Salivary Gland Pathology

Salivary Gland Pathology
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Salivary Gland Pathology: Diagnosis and Management, Third Edition  is an authoritative reference to this important discipline in medicine, dentistry, and surgery. Covering the etiology, diagnosis, and treatment of a broad range of pathologies, this comprehensive textbook provides insight into every facet of diagnosis and treatment for all salivary gland pathologies, and offers a wealth of high-quality clinical images, detailed surgical illustrations, and video clips of actual surgeries via a companion website.  The fully revised third edition contains new chapters on complications in salivary gland surgery and minimally invasive salivary gland pathology, and includes approximately 100 new clinical images and numerous surgical line drawings.  Salivary Gland Pathology  now features case presentations to place the information in context, as well as additional treatment algorithms in each chapter to assist in clinical decision making. Written by highly respected clinicians, educators, and researchers with extensive expertise in oral and maxillofacial surgery, this authoritative resource:  Reviews the etiology, diagnosis, and treatment of all salivary gland pathologies, with detailed explanations and hundreds of full-color clinical images Incorporates new information on the taxonomy of salivary gland tumors, neoplastic and non-neoplastic entities, image guided biopsies of salivary gland lesions, and complications in traditional and non-traditional forms of salivary gland surgery Offers expanded coverage of histopathology, including classification, grading, and staging of salivary gland tumors Features up-to-date chapters on anatomy and physiology, imaging, cysts, systemic diseases, tumors, trauma, and innovative salivary gland surgical techniques Includes a discussion of meta-analyses and systematic reviews to support evidence-based practice    Salivary Gland Pathology: Diagnosis and Management, Third Edition  remains the definitive resource for oral and maxillofacial surgeons, otolaryngologists, head and neck surgeons, and general surgeons as well as their residents providing care for patients with salivary gland pathology.

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Группа авторов. Salivary Gland Pathology

Table of Contents

List of Tables

List of Illustrations

Guide

Pages

SALIVARY GLAND PATHOLOGY. DIAGNOSIS AND MANAGEMENT

Contributors

Foreword First Edition

Foreword Second Edition

Foreword Third Edition

Preface First Edition

Preface Second Edition

Preface Third Edition

Acknowledgments

About the Companion Website

Chapter 1 Surgical Anatomy, Embryology, and Physiology of the Salivary Glands

Outline

Introduction

Parotid Gland. EMBRYOLOGY

ANATOMY

CONTENTS OF THE PAROTID GLAND. Facial Nerve

Auriculotemporal Nerve

Retromandibular Vein

External Carotid Artery

Parotid Lymph Nodes

Parotid Duct

Nerve Supply to the Parotid

Submandibular Gland. EMBRYOLOGY

ANATOMY

Superficial Lobe

Deep Lobe

Submandibular Duct

Blood Supply and Lymphatic Drainage

Nerve Supply to the Submandibular Gland. Parasympathetic innervation

Sympathetic innervation

Sensory innervation

Sublingual Gland. EMBRYOLOGY

ANATOMY

Sublingual Ducts

Blood Supply, Innervation, and Lymphatic Drainage

Minor Salivary Glands

Tubarial Salivary Glands

Histology of the Salivary Glands

Control of Salivation

Summary

Case Presentation – Wait, What?

Past Medical History

Imaging

Diagnosis

TAKE HOME POINTS

References

Chapter 2 Diagnostic Imaging of Salivary Gland Pathology

Outline

Introduction

Imaging Modalities. COMPUTED TOMOGRAPHY (CT)

CT Technique

Advanced computed tomography

MAGNETIC RESONANCE IMAGING (MRI)

MRI Technique

Spin‐echo T1

Spin‐echo T2

Proton density images (PD)

Gradient recalled echo imaging (GRE)

Short tau inversion recovery (STIR)

Gadolinium (Gd) contrast

Fluid attenuation inversion recovery (FLAIR)

Diffusion weighted images (DWI)

MR spectroscopy

Dynamic contrast‐enhanced magnetic resonance imaging

Other magnetic resonance imaging techniques

ULTRASONOGRAPHY (US)

