Search

Introduction: Recent advances have led to the development of sialendoscopy, an accurate, minimally invasive procedure with high diagnostic and therapeutic capabilities in treating sialolithiasis. This study aimed to evaluate the results and complications of sialendoscopy in patients suffering from sialoadenitis. Materials and Methods: This study was a prospective interventional case series study on patients with sialoadenitis due to sludge or stone formation preoperatively confirmed by sonography or computed tomography (CT) scanning. Diagnostic sialendoscopy was performed, and the presence of stenosis, sludge, or stones inside the gland or duct was examined, and surgery was done. During follow-up time (18.8 ± 7.4 months), recurrence of symptoms, the need for reoperation, and postoperative complications were also assessed. Results: The sialendoscopy was performed in 51 patients, including 55 glands. Forty-five Patients (88.2%) reported pain relief, and 46 patients (90.2%) reported that the treatment using sialendoscopy was better than conservative methods. The duct restenosis also occurred in one patient requiring open surgery. In assessing the main factors predicting the need for reoperation, the site of involvement (parotid versus submandibular glands) and the size of the stone were identified as the main determinants. The best cutoff value for stone size in predicting reoperation requirement was 7.0mm, with a sensitivity of 100% and a specificity of 85.7%. Conclusion: Intraoperative sialendoscopy is a successful diagnostic and therapeutic tool with minimal postoperative complications in salivary gland duct involvement patients. [ABSTRACT FROM AUTHOR]

Non-Hodgkin lymphomas (NHLs) commonly show extranodal involvement (20–30%). Primary diffuse large B-cell lymphomas (DLBCLs) with extranodal localization represent clinically and molecularly distinct entities. Here, we present a case of DLBCL affecting the parotid gland that initially seemed to be sialadenitis. The magnetic resonance Imaging (MRI) and positron emission tomography (PET) scans showed a neoplastic mass in the parotid gland and involvement of the spleen, respectively. The immunohistochemistry (IHC) confirmed the diagnosis of DLBCL. The patient was treated successfully with chemotherapy. A high degree of skepticism is involved in an early diagnosis of NHL as it can mimic benign and malignant entities.

Acute enlargement of the parotid gland following general anaesthetic administration is an uncommon, harmless, and self-limiting complication. The most likely cause was thought to be anaesthesia mumps, which involves a complex interaction of multiple factors, including factors such as direct trauma, patient position leading to altered salivary flow along with an increase in viscosity due to dehydration, its occurrence following arthroscopic shoulder surgery under general anaesthesia is relatively rare. It is usually a self-limiting disease and requires only follow-up observation, and in a few case reports, evaluation with imaging studies has been performed. However, severe complications may sometimes occur. If upper airway obstruction develops as in the present case, then emergency airway management must also be considered. Several surgical subspecialties, including orthopaedics, obstetrics and gynaecology, neurology, and spinal surgery, have recognised this uncommon postoperative syndrome. The present case report describes the medical condition of a 50-year-old female patient who experienced postoperative parotitis and underwent arthroscopic shoulder surgery for rotator cuff repair involving general anaesthesia. [ABSTRACT FROM AUTHOR]

Our review of the literature shows anatomical variation of the submandibular gland is a rare entity, unlike the variation that can be seen in parotid glands. Specifically, bilateral submandibular abnormality has only been reported on one occasion with limited imaging in our review. We report a 78-year-old female with a history of sialadenitis and sialolithiasis who presents with swelling and pain in the right submandibular gland. Sialography of the right submandibular gland disclosed a second primary duct branching off the main duct to a second submandibular gland. Cannulation of the left submandibular duct was unsuccessful due to scarring of the duct orifice; however, subsequent MR sialography identified marked submandibular duct dilation and the incidental finding of a second anteriorly located left submandibular gland. The anatomic detail provided by conventional digital sialography is contrasted to the useful but less-defined imaging provided by MR sialography. To our knowledge, this is the first reported case of bilateral accessory submandibular glands that has been evaluated using both conventional and MR sialography.

Sialadenosis is a dystrophic disease of the salivary glands parenchyma, which leads to secretory disorders and hypertrophy of salivary glands. Sialadenitis develops in cases of secondary inflammation. Standard methods and medications for the treatment of sialadenosis lead to regression of clinical manifestations and remission. Usage of herbal extracts with prolonged action has a long-term local anti-inflammatory effect with minimal side effects, including those affecting oral mucosa. However, their use in the complex treatment of sialadenosis has been scarcely studied. Objective of our investigation was to estimate cytokine status dynamics in saliva from the parotid glands in the patients with sialadenosis and hypothyroidism during complex treatment which included the prolonged-action herbal remedy. 52 patients with sialadenosis of parotid salivary glands and hypothyroidism were divided into 2 groups: in the I group, 26 patients received basic therapy; in the II group, 26 patients received basic therapy + herbal drugs with prolonged effect as resorbable tablets. Control group consisted of 20 conditionally healthy people without disorders of parotid glands and thyroid gland. Comparative evaluation was performed 1 and 6 months after starting the treatment, with respect to clinical findings, sialometry and cytokine profile. The content of interleukins IL-1β, IL-6, IL-10 and tumor necrosis factor (TNF) was determined in saliva of parotid glands by ELISA technique. The 1st group of patients showed exacerbations within six months of basic treatment, and the sialometry data pointed to maintenance of decreased parotid function. In the 2nd group, when using basic treatment + herbal drugs, no clinical features of sialadenosis were evident within 6 months. The sialometry values were normalized, and the secretory function of the parotid glands was found to be increased. Therefore, it exerted an effect upon moisturization of oral mucosal and improvement quality of life in the patients. Regression of IL- 1β, IL-6 and TNF contents, and IL-10 increase in parotid gland secretions was significantly more pronounced at the terms of 1 and 6 months in cases treated with herbal drugs, compared to Group 1, where a conventional protocol was used. Addition of herbal drugs of prolonged action to the standard protocol of sialadenosis treatment is reasonable and effective.

Skin tumours are among the most prevalent neoplasms in older dogs, and often display diverse clinical signs. This case report outlines the clinical presentation, diagnosis, and treatment of a suspected skin tumour in a 10-year-old obese female Golden Retriever weighing 46 kg. The owner brought the dog to West Java Provincial Animal Hospital with mandibular swelling, decreased appetite, and tachypnoea. Physical examination revealed a rectal temperature of 40.1°C, painful mandibular swelling, respiratory rate of 236 breaths per minute, and heart rate of 88 beats per minute. Cytology revealed pleomorphism, coarse chromatin, and nuclear moulding, suggesting increased cellular activity. Haematological results showed leukocytosis, granulocytosis, and hyperchromic normocytic anaemia, likely due to the release of proinflammatory cytokines from the tumour and immune cells. Differential diagnosis included sialadenitis, apocrine gland tumours, and salivary gland adenocarcinoma. The final diagnosis was skin tumour with poor prognosis. The treatment involved iron dextran, supplements, dexamethasone, sulfadiazine- trimethoprim, cyproheptadine HCl, and tolfenamic acid. [ABSTRACT FROM AUTHOR]

The article describes the case of a 61-year-old woman presented with the chief complaints of dysosmia , dysacousis, ear fullness, wheezes, swelling of bilateral submandibular glands, and seven kilogram (kg) weight loss in four months. Topics include findings on physical examination, the potential of dupilumab monotherapy to resolve mass lesions, and advice to consider using dupilumab monotherapy only in patients without life-threatening lesions.

