gland and/or submandibular gland ducts using three-dimensional fast asymmetric spin-echo (3D-FASE) sequencing. The objective was to make three-dimensional (3D) reconstruction images and virtual endoscopic views of the parotid gland ducts using MR sialography data sets of 3D-FASE sequences. METHODS: We reviewed the MR sialography data sets with 3D-FASE sequencing of 10 control volunteers and six patients. Three-dimensional reconstruction images and virtual endoscopic views of the parotid gland and/or submandibular gland ducts were generated with maximum intensity projection (MIP), shaded surface display (SSD), and volume rendering techniques (VRT). RESULTS: The main parotid gland and/or submandibular gland ducts, large branches within the glands, and small branches were fairly well defined in a very short acquisition time on MR sialographic images with 3D-FASE sequencing in nine of the 10 healthy volunteers. The 3D-reconstruction images of the parotid gland ducts and/or submandibular gland ducts showed the entire length of the branch paths and complete images from all angles, and the virtual endoscopic views showed the endoluminal tracts of the main ducts and the large branches in nine. In the patient with Sjogren's syndrome, chronic sialoadenitis, and salivary calculi in the Wharton ducts, the MR sialographic images showed diffuse areas of punctate high signal intensity, dilatation of Stensen's duct, or stones of Wharton's duct, respectively. Furthermore, the 3D-reconstruction images of the salivary gland ducts showed the stenoses and stones in the branch paths and complete images from all angles, and the virtual endoscopic views showed the stenoses and stones in the endoluminal tracts of the main and large branches. CONCLUSIONS: Our initial experience showed that virtual MR endoscopy could be performed to observe the endoluminal tracts of parotid and submandibular glands. The clinical use of the virtual MR endoscopy for salivary gland ducts has not been established yet. Future applications of the 3D-reconstruction images and virtual endoscopic views using MR sialography data sets of 3D-FASE sequences are very attractive and further expansion of this field is expected.     

超声弹性成像在干燥综合征唾液腺病变中的应用价值

目的: 探讨超声弹性成像技术中应变率比值法（SR）和声辐射力脉冲成像法（ARFI）在干燥综合征（SS）唾液腺病变诊断中的应用价值。方法: 收集 2017年1月—2017年7月上海交通大学医学院附属第九人民医院口腔外科门诊确诊的干燥综合征患者36例,健康对照病例25例。对双侧腮腺及下颌下腺进行SR及ARFI检查,获得双侧腮腺及下颌下腺的SR和剪切波速度（SWV）。比较同一组内腮腺、下颌下腺左侧与右侧之间以及不同组间同侧腮腺、下颌下腺 SR和SWV 的差异。采用SPSS 22.0软件包对数据进行统计学分析。结果: ①无论SS组还是健康对照组,左、右侧腮腺及下颌下腺之间SR值和SWV值差异均无显著性（P>0.05）;组间双侧腮腺、下颌下腺SR值差异均有显著性（P<0.05）;组间腮腺、下颌下腺SWV值差异均有显著性（P<0.05）。②以0.8962为截断值,采用SR检测腮腺、诊断SS的敏感度为77.8%,特异度为88.0%,曲线下面积达0.844;以0.8987为截断值,采用SR检测下颌下腺、诊断SS的敏感度为47.22%,特异度为84.0%,曲线下面积达0.652。③以1.6288为截断值,采用ARFI技术检测腮腺、诊断SS的敏感度为91.7%,特异度为88.0%,曲线下面积达0.943;以1.8788为截断值,采用ARFI技术检测下颌下腺、诊断SS的敏感度为44.4%,特异度为96.0%,曲线下面积0.614。结论: 超声弹性成像技术SR及ARFI可以提供腮腺及下颌下腺SR及SWV值,定量分析SS患者的腺体硬度,在临床诊断干燥综合征中有很好的应用价值。     