Ultrasound (US) Technique

SIALOGRAPHY

IMAGE‐GUIDED BIOPSIES OF SALIVARY GLAND PATHOLOGY

RADIONUCLIDE IMAGING (RNI)

POSITRON EMISSION TOMOGRAPHY (PET)

POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY (PET/CT)

Diagnostic Imaging Anatomy. PAROTID GLAND

SUBMANDIBULAR GLAND

SUBLINGUAL GLAND

MINOR SALIVARY GLANDS

Pathology of the Salivary Glands

VASCULAR LESIONS. Lymphangioma (Cystic Hygroma)

Hemangioma

ACUTE SIALADENITIS

CHRONIC SIALADENITIS

HIV‐ASSOCIATED LYMPHOEPITHELIAL LESIONS

MUCOUS ESCAPE PHENOMENA

SIALADENOSIS (SIALOSIS)

SIALOLITHIASIS

SJÖGREN SYNDROME

SARCOIDOSIS

CONGENITAL ANOMALIES OF THE SALIVARY GLANDS. First Branchial Cleft Cyst

NEOPLASMS – SALIVARY, EPITHELIAL. Benign. Pleomorphic adenoma

Warthin tumor

Oncocytoma

Malignant Tumors. Mucoepidermoid carcinoma

Adenoid cystic carcinoma

NEOPLASMS – NON‐SALIVARY. Benign. Lipoma

Neurogenic tumors

Malignant. Lymphoma

Metastases

Summary

Case Presentation – Duplicity

Past Medical History

Social History

Examination

Imaging

Diagnosis

TAKE‐HOME POINTS

References

Chapter 3 Infections of the Salivary Glands. Outline

Introduction

General Considerations

Bacterial Salivary Gland Infections. ACUTE BACTERIAL PAROTITIS

Variants of ABP and Their Etiology

Diagnosis of Acute Bacterial Parotitis

Treatment of Acute Bacterial Parotitis

CHRONIC (RECURRENT OR REFRACTORY) BACTERIAL PAROTITIS

Treatment of Chronic Bacterial Parotitis

CHRONIC RECURRENT JUVENILE PAROTITIS

Treatment of Chronic Recurrent Juvenile Parotitis

ACUTE BACTERIAL SUBMANDIBULAR SIALADENITIS

Treatment of Acute Bacterial Submandibular Sialadenitis

CHRONIC RECURRENT SUBMANDIBULAR SIALADENITIS

BARTONELLA HENSELAE (CAT‐SCRATCH DISEASE)

TUBERCULOUS MYCOBACTERIAL DISEASE

NONTUBERCULOUS MYCOBACTERIAL DISEASE

Viral Salivary Gland Infections. MUMPS

HUMAN IMMUNODEFICIENCY VIRUS

INFLUENZA A

Bacterial Sialadenitis in Pregnancy

Autoimmune Sialadenitis and IgG4‐Related Disease

Summary

Case Presentation – Gadzooks

Past Medical History

Physical Examination

Imaging

Diagnosis

TAKE‐HOME POINTS

References

Chapter 4 Cysts and Cyst‐Like Lesions of the Salivary Glands. Outline

Introduction

Mucous Escape Reaction

CLINICAL FEATURES AND TREATMENT OF THE MUCUS ESCAPE REACTION

Mucocele

Ranula and Plunging Ranula

Submandibular Gland Mucocele

Cyst of Blandin and Nuhn's Gland

Mucous Retention Cyst

Parotid Cysts Associated with Human Immunodeficiency Virus Infection

Branchial Cleft Cysts

Parotid Neoplasms Masquerading as Cysts

Summary

Case Presentation ‐ Down Yonder

Past Medical History

Imaging

Surgical Procedure

TAKE‐HOME POINTS

References

Chapter 5 Sialolithiasis. Outline

Introduction

Pathophysiology of Sialolithiasis

Clinical Features of Sialolithiasis

MULTIPLE SIALOLITHS

BILATERAL SIALOLITHS

Differential Diagnosis and Diagnosis of Sialolithiasis

Treatment of Sialolithiasis

SUBMANDIBULAR SIALOLITHIASIS

PAROTID SIALOLITHIASIS

TREATMENT OF MULTIPLE SIALOLITHS AND BILATERAL (MULTIPLE GLAND) SIALOLITHS

Sialolithiasis of the Sublingual Gland and Minor Salivary Glands

The Relationship of Salivary Lithiasis to Nephrolithiasis, Cholelithiasis, Primary Hyperparathyroidism, and Gout