Introduction: Salivary gland lesions are one of the most heterogenous lesions with overlapping features between low grade malignancy and benign lesions thus making them one of the most difficult areas for diagnosing. Cytology of salivary gland lesions plays an extremely important part in diagnosing the lesions and categorising them into non neoplastic, benign and malignant neoplasms, thereby allowing the patients and clinicians to make an accurate decision regarding whether the lesion is followed, biopsied, excised or a radical operation might be needed. Aim: To classify salivary gland lesions according to MILAN System for Reporting Salivary Gland Cytopathology (MSRSGC). Materials and Methods: This observational study was conducted from June 2021 to May 2022 where Fine Neddle Aspiration Cytology (FNAC) of salivary gland lumps was done on patients presenting to the Department of Pathology Rohilkhand Medical College and Hospital, Bareilly. The clinical and radiological features were noted. The cases were diagnosed on conventional cytopathology. Additionally categorisation as per MILAN System was done by two pathologists independently. The results were compared with histopathology, where available. Data was collected, entered and compiled in Microsoft excel followed by analysis using the software Statistical Package for Social Sciences (SPSS) version 23.0. The data was represented in frequency and further analysed using Kappa statistics. Also the validity was calculated in terms of sensitivity, specificity, Positive Predictive Value and Negative Predictive Value (NPV). Results: Total of 60 cases were included with M:F ratio as 1.6:1. Most common age group was third decade with 17 (28.3%) cases, closely followed by fourth decade with 11 (18.3%) cases. Most common salivary gland to be affected was parotid gland with 30 (50%) cases. Most common MILAN category was II, non neoplastic with 26 (43.3%) cases, followed by IV A, benign neoplasm with 19 (31.67%) cases. The Cohen kappa coefficient was 0.952 which showed a near perfect agreement between the two pathologists. The sensitivity, specificity, PPV and NPV and accuracy was 75%, 92.8%, 75% and 92.8%, 89% respectively. The Risk of Malignancy (ROM) for category I,II,III,IVA,VI was 0%, 0%, 50%, 9%, 100% respectively. Conclusion: The MILAN System for Reporting Salivary Gland Cytopathology (MSRSGC) offers a structured reporting system. The terminologies are reproducible and convey clear meaning among all the medical professionals including different pathologists and treating physician or surgeon and guide in deciding the accurate treatment based on the ROM for different categories.

Introduction: Chronic obstructive sialadenitis (COS) is an entity that causes a marked loss in patient quality of life, including changes in eating habits and a progressive loss of gland function. It is characterized by repeated episodes of painful glandular swelling often requiring emergency care. There are multiple causes of COS, including lithiasis, strictures, anatomical variants, and others. The development of specific imaging tests such as magnetic resonance (MR) sialography or sialendoscopy have increased knowledge of these obstructions and how to specifically treat them. Case Summary: We present an unusual case of a woman with a years-long history of chronic obstructive sialadenitis in which an abnormal path of Wharton's duct was in evidence. This duct, which was atrophic and smaller in diameter, opened in the tonsillar fossa rather than lateral to the lingual frenulum. This case, the first in vivo description of its kind, was confirmed by MR sialography and sialendoscopy. Discussion: Congenital anomalies of the submandibular duct are a rare finding, but may cause COS. Therefore, COS requires a detailed diagnostic study, usually by ultrasound, MR sialography and sialendoscopy, to rule out complex anatomical variants. [ABSTRACT FROM AUTHOR]

Identifying a submandibular (Wharton's) duct punctum often hinders sialendoscopy; however, there is a paucity of evidence on whether the appearance of Wharton's duct papilla impacts the sialendoscopic procedure. A classification of Wharton's duct papillae based on the macroscopic appearance, size of dilatation probes, and sialendoscopic approach was proposed herein. The classification describing four main types of papillae, A, B, C, and D, was prospectively evaluated on 351 Wharton's duct papillae in 315 patients. For each papillae type, the demographic/clinical data, intraoperative complications, and time required for sialendoscope introduction were analyzed. Estuary-like papilla (type A) was commonly seen after spontaneous stone extrusion, had no intraoperative complications noted, and had the shortest time required for the sialendoscope introduction. Normal papilla (type B) was the most frequently observed papilla (48.1%), reflecting diverse underlying pathology, while difficult papilla (type C) was often associated with unfavorable anatomical variations of the mandible or floor of the mouth. Substantially closed papilla (type D) had the highest rate of intraoperative complications, namely, perforation with a false passage, and required the longest time for the sialendoscope introduction. In seven patients (2.0%), the entrance into the duct was feasible only through the fistula, while the sialendoscope introduction failed in eight patients (2.3%). In conclusion, the appearance of Wharton's duct papillae may be influenced by the underlying pathology. Based on the proposed classification, papilla typology affects the duration of sialendoscope introduction and may influence the frequency of intraoperative complications. [ABSTRACT FROM AUTHOR]

Objectives: Patients are increasingly relying on YouTube for health information. We objectively evaluated the quality and comprehensiveness of sialendoscopy YouTube videos available to patients. We further investigated the relationship between video content and video popularity. Methods: We identified 150 videos using the search term "sialendoscopy." Videos were excluded if they were lectures for medical professionals, operating room (OR) recordings, unrelated, non‐English, or non‐audio. Video quality and comprehensiveness were evaluated using modified DISCERN criterion (range: 5–25) and novel sialendoscopy criterion (NSC, range: 0–7), respectively. Secondary outcomes included standard video metrics and Video Power Index to measure popularity. Videos were classified binarily by uploader type as from an academic medical center or from other sources. Results: Twenty‐two (14.7%) of 150 videos were included for review, with 7 (31.8%) uploaded from academic medical institutions. One hundred‐nine (72.7%) videos were excluded as lectures for medical professionals or OR recordings. Overall mean modified DISCERN (13.45 ± 3.42) and NSC (3.05 ± 0.96) scores were low; however, videos uploaded by academic medical institutions were significantly more comprehensive (NSC mean difference = 0.98, 95% CI: 0.16–1.80, p =.02). There were no significant correlations between video popularity and objective measures of quality or comprehensiveness. Conclusions: This study highlights the paucity and low quality of sialendoscopy videos for patients. More popular videos are not higher quality, and most videos are targeted more toward physicians rather than patients. As YouTube becomes increasingly used by patients, there is opportunity for otolaryngologists to produce more informative videos for patients while implementing targeted strategies to increase viewership. Level of Evidence: NA. [ABSTRACT FROM AUTHOR]

Objectives: To characterize the clinical features and outcomes of childhood-onset primary Sjögren's syndrome (pSS). Methods: Patients less than 18 years old who were diagnosed with pSS by paediatric rheumatologists were included, and all patients were applied the 2002 American-European Consensus Group (ACEG) criteria, the 2016 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for pSS, or the 1999 proposed juvenile pSS criteria. The electronic medical records of patients with pSS from 2013 to 2020 were collected and analysed. Results: Thirty-nine patients were included. Of them, 27 (69.2%), 38 (97.4%) and 35 (89.7%) patients fulfilled the AECG criteria, ACR/EULAR criteria and proposed juvenile pSS criteria, respectively. The female:male ratio was 3.9:1. The median ages at first signs or symptoms and at diagnosis were 9.2 (4.7, 14.5) years and 10.9 (6.3, 15.0) years, respectively. The main clinical manifestations were rash or purpura (20, 51.3%), followed by fever (12, 30.8%), glandular enlargement/recurrent parotitis (10, 25.6%), and dry mouth and/or dry eyes (9, 23.1%). Twenty-eight (56.4%) patients had systemic damage, the most common of which was haematological involvement (14, 35.9%), followed by hepatic (13, 33.3%) and renal involvement (8, 20.5%). Thirty-eight (97.4%) patients underwent labial minor salivary gland biopsy, and all exhibited focal lymphocytic sialadenitis. All patients had a global ESSDAI score ≥ 1 at diagnosis, and the median total score at diagnosis was 8 (2, 31). Thirty-six (92.3%) patients were followed up for a median time of 23.6 (7.9, 79.5) months, and three patients developed systemic lupus erythematosus (SLE) at follow-up times of 13.3, 38.8 and 63.8 months. Conclusions: The presentation of childhood-onset pSS is atypical, and extraglandular manifestations and systemic involvement are more common than in adult-onset pSS. Labial salivary gland biopsy is vital for patients with probable pSS. Some patients may develop SLE over time. [ABSTRACT FROM AUTHOR]

