DIAGNOSIS OF SALIVARY GLAND DISORDERS

Transcription

1 DIAGNOSIS OF SALIVARY GLAND DISORDERS

2 Diagnosis of salivary gland disorders edited by K. GRAAMANS Department of oj Otorhinolaryngology, Vniversity University Hospital Vtrecht, Ulrecht, Utrecht, The Netherlands and H.P. VAN DEN AKKER Department of oj Oral and Maxillofacial MaxilloJacial Surgery, Academic Medical Centre and Academic Centre Jor for Dentistry (ACTA), Vniversity University of oj Amsterdam, Amsterdam, The Netherlands Springer Science+Business Media, B.V.

3 Library of Congress Cataloging in Publication Data DIagnosis of sallvary gland disorders I edlted by K. Graamans and H.P. van den Akker. p. cm. Includes Index. ISBN ISBN (ebook) DOI / Sallvary glands--dlseases--dlagnosls. I. Graamans, K. 11. Akker, H. P. van den, [DNLM: 1. Sal1vary Gland Dlseases--dlagnosis. WI RC ' dc20 ONLM/OLC for Llbrary of Congress ISBN Cover illustrationfrom: Oesterreichers anatomische Steinstiche, nach Santorini. München, Courtesy Department of Functional Anatomy, Utrecht University, Utrecht, The Netherlands (head: B. Rillen). Printed on acid-free paper All Rights Reserved 1991 by Springer Science+Business Media Dordrecht Originally published by Kluwer Academic Publishers in 1991 Softcover reprint ofthe hardcover 1st edition 1991 No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owners.

4 Contents Preface xi List of contributors Xlii 1. History and physical examination K. Graamans and H.P. van den Akker 1. Introduction 2. History 3. Physical examination 4. Further considerations Plain radiography and sialography H.P. van den Akker and P.F. Dijkstra 1. Introduction 2. Plain radiography 3. Sialolithiasis 4. Inflammatory disorders 4.1. Acute sial adenitis and abscess formation 4.2. Chronic-recurrent sial adenitis Sialectasia 4.3. Sjogren's syndrome 4.4. Granulomatous diseases 5. Sialadenosis 6. Tumors and space-occupying lesions 7. Miscellaneous disorders 8. Conclusion References v

5 VI Contents 3. Computed tomography of the major salivary glands 27 E.L. Mooyaart and K. Graamans 1. Introduction CT versus CT-sialography of the parotid and submandibular gland Technique CT-sialography CT anatomy Parotid gland Submandibular gland Parotid gland masses Submandibular gland masses Benign versus malignant tumor Relationship of tumors to the facial nerve Inflammation CT appearance of salivary gland tumors Pleomorphic adenoma Recurrent pleomorphic adenoma Adenolymphoma Other benign masses of the parotid gland Malignant tumors 35 References Magnetic resonance imaging of the parotid gland 39 N.J.M. Freling and K. Graamans 1. Introduction Some remarks on MRI Basic characteristics Technique Contraindications Artifacts Normal anatomy Signal intensity Normal MRI anatomy of the parotid gland Pathology Image characteristics Pleomorphic adenoma Recurrent pleomorphic adenoma Adenolymphoma Malignant tumors Miscellaneous lesions MRI in parotid disease Conclusions 49 References 49

6 Contents Vll 5. Ultrasound in salivary gland disease 51 R.J. Baatenburg de Jong and R.J. Rongen 1. Introduction Ultrasound imaging principles Ultrasound examination of the salivary glands Normal glandular tissue Parotid gland Submandibular gland Sublingual gland Inflammatory disease Acute sialadenitis Abscess formation Chronic sialadenitis Sialolithiasis Abnormal ductal morphology Space-occupying lesions Cystic masses Benign salivary gland tumors Warthin's tumor Adenoma Other benign salivary gland tumors Intraglandular lymph nodes Malignant salivary gland tumors Diagnostic ultrasound in salivary gland disease Conclusion 68 References Salivary gland scintigraphy with 99mTc-pertechnetate 69 H.P. van den Akker and E. Busemann-Sokole 1. Introduction Scintigraphic method Normal images and time-activity curves Tumors Sialadenitis and sialolithiasis Sjogren's syndrome Sialadenosis Miscellaneous disorders Technical failure Developmental anomalies Obstructive disorders Traumatic lesions and fistulae Status after surgical treatment Conclusion 83 References 84