Summary

Case Presentation – Stoneorama

Past Medical History

Imaging

Diagnosis

Surgical Intervention

TAKE‐HOME POINTS

References

Chapter 6 Systemic Diseases Affecting the Salivary Glands. Outline

Introduction

Sjögren Syndrome

PATHOPHYSIOLOGY OF SJÖGREN SYNDROME

CLINICAL MANIFESTATIONS OF SJÖGREN SYNDROME

LYMPHOMA AND SJÖGREN SYNDROME

MIKULICZ DISEASE AND THE BENIGN LYMPHOEPITHELIAL LESION

DIAGNOSIS OF SJÖGREN SYNDROME WITH SALIVARY GLAND BIOPSY

Histopathology of Sjögren Syndrome

Sarcoidosis

PATHOPHYSIOLOGY OF SARCOIDOSIS

CLINICAL MANIFESTATIONS OF SARCOIDOSIS

DIAGNOSIS OF SARCOIDOSIS WITH SALIVARY GLAND BIOPSY

Histopathology of Sarcoidosis

Sialosis

CLINICAL MANIFESTATIONS OF SIALOSIS

DIAGNOSIS OF SIALOSIS WITH SALIVARY GLAND BIOPSY

Histopathology of Sialosis

IgG4‐Related Disease

Summary

Case Presentation – Esoterica

Past Medical History

Imaging

Cytology

Surgical Intervention

Diagnosis

TAKE‐HOME POINTS

References

Chapter 7 Salivary Gland Pathology in Children and Adolescents. Outline

Introduction

Nonneoplastic Salivary Gland Lesions

MUCOUS ESCAPE REACTION

BACTERIAL SIALADENITIS

Acute Submandibular Sialadenitis

Acute Suppurative Parotitis

Chronic Juvenile Recurrent Parotitis

Neoplastic Salivary Gland Disease

EPITHELIAL TUMORS

MESENCHYMAL TUMORS

Vascular Tumors

Lymphatic Malformations

Neural Tumors

PAROTID TUMORS

SUBMANDIBULAR GLAND TUMORS

MINOR SALIVARY GLAND TUMORS

Summary

Case Presentation – Size Matters

Past Medical History

Social History

Examination

Diagnosis

Imaging

Surgical Intervention

TAKE HOME POINTS

References

Chapter 8 Classification, Grading, and Staging of Salivary Gland Tumors

Outline

Introduction

Classification Systems for Salivary Gland Neoplasms

CELLULAR CLASSIFICATION OF SALIVARY GLAND NEOPLASMS

Benign Epithelial Salivary Gland Neoplasms. Pleomorphic Adenoma (Benign Mixed Tumor)

Warthin Tumor (Papillary Cystadenoma Lymphomatosum)

Basal Cell Adenoma

Canalicular Adenoma

Oncocytoma

Sebaceous Adenoma

Sebaceous Lymphadenoma

Myoepithelioma

Cystadenoma

Ductal Papilloma

Sialadenoma Papilliferum

Sclerosing Polycystic Adenoma

Malignant Epithelial Neoplasms. Mucoepidermoid Carcinoma

Adenoid Cystic Carcinoma

Acinic Cell Carcinoma

Polymorphous Adenocarcinoma

Adenocarcinoma, NOS (Otherwise Specified)

