Diagnosis of Salivary Gland Disorders

ISBN-13: 9789401056007 / Angielski / Miękka / 2012 / 175 str.

K. Graamans; H. P. Van Den Akker

Opis

Historically, disorders of salivary glands tend to be 'underdiagnosed and overtreated'. In the vast body of literature on this subject, emphasis has usually been put on therapeutic modalities of various diseases of the salivary glands. Whereas therapy and pathology have been treated in numerous thorough studies, the (patho )physiology of the salivary glands has remained rather poorly understood. Even less attention has been given to the diagnostic methods. Until a few decades ago, diagnosis consisted mainly of a clinical examin ation which included the patient's history, inspection, and palpation. These methods remain crucial, but a variety of new diagnostic tools have appeared since then. Their clinical value is still subject to controversy; each method has its advocates and opponents. The indications for enrolling a patient at a given point in a series of diagnostic procedures are interpreted differently. One of the most striking examples is the use of sialography. This has become a classic diagnostic procedure. Although sialography is still a useful method, it has considerable disadvantages, limitations, and even contraindications. In the major teaching hospitals, residents still tend to consider sialography as a panacea for the majority of their diagnostic problems, whereas the infor mation provided is actually rather restricted. Other modern methods such as CT and MRI have taken over the role of sialography to a certain extent. This also applies to ultrasonography and scintigraphy. Moreover, microbiol ogy, sialometry, sialochemistry, cytology, and histopathology may give super ior information in certain cases."

