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Objectives: Salivary gland injury is one of the most common complications of radiotherapy in head‐and‐neck cancers. This study investigated the mechanism by which rapamycin prevents irradiation (IR)‐induced injury in the parotid glands. Materials and Methods: Miniature pigs either received (a) no treatment (NT), (b) IR in the right parotid gland for 5 consecutive days (IR), or intraperitoneal administration of rapamycin (Rap) 1 h prior to IR (IR + Rap). Tissues were collected at three distinct time points (24 h, 4 weeks, and 16 weeks) after IR. Histological analyses, western blot, and real‐time reverse transcriptase‐polymerase chain reaction were performed to explore the mechanisms of IR‐induced injury in the parotid gland. Results: Rapamycin treatment maintained parotid salivary flow 16 weeks post‐IR, preserved the number of acinar cells, and reduced parotid tissue fibrosis, as well as reduced apoptosis levels, decreased cleaved caspase‐3 expression, and increased the Bcl‐2/Bax ratio in the parotid glands. Autophagy marker LC3B was upregulated by rapamycin after IR, while P62 expression was downregulated. Rapamycin reduced the expression of pro‐inflammatory factors and the mesenchymal tissue fibrosis following IR. Conclusions: Rapamycin maintains gland homeostasis after IR by decreasing apoptosis, reducing the expression of pro‐inflammatory factors, and enhancing autophagy. [ABSTRACT FROM AUTHOR]

Objective: Primary Sjögren syndrome (pSS) is a chronic systemic autoimmune disorder that harms exocrine glands located mainly in the oral and ocular regions. pSS patients often complain about pain and mouth dryness. The aim of this retrospective study was to evaluate the influence of parotid glands’ sialendoscopy on salivary flow in pSS patients and to assess the tissue characteristics of the parotid glands during the sialendoscopy procedure. Method and materials: Twenty-six pSS patients (52 glands) treated with sialendoscopy for their parotid glands between the years 2017 and 2019 were included. The unstimulated whole saliva (UWS) flow rate was obtained 2 weeks before intervention (T1) and 3 months post intervention (T2). For 20 patients, UWS was measured 6 months post intervention (T3); and for 11 patients, UWS was measured 12 months post intervention (T4). Patients were asked about their oral quality of life before and after sialendoscopy. Results: UWS was significantly higher at T2, T3, and T4 compared to T1 (P = .002, P = .01, and P = .04 respectively). In total, 22 patients (84.6%) reported substantial improvement of their oral quality of life at T2. Of the 52 glands, 33 (63.5%) exhibited avascularity in the walls of the Stensen duct, 33 (63.5%) had strictures, and in 8 (15.4%) mucus plugs were present. No major complications were observed in this study except for one patient who suffered from duct perforation, which during follow-up was spontaneously healed. Conclusion: This study indicates a positive effect of sialendoscopy on salivary flow rate and oral quality of life in pSS patients. Sialendoscopy should be considered as a vital tool in treating pSS patients. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the effect of cevimeline and different concentrations of gum arabic on the parotid gland of rats being given xerostomia-inducing methotrexate. Methods: One hundred twenty-five rats were divided into five equal groups of twenty-five each. The rats in Group I received basic diets, while those in Groups II, III, IV, and V received 20 mg/kg MTX as a single intraperitoneal dose on day one. Group III received 10 mg/kg CVM dissolved in saline orally and daily, and the other two groups received a 10% W/V aqueous suspension of GA. Therefore, Group IV received 2 ml/kg suspension orally and daily, while Group V received 3 ml/kg suspension orally and daily. After 9 days, the parotid glands were dissected carefully and prepared for hematoxylin and eosin (H&E) staining as a routine histological stain and caspase-3 and Ki67 immunohistochemical staining. Quantitative data from α-Caspase-3 staining and Ki67 staining were statistically analysed using one-way ANOVA followed by Tukey's multiple comparisons post hoc test. Results: Regarding caspase-3 and Ki67 immunohistochemical staining, one-way ANOVA revealed a significant difference among the five groups. For Caspase-3, the highest mean value was for group II (54.21 ± 6.90), and the lowest mean value was for group I (15.75 ± 3.67). The other three groups had mean values of 31.09 ± 5.90, 30.76 ± 5.82, and 20.65 ± 3.47 for groups III, IV, and V, respectively. For Ki67, the highest mean value was for group I (61.70 ± 6.58), and the lowest value was for group II (18.14a ± 5.16). The other three groups had mean values of 34.4 ± 9.27, 48.03 ± 8.40, and 50.63 ± 8.27 for groups III, IV, and V, respectively. Conclusion: GA, rather than the normally used drug CVM, had a desirable effect on the salivary glands of patients with xerostomia. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the performance of diffusion-weighted magnetic resonance imaging (DW-MRI) as a noninvasive tool for assessing parotid gland function in type 2 diabetes mellitus (T2DM) patients. Methods: T2DM patients (n = 40, male, age 40–60 years) and healthy controls (n = 40) were examined. Salivary function was assessed using 1.5D echo-planar diffusion-weighted imaging. The examinations were performed before and every 3 min until 10 times after acid stimulation with a 500-mg vitamin C pill. The maximum apparent diffusion coefficient (ADC) in the parotid glands (pADCmax) and time to peak ADC in the parotid glands (pTmax) during stimulation were obtained. ADC values at every time point and the peak value of ADC were compared between the two groups and statistically analyzed. Results: The ADC values in the parotid gland in the resting state in the patient group were slightly lower than those in the healthy controls ((1.02 ± 0.08) × 10−3 mm2/s vs. (1.11 ± 0.09) × 10−3 mm2/s, p > 0.05). The ADCs in the healthy controls increased after stimulation until they gradually reached their peak. The ADCs in the patient group first decreased after stimulation and then gradually increased until they peaked. The pADCmax in the patient group was significantly lower than that in the healthy controls ((1.45 ± 0.08) × 10−3 mm2/s vs. (1.7 ± 0.06) × 10−3 mm2/s, p < 0.05). The peak ADCs in the parotid gland and relative signal intensity after acid stimulation were significantly correlated (r = 0.666, p < 0.05). Conclusion: DW-MRI before and after acid stimulation is potentially useful for noninvasive prediction of diabetes-induced xerostomia severity. ADC value is a sensitive indicator of parotid gland dysfunction and may indirectly reflect the degree of this dysfunction caused by fat deposition. [ABSTRACT FROM AUTHOR]

As the largest salivary gland in oral cavity, the parotid gland plays an important role in initial digesting and lubricating food. The abnormal secretory function of the parotid gland can lead to dental caries and oral mucosal inflammation. In recent years, single-cell RNA sequencing (scRNA-seq) has been used to explore the heterogeneity and diversity of cells in various organs and tissues. However, the transcription profile of the human parotid gland at single-cell resolution has not been reported yet. In this study, we constructed the cell atlas of human parotid gland using the 10× Genomics platform. Characteristic gene analysis identified the biological functions of serous acinar cell populations in secreting digestive enzymes and antibacterial proteins. We revealed the specificity and similarity of the parotid gland compared to other digestive glands through comparative analyses of other published scRNA-seq data sets. We also identified the cell-specific expression of hub genes for Sjögren syndrome in the human parotid gland by integrating the results of genome-wide association studies and bulk RNA-seq, which highlighted the importance of immune cell dysfunction in parotid Sjögren syndrome pathogenesis. [ABSTRACT FROM AUTHOR]