Basal Cell Adenocarcinoma

Clear Cell Carcinoma

Hyalinizing Clear Cell Carcinoma

Cystadenocarcinoma

Sebaceous Adenocarcinoma

Sebaceous Lymphadenocarcinoma

Oncocytic Carcinoma

Salivary Duct Carcinoma

Malignant Mixed Tumors

Carcinoma Ex‐Pleomorphic Adenoma

Salivary Carcinosarcoma

Metastasizing Mixed Tumor

Sialoblastoma

Primary Squamous Cell Carcinoma

Epithelial‐Myoepithelial Carcinoma

Poorly Differentiated Carcinomas

Undifferentiated Carcinoma

Small Cell Neuroendocrine Carcinoma

Large Cell Neuroendocrine Carcinoma

Lymphoepithelial Carcinoma

Myoepithelial Carcinoma

Adenosquamous Carcinoma

Secretory Carcinoma

Non‐Epithelial Neoplasms. Lymphomas and Benign Lymphoepithelial Lesion

Mesenchymal Neoplasms

Benign Mesenchymal Salivary Gland Tumors

Malignant Mesenchymal Salivary Gland Tumors

Malignant Secondary Neoplasms

Grading and Staging of Salivary Gland Tumors. MOLECULAR SYSTEMATICS OF SALIVARY GLAND NEOPLASMS

TNM and Staging of Salivary Gland Tumors

EXTRAPARENCHYMAL EXTENSION

TNM DESCRIPTORS

ADDITIONAL DESCRIPTORS

Summary

Case Presentation – Reclassified

TAKE‐HOME POINTS

References

Chapter 9 The Molecular Biology of Benign and Malignant Salivary Gland Tumors

Outline

Introduction: The Puzzle and the Promise

Salivary Gland Tumor Cell Biology

Molecular Biology of Salivary Gland Neoplasms

PROTEIN DYSREGULATION AND SALIVARY GLAND NEOPLASM PHENOTYPES

Enhanced Proliferation

Evasion of Apoptosis

Immortalization

Neovascularization

Invasion and Metastasis

NUCLEIC ACID DYSREGULATION IN SALIVARY GLAND NEOPLASMS

Genetic Alterations in Salivary Gland Tumors

Epigenetic Alteration of Gene Expression in Salivary Gland Tumors

Summary and Clinical Applications

DIAGNOSTIC APPLICATIONS

THERAPEUTIC APPLICATIONS

Summary

References

Chapter 10 Tumors of the Parotid Gland. Outline

Introduction

Etiology and Epidemiology

Diagnosis

Surgical Management

BENIGN TUMORS. Pleomorphic Adenoma (PA)

WARTHIN TUMOR

MALIGNANT TUMORS. Principles of Management of Parotid Carcinoma

Summary

Case Presentation – How Did This All Start?

Past Medical History

Social History

Examination

Diagnosis

TAKE‐HOME POINTS

References

Chapter 11 Tumors of the Submandibular and Sublingual Glands. Outline

Introduction

Epidemiology and Etiology

Diagnosis. SUBMANDIBULAR GLAND TUMORS

SUBLINGUAL GLAND TUMORS

Management. SUBMANDIBULAR GLAND TUMORS

SUBLINGUAL GLAND TUMORS

Summary

Case Presentation – But I Took the Road Less Traveled

Past Medical History

Social History

Examination

Diagnosis

TAKE‐HOME POINTS

References

Chapter 12 Tumors of the Minor Salivary Glands. Outline

Introduction

Etiology of Minor Salivary Gland Tumors

Diagnosis of Minor Salivary Gland Tumors

Treatment of Minor Salivary Gland Tumors. GENERAL PRINCIPLES OF SURGERY FOR MINOR SALIVARY GLAND TUMORS