唾液腺内镜辅助下诊治腮腺导管结石的临床应用

目的 :分析唾液腺内镜辅助下口内切口和口外切口联合诊治腮腺导管结石的有效性。方法 :29例经超声和CT诊断为腮腺结石,并接受唾液腺内镜辅助保留腺体治疗的患者。根据结石的位置和性质选择单纯使用唾液腺内镜取石、唾液腺内镜辅助下的口内切口或唾液腺内镜辅助下的口外切口取石。结果:9人通过唾液腺内镜成功取石,15人在唾液腺内镜辅助下口内切口取石成功,另5人在唾液腺内镜辅助下口外切口取石成功。所有患者术后无并发症,腮腺功能均恢复到正常水平。结论:在缺乏碎石设备的情况下,唾液腺内镜辅助下口内和口外切口是治疗腮腺结石的有效方法,能够降低腮腺切除的比率。     

Fine-needle aspiration cytology: a reliable tool in the diagnosis of salivary gland lesions

J Oral Pathol Med (2012) 41 : 106–112 Background: Fine‐needle aspiration cytology (FNAC) is used as the main initial diagnostic investigation for lumps in the head and neck region. Major salivary glands and some minor salivary glands are easily accessible; therefore, they are optimal targets for FNAC. The aim of this study was to discuss the advantages and pitfalls of FNAC as compared to histopathology in the salivary gland lesions. Material and methods: A total of 127 FNAC were carried out on salivary gland lesions from January 2006 to December 2010 – a 5‐year period. Histopathological follow‐up data were obtained in 56 cases. The study was conducted to examine the sensitivity, specificity, and accuracy of FNAC for salivary gland swellings in comparison with histopathology. Results: The male‐to‐female ratio was 2.4:1. Parotid gland was involved in 51.1%, submandibular gland in 37%, sublingual gland in 4.7%, and minor salivary glands in 7% of patients. There were 55.9% cases of non‐neoplastic lesions and 44.1% cases of neoplastic lesions on biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of FNAC for malignant neoplastic lesions were 84.61%, 86.48%, 68.75%, and 94.11%, respectively, whereas for benign neoplastic lesions, they were 84.61%, 91.66%, 91.6%, and 85%, respectively. Conclusion: Fine‐needle aspiration cytology is found to be a good sensitive and specific technique for the diagnosis of most of the salivary gland lesions. FNAC should be adopted as an initial investigation for all salivary gland swellings in conjunction with other investigations where appropriate.     

下颌下腺结石的现代治疗策略

唾液腺结石好发于下颌下腺,常引起反复发作的进食后腺体肿胀和疼痛,曾是摘除腺体的主要原因之一.在现代医学愈来愈强调微创治疗的大趋势下,下颌下腺结石诊治过程中的腺体保留和功能恢复得到越来越多重视.临床上广泛应用的锥形束CT(cone beam computed tomography,CBCT)以及唾液腺内镜等新设备新技术,...     

采用双内镜微创治疗下颌下腺深部结石

目的评价涎腺内镜配合常规30°角腔镜在下颌下腺深部结石中的临床应用。方法选择2013年6月-2015年8月因单侧颌下区反复肿胀就诊患者17例,术前经下颌骨CT和唾液腺功能显像检查,诊断为下颌下腺深部结石。17例患者男性13例,女性4例,左侧12例,右侧5例;均应用涎腺内镜辅助常规30°角腔镜行口内取石术。结果下颌骨CT显示17例患者均有下颌下腺深部阳性结石,唾液腺功能检查显示患侧摄锝功能基本正常,而排泌功能明显下降。17例患者均采用双内镜辅助手术方法成功通过口内取出结石,手术时间（42±21）min,围手术期无明显并发症。结论双内镜辅助下行下颌下腺深部结石取出手术是一种有应用前景的新技术,可以避免因早期深部结石造成的腺体切除,但目前仍需严格选择适应证。     

Acetylcholine synthesis, muscarinic receptor subtypes, neuropeptides and secretion of ferret salivary glands with special reference to the zygomatic gland