Iodine contrast-induced sialadenitis (CIS) is an uncommon adverse effect to iodine-containing contrast exposition. There is scarce literature about its clinical course and demography. (1) To determine the clinical course and management of CIS. (2) To understand if CIS might be as rare as reported. A 2-month prospective observational study was conducted in the emergency room of a tertiary institution. ENT physicians on call received clinical formation about CIS while emergency physicians did not. During the study period, patients admitted at the emergency room matching the clinical and radiological features of CIS, were included. Information about demographics, iodine exposure, diagnostic workup, clinical course, and management was analyzed. ENT physicians on call detected 4 cases, however, emergency physicians did not. Patients were aged 68–76 years and presented a bilateral submandibular gland swelling debuting 12 to 72 h after an exposure to iodinated contrast. Characteristic ultrasonographic findings supported the diagnosis and the clinical course was self-limited after 60 to 150 h. Physicians' familiarity with CIS allows its detection and avoids costly and potentially harmful therapeutic/diagnostic efforts. The incidence is probably underestimated; however, further incidence studies are needed. [ABSTRACT FROM AUTHOR]

Introduction and objective: The parotid gland lymphomas are encountered unfrequently. The objective of this study is do a retrospective systematic review of the literature on parotid MALT lymphomas, to evaluate its epidemiology, clinical presentation, diagnostic methods, treatment, and prognosis. Method: Systematic review. Results: 28 original studies have been included (case report and case series), 10 of which included more than 25 cases. Studies showed a higher prevalence in women, according to its relationship with autoimmune diseases, Sjögren disease specifically. The studies outlined the difficulty on the differential diagnosis with other parotid diseases. Treatment varied between studies, with no specific benefit for any of them. Discussion: This lymphoma is a type of NHL related to chronic autoimmune inflammation in case of salivary glands localization. It presents as an asymptomatic and non-specific, slow growing mass. It is diagnosed by CT or MRI in the majority of cases. The treatment includes the association of parotidectomy and/or chemotherapy and/or radiotherapy. The 5-year survival rate is >80%. Conclusions: MALT salivary lymphomas are a rare entity that can be easily misdiagnosed by other common benign mases. We must suspect and don't forget this entity from the differential diagnosis diagram. [ABSTRACT FROM AUTHOR]

Introduction: Sialendoscopy is a minimally invasive technique for the management of salivary gland disease. This work characterizes its utility for treating chronic sialadenitis due to Sjogren's syndrome and radioactive iodine (RAI) therapy. Methods: A single-center, retrospective review of patients undergoing sialendoscopy between March 2013 and May 2019 for the treatment of chronic sialadenitis due to Sjogren's or prior RAI therapy was performed. Results: Thirty-four patients with Sjogren's and 25 patients who received RAI were identified, undergoing a total of 86 procedures. Median age at presentation was 53 years with mean follow-up time of 14.3 months. Seventy-two procedures were performed on the parotid gland, four on the submandibular gland, and ten on both glands. Corticosteroid injection and duct dilation were performed most commonly. Sixteen patients required repeat procedure. All patients were symptomatically improved at follow-up visit. Discussion/Conclusion: These results support the idea that sialendoscopy offers symptomatic benefit for patients with chronic sialadenitis due to Sjogren's or RAI. [ABSTRACT FROM AUTHOR]

Background: Fine-needle aspiration cytology (FNAC) of salivary gland is used worldwide for the diagnosis and management of salivary gland tumours. It provides a minimally invasive, quick, safe, cost-effective, and accurate outpatient technique that is extremely useful in identifying a substantial subset of salivary gland lesions and thus reduces unnecessary invasive surgical procedure in patients. Objective 1. To study the pattern of the lesions of salivary glands by "the Milan system of reporting for Salivary Gland Cytopathology". 2. To categorize the cytopathology of salivary gland lesions by the Milan system. 3. To create a uniform reporting system for salivary gland cytopathology. 4. To assist in the effective communication of the results to the clinicians. 5. To compare the cytopathology diagnosis with histopathology (wherever available). Materials and Methods: The present study was carried out in the Department of Pathology, Pt. J.N.M. Medical College, Raipur (CG) and associated Dr. Bhim Rao Ambedkar Memorial Hospital Raipur (CG), prospectively for two years. Approval from the Institutional Ethics And Scientific Committees was obtained. Result: Out of the total 86 cases, 54 were males and 32 were females. The Male: Female ratio was 1.6:1.The mean age of the subjects was 45.5 years. Under the Non-Neoplastic category, Sialadenitis was the most frequent diagnosis comprising 14 cases (51.9%). A total of 21 cases out of 86 cases were reported in the Benign neoplasm category. Pleomorphic adenoma was the most common diagnosis comprising 17 of 21 benign cases (80.9 %). Mucoepidermoid Carcinoma was the most frequent malignancy, comprising 8 cases out of 25 (32%) cases under malignant category. ROM (risk of malignancy) for each category was calculated. ROM for non-diagnostic, non-neoplastic, AUS, benign neoplasm, SUMP, SFM, and malignant categories were 0%, 14.2%, 0.0%, 7.6%, 0%, 66.6%, and 100% respectively. Conclusion: The FNAC reporting with the MILAN system, when undertaken meticulously, is an effective way of communication with the clinicians, avoiding a surgical procedure in some cases and thereby tremendously aiding the patient care in terms of reducing financial burden and most significantly, avoiding psychological trauma. Considering the high accuracy, sensitivity and specificity rates of FNAC diagnosis observed in the present study, it can be aptly concluded that FNAC when categorized by the MILAN system, further improves diagnosis, communication and risk stratification. [ABSTRACT FROM AUTHOR]

Background: Immune checkpoint inhibition with anti-PD(L)1 and anti-CTLA4 antibodies has significantly changed cancer treatment during the last 10 years. Nevertheless, boosting the immune system with immune checkpoint inhibition can result in immune-related adverse events, affecting different organ systems, among which the endocrine system is the most affected. However, there are few descriptions of the association of immune-related adverse events, and the pathophysiology of some is still lacking. Case summary: Here, we report a 70-year-old Caucasian patient treated with nivolumab (anti-PD1 monoclonal antibody) after resection of a unique relapse of melanoma in the neck region who presented with sicca syndrome, extreme fatigue, and weight loss 6 months after the start of anti-PD1 therapy. Blood tests revealed hypoglycemia and secondary hypocortisolism due to isolated adrenocorticotrophic hormone deficiency. Interestingly, brain methionine positron emission tomography/magnetic resonance revealed physiological metabolism of the pituitary gland, which was not increased in size, and no hypophyseal metastasis was detected. The sicca syndrome investigation revealed the absence of anti-SSA/SSB antibodies, while the labial salivary gland biopsy showed lymphoplasmatocytic infiltrates with a focus score of 1. To provide new insights into the physiopathology of the anti-PD1-related sialadenitis, we investigated the distribution of aquaporins 5 by immunostaining on the labial salivary gland acini, and compared this distribution with the one expressed in the primary Sjögren's syndrome. Contrary to patients with primary Sjögren's syndrome (in whom aquaporins 5 is mainly expressed at the basolateral side), but similar to the patients with no sialadenitis, we observed expression of aquaporins 5 at the apical pole. This new finding deserves to be confirmed in other patients with anti-PD1-related sialadenitis. Owing to these immune-related adverse events, anti-PD1 was stopped; nevertheless, the patient developed a new relapse 1 year later (March 2020) in the neck region, which was treated by radiotherapy. Since then, no relapse of melanoma was seen (1.5 years after radiotherapy), but the patient still requires hypophyseal replacement therapy. The sialoadenitis resolved partially. Conclusion: We report a combination of sialoadenitis and hypophysitis explaining extreme fatigue in a patient who was treated in the adjuvant setting with anti-PD1 for a melanoma relapse. [ABSTRACT FROM AUTHOR]