SURGICAL TREATMENT OF BENIGN MINOR SALIVARY GLAND TUMORS

Pleomorphic Adenoma

Canalicular Adenoma

SURGICAL TREATMENT OF MALIGNANT MINOR SALIVARY GLAND TUMORS

Mucoepidermoid Carcinoma

Central Mucoepidermoid Carcinoma

Adenoid Cystic Carcinoma

Polymorphous Adenocarcinoma

Acinic Cell Carcinoma

Epithelial‐Myoepithelial Carcinoma

Secretory Carcinoma

SURGICAL MANAGEMENT OF THE NECK FOR MINOR SALIVARY GLAND MALIGNANCIES

THE ROLE OF RADIATION THERAPY IN THE MANAGEMENT OF MINOR SALIVARY GLAND MALIGNANCIES

THE ROLE OF CHEMOTHERAPY IN THE MANAGEMENT OF MINOR SALIVARY GLAND MALIGNANCIES

Summary

Case Presentation – Two Peas in a Pod

Past Medical History

Imaging

Surgical Intervention

TAKE‐HOME POINTS

References

Chapter 13 Radiation Therapy for Salivary Gland Malignancies

Outline

Introduction

Low‐Risk Salivary Gland Malignancies

Moderate‐Risk Salivary Gland Malignancies

High‐Risk Salivary Gland Malignancies

Evolution of Radiation Techniques in Salivary Gland Malignancies

Complications of Radiation Therapy in Salivary Gland Malignancies. XEROSTOMIA

OSTEORADIONECROSIS

DYSPHAGIA

Radiation Technique for Low‐ and Moderate‐Risk Salivary Gland Tumors

Radiation Technique for High‐Risk Salivary Gland Tumors

ADENOID CYSTIC CARCINOMA

Advanced Radiation Therapy Techniques. PROTON THERAPY

NEUTRON THERAPY

CARBON ION THERAPY

Summary

References

Chapter 14 Systemic Therapy for Salivary Gland Cancer

Outline

Introduction

Epidemiology and Risk Factors

Molecular Biology of Salivary Gland Tumors

Clinical Presentation

Treatment

ADJUVANT TREATMENT

TREATMENT OF METASTATIC DISEASE

TARGETED THERAPY

Targeting C‐KIT

EGFR Inhibition

Her2 Inhibition

Multi Kinase Inhibition

Proteasome Inhibition

Androgen Receptor Inhibition

NTRK Inhibition

Immune Checkpoint Inhibition

Summary

Case Presentation – Well, If It Works for Breast Cancer!!

Past Medical History

Social History

Examination

Diagnosis

TAKE‐HOME POINTS

References

Chapter 15 Non‐salivary Tumors of the Salivary Glands. Outline

Introduction

Mesenchymal Tumors. BENIGN MESENCHYMAL TUMORS. Hemangiomas

Lymphangiomas

Neural Tumors

Lipomas

MALIGNANT MESENCHYMAL TUMORS. Sarcomas

Epithelial Non‐salivary Tumors. DIRECT INVOLVEMENT BY SKIN CANCERS

Tumors of Salivary Gland Lymph Nodes. PRIMARY LYMPH NODE TUMORS. Lymphomas

SECONDARY LYMPH NODE TUMORS. Mucosal Primary Cancer of the Head and Neck Metastasizing to Salivary Glands

Cutaneous Cancer Metastasizing to Parotid Nodes

Distant Metastases to Salivary Glands

Miscellaneous

Summary

Case Presentation – From One Salivary Gland to Another

PAST MEDICAL HISTORY

SOCIAL HISTORY

EXAMINATION

DIAGNOSIS

TAKE HOME POINTS

References

Chapter 16 Trauma and Injuries to the Salivary Glands. Outline

Introduction

Penetrating Injuries. TRAUMA TO THE GLAND. Salivary Fistula

Sialocele

Facial Nerve Injuries. Facial nerve injury in primary trauma

Facial nerve injury in elective surgery

Frey Syndrome

Hollowing

TRAUMA TO SALIVARY GLAND DUCTS. Transection of the Salivary Duct

Stricture of the Salivary Duct

Radiation Injury. EXTERNAL BEAM

RADIOACTIVE IODINE

PSMA Radioligand Therapy

Barotrauma

Summary (Figures 16.22 and 16.23)