Studies on salivary secretion are usually focused on parotid and submandibular glands. However, the film of mucin, that protects the oral structures and is responsible for the feeling of oral comfort, is produced by the submucosal glands. The submucosal zygomatic and molar glands are particularly large in carnivores such as the ferret. Comparisons between the mucous sublingual, zygomatic and molar glands, serous parotid and sero-mucous submandibular glands showed the acetylcholine synthesis, in terms of concentration, to be three to four times higher in the mucous glands than in the parotid and submandibular glands. Bromoacetylcholine inhibited 95-99% of the synthesis of acetylcholine in the incubates of the five types of glands, showing the acetylcholine synthesis to depend on the activity of choline acetyltransferase. The high acetylcholine synthesis in the zygomatic gland was of nervous origin, since cutting the buccal nerve, aiming at parasympathetic denervation, and allowing time for nerve degeneration, reduced the acetylcholine synthesising capacity of the gland by 95%. A similar reduction (96%) in the parotid gland followed upon the avulsion of the parasympathetic auriculo-temporal nerve. Zygomatic saliva was very viscous. The salivary flow rate in response to electrical stimulation (20 Hz) of the buccal nerve (zygomatic gland), expressed per gland weight, was one-third of that to stimulation of the auriculo-temporal nerve (parotid gland) or the chorda-lingual nerve (submandibular gland). As previously shown for the parotid and submandibular gland, a certain fraction (25%) of the parasympathetic secretory response of the zygomatic gland depended on non-adrenergic, non-cholinergic transmission mechanisms, probably involving substance P and vasoactive intestinal peptide and possibly calcitonin gene-related peptide. Particularly, high concentrations of vasoactive intestinal peptide were found in the sublingual and molar glands, and of substance P in the submandibular, zygomatic and molar glands; notably, the concentration of calcitonin gene-related peptide of the sublingual gland was not detectable. All five muscarinic receptor subtypes were detected in the five glands. The receptor protein profile, as judged by immunoblotting and semi-quantitative estimations, was about the same in the glands: high level of M3, low level of M2 and levels roughly in the same range of M1, M4 and M5. Compared to the parotid and submandibular glands, the M5 receptor level was particularly low in the mucin-secreting glands. The present study points out both similarities and dissimilarities between the five types of glands investigated. The zygomatic gland, in particular, appears to be a suitable model for future studies aiming at causing relief of dry mouth by local pharmacological treatment.     

锥形束CT在颌下腺结石诊断中的应用

目的:探讨锥形束CT(CBCT)对颌下腺结石的临床诊断价值。方法:利用CBCT的影像诊断系统对9例颌下腺肿大患者的下颌下区进行轴面、冠状面、矢状面及三维重建影像检查,同时进行测量分析。结果:8例患者经手术治疗后确定的结石大小、位置,与CBCT检查结果一致,1例术前自行排石。结论:CBCT对颌下腺结石有较高的诊断价值,能确定结石的数目、大小并定位,准确性高,为临床手术治疗提供直接依据。     

The diagnosis and surgical management of major salivary gland pathology

BACKGROUND: Major salivary gland pathology is an uncommon but important finding which may initially present to general dental and medical practitioners. The consequences of misdiagnosis are important, as acute obstruction and neoplasia are the main pathological lesions diagnosed. The purpose of this study was to analyze a consecutive series of major gland pathologies treated surgically to determine diagnostic and treatment problems. METHODS: A retrospective analysis of all cases of the major salivary glands treated on an inpatient surgical basis over a five-year period by the Oral and Maxillofacial Surgery Unit of the Royal Adelaide Hospital was performed. Particular emphasis was placed on the referring diagnosis as compared to the final diagnosis. RESULTS: Fifty-four patients had surgical management of 62 major salivary glands over the five-year period. By gland, 18 (33.3 per cent) were parotid, 35 (51.1 per cent) submandibular and nine (16.6 per cent) were sublingual. Fifty-one (82 per cent) of all lesions were inflammatory and 11 (18 per cent) neoplastic. The most common presentations were swelling (72 per cent) and pain (33 per cent). Most patients were referred by general dentists (37 per cent), followed by general medical practitioners (32 per cent) and specialists (28 per cent). The referring diagnosis was correct for only 45 per cent of the dentists but 76 per cent for the general medical practitioners and 87 per cent for the specialists. Only two of the 11 gland neoplasms were correctly identified as neoplasms, both by specialists. The morbidity of the surgical treatment was low. CONCLUSION: The general dental practitioner is often the first health professional with the opportunity to assess salivary gland pathology, and therefore needs to be aware of the presenting signs and symptoms of major salivary gland lesions.     