The study was designed to evaluate the influence of hyperbaric oxygenation therapy (HBOT) on the parotid gland in patients following radiotherapy for head and neck tumours. HBOT response was monitored by 3T magnetic resonance imaging (MRI) using T2 mapping and subsequent measurement of mean T2 and T2 variability as well as by salivary tests (salivary flow, buffer capacity, and pH). Eighteen patients previously treated with irradiation doses between 50 and 80 Gy as well as 18 healthy gender and age matched controls were enrolled. MRI was performed prior to HBOT (40.2 ± 20 months after radiotherapy) and after 20 daily HBOT at 2.5 ATA (absolute atmosphere). Each HBOT consisted of breathing 100% oxygen for 90 minutes. Significant differences in mean T2 prior to HBOT were observed between the ipsilateral irradiated (121 ± 20 ms), contralateral parotids (107 ± 21) and control group (96 ± 12 ms). A positive correlation in patients between T2 variability and irradiation dose was detected in contralateral parotids before HBOT (R = 0.489, p = 0.0287). In addition, negative correlations were observed between mean T2 in the ipsilateral as well as the contralateral gland and salivary flow before and after HBOT. Negative correlations between mean T2, T2 variability and pH of unstimulated saliva were also observed in the sides of parotid before and after HBOT. The study confirmed that T2 mapping had a potential for monitoring the differences between irradiated and normal parotid glands. It could also be useful in the assessment of the glandular tissue response to HBOT. [ABSTRACT FROM AUTHOR]

AIM: Mandibular condylar fractures account for 25 to 52 % of all mandibular fractures. Though current literature favors open reduction and internal fixation (ORIF) of condylar-base and low condylar-neck fractures, extraoral approaches are usually considered to be complicated by the risk of facial nerve injury and other possible complications. This study was undertaken to demonstrate that the periangular transmasseteric infraparotid surgical approach (TMIP) to condylar-base and low condylar-neck fractures provides excellent access to the bony fragments with minimal risk of complications such as facial nerve and parotid gland injury. PATIENTS: In the period from January 2010 to December 2018, 81patients (96 fractures) with condylar-base and low condylar-neck fractures underwent ORIF via periangular transmasseteric infraparotid surgical approach. RESULTS: The results of this retrospective study showed minimal postoperative complications. The periangular transmasseteric infraparotid surgical approach allowed precise anatomic repositioning and fixation of the bony fragments in almost all cases except for two juvenile cases with noticeable scars and one case with plate fracture. There were no transient or permanent facial nerve palsies, parotid gland or salivary fistulae complications during a 12-month follow-up period. CONCLUSION: The periangular infraparotid transmasseteric approach to ORIF of condylar-base and low condylar-neck fractures is an effective and safe approach allowing accurate anatomic reposition and fixation of the fragments with minimum surgical complications. [ABSTRACT FROM AUTHOR]

Background: Nodal metastasis in salivary gland malignancies has important clinical implications; a good understanding of their complex anatomy is paramount to the head and neck surgeon. Methods: A contemporary and comprehensive literature review was conducted of the lymphatic drainage of the salivary glands, with special emphasis on its surgical applications. Results: The parotid gland has extraglandular and intraglandular nodes acting as a single functional drainage unit. Intraglandular parotid notes are unique to the parotid gland, and consist of a larger superficial group and a smaller deep group. The presence of intraglandular submandibular nodes, as described by early anatomists, is much debated nowadays. The sublingual glands drain to the lingual lymph nodes, which are divided into median, intermediate and lateral groups. Conclusion: This review highlights the complex arrangements of lymph nodes draining the salivary glands. It may provide a valid anatomical explanation for the nodal metastasis patterns commonly seen in salivary gland malignancy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the phenotypic features of the masticatory biomechanics in atypical subjects with Down syndrome (DS). Its influence was analysed on sleep disorders, body adiposity and its risks, and some physicochemical properties of saliva. Methods: Seventy subjects were enrolled to assess masticatory biomechanical function and divided into two groups: DS and control groups. Electrical activities of the masseter and temporal muscles (at rest and in maximum voluntary clench‐MVC), maximum bite force‐MBF and maximum mouth opening‐MMO were investigated. Among the atypical subjects, just 24 participants underwent the anthropometry, the polysomnography II and the saliva testing (salivary flow rate‐SFR, buffer capacity‐BC and salivary cortisol levels, morning/SC‐AM and night/SC‐PM). Results: MVC and MBF values showed high statistical significance in the control group (P <.001) than in the DS group of 35. MMO values were slightly increased in the DS group in relation to the control group. Overweight and obesity were found in both genders. Atypical women showed higher risk to develop cardiovascular‐metabolic diseases than in atypical men. OSA severe was 20% for atypical women and 42.8% for atypical men, whereas snoring index was present in all genders. SFR was reduced in 100% of atypical subjects (hyposalivation in 10% women and 28.5% men). Furthermore, 100% BC, 66.6% SC‐AM and 91.6% SC‐PM showed normal patterns. Conclusion: Masseter and temporal muscle hypotonia was found in all atypical subjects with DS. This muscle dysfunction strongly was related to overweight/obesity, risks for development of cardiovascular/metabolic diseases, OSA severity, successive snoring episodes and salivary flow reduction in DS. [ABSTRACT FROM AUTHOR]

Myeloid sarcoma (MS) is a rarely encountered extramedullary localized tumor that is composed of immature myeloid cells. We reported an extremely rare case of MS with concurrent bone marrow (BM) involvement that invaded into a preexisting sebaceous lymphadenoma in the parotid gland and neck lymph nodes. Prompted by this case, we also present a literature review of MS invasion into salivary glands. A 62-year-old man was initially diagnosed with carcinoma that arose in a sebaceous lymphadenoma in the parotid gland, through a total parotidectomy with neck dissection. After an extensive histopathological review that included immunohistochemistry, a pathologic diagnosis of MS with infiltration into the sebaceous lymphadenoma with concurrent BM involvement was confirmed. MS is difficult to diagnose accurately; herein, we analyzed the clinical presentations and effectiveness of the various diagnostic methods with a review of the literature. 0ere are 17 cases, including our case, reported in 13 studies. Of the cases in which the salivary glands were affected, 10 involved the parotid gland, six involved the submandibular gland, and one involved both. Isolated invasion of the salivary gland was found in one case of parotid gland invasion and three cases of submandibular gland invasion. In 13 cases, the salivary glands were affected by various other lesions. Although there were no incidences of isolated MS, six patients were diagnosed with secondary MS and eight patients with MS with BM involvement, including this case. 0e diagnosis of MS is difficult given its rarity, and a high index of suspicion and integrated radiologic and careful histopathologic evaluation are required. Most cases of MS infiltrating the salivary gland might be indicated by the possibility of BM involvement. MS with BM involvement predicts poor prognosis and the need for intensive systemic treatment. [ABSTRACT FROM AUTHOR]

Juvenile recurrent parotitis (JRP) is a recurrent parotid inflammation of nonobstructive, nonsuppurative nature. It manifests in childhood and usually resolves after puberty but may also persist into adulthood. JRP is characterized by recurrent episodes of unilateral or/and bilateral parotid swelling with pain, reduction of salivary secretion, swallowing difficulty, fever, and malaise. The cause of this condition remains obscure. Throughout the last two decades, many therapeutic methods have been used in order to reduce the frequency and severity of JRP. During the acute episodes, conservative approaches (antibiotics, analgesics, sialogogues, massage of the parotid gland, and mouth rinses) are used. Parotidectomy has been suggested in rare selective occasions. Recently, a promising concept of sialendoscopy, which is a minimal invasive endoscopic technique, has been applied. This review outlines the literature on JRP focusing on methods and challenges in diagnosing JRP along with the differential diagnosis of JRP and the function of the parotid during JRP. In addition, we describe the treatment options for JRP, pointing out the importance of sialendoscopy as a diagnostic and treatment procedure that offers improvement in patients' daily life. [ABSTRACT FROM AUTHOR]