References

Chapter 17 Miscellaneous Pathologic Processes of the Salivary Glands. Outline

Introduction

Hereditary and Congenital Conditions. APLASIA

DUCT ATRESIA

ABERRANT GLANDS

POLYCYSTIC DISEASE OF THE SALIVARY GLANDS

FIRST BRANCHIAL CLEFT CYSTS, FISTULAE, AND SINUSES

CYSTIC FIBROSIS

Saliva. SALIVA AS A DIAGNOSTIC FLUID

DROOLING

SALIVA IN THE MANAGEMENT OF XEROPHTHALMIA

Ischemic/Degenerative Changes. NECROTIZING SIALOMETAPLASIA

AGE CHANGES IN SALIVARY GLANDS

Küttner Tumor

Salivary Gland Biopsy for Systemic Disease

AMYLOID AND THE SALIVARY GLANDS

Hereditary Amyloidosis

AL Amyloidosis (Primary Amyloidosis)

AA Amyloidosis (Secondary Amyloidosis)

PARKINSON DISEASE

Summary

Case Presentation – The Great Pretender

Past Medical History

Social History

Examination

Diagnosis

TAKE‐HOME POINTS

References

Chapter 18 Complications of Salivary Gland Surgery

Outline

Introduction

General Considerations

Complications of Parotid Gland Surgery. FACIAL NERVE PARALYSIS

Relationship of the Facial Nerve to the Parotid Gland

Approaches to the Parotid Gland

Blair incision

Retromandibular incision

Assessment of Facial Nerve Weakness

THE AURICULOTEMPORAL NERVE AND FREY SYNDROME

Diagnosis of Frey Syndrome

Management of Frey Syndrome

Surgical Prevention of Frey Syndrome and Facial Defects

Temporoparietal fascia flap

Sternocleidomastoid muscle flap

Superficial musculoaponeurotic system flap

Acellular dermal matrix

Fat grafting

PAROTID GLAND SALIVARY LEAKAGE

Classification of Parotid Gland Salivary Leakage

Management of Parotid Salivary Leakage

Conservative management of parotid gland salivary leakage

Botulinum toxin for the management of parotid gland salivary leakage

Scopolamine patch

Sclerosing agents

Surgical repair of parotid gland salivary leakage

Tympanic neurectomy

Radiotherapy

Temporalis fascia and cyanoacrylate

Postoperative Infections

Parotid Duct Leakage

MANAGEMENT OF PAROTID DUCT INJURIES

Endoscopic Management of Parotid Salivary Duct Injuries

Surgical management of a parotid megaduct

Avulsion of the Parotid Duct

Stenosis of the Parotid Duct Orifice

Complications of Submandibular and Sublingual Gland Surgery

COMPLICATIONS ASSOCIATED WITH AN INTRAORAL APPROACH TO THE SUBLINGUAL AND SUBMANDIBULAR GLANDS

Ranulas (Mucous Extravasation Phenomenon)