��Һ��ECT�ڷ���������Һ�ټ����е���ϼ�ֵ�о�

??Abstract??Objective To evaluate the diagnostic value of ECT in patients with salivary gland diseases. Methods Totally 52 patients with salivary gland disease ??30 parotitis?? 15 submandibular gland calculi?? 7 Sjogren's syndrome??were selected to this retrospective study from Dec. 2010 to Dec. 2013. All the patients had ECT and other routine examinations before operation. Comparison was made among them to find out the diagnostic value of ECT. Results In parotitis??ECT revealed decrease in excretion with affected glands of different extent?? showing obstruction in the duct??in sialolithiasis??ECT revealed apparent decrease in excretion with affected glands?? and 5 patients' uptake also decreased??in Sjogren's syndrome?? ECT revealed abnormal uptake and excretion with the four glands. Conclusion ECT plays an important role in the diagnosis and differential diagnosis of salivary disease and provids a valuable basis in treating salivary gland diseases.     

Pleomorphic adenoma of the soft palate

Pleomorphic adenoma is the commonest benign salivary gland tumour, accounting for almost three fourths of all such tumours. Pleomorphic adenoma most commonly occurs in the parotid gland; however it is also encountered in the submandibular, sublingual and minor salivary glands.     

唾液腺ECT在非肿瘤性唾液腺疾病中的诊断价值研究

目的 探讨唾液腺ECT在非肿瘤性唾液腺疾病中的诊断价值。方法 选取2010年12月至2013年12月来中国医科大学附属口腔医院口腔颌面外科就诊并接受治疗的非肿瘤性唾液腺疾病患者52例,其中慢性阻塞性腮腺炎30例,颌下腺结石15例,舍格伦综合征7例。所有患者常规检查及唾液腺ECT检查资料完整,回顾性分析检查结果,以明确唾液腺ECT在该类涎腺疾病诊断中的作用。结果 慢性阻塞性腮腺炎患者唾液腺ECT回报患侧腺体排泌功能不同程度降低,提示导管不同程度阻塞;涎石症患者唾液腺ECT回报患侧腺体排泌功能显著降低,提示导管重度阻塞,其中5例腺体摄取功能亦显著降低;舍格伦综合征患者ECT回报4个腺体（双侧腮腺和双侧颌下腺）摄取及排泌功能均有异常。结论 唾液腺ECT在非肿瘤性涎腺疾病中有一定的诊断和鉴别诊断价值,并能为临床治疗该类疾病提供有价值的依据。     

用PCR法检测唾液腺组织中HHV－6DNA

采用多聚酶链反应（ＰＣＲ）的方法，首次对１８例国人唾液腺组织标本中人类疱疹病毒６型（ＨＨＶ６）特异ＤＮＡ序列进行了检测。结果腮腺组织８例阳性（８／９），颌下腺组织５例阳性（５／７），舌下腺组织１例阳性（１／２）。提示唾液腺可能是ＨＨＶ６的主要潜伏部位之一，唾液可能是该病毒的传播媒介。     

Transfacial lithotomy approach to intraparenchymal stones in the submandibular gland: our primary exploration

The article describes our exploration of a sialendoscopy-assisted transfacial sialolithotomy approach to intraparenchymal stones in the submandibular gland with gland preservation. Five patients with large intraparenchymal stones in the submandibular gland were included. Ultrasonography and computed tomograms (CT) were performed to locate the stones. As the large stones failed to be retrieved during endoscopy, patients were treated by a transfacial lithotomy approach with sialendoscopy. The glands were preserved in all cases. This approach can be considered an optional technique for the treatment of large intraparenchymal stones in the submandibular gland that fail to be removed during a transoral procedure.     