Prolonged high intake of any alcohol-containing beverage can lead to bilateral parotid gland (PG) swelling. The diagnosis of this PG abnormality (PG sialosis) is facilitated by the patient’s clinical history, PG findings and imaging study. [ABSTRACT FROM AUTHOR]

Skin secretions of frogs have a high chemical complexity. They have diverse types of biomolecules, such as proteins, peptides, biogenic amines, and alkaloids. These compounds protect amphibians' skin against growth of bacteria, fungi, and protozoa and participate in defense system against attack from predators. Therewith, this work performed biochemical and biological profile of macroglands parotoid secretion from cane toad. For poison analysis, we performed molecular exclusion and reverse phase chromatography, electrophoresis, and mass spectrometry. Antimicrobial, antiplasmodial, leishmanicidal, cytotoxicity, genotoxicity, and inflammatory activity of crude and/or fractions of R. marina secretion were also evaluated. Fractionation prior to filtration from poison showed separation of low mass content (steroids and alkaloids) and high molecular mass (protein). Material below 10 kDa two steroids, marinobufagin and desacetylcinobufagin, was detected. Crude extract and fractions were active against Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Plasmodium falciparum, Leishmania guyanensis, and Leishmania braziliensis. Crude extract was also active against cancer cells although it was not cytotoxic for normal cells. This extract did not show significant DNA damage but it showed an important inflammatory effect in vivo. The information obtained in this work contributes to the understanding of the constituents of R. marina secretion as well as the bioactive potential of these molecules. [ABSTRACT FROM AUTHOR]

Juvenile recurrent parotitis is a rare recurrent inflammation of the parotid glands occurring in children. The etiology remains obscure and the treatment is still debated. In the present study, we perform a systematic review of the literature with the purpose of identifying and discussing the treatment options emerged over the last 28 years in order to prevent recurrent episodes of parotitis. We ultimately included 24 studies. The definitions used for juvenile recurrent parotitis varied widely and none of the selected studies referred exactly to the same definition. Only one was a randomized controlled trial and it showed marked benefits with the use of Bear Bile and Huangqi, two traditional Chinese medicines. Two additional study on sialendoscopy included a control group but was not randomized. All the remaining contributions were case series or case reports. The vast majority (n = 19) of the selected studies reported on sialendoscopy. They all documented improvement of the condition following this intervention. An analysis grouping all these studies (corresponding to 336 children) showed that only 25.8% (95% Confidence Interval: 21.5–30.8) of the treated children had further recurrences. However, the only two controlled study on sialendoscopy showed a similar improvement in controls. The remaining four studies were on sialography (n = 2), on oral appliance in the specific group of children with concomitant dental malocclusion (n = 1) on ductal hydrocortisone infusion through catheter inserted in the parotid duct (n = 1). Improvements were documented in all four contributions. This systematic review of the literature did not consent us to draw definite conclusions on the most suitable treatment for juvenile recurrent parotitis. The available evidence is indeed weak and difficult to interpret because of the scarcity of randomized controlled trials, the heterogeneity of the definitions used and the high rate of spontaneous resolution. Future large and well-designed randomized controlled trials that will include children fulfilling a shared definition of the condition are warranted. [ABSTRACT FROM AUTHOR]

Abstract: Background: The accuracy of fine‐needle aspiration biopsy (FNAB) is controversial in parotid tumors. We aimed to compare FNAB results with the final histopathological diagnosis and to apply the “Sal classification” to our data and discuss its results and its place in parotid gland cytology. Methods: The FNAB cytological findings and final histological diagnosis were assessed retrospectively in 2 different scenarios based on the distribution of nondefinitive cytology, and we applied the Sal classification and determined malignancy rate, sensitivity, and specificity for each category. Results: In 2 different scenarios FNAB sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 81%, 87%, 54.7%, and 96.1%; and 65.3%, 100%, 100%, and 96.1%, respectively. The malignancy rates and sensitivity and specificity were also calculated and discussed for each Sal category. Conclusion: We believe that the Sal classification has a great potential to be a useful tool in classification of parotid gland cytology. [ABSTRACT FROM AUTHOR]

Purpose: To demonstrate that sonic hedgehog (Shh) is present in human parotid saliva and is decreased in human taste dysfunction.Methods: Shh was measured in parotid saliva of 27 normal subjects and 81 patients with taste dysfunction of multiple etiologies using a sensitive spectrophotometric ELISA assay. Taste dysfunction was defined clinically both by subjective decreases of taste acuity and flavor perception and by impaired gustometry.Results: Shh was found in parotid saliva of both normal subjects and patients with taste dysfunction. Levels were significantly lower in patients than in normal subjects. Both subjective loss of taste acuity and flavor perception and impaired gustometry was measured in untreated patients.Conclusions: This is the first demonstration of Shh in human saliva. As Shh has been related to taste bud growth and development, its presence in saliva is consistent with its role as a cell signaling moiety involved with stimulation of taste bud stem cells to generate taste receptors. Decreased saliva Shh secretion can be considered a marker of taste dysfunction in patients with multiple pathologies for their dysfunction. [ABSTRACT FROM AUTHOR]

Compounds activating γ-aminobutyric acid type A receptor were isolated from the toad Bufo bufo venom as a result of chromatographic separation. Analysis of the structure of these compounds by mass spectrometry and nuclear magnetic resonance showed that they are arginine derivatives of dicarboxylic acids and represent suberylarginine, pimeloylarginine, and adipoylarginine. [ABSTRACT FROM AUTHOR]

Objective In patients with anorexia nervosa (AN) specific signs may occur in the oral cavity, but there are conflicting reports about their significance, especially concerning changes in salivary composition. The aim of this clinical study was to evaluate the resting parotid flow rate (PFR) and the activity of the following enzymes in parotid saliva: amylase, aspartate amino transferase (AST), lysozyme, peroxidase, serine and acidic proteases in the acute phase of the restrictive type of AN and to compare the findings with those in healthy controls. Design Forty-one subjects participated (20 patients with AN, 21 matched healthy controls), parotid saliva was collected using a modified Lashley cap at rest. Enzyme activities were measured with fluorimetric and photometric assays. Results The unstimulated PFR was significantly lower than in the controls, lysozyme and AST activity was significantly lower, and amylase showed a high inter-individual variability. A positive correlation for amylase and lysozyme and negative ones for lysozyme and BMI, lysozyme and IBW%, serine protease and salivary flow were observed. Conclusions The reduced PFR and enzyme activities levels suggest that AN does not only affect the quantity of the saliva but also its quality and, its biological functions. The results obtained should help to provide a better understanding of the effect of AN disease on the pathogenesis of at least some oral diseases. Further research is needed on any possible role of reduced lysozyme and transaminase activity in maintaining oral protection against external toxic agents and bacteria. [ABSTRACT FROM AUTHOR]

Background The aims of this study were to investigate temporal patterns and potential risk factors for severe hyposalivation (xerostomia) after intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC), and to test the two QUANTEC (Quantitative Analysis of Normal Tissue Effects in the Clinic) guidelines. Patients and methods Sixty-three patients treated at the Memorial Sloan Kettering Cancer Center between 2006 and 2015, who had a minimum of three stimulated whole mouth saliva flow measurements (WMSFM) at a median follow-up time of 11 (range: 3–24) months were included. Xerostomia was defined as WMSFM ≤25% compared to relative pre-radiotherapy. Patients were stratified into three follow-up groups: 1: <6 months; 2: 6–11 months; and 3: 12–24 months. Potential risk factors were investigated (Mann–Whitney U test), and relative risks (RRs) assessed for the two QUANTEC guidelines. Results The incidence of xerostomia was 27%, 14% and 17% at follow-up time points 1, 2 and 3, respectively. At <6 months, the mean dose to the contralateral and the ipsilateral parotid glands (Dmean contra , Dmean ipsi ) was higher among patients with xerostomia (Dmean contra : 25 Gy vs. 15 Gy; Dmean ipsi : 44 Gy vs. 25 Gy). Patients with xerostomia had higher pre-RT WMSFM (3.5 g vs. 2.4 g), and had been treated more frequently with additional chemotherapy (93% vs. 63%; all 4 variables: p < 0.05). At 6–11 months, Dmean contra among patients with xerostomia was higher compared to patients without (26 Gy vs. 20 Gy). The RR as specified by the one- and two-gland QUANTEC guideline was 2.3 and 1.4 for patients with <6 months follow-up time, and 2.0 and 1.2 for patients with longer follow-up (6–11 + 6–24 months). Conclusion Xerostomia following IMRT peaks within six months post-radiotherapy and fades with time. Limiting the mean dose to both parotid glands (ipsilateral <25 Gy, contralateral <25 Gy) and reducing the use of chemotherapy will likely decrease the rate of xerostomia. Both QUANTEC guidelines are effective in preventing xerostomia. [ABSTRACT FROM AUTHOR]