Autoimmune pancreatitis (AIP) and IgG4-related disease (IgG4-RD) are new disease entities characterized by enhanced IgG4 antibody responses and involvement of multiple organs, including the pancreas and salivary glands. Although the immunopathogenesis of AIP and IgG4-RD is poorly understood, we previously reported that intestinal dysbiosis mediates experimental AIP through the activation of IFN-α- and IL-33-producing plasmacytoid dendritic cells (pDCs). Because intestinal dysbiosis is linked to intestinal barrier dysfunction, we explored whether the latter affects the development of AIP and autoimmune sialadenitis in MRL/MpJ mice treated with repeated injections of polyinosinic–polycytidylic acid [poly (I:C)]. Epithelial barrier disruption was induced by the administration of dextran sodium sulfate (DSS) in the drinking water. Mice co-treated with poly (I:C) and DSS, but not those treated with either agent alone, developed severe AIP, but not autoimmune sialadenitis, which was accompanied by the increased accumulation of IFN-α- and IL-33-producing pDCs. Sequencing of 16S ribosomal RNA revealed that Staphylococcus sciuri translocation from the gut to the pancreas was preferentially observed in mice with severe AIP co-treated with DSS and poly (I:C). The degree of experimental AIP, but not of autoimmune sialadenitis, was greater in germ-free mice mono-colonized with S. sciuri and treated with poly (I:C) than in germ-free mice treated with poly (I:C) alone, which was accompanied by the increased accumulation of IFN-α- and IL-33-producing pDCs. Taken together, these data suggest that intestinal barrier dysfunction exacerbates AIP through the activation of pDCs and translocation of S. sciuri into the pancreas. [ABSTRACT FROM AUTHOR]

Secretory carcinoma (SC) is a rare salivary gland tumor and has been recently included in the fourth edition of the World Health Organization classification of head and neck tumors. To understand the histopathologic findings and clinical behavior of mammary analogue secretory carcinoma (MASC) of the submandibular gland in a 23 year old female. MASC is an intriguing and rare malignant salivary gland tumor first described in 2010. It shares histologic, immunohistochemical and genetic features with secretory carcinoma of the breast. The clinical behavior of MASC ranges from slowly growing tumors to aggressive tumors that can cause widespread metastasis. Many cases of MASC were discovered in archived cases previously classified as pleomorphic adenoma, acinic cell carcinoma, mucoepidermoid carcinoma, and adenocarcinoma. They are only a few reported in submandibular gland. MASC is a newly recognized variant of salivary gland malignancy. Further research is needed to better delineate its overall prevalence and to define an appropriate treatment algorithm for this new clinical entity. [ABSTRACT FROM AUTHOR]

Cysticercosis is a common infection in tropical countries with occasional uncommon manifestations. We present the case of a 34 year old immunocompetent man who presented with multiple lesions in a short span of time, some of which were atypical in location viz submandibular region and masseter, aside from abdominal wall. Role of ultrasound, fine needle aspiration cytology and magnetic resonance imaging in diagnosis is discussed. Cysticercosis is a common disease with occasionally unexpected manifestations and hence must be considered in differential diagnoses of swellings in/around head and neck. There should be a low threshold for obtaining ultrasound and fine needle aspiration cytology in such swellings. [ABSTRACT FROM AUTHOR]

Background: Radiomics of salivary gland imaging can support clinical decisions in different clinical scenarios, such as tumors, radiation-induced xerostomia and sialadenitis. This review aims to evaluate the methodological quality of radiomics studies on salivary gland imaging. Material and Methods: A systematic search was performed, and the methodological quality was evaluated using the radiomics quality score (RQS). Subgroup analyses according to the first author's professional role (medical or not medical), journal type (radiological journal or other) and the year of publication (2021 or before) were performed. The correlation of RQS with the number of patients was calculated. Results: Twenty-three articles were included (mean RQS 11.34 ± 3.68). Most studies well-documented the imaging protocol (87%), while neither prospective validations nor cost-effectiveness analyses were performed. None of the included studies provided open-source data. A statistically significant difference in RQS according to the year of publication was found (p = 0.009), with papers published in 2021 having slightly higher RQSs than older ones. No differences according to journal type or the first author's professional role were demonstrated. A moderate relationship between the overall RQS and the number of patients was found. Conclusions: Radiomics application in salivary gland imaging is increasing. Although its current clinical applicability can be affected by the somewhat inadequate quality of the papers, a significant improvement in radiomics methodologies has been demonstrated in the last year. [ABSTRACT FROM AUTHOR]

Purpose: Chronic obstructive sialadenitis (COS) is a recurring inflammation of the salivary gland. To date, there are no known predisposing factors for COS. Given the advances seen in radiology and sialendoscopy, we must update our knowledge of COS, analyzing factors that can favor its development. Methods: We prospectively analyzed 333 patients who underwent sialendoscopy between 2012 and 2021. Epidemiologic, radiologic, and sialendoscopy-related factors were correlated. Suspected diagnosis was established based on the clinical and radiologic data. The final diagnosis was determined on the basis of sialendoscopic findings. Results: The most common etiology of COS was stricture (40.8%). Lack of papilla distensibility (LPD) was also described as an etiology. COS was related to patient gender and age. Submandibular gland involvement was significantly more associated with lithiasis and LPD, while COS of the parotid gland was most frequently caused by stricture. Radioiodine sialadenitis and Sjögren's syndrome were significantly associated with stricture. MR sialography (MR-Si) showed the best overall sensitivity and specificity. Conclusion: In our series, stricture was the most common cause of COS. We describe LPD as a frequent cause of COS in this series; ours is the first study to report this finding. There was a significant association between the salivary gland involved, patient sex and age, and the cause of COS. MR-Si showed the greatest diagnostic yield. [ABSTRACT FROM AUTHOR]

Oncocytic carcinomas of the salivary glands are rare. The submandibular gland is a rare location. It is usually associated with a poor prognosis and recurrence after treatment. We report a case of a 52‐year‐old man with a lymph node and brain metastasis recurrence of an oncocytic carcinoma of the submandibular gland. [ABSTRACT FROM AUTHOR]

Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition of unknown etiology. Although the salivary glands are currently considered among the most commonly affected among them, oral and maxillofacial surgeons are generally not familiar with the condition. Enlargement of the major salivary glands may be the first identifiable sign of IgG4-RD. A salivary gland biopsy along with IgG4 serum level assessment may help differentiate IgG4-related sialadenitis (IgG4-RS) from malignancies, infectious diseases, and obstructive conditions. Greater knowledge and higher levels of awareness of IgG4-RS may contribute to the expansion of differential diagnostic and treatment approaches. This case report describes a patient with bilateral submandibular salivary gland swelling who was diagnosed as having IgG4-RS on the basis of the histopathologic findings of a submandibular salivary gland biopsy and subsequent IgG4 levels. [ABSTRACT FROM AUTHOR]

Objective: To analyze the long-term symptomatic results of laser-assisted sialolithotripsy (LAS) in cases of obstructive sialolithiasis and correlate with objective criteria using diagnostic sialendoscopy (DS) as a method of examination. Methods: This is a retrospective study comprising 50 consecutive patients who underwent holmium-YAG LAS and completed follow-up of at least 6 months. Symptom scoring and endoscopic scoring were done at 6 weeks and 6 months intervals for further study purposes. Results: At the end of 6 weeks post-LAS, 70% patients were asymptomatic (A-sym) and only 30% had residual symptoms (Sym). However, obstructed duct (OB-duct) was observed on endoscopic scoring in 88% due to stenosis, residual stones, or both stenosis and residual stones. The obstructed ducts were treated in outpatient clinic and followed up over time, leading to 98% of patients being in A-sym group at the end of study period of 6 months. At the end of study, 82% of patients had clear duct (CL-duct). Conclusion: Holmium LAS is a viable option for the management of intermediate-sized stones. LAS if used judiciously, and in properly selected cases, has high rate of stone fragmentation and symptom resolution. A vigilant postoperative protocol taking into account residual mealtime symptoms and altered salivary characteristics combined with early DS can help identify and treat patients with residual stone fragments and ductal stenosis. [ABSTRACT FROM AUTHOR]