Salivary gland involvement in hypohidrotic ectodermal dysplasia

Ectodermal dysplasias (EDs) are a group of developmental disorders (more than 100) mainly affecting ectodermal tissues and organs. The X-linked hypohidrotic ED (HED) is the most common form of EDs, involving defects in teeth, sweat glands, and hair. In a few reports, HED has been associated with reduced salivary function. In the present case report, a dramatically reduced salivary fluid and acidic proline rich protein production was identified in a 38-year-old man with HED. Computed tomography was performed, revealing that one submandibular gland and both parotid glands were hypoplastic, whereas the right submandibular gland seemed to be absent. These findings are in line with a general developmental disturbance also involving the salivary glands. As salivary tests are inexpensive and easy to perform, it is suggested to routinely evaluate salivary secretion in persons with HED, to prevent a possible negative impact on oral health.     

Trefoil factor family 3 expression in the oral cavity

This study examined the expression, in oral keratinocytes and in the major and minor salivary glands, of Trefoil factor family 3 (TFF3) peptide. Trefoil factor family 3 messenger RNA (mRNA) and peptide were detected in cultures of normal oral keratinocytes by quantitative real‐time polymerase chain reaction (PCR) and western blotting, respectively. Trefoil factor family 3 was found, by immunohistochemical analyses, to be expressed in the basal layers of the oral mucosal epithelium. In salivary glands, immunohistochemical staining showed that TFF3 peptide expression was strongest in the mucous acini of the submandibular and the small salivary glands. Serous cells in the same glands showed weak staining. In the parotid gland, many serous acini showed weak positive staining, while other areas did not. In all glands examined, the intercalated, striated, and collecting ducts were moderately TFF3‐positive. Double immunostaining confirmed that mucous (MUC5B positive) cells were moderately or strongly positive for TFF3 and that some serous (MUC7 positive) cells showed restricted TFF3 expression, mostly in a granular pattern. The prevalence of the TFF3 peptide in the salivary secretions of healthy volunteers was detected by western blotting of saliva from minor salivary glands (four of five) and the parotid gland (one of five) and of mixed submandibular/sublingual saliva (five of five). In conclusion, the submandibular and small salivary glands appear to be the major producers of oral TFF3, but duct cells of all glands and keratinocytes of the oral mucosa may also contribute as sources of TFF3 in the oral cavity.     

Tumor-associated glycoprotein 72 (TAG-72) expression in salivary gland neoplasia: an immunohistochemical study using the monoclonal antibody (MAb) CC49

OBJECTIVES: The purpose of this study was to investigate immunohistochemically the expression of tumor-associated glycoprotein 72 (TAG-72) using the monoclonal antibody (MAb) CC49 in salivary gland neoplasia and normal salivary glands in an attempt to determine the potential usefulness of MAb CC49 in diagnostic and therapeutic applications. MATERIALS AND METHODS: Eighty-six specimens (21 benign tumors, 41 malignant, and 24 normal salivary glands), fixed in 10% formalin and embedded in paraffin, were retrieved from the files of the Department of Oral Medicine and Oral Pathology at the Dental School of Aristotle University, Thessaloniki, Greece, and were retrospectively studied with hematoxylin and eosin and with the streptavidin-biotin-complex method using the MAb CC49. RESULTS: Strong immunoreactivity for TAG-72 was observed in salivary duct carcinoma, adenocarcinoma, papillary cystadenocarcinoma, low-grade mucoepidermoid carcinoma, normal submandibular, sublingual, and minor salivary glands. Weak or no immunoreactivity was found in adenoid cystic carcinoma, basal cell adenocarcinoma, polymorphous low-grade adenocarcinoma, and normal parotid gland. CONCLUSIONS: Our results suggest the potential use of MAb CC49 in the differential diagnosis of some salivary gland neoplasms in which their histopathologic features overlap, and in the radiation immunolocalization and immunotherapy of malignant tumors that are localized in the parotid gland.