Purpose: To demonstrate the feasibility of intravoxel incoherent motion imaging (IVIM) for quantification of perfusion changes in the parotid gland after gustatory stimulation.Materials and Methods: Eight healthy volunteers underwent diffusion-weighted magnetic resonance imaging (MRI) of the neck at 3T with 11 dynamic acquisitions (9 b-values between 0 and 980 s/mm2 , 2:40 min each). After 5:20 minutes, a lemon-mint-drop was administered orally. Perfusion fraction (Fp ), pseudodiffusion (D*), tissue diffusion (Dt ) coefficients, and optimal b-value threshold were measured using a multistep variable b-value threshold fitting approach. Dynamic changes in the coefficients between three exemplary timepoints (baseline, after stimulation, after dissolution) were compared using a Mann-Whitney U-test with Bonferroni correction (P < 0.016 significance level).Results: Mean values (95% confidence interval [CI]) for IVIM parameters at baseline were Fp : 0.11 (0.08-0.15), D*: 56.48 mm2 /s (39.71-98.27), Dt : 1.01 mm2 /s (0.84-1.06), b-value threshold: 30 s/mm2 (21.25-105). After stimulation: Fp 0.16 (0.15-0.24; P < 0.01), D* 93.83 mm2 /s (77.98-129.53, P = 0.25), Dt 0.93 mm2 /s (0.87-1.08, P = 0.94), b-value threshold 20 s/mm2 (13.75-26.25 s/mm2 , P = 0.10), reflecting the increase in tissue perfusion. After dissolution of the drop: Fp : 0.13 (0.11-0.18, P = 0.38), D*: 101.61 mm2 /s (90.68-144.55, P = 0.07), Dt : 0.91 mm2 /s (0.85-1.05, P = 0.64), b-value threshold: 15 s/mm2 (11.25-40, P = 0.38).Conclusion: The IVIM method allows for simultaneous quantification of changes in perfusion and diffusion effects after gustatory stimulation of the parotid gland.Level Of Evidence: 2 J. Magn. Reson. Imaging 2017;45:570-578. [ABSTRACT FROM AUTHOR]

The parotid gland is drained by the parotid duct which normally measures 50 mm in length and 3 mm in width. The parotid duct emerges at the anterior border of the gland and runs horizontally across the masseter muscle to pierce the buccinator and open into the vestibule of the mouth. The occurrence of double parotid duct is 7% and there are only very few literature references. The parotid gland develops as an epithelial bud arising from the oral ectoderm and invaginating into the underlying mesenchyme. The proximal part canalises to form the duct and the distal end diferentiates to form the acini. An early division of the parotid duct with acini from both ducts intermingling with each other results in the formation of double parotid duct. The cytodiferentiation and morphogenesis of parotid gland are infuenced by cell specifc gene expression and cell-matrix interactions that produce collagen responsible for branching and hyaluronidase responsible for acini formation. The awareness of presence of a double parotid duct is signifcant in ductal endoscopic procedures and in performing surgery in the parotid region. [ABSTRACT FROM AUTHOR]

Introduction. Angiofollicular lymph node hyperplasia (Castleman’s disease) is a nonmalignant lymphoproliferative disorder that generally involves the lymph nodes of young adults, most commonly in the mediastinum. Rarely, Castleman’s disease may present in the parotid gland. The disease can be further classified into unicentric or multicentric forms, with considerable differences in presentation, treatment, and prognosis. Case(s). We present cases of two pediatric patients, aged 7 and 11, who both presented with a slow-growing, painless parotid mass. In each case, the mass was excised via a superficial parotidectomy and the diagnosis made postoperatively upon further pathologic examination. At 6 months of follow-up, both had fully intact facial nerve function and no evidence of recurrence. Discussion. Castleman’s disease presents a diagnostic challenge in the head and neck region, as radiographic characteristics and fine needle aspiration results are often inconclusive. Definitive diagnosis requires surgical excision for pathologic examination. The unicentric form generally presents as a painless mass and can be successfully treated with complete excision. The multicentric form is associated with constitutional symptoms and its treatment remains controversial. Conclusion. Although rare, clinicians should be aware of both forms of Castleman’s disease when creating a differential diagnosis for parotid masses. [ABSTRACT FROM AUTHOR]

During radiotherapy treatment of patients with head-and-neck cancer, the possibility that parotid glands shrink was evidenced, connected with increasing risk of acute toxicity. In this ambit, the early identification of patients in danger is of primary importance, in order to treat them with adaptive therapy. This work studies different approaches for classifying parotid gland samples, taking into account textural features extracted from computed tomography (CT) images of monitored patients. A real dataset is used, and accuracy, sensitivity and specificity are counted as classification performances. Therefore, firstly, different procedures to define classes are compared in terms of their physical meaning and classification performances. Then, different methods for extracting knowledge from the dataset are implemented and compared in terms of performances and model interpretability. First-rate performance was obtained by using Likelihood-Fuzzy Analysis (LFA), which is a recently developing method based on the use of statistical information by means of Fuzzy Logic. The interpretable models extracted with LFA also allow identifying among textural features those able to predict parotid shrinkage. Some of these features are already known and are confirmed here, others are new, and some of them are very early predictors. Finally, an example of textural feature monitoring and classification of a patient is presented, through a reasoning scheme similar to human reasoning, based on the interpretation of simple rule-based models using linguistic variables. [ABSTRACT FROM AUTHOR]

Introduction The aim of this study was to describe our experiences of a mini-preauricular transparotid approach for direct reduction and plating of condylar neck fractures. Materials and methods A retrospective study was conducted on 58 patients from 2009 to 2011 with 69 condylar neck fractures in Chang Gung Memorial Hospital. The fractures were treated surgically either with a 2-cm mini-preauricular and transparotid approach in 29 patients with 36 fractures, or via endoscope-assisted intraoral, or facelift or retromandibular approaches in a control group of 29 patients with 32 fractures. The postoperative hospital stay, occlusion status, mouth opening and facial nerve and parotid gland related complications were compared between the two groups. Results In both groups around 90% of patients had good restoration of preinjury occlusion. Postoperative mouth opening was 39.8 mm and 39.9 mm in the mini-preauricular approach and the other approaches group, respectively. Facial symmetry was achieved in all of the patients. There was no incidence of facial nerve palsy, infection or hemorrhage in the mini-preauricular group. One patient in the control group had a persistent weakness due to frontal nerve palsy. Conclusion Based on the results, the mini-preauricular approach can be an alternative, safe and effective method in the management of condylar neck and high subcondylar fractures. [ABSTRACT FROM AUTHOR]