Abstract Background Immunoglobulin G4-related disease (IgG4-RD) is a systemic lymphoproliferative disorder characterized by elevated serum IgG4 levels and tumefactive lesions that can involve nearly every organ system. Involvement of the prostate is rare but has been reported in limited cases. Case presentation A 28-year-old man of Asian descent with a history of sinusitis and priapism presented to hospital with rigors and voiding symptoms. He was diagnosed with IgG4-RD one month prior to presentation, following pathological analysis of a submandibular mass that demonstrated chronic sclerosing sialadenitis. On presentation, white blood cell count, C-reactive protein, and prostate serum antigen levels were all within normal limits. Examination was notable for a large, firm prostate, and a foley catheter was inserted. Contrast CT of the abdomen was unremarkable. Further workup revealed elevated serum IgG4 levels (9.22 g/L) and he was subsequently started on prednisone 35 mg daily. Imaging to screen for systemic IgG4-RD involvement demonstrated paravertebral soft tissue involvement and he was given rituximab 1000 mg IV × 2 doses. MRI revealed diffuse prostatitis. Five days after starting prednisone and one day after his first dose of rituximab, he successfully passed trial of void and was discharged home. Conclusions IgG4-related prostatitis is a rare and underrecognized manifestation of IgG4-RD. Our case highlights the need to consider IgG4-related prostatitis as an etiology of urinary obstruction in young individuals. Resolution of symptoms following treatment with steroids may be diagnostic of IgG4-related prostatitis, and may potentially avoid the need for invasive diagnostic procedures such as prostate biopsy.

Chronic inflammation in the salivary glands (SG) often triggers epithelial-mesenchymal transition (EMT), leading to the loss of acinar function and promoting fibrosis. This study explores the role of Metformin in mitigating partial EMT in SG inflammation. In vitro, human salivary gland epithelial cells (hSGECs) were treated with lipopolysaccharide (LPS) and Metformin. EMT markers and the PI3K/Akt/GSK3β/Snail signaling axis were assessed using RNA-seq and Western blot analysis. In vivo, a Wharton’s duct ligation rat model was employed to mimic chronic sialadenitis (CS). Nine Wistar rats were randomly divided into three groups: Control, Ligation and Ligation + Metformin groups, with three rats per group. After ductal ligation, the Ligation + Metformin group received 100 mg/kg of Metformin via intragastric administration, while the Control and Ligation groups received an equivalent saline every 24 h. Histological analysis, immunohistochemical and immunofluorescence staining were conducted to evaluate acinar morphology, EMT, and the PI3K/Akt/GSK3β/Snail signaling axis. The results showed that in CS tissues, atrophied acinar cells underwent partial EMT. In vitro, Metformin reversed LPS-induced EMT in hSGECs. RNA-seq and Western blot revealed that Metformin achieved this effect by targeting the PI3K/Akt/GSK3β/Snail signaling axis (P < 0.01). In ductal ligation models, Metformin treatment restored ligation-induced acinar damage and functional loss (P < 0.01). Further histological evidence supported that Metformin mitigated EMT by inhibiting inflammatory activation of PI3K/Akt/GSK3β/Snail signaling axis (P < 0.01). In conclusion, Metformin alleviates partial EMT in SG inflammation by targeting the PI3K/Akt/GSK3β/Snail signaling axis, highlighting its potential as a therapeutic strategy for SG inflammation.Graphical Abstract: Chronic inflammation in the salivary glands (SG) often triggers epithelial-mesenchymal transition (EMT), leading to the loss of acinar function and promoting fibrosis. This study explores the role of Metformin in mitigating partial EMT in SG inflammation. In vitro, human salivary gland epithelial cells (hSGECs) were treated with lipopolysaccharide (LPS) and Metformin. EMT markers and the PI3K/Akt/GSK3β/Snail signaling axis were assessed using RNA-seq and Western blot analysis. In vivo, a Wharton’s duct ligation rat model was employed to mimic chronic sialadenitis (CS). Nine Wistar rats were randomly divided into three groups: Control, Ligation and Ligation + Metformin groups, with three rats per group. After ductal ligation, the Ligation + Metformin group received 100 mg/kg of Metformin via intragastric administration, while the Control and Ligation groups received an equivalent saline every 24 h. Histological analysis, immunohistochemical and immunofluorescence staining were conducted to evaluate acinar morphology, EMT, and the PI3K/Akt/GSK3β/Snail signaling axis. The results showed that in CS tissues, atrophied acinar cells underwent partial EMT. In vitro, Metformin reversed LPS-induced EMT in hSGECs. RNA-seq and Western blot revealed that Metformin achieved this effect by targeting the PI3K/Akt/GSK3β/Snail signaling axis (P < 0.01). In ductal ligation models, Metformin treatment restored ligation-induced acinar damage and functional loss (P < 0.01). Further histological evidence supported that Metformin mitigated EMT by inhibiting inflammatory activation of PI3K/Akt/GSK3β/Snail signaling axis (P < 0.01). In conclusion, Metformin alleviates partial EMT in SG inflammation by targeting the PI3K/Akt/GSK3β/Snail signaling axis, highlighting its potential as a therapeutic strategy for SG inflammation. [ABSTRACT FROM AUTHOR]

Abstract Background Sialendoscopy assisted treatments are a minimally invasive management modality for chronic sialadenitis. Clinicians report improved patient quality of life (QoL) following sialendoscopy assisted treatments, but there exist gaps in current literature about patient reported outcomes (PROs). PROs are outcome measures developed based on patient perceptions. Objective The objective of this study was to create a PRO instrument for chronic sialadenitis, to assess the efficacy of sialendoscopy assisted treatments in improve patients’ QoL. Design This four-phase qualitative study employed grounded theory methodology and a modified Delphi technique. In Phase I, ten patients were interviewed to identify the QoL domains impacted by chronic sialadenitis. In Phase II, these QoL domains were presented to a focus group of different chronic sialadenitis patients, who were asked to rank them by order of importance. A conceptual framework of QoL domains impacted by chronic sialadenitis was created based on patient consensus. Itemization of the PRO questionnaire was done by a focus group of four Otolaryngologists in phase III. Lastly, the questionnaire was completed in Phase IV by cognitive interviewing of five new chronic sialadenitis patients; ensuring ease of understanding and clarity. Results Patients identified 15 domains of QoL impacted by chronic sialadenitis, divided into three sub-scales: physical symptoms, psychosocial symptoms, and activity restriction. These domains provided the basis for creation of a 22-item PRO questionnaire, with a Likert-type response scale. Conclusion Clinical application of the novel questionnaire produced by this study will allow for a patient-centered assessment of the patient reported effectiveness of sialendoscopy assisted therapies for management of chronic sialadenitis. Level of evidence Level V. Graphical Abstract

Anesthesia mumps have rarely been reported. This article presents the diagnosis and treatment of a case of anesthesia mumps with airway obstruction in the urology department and reviews previous cases of the disease. A 58-year-old man had a history of hypertension and diabetes, and his blood pressure and glucose levels were well controlled. He underwent laparoscopic radical nephrectomy for a right renal tumor. Postoperatively, a swelling of approximately 5 × 4 cm was observed in the left parotid region and left eyelid, no palpable crepitation was detected, and the skin overlying the left parotid gland was mildly hyperemic and tender. Enhanced computed tomography of the head and neck revealed obvious swelling of the laryngopharyngeal airway, and electronic laryngoscopy showed narrow airway. Laboratory test results including white blood cell count, C-reactive protein, serum amylase, and lipase levels were normal. Glycosylated hemoglobin level was 6.8%, and the salivary culture from Stensen's duct was negative. The patient was managed with endotracheal intubation and a ventilator to maintain breathing along with anti-infection, expectorant, and symptomatic treatment. The swelling in the left parotid gland gradually resolved without recurrence, and the patient was extubated on the 7th postoperative day. In this case, the pathophysiology of anesthesia mumps may have been related to the incorrect positioning of the thick short neck and the use of a head ring, which can result in the squeezing of vessels. In most cases, the salivary gland swelling resolves with observation and symptomatic treatment. In patients with anesthesia mumps, emergency airway management and careful observation are necessary if upper airway obstruction occurs. This case report should increase awareness of anesthesia mumps and its complications among anesthesiologists, surgeons, and postoperative caregivers.

Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease characterized by chronic inflammation of exocrine tissue, resulting in loss of tears and saliva. Patients also experience many extra-glandular disease manifestations. Treatment for pSS is palliative, and there are currently no treatments available that target disease etiology. Previous studies in our lab demonstrated that MyD88 is crucial for pSS pathogenesis in the NOD.B10Sn-H2b (NOD.B10) pSS mouse model, although the way in which MyD88-dependent pathways become activated in disease remains unknown. Based on its importance in other autoimmune diseases, we hypothesized that TLR7 activation accelerates pSS pathogenesis. We administered the TLR7 agonist Imiquimod (Imq) or sham treatment to pre-disease NOD.B10 females for 6 weeks. Parallel experiments were performed in age and sex-matched C57BL/10 controls. Imq-treated pSS animals exhibited cervical lymphadenopathy, splenomegaly, and expansion of TLR7-expressing B cells. Robust lymphocytic infiltration of exocrine tissues, kidney and lung was observed in pSS mice following treatment with Imq. TLR7 agonism also induced salivary hypofunction in pSS mice, which is a hallmark of disease. Anti-nuclear autoantibodies, including Ro (SSA) and La (SSB) were increased in pSS mice following Imq administration. Cervical lymph nodes from Imq-treated NOD.B10 animals demonstrated an increase in the percentage of activated/memory CD4+ T cells. Finally, T-bet+ B cells were expanded in the spleens of Imq-treated pSS mice. Thus, activation of TLR7 accelerates local and systemic disease and promotes expansion of T-bet-expressing B cells in pSS.

Frey's syndrome, also known as auriculotemporal syndrome, is characterized by gustatory flushing, warmth and sweating of the facial area innervated by the auriculotemporal nerve. A tale of two syndromes: nontraumatic Frey's syndrome in a woman with Sjögren's syndrome Although we believe co-occurrence of both syndromes may be rare, it is likely that other patients with Sjögren's-associated Frey's syndrome may be undiagnosed or misdiagnosed when their flushing is attributed to other more common causes. We describe a 39-year-old woman with Sjögren's syndrome who presented with Frey's syndrome without a past history of salivary gland surgery, diabetes or infection. [Extracted from the article]

Intermittent fasting confers protections to various diseases including autoimmune disorders, but the specific effects of intermittent fasting on Sjögren's syndrome (SS) remains inconclusive. The present study was undertaken to determine the specific impact of alternate-day fasting (ADF) on newly established SS-like sialadenitis using non-obese diabetic (NOD) mice. Female NOD mice were deprived of food every other day from 10 to 13 weeks of age, the early stage of established SS, and then analyzed for the disease characteristics. Mice in the ADF group had higher salivary flow rate and attenuated submandibular gland (SMG) inflammation, compared to the control mice fed with standard chow ad libitum. The improvements were accompanied with a decrease in the total leukocytes, T and B lymphocytes and activated CD4 and CD8 T cells, and a down-regulation of pro-inflammatory cytokines IFN-γ and IL-17, chemokine receptor CXCR3 and its ligands CXCL9 and CXCL11 in the SMGs. ADF also led to elevated mRNA levels of water channel protein aquaporin 5 and tight junction protein claudin-1, two factors crucial for normal salivary secretion in the SMGs. In addition, ADF reduced the proportion of IFN-γ- and IL-17- expressing CD4 T cells and diminished mRNA levels of IFN-γ, TNF-α, and IL-17 in the total submandibular draining lymph node cells. Taken together, ADF is effective in ameliorating newly established SS-associated salivary gland exocrinopathy in NOD mice. [ABSTRACT FROM AUTHOR]

Interleukin-22 (IL-22) affects epithelial tissue function and integrity in a context-dependent manner. IL-22 levels are elevated in salivary glands of Sjögren's syndrome (SS) patients, but its role in the pathogenesis of this disease remains unclear. The objective of this study is to elucidate the impact of IL-22 on salivary gland tissue integrity and function in murine models. We showed that IL-22 levels in sera and salivary glands increased progressively in female non-obese diabetic (NOD) mice, accompanying the development of SS. Administration of IL-22 to the submandibular glands of NOD mice prior to the disease onset reduced salivary secretion and induced caspase-3 activation in salivary gland tissues, which were accompanied by alterations in multiple genes controlling tissue integrity and inflammation. Similarly, IL-22 administration to submandibular glands of C57BL/6 mice also induced hyposalivation and caspase-3 activation, whereas blockade of endogenous IL-22 in C57BL/6 mice treated with anti-CD3 antibody mitigated hyposalivation and caspase-3 activation. Finally, IL-22 treatment reduced the number of viable C57BL/6 mouse submandibular gland epithelial cells cultured in vitro, indicating a direct impact of this cytokine on these cells. We conclude that IL-22 exerts a detrimental impact on salivary gland tissues. [ABSTRACT FROM AUTHOR]

Introduction: Mucoepidermoid carcinoma (MEC) has several diagnostic, biological, and histopathological manifestations, each of which presents issues and difficulties in terms of diagnosis, grading, classification, and therapy. The goal of this study was to find out how the anti-apoptotic protein Bcl2 was expressed in salivary gland (SG) MEC and how it related to a number of clinicopathological factors. Methods: The present study comprised 30 MECs of the SG lesions that were histopathologically diagnosed. The immunohistochemistry method was used to determine Bcl-2 expression. The spss software version 20.0 was used to find a link between Bcl-2 expression and clinical and histological features. Results: The patients’ average age was 49.93 years, and MEC of SGs was more common in females. The palate was the most commonly involved area, accounting for 13 (43.3%) of cases, followed by the parotid glands, which accounted for 8 (26.7%). High-grade tumors accounted for 14 (46.7%) of the cases, whereas mild-grade tumors accounted for 10 (33.3%) and moderate-grade tumors accounted for 6% (20.0%). Bcl-2 immunostaining was associated with gender (P = 0.047), there was also a significant (P = 0.002) difference in tumor grade and age groups. Furthermore, no significant relationships between Bcl-2 expression and the other variables were discovered. Conclusion: Gender and age affect MEC tumor aggressiveness and grade. Highgrade MEC tumors expressed Bcl-2 strongly and moderately, whereas low-grade tumors expressed it moderately. Bcl-2 may predict MEC tumor aggressiveness. MEC therapy may target Bcl-2. [ABSTRACT FROM AUTHOR]

Introduction: Haemangioma or hemangioendothelioma is amongst the commonest developmental, vascular lesions of infancy and childhood. Hemangioendothelioma of the salivary glands, however, is extremely rare. Due to their rarity, they may be misdiagnosed as lymphangiomas or other cystic lesions found more commonly in the region. This may lead to surgical complications including torrential hemorrhage that may have dire consequences for the patient. Case Report: Herein we present the case of a nine-year-old male with a cavernous haemangioma involving the left submandibular gland which was diagnosed on-table due to inconclusive pre-operative radiological and pathological diagnosis. Fortunately, due to meticulous dissection and care the lesion was excised in toto without any significant blood loss. Conclusions: Haemangioma of the submandibular gland is so uncommon that often it isn't even considered a differential diagnosis for cystic swellings and lesions in this region. Mistaken diagnoses preoperatively may prove disastrous for the patient. Excision of haemangiomas requires planning for hemostasis and blood loss if it occurs. Even minor iatrogenic manipulation of vascular lesions may completely obscure the field due to bleeding, making dissection and recognition of anatomical landmarks very difficult. This is especially dangerous in the submandibular region due to the proximity of various vital vascular and neural elements. A differential of haemangioma should therefore always be considered by surgeons and radiologists alike for lesions with suspicious or indeterminate features, in this region. [ABSTRACT FROM AUTHOR]