Complications associated with the management of ranulas

Recurrence of ranulas

Lingual nerve injury during sublingual gland removal

Submandibular duct injury during sublingual gland removal

Complications Associated with Intraoral Surgery of Submandibular Ducts

Stricture of the submandibular gland duct

Lingual nerve injuries

Extravasation of fluid and airway obstruction

Ranula formation

Submandibular duct avulsion

COMPLICATIONS ASSOCIATED WITH TRANSCERVICAL APPROACHES TO THE SUBMANDIBULAR GLAND

Marginal Mandibular Branch Injury During a Sialadenectomy

Lingual Nerve Injury during a Sialadenectomy

Hypoglossal Nerve Injury during a Sialadenectomy

Hematoma Formation

Hyposalivation

Complications Associated with Removal of Minor Salivary Gland Mucocele

COMPLICATIONS ASSOCIATED WITH REMOVAL OF MUCOCELE OF THE LOWER LIP

Mucocele Recurrence

Neurosensory Change

Esthetic Defects of the Lip

Summary

Case Presentation – Get It Right the First Time. That's the Main Thing

TAKE HOME POINTS

References

Chapter 19 Innovations in Salivary Gland Surgery

Outline

Minimally Invasive Parotid Gland Surgery. HISTORY OF PAROTID SURGERY

MINIMALLY INVASIVE SURGICAL APPROACHES TO THE PAROTID GLAND

Partial Superficial Parotidectomy

Extracapsular Dissection with Extended Option

ECD Performed for Malignant Parotid Tumors

Extended ECD

Minimally Invasive Sublingual Gland Surgery

SUBLINGUAL GLAND ANATOMY

DIAGNOSIS OF MUCOCELE, RANULA, AND PLUNGING RANULA

TREATMENT OF MUCOCELE, RANULA, AND PLUNGING RANULA. Mucocele

Simple Ranula in Floor of Mouth

Plunging Ranula

Minimally Invasive Salivary Gland Surgery with Sialendoscopy

IMAGING MODALITIES IN THE MANAGEMENT OF SIALOLITHIASIS. Ultrasound

Sialography

Other Imaging Modalities

SIALENDOSCOPY

Basket Retrieval of Stones

Fragmentation of Stones

Microforceps

Laser Lithotripsy

Intracorporeal Shock Wave Lithotripsy

Extracorporeal Shock Wave Lithotripsy

Intraoral Stone Release of Submandibular Gland Hilar Stones

Combined Open and Endoscopic Removal of Parotid Stones

ROBOTIC‐ASSISTED PROCEDURES

SALIVARY DUCT STRICTURES

Investigation of Salivary Duct Strictures

Classification of Salivary Duct Strictures

Treatment of Salivary Duct Strictures

Sialendoscopy‐Guided Duct Dilatation

Balloon Dilatation

Treatment Adjuncts

Treatment Outcomes of Salivary Duct Dilatation

Other Treatment Options for Stenoses

Summary

References

Index

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Third Edition

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The role of FDG PET or PET/CT and that of conventional CT and MRI on the diagnosis, staging, restaging, and follow‐up post‐therapy of salivary gland tumors has been studied (Keyes et al. 1994; Bui et al. 2003; Otsuka et al. 2005; Alexander de Ru et al. 2007; Roh et al. 2007). Although both CT and MRI are relatively equal in anatomic localization of disease and the effect of the tumors on local invasion and cervical nodal metastases, FDG PET/CT significantly improved sensitivity and specificity for salivary malignancies including nodal metastases (Otsuka et al. 2005; Uchida et al. 2005; Alexander de Ru et al. 2007; Jeong et al. 2007; Roh et al. 2007).

Early studies have demonstrated FDG PET's relative inability to distinguish benign from malignant salivary neoplasms (Keyes et al. 1994). The variable uptake of FDG by pleomorphic adenomas and the increased uptake and SUVs by Warthin tumors result in significant false positives (Jeong et al. 2007; Roh et al. 2007). In a similar manner, adenoid cystic carcinomas, which are relatively slower growing, may not accumulate significant concentrations of FDG and demonstrate low SUVs and therefore contribute to the false negatives (Jeong et al. 2007; Keyes et al. 1994). False negatives may also be caused by the relatively lower mean SUV of salivary tumors (SUV 3.8 ± 2.1) relative to squamous cell carcinoma (SUV 7.5 ± 3.4) (Roh et al. 2007). The low SUV of salivary neoplasms may also be obscured by the normal uptake of FDG by salivary glands (Roh et al. 2007). In general, FDG PET has demonstrated that lower grade malignancies tend to have lower SUV and vice versa for higher grade malignancies (Jeong et al. 2007; Roh et al. 2007). FDG PET has been shown to be more sensitive and specific compared to conventional CT or MRI (Otsuka et al. 2005; Cermik et al. 2007; Roh et al. 2007). Small tumor size can contribute to false negative results and inflammatory changes contribute to false positive results (Roh et al. 2007). The use of concurrent salivary scintigraphy with 99mTc‐pertechnetate imaging can improve the false positive rate by identifying Warthin's tumors and oncocytomas, which tend to accumulate pertechnetate (and retain it after induced salivary gland washout) and have increased uptake of FDG (Uchida et al. 2005).

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