Xerostomia is a common side effect of ionizing radiation used to treat head and neck cancer. A groundbreaking Phase I human clinical trial using Adenoviral gene transfer of Aquaporin-1 (AQP1) to a single salivary gland of individuals suffering from radiation-induced xerostomia has recently been reported. Unfortunately, the limitations of the Adenoviral vector system used in this pioneering trial preclude its advancement to a Phase II trial, and we have thus undertaken to evaluate the therapeutic potential of ultrasound-assisted nonviral gene transfer (UAGT) as an alternative means of delivering AQP1 gene therapy to the salivary gland by comparing head-to-head with the canonical Adenoviral vector in a swine model. Swine irradiated unilaterally with a 10-Gy electron beam targeted at the parotid gland suffered from significant, sustained hyposalivation that was bilateral, despite irradiation being confined to the targeted gland. Unilateral AQP1 gene therapy with UAGT resulted in bilateral restoration of stimulated salivary flow at 48 h and 1 week post treatment (1.62±0.48 ml and 1.87±0.45 ml) to preinjury levels (1.34±0.14 ml) in a manner comparable to Adenoviral delivery (2.32±0.6 ml and 1.33±0.97 ml). UAGT can replace the Adenoviral vector as a means of delivering AQP1 gene therapy in the irradiated swine model, and it is a candidate for advancement to a Phase I human clinical trial. [ABSTRACT FROM AUTHOR]

Objectives The influence of experimental diabetes (alloxan, 100 mg kg−1) was studied on rabbit parotid gland function. Material and Methods Carbachol-induced parotid secretion in vivo, and in vitro quantification of inducible nitric oxide synthase ( iNOS) mRNA expression, by real-time RT- PCR, and activity of superoxide dismutase ( SOD) and total antioxidant capacity ( TAC) in commercial colorimetric assays were measured in parotid glands of non-diabetic and diabetic rabbits. Results Carbachol-induced dose-dependent increase in parotid secretion significantly reduced in diabetic rabbits. Functional studies in the presence of muscarinic receptor and nitric oxide synthase ( NOS) antagonists revealed that in M3 receptor-mediated carbachol secretion, nitric oxide, deriving mainly from neuronal NOS ( nNOS) in control, and iNOS in diabetic rabbits, was involved. Also, upregulation of iNOS mRNA expression and enhanced SOD activity and TAC were detected in diabetic glands. Conclusions Our data suggest that decreased M3 receptor-mediated parotid secretion in diabetic rabbits appears to be due to alterations in NO signaling, mainly due to iNOS induction, accompanied by elevated antioxidant response. [ABSTRACT FROM AUTHOR]

The aim of this prospective open-label study was to treat disabling drooling in children with cerebral palsy (CP) with onabotulinumtoxin A (A/Ona, Botox®) into submandibular and parotid glands and find the lowest effective dosage and least invasive method. A/Ona was injected in 14 children, Mean age 9 years, SD 3 years, under ultrasonic guidance in six successive Series, with at least six months between injections. Doses and gland involvement increased from Series A to F (units (U) per submandibular/parotid gland: A, 10/0; B, 15/0; C, 20/0; D, 20/20; E, 30/20; and F, 30/30). The effect was assessed 2, 4, 8, 12, and 20 weeks after A/Ona (drooling problems (VAS), impact (0-7), treatment effect (0-5), unstimulated whole saliva (UWS) flow and composition)) and analyzed by two-way ANOVA. The effect was unchanged-moderate in A to moderate-marked in F. Changes in all parameters were significant in E and F, but with swallowing problems ≤5 weeks in 3 of 28 treatments. F had largest VAS and UWS reduction (64% and 49%). We recommend: Start with dose D A/Ona (both submandibular and parotid glands and a total of 80 U) and increase to E and eventually F (total 120 U) without sufficient response. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Intensity-modulated radiation therapy (IMRT) uses solid compensators or multileaf collimators to modulate the intensity of radiation in each field, delivering highly conformal dose distributions. This technique allows treating volumes with concave shapes when the target is close to a critical structure. The movement of multileaf collimator under computer control can modulate the dose in 3 main ways: IMRT with static field with segments, IMRT with dynamic delivery, and IMRT rotational therapy. Volumetric modulated arc therapy (VMAT) is a novel radiation technique that creates conformal distributions with variable gantry speed, dynamic movements of multileaf collimator, and variations in dose rate. The purpose of this study was to review the basis of VMAT, highlighting the differences with other IMRT techniques. © 2014 Wiley Periodicals, Inc. Head Neck 37: 909-914, 2015 [ABSTRACT FROM AUTHOR]

The goal of this study was to evaluate the actual anatomical and dosimetric changes of parotid glands in nasopharyngeal carcinoma patients during intensity modulated radiation therapy. With helical tomotherapy, its planning system, and adaptive software, weekly anatomical and dosimetric changes of parotid glands in 35 NPC patients were evaluated. Interweekly parotid volume varied significantly (P<0.03). The rate of volume change reached the highest level at the 16th fraction. The average V1 increased by 32.2 (left) and 28.6 (right), and the average D50 increased by 33.9 (left) and 24.93 (right), respectively. Repeat data comparison indicated that the V1 and D50 varied significantly among different fractions (both with P=0.000). The variation of parotid volume was inversely correlated with that of the V1 and D50 (both with P=0.000). In conclusion, parotid volume and actual dose vary significantly in NPC patients during IMRT. Replanning at the end of the fourth week of IMRT may have clinical benefits. [ABSTRACT FROM AUTHOR]

Secretory proteins produced by salivary glands are stored in granules and released into saliva. Rodent salivary glands are a reliable experimental model because they are morphologically and functionally similar to those of humans. To determine if the effects of microgravity on secretory proteins are increased on extended flights, their expression in mouse parotid glands, morphological, immunocytochemical, and biochemical/molecular methods were employed. Acinar cells of STS-135 (13 day) and Bion-M1 (30 day) flight animals showed an increase of autophagy and apoptosis, while duct cells contained vacuoles with endocytosed proteins. In STS-135, decreases were seen in the regulatory subunit of type II protein kinase A (RII) by Western blotting, and demilune cell and parotid protein (DCPP) and α- amylase (p<0.01) by immunogold labeling, while proline-rich proteins (PRPs, p<0.001) and parotid secretory protein (PSP, p<0.05) were increased. These results suggest microgravity effects on secretion are function-dependent. Microarray analyses showed significant changes in the expression of a number of genes, including components of the cyclic-3',5',-adenosine monophosphate (cyclic AMP) signaling pathway. Compared to habitat ground controls, mice from both flights exhibited altered expression of cyclic AMP-specific phosphodiesterases, adenylate cyclase isoforms, and several A-kinase anchoring proteins. Bion-M1 flight mice showed increases in gene expression for lysozyme and amylase, a decrease in PRPs, and RII expression was unchanged from control values. Secretory protein expression is altered by travel in space, representing a reversible adjustment to microgravity conditions. Ultimately, the goal is to develop a test kit using saliva -- an easily obtained body fluid -- to assess the physiologic effects of travel in space. [ABSTRACT FROM AUTHOR]