Objectives: To clarify the clinicopathological characteristics of primary hyper‐IgE‐related salivary gland disease (PHIESD), which is a newly proposed entity. Methods: Fifteen consecutive patients pathologically diagnosed with chronic sialadenitis were enrolled, and their clinicopathological features were comprehensively analyzed. Inclusion criteria: (1) multiple salivary gland enlargement; (2) elevated serum IgE and/or IgE‐positive cell infiltration in salivary gland tissues; (3) histology‐confirmed lymphoplasmacytic infiltration; (4) exclusion of other known diseases. Results: The male‐to‐female ratio was 5:10. The median age was 21 (range, 3–63) years. The average number of affected glands was 3.7 ± 1.4. Submandibular, parotid, and sublingual glands were involved in 15, 8, and 2 patients, respectively. Comorbid diseases included allergic diseases in seven patients and autoimmune diseases in two. Elevated serum IgE (median 175 kU/L) was seen in all patients. Serum IgG4 was slightly elevated in three patients. Histologically, most patients had mild lesions, including mild lymphocyte infiltration (60%) and focal fibrosis (66.7%). Lymphoid follicular formation (53.3%), moderate to severe lymphocytic inflammation (40%) and severe fibrosis (33.3%) were also observed. Immunohistochemically, IgE‐positive cells infiltrated mainly around the ducts, with scattered infiltration of IgG4‐positive, mast, and interleukin‐4 positive cells. During follow‐up (median, 46 months) of ten patients without intervention and two with immunosuppressive therapy, no significant changes in gland size or serum IgE level were noted. Conclusions: PHIESD manifests as homogeneous enlargement of multiple salivary glands and elevated serum IgE. Histopathology further verifies the diagnosis. It might be associated with anaphylaxis or autoimmune dysfunction. Conservative treatment is suggested. Level of Evidence: 4 Laryngoscope, 132:2132–2138, 2022 [ABSTRACT FROM AUTHOR]

Heart failure (HF) is one of the leading causes of death worldwide. HF results not only in cardiovascular dysfunction, but also numerous pathologies in the oral cavity and salivary glands. The present study is the first to evaluate whether salivary inflammatory and anti-inflammatory factors may be related with the occurrence of hyposalivation in HF patients. We also evaluated the potential of salivary biomarkers in the diagnostics of HF. The study included 30 women with HF and 30 sex- and age-matched healthy controls. We demonstrated significantly higher levels of pro-inflammatory cytokines, anti-inflammatory cytokines, Th1, Th2, Th17, chemokines and growth factors in unstimulated saliva of HF patients compared to controls. However, the results do not indicate dominance of either branch of the immune response. The concentration of selected biomarkers is significantly higher in patients with HF and salivary gland dysfunction compared to patients with normal saliva secretion and healthy subjects (IL-1b, TNF-a, IL-7, IL-13, INF-g, IL-12, IL-15, IL-5, IL-6, IL-9, IL-17, MCP-1/CCL-2, EOTAXIN/CCL11, RANTES/CCL5, GM-CSF, VEGF, FGF basic, PDFG-BB). Multivariate regression analysis showed that the content of salivary cytokines, chemokines and growth factors is highly dependent on salivary gland function, i.e. salivary flow rate, total protein content and amylase activity. Using receiver operating characteristic (ROC) analysis, we showed that salivary TNF-a, INF-g, IL-12 and EOTAXIN/CCL11 differentiated patients with HF and hyposalivation with the highest sensitivity and specificity compared to patients with normal salivary secretion and controls. Interestingly, the content of some pro- and anti-inflammatory mediators in saliva significantly exceeds their concentration in plasma. In addition, salivary biomarker levels do not reflect their plasma content, which may suggest a different nature/severity of inflammatory changes at the central (blood) and local (salivary) levels. Although our study was purely observational, the significantly higher concentration of inflammatory parameters in saliva compared to plasma, as well as the lack of saliva-blood correlation, may suggest increased production/ secretion of these compounds in salivary cells of HF patients. ROC analysis did not confirm the diagnostic utility of salivary cytokines and chemokines in the differential diagnosis of HF patients. [ABSTRACT FROM AUTHOR]

Xerostomia, or dryness in mouth is usually concerned with decrease in the amount of saliva flow causing severe discomfort to the patients. As saliva is the most beneficial fluid which play a very important role in the sensation of flavour perceived in the mouth and lubrication of tongue. Along with this it also contributes in defending of the oral mucous membranes by providing bactericidal action such as proteolytic enzymes, lysozyme, lacto-peroxidase and IgA, IgG antibodies. The significant risk factors for xerostomia may be systemic or be iatrogenic-demonstrated by many types of pharmacologically active agents or chemotherapy, ionized radiation which is used as adjuvant in destroying malignant cells and aging issues. The related syndrome to this group include Sjogren's syndrome manifested primarily by lacrimal and salivary glands inflammation producing various clinical symptoms. This is a typical problem for diabetes patients which is correlated with inadequate salivary flow followed by alterations in the microcirculation. Several treatment strategies for the management of such condition include medications for lubrication of mucosa and saliva substitutes. But, understanding the primary cause of xerostomia enables quicker diagnosis and a most effective treatment strategy. The intent of this article is to briefly review the etiology of xerostomia along with risk factors. [ABSTRACT FROM AUTHOR]

Introduction: Non-specific chronic sialadenitis (NSCS) is a common pathology of labial salivary glands (LSGs), and NSCS with positive anti-SSA/SSB antibodies is common in clinical practice. Previous studies have evaluated the associations of high focus score (FS) with clinical manifestations in primary Sjögren's syndrome (pSS) patients extensively, but the characteristics of pSS with NSCS have seldom been investigated. We here analyzed the characteristics of pSS patients with NSCS. Methods: Among 425 patients who underwent LSG biopsies, 217 had pSS and 37 non-SS sicca patients had NSCS without other diseases (i.e., sicca controls). We categorized these 217 pSS patients into three groups based on the pathology of LSGs: FS ≥ 1 (n = 104), 0 ≤ FS < 1 (n = 76), and NSCS (n = 37). We then compared the three groups while focusing on the NSCS group. Multivariate logistic regression analysis was performed to identify variables that influenced NSCS. Results: The mean age of pSS patients with NSCS (58.3 ± 11.0 years) was significantly higher than those with FS ≥ 1 (48.5 ± 14.9 years) and 0 ≤ FS < 1 (45.3 ± 13.7 years), but other clinical characteristics were similar. NSCS had a significant positive correlation with age (OR = 7.282, 95% CI 2.085–25.44 and OR = 13.130, 95% CI 3.368–51.189 for patients aged 45–64 years and > 65 years, respectively). Significantly higher levels of lymphocytic infiltration were found in the pSS NSCS group than in the sicca NSCS controls (48.6 vs. 10.8%, respectively). Conclusions: The pSS patients with NSCS were older than corresponding non-NSCS pSS individuals, but they had similar clinical features. NSCS is associated with age and seldom occurred below the age of 45 years, regardless of the presence or absence of pSS. NSCS may be a subtype of pSS in elderly patients. [ABSTRACT FROM AUTHOR]

Submandibular salivary gland is an uncommon and unusual site for tuberculosis. It is a rare extrapulmonary manifestation of a common infection caused by Mycobacterium tubercle bacillus. Submandibular gland TB can be due to primary or secondary infection. The clinical features are non-specific and depend on its manifestations. A delay in diagnosis is common because of the rarity of disease. Direct histological examination is the best method of diagnosis. As the disease is curable with antituberculous drugs; treatment should not be withheld in suspected cases until the diagnosis is confirmed. Surgery is indicated for non-responsive disease and complications. Till date, only 15 cases have been reported in the literature. First case was reported in the year 1990. The authors encountered three cases in last 10 years. The aims of this study are to review clinical presentation, epidemiological features, diagnostic methods and to provide our data and guidelines for optimum management of this rare pathology. [ABSTRACT FROM AUTHOR]