7 Vlll Contents 7. Fine-needle aspiration cytology 89 P. van Heerde 1. Introduction Technique of FNA Conditions for optimum FNA results Complications of FNA Reliability of FNA Interpretation FNA of salivary glands: cytological features Normal salivary glands Regressive changes in normal salivary gland cells Benign salivary gland lesions Cysts Inflammation Benign lymphoepithelial lesions Pleomorphic adenoma Papillary cystadenoma lymphomatosum (Warthin's tumor) Malignant salivary gland lesions Adenoid cystic carcinoma Mucoepidermoid carcinoma Acinic cell carcinoma Other rare malignant neoplasms Pitfalls in cytodiagnosis Conclusion 102 References Histopathologic diagnosis of salivary gland disorders 105 P.l. Slootweg 1. Introduction Histology Histopathology Non-neoplastic disorders Inflammatory disorders Non-neoplastic and non-inflammatory gland enlargements Cysts of the salivary glands Salivary gland biopsy as a diagnostic aid in systemic disease Tumors Introduction Epithelial tumors Adenomas 113

8 Contents IX Carcinomas Non-epithelial neoplastic diseases 125 References Microbiology of salivary gland infections 129 P.B. van Cauwenberge 1. Introduction Overview of salivary gland infections Viral infections Mumps Cytomegalovirus infection Bacterial infections Fungi and yeasts Diagnosis of viral and bacterial infections of the salivary ~ands Viral infections Bacterial infections Direct microscopic examination Gram stain Giemsa stain Cultures Conclusion 137 References Sialometry and sialochemistry 139 L.F.E. Michels 1. Introduction Salivary secretion The collection of saliva Sialometry Flow rate Latency time Salivary pressure Sialochemistry l. Sodium Bicarbonate Urea Potassium Protein Blood chemistry Diagnostic aids to salivary gland disease Inflammation Mumps 151

9 x Contents 7.3. Recurrent obstructive parotitis 7.4. Sjogren'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 Concluding remarks and recommendations H.P. van den Akker and K. Graamans 1. Introduction 2. Major salivary glands 2.1. Inflammatory disorders Acute inflammatory disorders Chronic recurrent inflammatory disorders Sjogren's syndrome Sarcoidosis 2.2. Tumors Benign salivary gland tumors Malignant salivary gland tumors 2.3. Sialolithiasis 2.4. Sialadenosis 2.5. Developmental anomalies and trauma 3. Accessory salivary glands References Index of subjects

10 Preface 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 examination 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 information 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, microbiology, sialometry, sialochemistry, cytology, and histopathology may give superior information in certain cases. Therefore, this book is intended to review the application of available diagnostic modalities in patients with salivary gland disorders. Indications for these methods, their value, and applicability are discussed. We are delighted that a panel of experts in the Netherlands and Belgium were willing to contribute to our efforts to review the state of the art in the diagnosis of salivary gland disorders. We are especially indebted to the board of the Netherlands Society for Oto-Rhino-Laryngology and Cervico-Facial Surgery and to the board of the Dutch Association for Oral and Maxillofacial Surgery for their confidence and support. K. GRAAMANS H.P. VAN DEN AKKER K. Graamans & H.P, l'an den Akkcr (cds). Diagnosis of Sa/h'({I'.\' Gland Disorder.l. xi 1991 Kluwer Academic Publishers, XI

11 List of contributors H.P. VAN DEN AKKER Department of Oral and Maxillofacial Surgery, Academic Medical Centre and Academic Centre for Dentistry (ACTA), University of Amsterdam, The Netherlands R.I. BAATENBURG DE fong Department of Otorhinolaryngology, University Hospital Leiden, Leiden, The Netherlands E. BUSEMANN-SOKOLE Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands P.B. VAN CAUWENBERGE Department of Otorhinolaryngology, State University, Ghent. Belgium P.F. DIlKSTRA Department of Radiology, Academic Medical Centre, University of Amsterdam, The Netherlands N.I.M. FRELING Department of Radiology, Groningen University Hospital, Groningen, The Netherlands K. GRAAMANS Department of Otorhinolaryngology, University Hospital Utrecht, Utrecht, The Netherlands P. VAN HEERDE Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands L.F.E. MICHELS Department of Oral and Maxillofacial Surgery, Catharina Hospital, Eindhoven, The Netherlands xiii

12 xiv List of contributors E.L. MOOYAART Department of Radiology, Groningen University Hospital, Groningen, The Netherlands R.I. RONGEN Department of Radiology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands P.l. SLOOTWEG Department of Pathology, University Hospital Utrecht, Utrecht, The Netherlands