Background To determine the position and dose delivery changes rules of parotid gland (PG) during the course of intensity modulated radiation therapy (IMRT) in nasopharyngeal carcinoma patients (NPC). Materials and methods One hundred and forty one competed tomography (CT) images from 47 NPC patients (three images for each patient were acquired before treatment, at the 15th and 25th fraction during the treatment) who underwent radical IMRT were selected for this study. A total of 70-76Gy at 2.12-2.3 Gy/fraction/d was given to the GTVnx in 33 fractions. The distances between the lateral/medial aspects of PG and midline (DLM and DMM) at the level of odontoid process were measured. The dose differences between plan and actual delivery were calculated. Results The volume reductions of PGs between fractions 15 and 25 were larger than those in the first 15 fractions (4.68 ± 3.23 cc vs. 2.46 ± 4.55 cc for the right PG and 5.96 ± 2.99 cc vs. 2.06 ± 2.99 cc for the left PG). However, the percentage of gland volume receiving ≥30Gy (V30) of bilateral PGs decreased more significantly in the first 15 fractions than that between fractions 15 and 25 (5.61 ± 16.04% vs. 1.14 ± 21.54% for the right PG and 6.87 ± 15.58% vs. 0.81 ± 15.94% for the left PG). The gross tumor volume of the nasopharynx (GTVnx) decreased more significantly in the first 15 fractions than that between the 15th and 25th fraction (8.23 ± 13.61 cc vs. 3.30 ± 8.09 cc). The DMM of ipsilateral PGs reduced in the first 15 fractions (0.80 ± 2.96 mm) but increased between fraction 15 and 25 (-2.19 ± 3.96 mm). While ipsilateral PG shifted into target volume but shifted out target volume between fraction 15 and 25. Parotid glands V30 was correlated with GTVnx, GTVnx reduction and DMM reduction (p < 0.01). Conclusion Our results indicate that the reduction of GTVnx leads to the positional change of the parotid gland, which results in more significant dose change of the parotid gland in the first 15 fractions than that between fraction 15 and 25. [ABSTRACT FROM AUTHOR]

Summary Objectives: Swallowing can be significantly affected during and following radiotherapy for head and neck cancer (HNC). The purpose of this study was to understand: (1) the trajectory of swallowing recovery following parotid-sparing intensity-modulated radiotherapy (IMRT) and (2) overall physical and social-emotional wellbeing and how patients prioritise swallowing following treatment. Materials and methods: Sixty-one HNC patients completed questionnaires as part of a prospective study exploring patient-reported swallowing outcomes following parotid-sparing IMRT. Participants were asked to complete the M.D. Anderson Dysphagia Inventory (MDADI) and University of Washington Quality of Life Questionnaire (UW-QoL) v.04 before treatment and 3, 6 and 12 months after treatment. Given the rise in human papilloma virus (HPV) and associated oropharyngeal cancers, we completed a sub analysis of the data in those participants. Results: There was a significant reduction in the MDADI composite scores 3 months after completion of treatment. Improvements were observed by 12 months, however, scores did not recover to baseline. The recovery in physical function was limited in comparison to social-emotional recovery at 12 months. When oropharyngeal cancer scores were analysed, there was not a substantial difference to the whole group results. There was a shift in priorities following treatment. Swallowing was highlighted as a concern by 44% of HNC patients up to 12 months after treatment with swallowing-related factors (saliva, taste and chewing) rated highly. Conclusions: Patient reported swallowing outcomes were significantly affected from baseline to all follow-up time points and remained a priority concern at 12 months following treatment. Overall social-emotional functioning does improve, suggesting that patients have the potential to adapt to their “new normal” following IMRT for HNC. [ABSTRACT FROM AUTHOR]

Basal cell adenoma is an uncommon type of monomorphous adenoma of the salivary gland. Its most frequent location is the parotid gland. Its recurrence rate and conversion to basal cell adenocarcinoma after inadequate surgical excision is high. We present a 68-year-old female patient with a basal cell adenoma of the upper lip arising from minor salivary gland. [ABSTRACT FROM AUTHOR]

Background and purpose To compare volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) plans for treatment of unresectable paranasal sinuses cancers (PNSCs) with different clinical presentations. Material and methods Four patients treated for primary target volume only (group 1), four requiring elective nodal irradiation (group 2) and four with positive nodes in macroscopic disease (group 3) were selected. For each patient were generated 7 fields IMRT, coplanar VMAT (c-VMAT) and non-coplanar VMAT (nc-VMAT) treatment plans. Total doses were 70 Gy and 54 Gy to high dose planning target volume (HD-PTV) and low-dose-PTV, respectively. Dose–volume histogram, conformity and homogeneity index (CI and HI), and monitor units (MUs) per Gy were evaluated. Results VMAT provided significantly better target coverage, in terms of V 100% (Volume encompassed by the isodose 100%), than IMRT, in particular when nc-VMAT was used. In general, organ at risk sparing is similar with the three approaches, although nc-VMAT can allow a statistically significant reduction of dose to contralateral parotid gland and cochlea for all three groups. Conclusions VMAT can offer significant improvement of treatment for all unresectable PNSCs over existing IMRT techniques. In particular, nc-VMAT may be a further advantage for those patients with sinonasal cancers and involvement of the nodes in whom large volumes and complex/irregular shape have to be irradiated, even if clinical benefits should be established in the future. [ABSTRACT FROM AUTHOR]

Phospholipase D (PLD) has been implicated in many cellular functions, such as vesicle trafficking, exocytosis, differentiation, and proliferation. The aim of this study was to characterize the role of PLD in HSY cells, a human cell line originating from the intercalated duct of the parotid gland. As the function and intracellular localization of PLD varies according to cell type, initially, the intracellular localization of PLD1 and PLD2 was determined. By immunofluorescence, PLD1 and PLD2 both showed a punctate cytoplasmic distribution with extensive co-localization with TGN-46. PLD1 was also found in the nucleus, while PLD2 was associated with the plasma membrane. Treatment of cells with the primary alcohol 1-butanol inhibits the hydrolysis of phosphatidylcoline by PLD thereby suppressing phosphatidic acid (PA) production. In untreated HSY cells, there was only a slight co-localization of PLD with the clathrin coated vesicles. When HSY cells were incubated with 1-butanol the total number of clathrin coated vesicles increased, especially in the juxtanuclear region and the co-localization of PLD with the clathrin coated vesicles was augmented. Transmission electron microscopy confirmed that the number of Golgi-associated coated vesicles was greater. Treatment with 1-butanol also affected the Golgi apparatus, increasing the volume of the Golgi saccules. The decrease in PA levels after treatment with 1-butanol likewise resulted in an accumulation of enlarged lysosomes in the perinuclear region. Therefore, in HSY cells PLD appears to be involved in the formation of Golgi associated clathrin coated vesicles as well as in the structural maintenance of the Golgi apparatus. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: During radiotherapy (RT) for head-and-neck cancer, parotid glands undergo significant anatomic, functional and structural changes which could characterize pre-clinical signs of an increased risk of xerostomia. Texture analysis is proposed to assess structural changes of parotids induced by RT, and to investigate whether early variations of textural parameters (such as mean intensity and fractal dimension) can predict parotid shrinkage at the end of treatment. Material and methods: Textural parameters and volumes of 42 parotids from 21 patients treated with intensity-modulated RT for nasopharyngeal cancer were extracted from CT images. To individuate which parameters changed during RT, a Wilcoxon signed-rank test between textural indices (first and second RT week; first and last RT week) was performed. Discriminant analysis was applied to variations of these parameters in the first two weeks of RT to assess their power in predicting parotid shrinkage at the end of RT. Results: A significant decrease in mean intensity (1.7HU and 3.8HU after the second and last weeks, respectively) and fractal dimension (0.016 and 0.021) was found. Discriminant analysis, based on volume and fractal dimension, was able to predict the final parotid shrinkage (accuracy of 71.4%). Conclusion: Textural features could be used in combination with volume to characterize structural modifications on parotid glands and to predict parotid shrinkage at the end of RT. [Copyright &y& Elsevier]

The article presents a study which aims to evaluate the significance of diffusion-weighted magnetic resonance imaging (DWI) in assessing parotid gland's physiological changes before and after parotid-sparing radiotherapy (RT) and during gustatory stimulation. Student t tests, apparent diffusion coefficient, and DWI sequence were performed during the study. Results show that DWI with gustatory stimulation can be used as a tool for non-invasive assessment of salivary gland function.