Sjögren's syndrome is a chronic autoimmune disease characterized by systemic dysfunction of exocrine glands, mainly the salivary and lachrymal glands. Sjögren's syndrome consists of two forms: primary Sjögren's syndrome, which is characterized by dry eyes and dry mouth without autoimmune diseases; and secondary Sjögren's syndrome, which is characterized by symptoms associated with other autoimmune diseases, such as systemic lupus erythematosus. Disease severities vary considerably from mild glandular dryness to severe glandular involvement with numerous extraglandular and systemic features. Sensorineural hearing loss is sometimes observed in both primary and secondary Sjögren's syndrome. This review article consists of (1) Pathology of Sjögren's syndrome, (2) Clinical manifestation of Sjögren's syndrome, (3) Autoimmune inner ear disease, (4) Histoanatomical features of the inner ear, (5) Immunological characteristics of the inner ear, (6) Pathophysiology of autoimmune inner ear disease, (7) Treatment for sensorineural hearing loss in Sjögren's syndrome, and (8) Future direction. Finally, we introduce a recently developed disease model of salivary gland inflammation and discuss future expectations for the treatment of sensorineural hearing loss in Sjögren's syndrome. [ABSTRACT FROM AUTHOR]

Objectives: The development of sialolithiasis is commonly related to local factors, such as the retrograde migration of foods, bacteria, or foreign bodies from the oral cavity. The association of sialolithiasis and saliva stasis resulting from decreased spontaneous secretion remains largely unexplored. The current study investigated the potential role of impaired spontaneous secretion in association with the formation of submandibular gland calculi. Study Design: A retrospective cohort study. Methods: Between September 2016 and December 2017, 11 patients with unilateral submandibular gland sialolithiasis confirmed with sialendoscopy were assigned to the experimental group. Another 35 patients clinically diagnosed with parotid obstructive sialadenitis were assigned as the control group. The slope changes of the isotope count curve of the unaffected submandibular gland in the experimental group and the bilateral submandibular glands in the control group were calculated and compared to estimate the spontaneous secretion differences. The degree of spontaneous secretion was defined as the slope changes in the steady ascending stage of the scintigraphic exam. Results: The slope decline (degree of spontaneous secretion) on the unaffected side in patients with single‐gland submandibular obstructive sialadenitis was significantly lower than that in the control individuals (p =.002). In contrast, the between‐group comparison in the unaffected parotid glands revealed no difference in the slope decline. Conclusion: The spontaneous secretion of the submandibular gland in patients with submandibular sialolithiasis was decreased compared to that in patients without submandibular sialolithiasis. This phenomenon might be associated with the development of sialolithiasis. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Objectives: To clarify the ultrasonographic features of immunoglobulin G4 (IgG4)-related dacryoadenitis and sialadenitis (IgG4-DS) and their usefulness in clinical diagnostic sessions. Methods: By re-evaluating 96 consecutive patients with IgG4-related disease, we identified 54 patients (male:female=37:17; median age, 69.5 years) who underwent lacrimal or submandibular gland (LG or SG, respectively) ultrasonography and computed tomography (CT). Their clinical and ultrasonographic features were retrospectively analysed. Radio-pathological correlations were also examined in LG (23 cases) and SG lesions (20 cases). Additionally, the diagnostic accuracy of CT for LG/SG lesions was evaluated. Results: Abnormal ultrasonographic findings were detected in 33 (LGs) and 38 (SGs) patients, and most of them were observed bilaterally. All lesions were well demarcated and demonstrated diffuse low-echoic areas (rocky pattern) or multiple low-echoic nodules surrounded by highechoic linear shadows (cobblestone pattern) corresponding to intra-lobular inflammation and inter-lobular fibrosis. Moreover, 42% (LGs; 14/33) and 42% (SGs; 16/38) patients had glandular lesions without clinical symptoms associated with the affected glands. The diagnostic accuracy of CT was ~80% for LG and 55% for SG. Conclusions: Ultrasonographic findings in IgG4-DS included diffuse or nodular low-echoic areas with linear high-echoic structures corresponding to inflamed lobules and inter-lobular fibrosis. These findings can help detect IgG4-DS. [ABSTRACT FROM AUTHOR]

IgG4-related kidney disease (IgG4 RKD) is a rare clinical entity characterized by lymphoplasmacytic infiltration rich in IgG4-positive plasma cells along with fibrosis affecting several organs. Tubulointerstitial nephritis is commonly the predominant finding on kidney biopsy. Our patient was admitted with a provisional diagnosis of cardiorenal syndrome of unknown etiology. The patient was dialysis dependent for around 45 days following which kidney biopsy revealed features of acute tubulointerstitial nephritis (ATIN) with IgG4-positive plasma cells and no glomerular involvement. Positron emission tomography--computed tomography was supportive of findings of sialadenitis along with myocarditis. Our patient responded to treatment with steroids with definitive improvement in both renal and cardiac functions. This case highlights the importance of IgG4 RKD as an important differential in patients with ATIN presenting as a clinical syndrome. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the prevalence of extra‐glandular lesions in patients with immunoglobulin G4‐related sialadenitis (IgG4‐RS). Methods: Six electronic databases (PubMed, EMBASE, Science Direct, Scopus, Web of Science, and China National Knowledge Infrastructure) were systematically searched from the date of inception of each database to March 2021. The Strengthening the Reporting of Observational Studies in Epidemiology statement was used to conduct methodological quality assessment, and a random‐effect meta‐analysis model was applied to estimate the prevalence. Publication bias was visually assessed using a funnel plot and calculated via Begg's and Egger's tests. The Stata 15 software was used to perform data analysis. Results: A total of 43 articles comprising 1,864 patients with IgG4‐RS were considered to be eligible for this study. The pooled prevalence of extra‐salivary gland lesions in IgG4‐RS was 76.53% with a confidence interval (CI) of (69.39%, 83.04%). A higher prevalence was associated with studies published before or during 2015 (84.38%, CI [74.23%, 92.58%]) than those published after 2015 (68.55%, CI [58.44%, 77.88%]). Lacrimal gland involvement (54.68%, CI [45.61%, 63.60%]) and lymph node swelling (56.96%, CI [48.16%, 65.56%]) were the most frequent lesions. Conclusions: Extra‐glandular lesions were common in patients with IgG4‐RS. More high‐quality prospective studies with less heterogeneity are required to determine the accurate prevalence. [ABSTRACT FROM AUTHOR]

Dry mouth is the main manifestation of Sjögren syndrome (SS). Quercetin has been reported to alleviate radiation‐induced salivary gland damage, yet the effect of quercetin on SS‐caused salivary gland damage remains unclear. This study aimed to investigate the effects of quercetin on SS‐induced salivary gland damage and the mechanism underlying its therapeutic potential in SS. Here, NOD/Ltj mice were used to spontaneously mimic SS‐induced salivary gland inflammation in vivo and salivary gland epithelial cells (SGECs) were stimulated by interferon‐γ (IFN‐γ) to mimic cell inflammation in vitro. Results showed that quercetin significantly reduced loss of saliva flow, salivary gland damage, cell apoptosis, and inflammatory response in NOD/Ltj mice. Quercetin treatment also significantly reduced the increased serum leptin (LP) levels in NOD/Ltj mice. Furthermore, quercetin blocked the increases in the expression of obesity receptor (OB‐R) and its downstream Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling in the salivary glands. In vitro experiments confirmed that quercetin could protect SGECs from IFN‐γ‐induced cell apoptosis and inflammation through the LP/OB‐R‐activated JAK2/STAT3 signaling. Hence, quercetin might protect against SS‐induced salivary gland damage by relieving cell apoptosis and inflammation by inhibiting the LP/OB‐R signaling, providing a new perspective for treating SS‐induced dry mouth. [ABSTRACT FROM AUTHOR]

Copyright of Médicas UIS is the property of Universidad Industrial de Santander and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)