Spis treści

1. History and physical examination.- 1. Introduction.- 2. History.- 3. Physical examination.- 4. Further considerations.- 2. Plain radiography and sialography.- 1. Introduction.- 2. Plain radiography.- 3. Sialolithiasis.- 4. Inflammatory disorders.- 4.1. Acute sialadenitis and abscess formation.- 4.2. Chronic-recurrent sialadenitis.- 4.2.1. Sialectasia.- 4.3. Sjögren’s syndrome.- 4.4. Granulomatous diseases.- 5. Sialadenosis.- 6. Tumors and space-occupying lesions.- 7. Miscellaneous disorders.- 8. Conclusion.- References.- 3. Computed tomography of the major salivary glands.- 1. Introduction.- 2. CT versus CT-sialography of the parotid and submandibular gland.- 3. Technique.- 4. CT-sialography.- 5. CT anatomy.- 5.1. Parotid gland.- 5.2. Submandibular gland.- 5.3. Parotid gland masses.- 5.4. Submandibular gland masses.- 5.5. Benign versus malignant tumor.- 5.6. Relationship of tumors to the facial nerve.- 5.7. Inflammation.- 6. CT appearance of salivary gland tumors.- 6.1. Pleomorphic adenoma.- 6.2. Recurrent pleomorphic adenoma.- 6.3. Adenolymphoma.- 6.4. Other benign masses of the parotid gland.- 6.5. Malignant tumors.- References.- 4. Magnetic resonance imaging of the parotid gland.- 1. Introduction.- 2. Some remarks on MRI.- 2.1. Basic characteristics.- 2.2. Technique.- 2.3. Contraindications.- 2.4. Artifacts.- 3. Normal anatomy.- 3.1. Signal intensity.- 3.2. Normal MRI anatomy of the parotid gland.- 4. Pathology.- 4.1. Image characteristics.- 4.2. Pleomorphic adenoma.- 4.3. Recurrent pleomorphic adenoma.- 4.4. Adenolymphoma.- 4.5. Malignant tumors.- 4.6. Miscellaneous lesions.- 5. MRI in parotid disease.- 6. Conclusions.- References.- 5. Ultrasound in salivary gland disease.- 1. Introduction.- 2. Ultrasound imaging principles.- 3. Ultrasound examination of the salivary glands.- 3.1. Normal glandular tissue.- 3.1.1. Parotid gland.- 3.1.2. Submandibular gland.- 3.1.3. Sublingual gland.- 4. Inflammatory disease.- 4.1. Acute sialadenitis.- 4.2. Abscess formation.- 4.3. Chronic sialadenitis.- 4.4. Sialolithiasis.- 4.5. Abnormal ductal morphology.- 5. Space-occupying lesions.- 5.1. Cystic masses.- 5.2. Benign salivary gland tumors.- 5.2.1. Warthin’s tumor.- 5.2.2. Adenoma.- 5.2.3. Other benign salivary gland tumors.- 5.2.4. Intraglandular lymph nodes.- 5.3. Malignant salivary gland tumors.- 6. Diagnostic ultrasound in salivary gland disease.- 7. Conclusion.- References.- 6. Salivary gland scintigraphy with 99mTc-pertechnetate.- 1. Introduction.- 2. Scintigraphic method.- 3. Normal images and time-activity curves.- 4. Tumors.- 5. Sialadenitis and sialolithiasis.- 6. Sjögren’s syndrome.- 7. Sialadenosis.- 8. Miscellaneous disorders.- 8.1. Technical failure.- 8.2. Developmental anomalies.- 8.3. Obstructive disorders.- 8.4. Traumatic lesions and fistulae.- 8.5. Status after surgical treatment.- 9. Conclusion.- References.- 7. Fine-needle aspiration cytology.- 1. Introduction.- 2. Technique of FNA.- 3. Conditions for optimum FNA results.- 4. Complications of FNA.- 5. Reliability of FNA.- 6. Interpretation.- 7. FNA of salivary glands: cytological features.- 7.1. Normal salivary glands.- 7.2. Regressive changes in normal salivary gland cells.- 7.3. Benign salivary gland lesions.- 7.3.1. Cysts.- 7.3.2. Inflammation.- 7.3.3. Benign lymphoepithelial lesions.- 7.3.4. Pleomorphic adenoma.- 7.3.5. Papillary cystadenoma lymphomatosum (Warthin’s tumor).- 7.4. Malignant salivary gland lesions.- 7.4.1. Adenoid cystic carcinoma.- 7.4.2. Mucoepidermoid carcinoma.- 7.4.3. Acinic cell carcinoma.- 7.4.4. Other rare malignant neoplasms.- 8. Pitfalls in cytodiagnosis.- 9. Conclusion.- References.- 8. Histopathologic diagnosis of salivary gland disorders.- 1. Introduction.- 2. Histology.- 3. Histopathology.- 3.1. Non-neoplastic disorders.- 3.1.1. Inflammatory disorders.- 3.1.2. Non-neoplastic and non-inflammatory gland enlargements.- 3.1.3. Cysts of the salivary glands.- 3.2. Salivary gland biopsy as a diagnostic aid in systemic disease.- 3.3. Tumors.- 3.3.1. Introduction.- 3.3.2. Epithelial tumors.- 3.3.2.1. Adenomas.- 3.3.2.2. Carcinomas.- 3.3.3. Non-epithelial neoplastic diseases.- References.- 9. Microbiology of salivary gland infections.- 1. Introduction.- 2. Overview of salivary gland infections.- 2.1. Viral infections.- 2.1.1. Mumps.- 2.1.2. Cytomegalovirus infection.- 2.2. Bacterial infections.- 2.3. Fungi and yeasts.- 3. Diagnosis of viral and bacterial infections of the salivary glands.- 3.1. Viral infections.- 3.2. Bacterial infections.- 3.2.1. Direct microscopic examination.- 3.2.2. Gram stain.- 3.2.3. Giemsa stain.- 3.2.4. Cultures.- 4. Conclusion.- References.- 10. Sialometry and sialochemistry.- 1. Introduction.- 2. Salivary secretion.- 3. The collection of saliva.- 4. Sialometry.- 4.1. Flow rate.- 4.2. Latency time.- 4.3. Salivary pressure.- 5. Sialochemistry.- 5.1. Sodium.- 5.2. Bicarbonate.- 5.3. Urea.- 5.4. Potassium.- 5.5. Protein.- 6. Blood chemistry.- 7. Diagnostic aids to salivary gland disease.- 7.1. Inflammation.- 7.2. Mumps.- 7.3. Recurrent obstructive parotitis.- 7.4. Sjögren’s syndrome.- 7.5. Sarcoidosis (Heerfordt’s disease).- 8. Irradiation.- 9. Sodium retention dysfunction syndrome.- 10. Sialadenosis.- 11. Salivary gland disease in terminal illness.- 12. Tumors of the salivary glands.- 13. The effects of drugs.- 14. Conclusion.- References.- 11. Concluding remarks and recommendations.- 1. Introduction.- 2. Major salivary glands.- 2.1. Inflammatory disorders.- 2.1.1. Acute inflammatory disorders.- 2.1.2. Chronic recurrent inflammatory disorders.- 2.1.3. Sjögren’s syndrome.- 2.1.4. Sarcoidosis.- 2.2. Tumors.- 2.2.1. Benign salivary gland tumors.- 2.2.2. Malignant salivary gland tumors.- 2.3. Sialolithiasis.- 2.4. Sialadenosis.- 2.5. Developmental anomalies and trauma.- 3. Accessory salivary glands.- References.- Index of subjects.