Purpose: To investigate parotid perfusion in early-to-intermediate stage after parotid-sparing radiation dose using fat-saturated DCE-MRI, and to verify whether the perfusion alteration was related to radiation dose and the PSV. Methods and Materials: Thirty-two parotid glands from 16 consecutive patients with pathologically proven nasopharyngeal carcinoma treated by IMRT were examined. The parotid glands received a radiation dose of 28.9±3.9Gy with a PSV of 43.1%±13.9%. Perfusion parameters were calculated using time-shifted Brix model from fat-saturated DCE-MRI data before (pre-RT) and in early-to-intermediate stage after (post-RT) IMRT. Paired t-test was used to evaluate perfusion changes, while Pearson's correlation test was used to examine perfusion dependency on radiation dose and PSV. For multiple comparisons Bonferroni correction was applied. Results: Successful fat saturation was achieved in 29 of 32 parotid glands. Compared with pre-RT, the post-RT parotid glands showed significantly higher A, peak enhancement, and wash-in slope, plus a lower K el, suggesting a mixed effect of increased vascular permeability and acinar loss. Linear regression showed that peak enhancement was positively associated with radiation dose in post-RT parotid glands. K el and slope were negatively associated with PSV, while time-to-peak was positively associated with PSV significantly. Conclusions: Our results suggest that time-shifted Brix model is feasible for quantifying parotid perfusion using DCE-MRI. The perfusion alterations in early-to-intermediate stage after IMRT might be related to a mixed effect of increased vascular permeability and acinar loss with dose and PSV dependencies. [ABSTRACT FROM AUTHOR]

Objective: To discuss the clinical characteristics and patterns of failure in the parotid region after inten-sity-modulated radiotherapy for nasopharygeal carcinoma. Materials and Methods: We retrospectively reviewed the charts of 716 patients with nasopharygeal car-cinoma who underwent intensity-modulated radiotherapy in our centre from January 2005 to December 2010. Disease recurred in a spared parotid gland in 10 patients (1.4%). There were 2 females and 8 males with a median age of 38.5 (34-53) years. The most common presenting symptom was a swelling in pre-auricular region (7/10). Parotid glands were spared bilaterally in these patients. None of these patients had undergone previous radiotherapy or surgical treatment of the head and neck. The location of peripar-otid failures were transferred to the pretreatment planning computed tomography for dosimetry analysis. Results: The median time from day 1 of radiotherapy to periparoid recurrence was 17.4 (4.4-40.5) months. The median survivial after periparoid recurrence was 25.1 (5.0-74.5) months. There were 9 (90%) patients with lateral retropharyngeal lymphadenopathy. Seven of the periparotid failures were marginal. Of the 7 marginal failures, 6 occurred at the ipslateral parotid of the primary tumor centre. The average mean dose of the ipslateral parotid was 38.1 (32.3-44.1 ) Gy. Conclusion: Periparotid recurrence is an uncommon pattern of failure after definitive intensity-modulated radiotherapy for nasopharygeal carcinoma. To reduce the risk of periparotid recurrence.one possible strat-egy is to lessen the dose constraint criteria to ipslateral parotid of the primary tumor centre especially for nasopharygeal carcinoma with lateral retropharyngeal lymphadenopathy. [ABSTRACT FROM AUTHOR]

Aim: In recent years, tularemia's importance has been reemerging in Turkey. However, the majority of tularemia cases were reported in the northern cities of Turkey. In this study, we report 16 oropharyngeal tularemia patients living in rural areas of the city of Konya, which is located in the southern zone of the Central Anatolia Region of Turkey. Materials and methods: Sixteen patients (12 males, 4 females; mean age: 33.7 years, range: 10-73 years) were included in this study. All patients were admitted to our clinic for the evaluation of intractable cervical mass lesions. The diagnosis of tularemia was made after exclusion of other possible causes of the neck masses and the presence of a positive tularemia agglutination test. Each patient was treated with streptomycin and doxycycline for at least 3 weeks. Results: All patients suffered oropharyngeal stiffness. There were neck mass and tonsillitis on the same side in 2 patients, neck mass and acute pharyngitis in 3 patients, and only swelling in the neck region in 11 patients. One of the patients with tonsillitis had common maculopapular skin rashes with fever. Thirteen patients had mass at level 2 zones, 11 patients had mass on the right side of the neck, and 5 patients had mass on the left side of the neck. The right parotid gland was involved in 1 patient. Nine patients were successfully treated with only antimicrobial agents. Lymph node excision was performed in 6 patients, and parotidectomy was performed in 1 patient. Conclusion: This is the second series of tularemia from the city of Konya in Turkey. Tularemia should be considered in the differential diagnosis of patients with intractable neck mass, because early diagnosis and treatment may prevent surgical interventions. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To describe the dose–response relationships for the different measures of salivary gland recovery following radical radiotherapy for locally advanced head and neck squamous cell cancers (LA-HNSCC). Methods and materials: Dosimetric analysis of data from the PARSPORT trial, a Phase III study of conventional RT (RT) and intensity modulated radiotherapy (IMRT) for LA-HNSCC was undertaken to determine the relationship between parotid gland mean dose and toxicity endpoints: high-grade subjective and objective xerostomia and xerostomia-related quality of life scores. LKB-NTCP parameters (TD50, m and n) were generated and tolerance doses (D50) reported using non-linear logistic regression analysis. Results: Data were available on 63 patients from the PARSPORT trial. Parotid saliva flow rate provided the strongest association between mean dose and recovery, D50=23.4Gy (20.6–26.2) and k =3.2 (1.9–4.5), R 2 =0.85. Corresponding LKB parameters were TD50=26.3Gy (95% CI: 24.0–30.1), m =0.25 (0.18–1.0 and n =1). LENTSOMA subjective xerostomia also demonstrated a strong association D50=33.3Gy (26.7–39.8), k =2.8 (91.4–4.4), R 2 =0.77). Conclusion: We recommend using the LENT SOMA subjective xerostomia score to predict recovery of salivation due to its strong association with dosimetry and ease of recording. [Copyright &y& Elsevier]

Abstract: Purpose: To determine whether concomitant chemotherapy increases the incidence of high grade xerostomia following parotid-sparing intensity-modulated radiotherapy (IMRT) in patients with locally advanced head and neck squamous cell cancer. Materials and methods: The incidence of high grade (⩾G2) acute (CTCAEv3.0) and late (LENTSOMA and RTOG) xerostomia was compared between patients treated with either IMRT or concomitant chemo-IMRT (c-IMRT) in 2 prospective studies. Parotid gland mean tolerance doses (D 50) were reported using non-linear logistic regression analysis. Results: Thirty-six patients received IMRT alone and 60 patients received c-IMRT. Patients received 65Gy in 30 daily fractions to the primary site and involved nodal groups and 54Gy in 30 fractions to elective nodal groups, mean doses to the parotid glands were comparable. Concomitant cisplatin 100mg/m2 was administered on days 1 and 29 of IMRT. The incidence of ⩾G2 subjective xerostomia was similar in both groups; acute-64.7% (IMRT) versus 60.3% (c-IMRT), p =0.83; late-43% (IMRT) versus 34% (c-IMRT), p =0.51. Recovery of parotid salivary flow at 1year was higher with IMRT (64% vs 50%), but not statistically significant (p =0.15). D 50 for absence of parotid saliva flow at 1year was 23.2Gy (95% CI: 17.7–28.7) for IMRT and 21.1Gy (11.8–30.3) for c-IMRT. Conclusion: Concomitant c-IMRT does not increase the incidence of acute or late xerostomia relative to IMRT alone. [Copyright &y& Elsevier]

