Abstract
Background/objectives
The present controlled sialographical study was conducted to learn more from the horizontal and vertical symmetry of the ductal lesions of the major salivary glands in primary (pSS) and secondary (sSS) forms of the disease.
Materials and methods
A total of 98 patients (38 pSS patients, 38 sSS patients, 22 control subjects) were included in the study. Contrast radiography of both parotid and submandibular glands was performed within the same session. A 6-point scoring system allowed summary indexes for each of the glands to be calculated.
Results
Pansialography was accomplished within 30 min each. The sparsity of the branching pattern of the ducts was the most frequent pathological finding. In pSS, horizontal symmetry was more pronounced in the parotid glands, whereas in sSS it was more pronounced in the submandibular glands. The most discriminating features were the width of the peripheral ducts in the parotid and the number of acinar dilatations in the submandibular glands. The most advanced lesions were found in the left parotid gland.
Conclusion
The peripheral ducts are more affected by SS than the main excretory duct. There is a tendency for asymmetric involvement of the parotid glands in pSS and of the submandibular glands in sSS. Parotid glands are globally more involved than submandibular glands. Differential diagnosis between pSS and sSS cannot be accomplished by means of pansialography alone. Left parotid sialography is recommended for routine use.
Zusammenfassung
Ziel der Arbeit
Die kontrollierte sialographische Studie soll dazu beitragen, die Kenntnis der horizontalen und vertikalen Symmetrie der duktalen Läsionen der großen Speicheldrüsen bei der primären (pSS) und sekundären (sSS) Form des Sjögren-Syndroms (SS) zu vertiefen.
Material und Methoden
Insgesamt 98 Patienten (38 pSS- und 38 sSS-Patienten sowie 22 Patienten in der Kontrollgruppe) wurden in die Studie aufgenommen. Die Kontrastdarstellung der Ausführungsgänge beider Ohr- und Unterkieferspeicheldrüsen wurde jeweils in der gleichen Sitzung durchgeführt. Mithilfe eines 6-Punkte-Bewertungssystems wurden für jede Drüse Summenindizes ermittelt und diese anschließend miteinander verglichen.
Ergebnisse
Alle Pansialographien wurden innerhalb von maximal 30 min durchgeführt. Häufigster pathologischer Befund war die Rarefizierung des Verzweigungsmusters der Drüsenausführungsgänge. Horizontal symmetrische Läsionen fanden sich beim pSS vorwiegend in den Ohrspeicheldrüsen, beim sSS vorwiegend in den Unterkieferspeicheldrüsen. Die zur Differenzierung am besten geeigneten Merkmale waren die Weite der peripheren Gänge in den Ohrspeicheldrüsen und die Zahl der azinären Dilatationen in den Unterkieferspeicheldrüsen. Die am meisten fortgeschrittenen Läsionen wurden in der linken Ohrspeicheldrüse nachgewiesen.
Diskussion
Die peripheren Gänge sind beim SS in allen Drüsen stärker betroffen als der Hauptausführungsgang. Beim pSS wird symmetrischer Befall vorwiegend in den Ohrspeicheldrüsen, beim sSS vorwiegend in den Unterkieferspeicheldrüsen nachgewiesen. Grundsätzlich sind die Ohrspeicheldrüsen stärker betroffen als die Unterkieferspeicheldrüsen. Die Differenzialdiagnose zwischen pSS und sSS ist mithlfe der Pansialographie nicht möglich. Für die klinische Routine wird die Sialographie der linken Ohrspeicheldrüse empfohlen.
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Acknowledgments
The authors thank Michael Borchert, Kornelia Kliem, and Hans-Jürgen Wolf, Berlin, and all involved patients for their invaluable contributions to the study.
Compliance with ethical guidelines
Conflict of interest. W. Golder and M. Stiller state that there are no conflicts of interest.
All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.
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Golder, W., Stiller, M. Distribution pattern of Sjögren’s syndrome. Z. Rheumatol. 73, 928–933 (2014). https://doi.org/10.1007/s00393-014-1372-5
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DOI: https://doi.org/10.1007/s00393-014-1372-5