Methods of Investigation

5 Methods of Investigation

Orlando Guntinas-Lichius

Introduction

Examining the Patient

Examining Saliva

Ultrasonography

Fine-Needle Aspiration Cytology (FNAC)

Sialendoscopy

Salivary Gland Biopsy

Magnetic Resonance Imaging and Computed Tomography

Classic Sialography and Magnetic Resonance Sialography

Salivary Gland Scintigraphy

Serologic Examinations

Key Points

Introduction

The salivary glands can be affected by either localized or systemic disease. The diseases involved are diverse, ranging from acute infection by a wide variety of pathogens—viruses, bacteria, fungi, protozoans, or secondary to salivary stones—to chronic inflammation, predominantly in Sjögren syndrome; and benign or malignant primary neoplastic diseases, as well as involvement in secondary malignant neoplastic diseases, lymphoma, and cutaneous and mucosal malignancies. The symptoms of these diseases are often nonspecific, and a wide range of investigative methods need to be employed to confirm the likely diagnosis (overview in Table 5.1). This chapter provides an outline of these investigative methods and proposes a rationale for using them, as well as discussing symptoms and the causative disease processes likely to be associated with them (Table 5.2).

Table 5.1 Most important investigations for examination and diagnostic work-up in patients with salivary gland symptoms

Basic examination

Clinical examination

Chapter 6

Basic examination

Ultrasonography

Chapters 6 and 7

Obstructive symptoms

Sialendoscopy

Chapter 9

Discrete “lump”

Fine-needle aspiration cytology

Chapter 8

Suspected malignancy

Magnetic resonance imaging, computed tomography

Chapter 7

Autoimmune disease

Saliva function tests

Chapter 3

Examining the Patient

Examination of the patient is the cornerstone on which any diagnostic work-up in salivary gland diseases is based and which directs any further investigations. The clinical examination of patients who present with diseases related to the salivary glands is described in Chapter 6. Despite modern technology, taking the patient’s history and carrying out a physical examination are still crucial steps that are required before subsequent investigations are decided on. The cardinal symptoms usually determine the next steps in the further work-up, hopefully leading to a diagnosis (Table 5.2).

Examining Saliva

Although saliva is the most important product of the salivary glands, a detailed examination of it is only indicated in a small minority of patients.1 The tests currently available are listed and discussed in Chapter 3. Saliva function tests play a role in patients with hyposalivation and xerostomia, to quantify the degree of saliva function. These are predominantly patients with Sjögren syndrome or patients who have been treated with chemotherapy and radiotherapy for head and neck cancer. Chapter 16 describes specific details involved in examining patients with Sjögren syndrome, and Chapter 42 discusses causes and findings in patients treated with chemotherapy and radiotherapy. Saliva flow has to be measured in patients with symptoms of drooling (or hypersalivation). This is important firstly in order to objectify the symptoms and secondly to allow the effects of treatment to be checked. The majority of patients with drooling are children, and details about these patients and saliva testing are given in Chapter 12.

Table 5.2 Symptom-oriented recommendations for the diagnostic work-up in patients with salivary gland diseases after the basic clinical examination

Cardinal symptom

Investigations

Related diseases

Acute and recurrent painful swelling

Ultrasonography

Acute viral sialadenitis

 

Serology

Acute bacterial sialadenitis

 

Sialendoscopy

Sialolithiasis

 

MRI or CT

Chronic sialadenitis

 

 

Recurrent juvenile and adult parotitis

 

 

Salivary gland abscess

Diffuse painless swelling

Ultrasonography

Chronic radiogenic sialadenitis

 

FNAC

Benign tumor

 

Biopsy

Malignant tumor

 

Chest radiography

Sialadenosis

 

Serology

Chronic epithelioid cell sialadenitis (sarcoidosis, Heerfordt syndrome)

Diffuse painful swelling

Ultrasonography

Malignant tumor

 

FNAC

Reactive and specific lymphadenitis

 

MRI or CT

 

Dry mouth

Ultrasonography

Autoimmune sialadenitis

 

Serology

Chronic sialadenitis

 

Saliva function test and lacrimation test

Pharmacological

 

MRI

Drug-related

 

Rheumatological examination

 

Drooling

Neurological examination

Dysphagia-related disease

 

Ultrasonography

Neurological/neurodegenerative disease

 

Saliva function test

Drug-related chronic sialadenitis

CT, computed tomography; FNAC, fine-needle aspiration cytology; MRI, magnetic resonance imaging.

images Functional testing of salivation is able to quantify hyposalivation and can be used to check the effects of treatment in such patients.

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Jul 24, 2016 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Methods of Investigation
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