Objective. The relationship of cryoglobulinaemia with lymphoproliferation of mucosa-associated lymphoid tissue (MALT) as risk factors for lymphoma evolution in SS remains to be clarified. The different biologic background of SS-related cryoglobulinaemia as compared with cryoglobulinaemia linked to HCV infection was clarified by different clinical and biologic approaches.Methods. B-cell clonal expansion was analysed in the bone marrow of 27 consecutive cases with primary SS and mixed cryoglobulinaemia, HCV unrelated, in comparison with 55 HCV-related patients with cryoglobulinaemic vasculitis (CV) without SS. The results were related to the possible occurrence and localization of B-cell lymphoma in the single case. Secondly, the prevalence of mixed cryoglobulinaemia was investigated in 41 unselected patients with primary SS showing either parotid myoepithelial sialadenitis (MESA) or a frank B-cell non-Hodgkin's lymphoma. Thirdly, the levels of serum cryoglobulins and RF were followed in one patient with primary SS, CV and parotid B-cell lymphoma of MALT after bilateral subtotal parotidectomy.Results. A polyclonal pattern of B expansion in the bone marrow was significantly more frequent in SS-related (19/27 cases) than in HCV-related cryoglobulinaemia (19/55) (P = 0.003). Cryoglobulins were positive in a fraction of patients with SS and malignant lymphoma or with parotid MESA (13/18 and 7/23, respectively), whereas MALT involvement by the lymphoproliferative disorder was the rule. Finally, the levels of serum cryoglobulins and RF markedly decreased in the SS patient undergoing bilateral subtotal parotidectomy.Conclusion. Lymphoproliferation of MALT appears as the biologic background of cryoglobulinaemia in SS, differently from HCV-related cryoglobulinaemia. [ABSTRACT FROM PUBLISHER]

Objective:The chorda tympani is at risk of iatrogenic injury throughout its course. This paper reviews the clinical anatomy of the nerve in adults.Design:Systematic literature review.Method:Relevant English-language articles were identified using five electronic databases and one search engine. Data from approximately 70 scientific papers were supplemented with information from selected reference texts.Results:The anatomy of the chorda tympani differs from standard descriptions, particularly regarding its exit from the middle ear and area of lingual innervation. Whilst it is known to convey taste sensation from the anterior two-thirds of the tongue and parasympathetic innervation to the submandibular and sublingual salivary glands, the chorda tympani probably has additional sensory and secretomotor functions.Conclusion:A detailed understanding of the anatomy of the chorda tympani may help to reduce the risk of iatrogenic injury during head, neck and middle-ear surgery, and to explain the variable consequences of such injury. [ABSTRACT FROM PUBLISHER]

Background. Advances in salivary gland tissue engineering can benefit patients diagnosed with xerostomia. Complexity of the gland explains the urgent demand for a reliable protocol to isolate and expand various gland cells that can be used for further study. Methods. Three cells with different morphologies were isolated from the same human parotid glands using different culture medium systems and then were identified by the expressions from mRNA to the protein level. Results. Among the 34 specimens, parotid gland acinar cells, myoepithelial cells, and fibroblasts expressing specific markers that belonged to individual cell types, were successfully isolated and expanded from 30 specimens without a complex mechanical process and expensive flow technique. Conclusion. The proposed protocol is simple with a high success rate to culture various gland cells, making it highly promising for use in future tissue engineering studies. [ABSTRACT FROM AUTHOR]

Development of facial nerve palsy (FNP) may lead to dramatic change in the patient's facial function, expression, and emotions. The ophthalmologist may play an important role in the initial evaluation, and the long-term management of patients with new-onset of FNP. In patients with expected temporary facial weakness, no efforts should be wasted to ensure proper corneal protection. Patients with permanent functional deficit may require combination of surgical procedures tailored to the patient's clinical findings that may require good eye comfort and cosmesis. [ABSTRACT FROM AUTHOR]

Objectives: We performed a retrospective analysis to contribute to the increasing number of reports on sialendoscopy in the literature and give basic concepts for beginners at the same lime. Methods: Between 2004 and 2009, 83 patients with symptoms of ductal obstruction of the major salivary glands were admitted to our clinic. Diagnostic and/or interventional sialendoscopy was applied to 60 glands (33 submandibular and 27 parotid) of 54 patients. A holmium:yttrium-aluminum-garnet laser or a pneumatic lithotripter was used for intraductal stone fragmentation. Results: Sialendoscopy revealed no disorder in 2 cases, and in 38 glands (28 submandibular and 10 parotid) sialolithiasis was the underlying disease. Fifteen glands (5 submandibular and 10 parotid) were found to have other main disorders such as stenosis, synechia or kink formation. Other findings included sialodochitis in 6 glands (2 submandibular and 4 parotid), a polyp in 1 parotid gland, mucus plugs in 21 glands (6 submandibular and 15 parotid), ductal ectasia in 4 glands (2 submandibular and 2 parotid), and ductal collapse in 1 parotid gland. The overall interventional success rate was 83% of all cases, and no complications occurred. Conclusions: The success rate of the interventional sialendoscopy performed in the current study shows consistency with the results given in the related medical literature. In the age of sialendoscopy, the adjunctive intraoral surgeries can be argued to be safer, easier, and more successful than before. Sialendoscopy may be considered to be the best practice not only in sialolithiasis but also in other treatments of obstructive ductal disorders. [ABSTRACT FROM AUTHOR]

Individuals receiving clozapine treatment for schizophrenia complain of drooling. Reports on salivary flow measurements are contradictory in humans and lacking in animals. Clozapine has affinity for several different receptor types and may, hypothetically, both stimulate and inhibit salivary secretion. In rats, intravenous clozapine evoked a long-lasting secretion, being more prominent from submandibular than from parotid glands. Chronic denervation enhanced the responses. Clozapine acted on muscarinic (M1-) receptors of acinar cells, independent of central nervous mechanisms, pre-synaptic intraglandular events, or circulating catecholamines. A fraction of the methacholine- and parasympathetic-nerve-evoked secretion was abolished by clozapine at doses below those evoking secretion. Sympathetic-nerve-evoked secretion was partially reduced by clozapine, due to antagonistic action on α-adrenoceptors; the β-adrenoceptor-mediated response persisted. Subsecretory doses of clozapine enhanced secretion induced by the β-adrenoceptor agonist isoprenaline. The overall actions of clozapine suggest that, in clozapine-treated humans, salivation is increased during sleep and at rest, but is decreased during meals. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the parotid function after parotid-sparing intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). Methods and Materials: From March 2003 to May 2004, 16 patients with nonmetastatic NPC underwent parotid-sparing IMRT. Eight of these patients had Stage III or IV NPC based on the 1997 American Joint Committee on Cancer staging system. The post-IMRT parotid function was evaluated by quantitative salivary scintigraphy and represented by the maximal excretion ratio (MER) of the parotid gland after sialogogue stimulation. The parotid function of 16 NPC patients who were previously treated with conventional radiotherapy was reviewed as the historical control. Results: In the parotid-sparing IMRT group, all 16 patients were alive and without cancer at the end of follow-up period (median, 24.2 months). The mean parotid MER was 53.5% before radiotherapy, 10.7% at 1 month post-IMRT, and 23.3% at 9 months post-IMRT. In the conventional radiotherapy group, the mean parotid MER was 0.6% at 6 to 12 months postradiotherapy. The difference was statistically significant (23.3% vs. 0.6%, p<0.001, Mann-Whitney test). In the IMRT group, the mean parotid doses ranged from 33.2 Gy to 58.8 Gy (average, 43.9 Gy). The correlation between the mean parotid dose and the percentage decrease of parotid MER at 9 months post-IMRT (dMER) was statically significant (p=0.008, Pearson correlation). Conclusions: Although the mean parotid doses are relatively high, the significant preservation of parotid function is achieved with IMRT for NPC patients. The significant correlation between mean parotid dose and parotid dMER demonstrates the dose-function relationship of the parotid gland. [ABSTRACT FROM AUTHOR]