Christian Arglebe

Reduction of Salivary Flow With Botulinum Toxin: Extended Report on 33 Patients with Drooling, Salivary Fistulas, and Sialadenitis

Objectives/Hypothesis: The aim of the study was the evaluation of the clinical data of 33 patients who had had drooling attributable to various diseases, salivary fistulas, and sialadenitis and had been treated with injection of botulinum toxin type A (Botox). A controlled follow‐up study documenting efficiency, possible side effects, and duration of the effect of treatment was also performed.

Botulinum toxin to reduce saliva flow: selected indications for ultrasound-guided toxin application into salivary glands.

Objectives/Hypothesis The study investigates the effect of local injections of botulinum toxin type A (Botox) into the major salivary glands of the head in various states of hypersalivation. In particular, we studied pathological states with permanent as well as passing hypersalivation disorders and present new indications for local application of botulinum toxin to the salivary glands.

Surgical management of nonneoplastic diseases of the submandibular gland: A follow-up study

A total of 233 patients with nonneoplastic diseases of the submandibular gland were treated between 1966 and 1992 at the otorhinolaryngology department of the University of Göttingen. Of them, 212 patients (91%) suffered from sialadenitis with or without sialolithiasis, and 21 (9%) suffered from other diseases. The first part of the present study analyzes the clinical data with regard to history, symptoms, and therapy. It was found that in most cases (77%) extirpation of the affected gland had been the standard operation. In the second part, the surgical procedures applied are critically assessed. Extirpation of the submandibular gland proved to be an effective therapy in all patients. Side-effects were rare. The management of chronic sialadenitis caused by calculi should include extirpation of the submandibular gland. In case of calculi not causing inflammatory disease, lithotripsy should be considered.

Retrospective analysis of 35 patients with acinic cell carcinoma of the parotid gland

PURPOSE This retrospective study evaluated data pertaining to the history, symptoms, treatment, and prognosis of a series of patients treated for acinic cell carcinoma (ACC). PATIENTS AND METHODS Data were based on the records of 35 patients. Follow-up was done by analyzing their records and contacting the referring doctors. RESULTS In 71% of the ACC patients, painful swelling of the lateral region of the face was the main symptom. Facial paralysis occurred in 11% of cases before treatment. Tumor recurrence after therapy was noted in 42% of cases. Highly differentiated ACC was the most frequent histologic subtype (74%). The grade of differentiation of the tumor was decisive for the prognosis. Highly differentiated ACC had a better prognosis (2 years overall survival, 100%; 5 years overall survival, 83%; 10 years overall survival, 50%) than lowly differentiated tumors (2 years overall survival, 70%; 5 years overall survival, 50%; 10 years overall survival, 30%). CONCLUSION ACC is a rare tumor located mainly in the parotid gland that is characterized by some special attributes. Surgery is the therapy of choice. Prognosis depends mainly on the histologic subtype.

Immunohistochemical and morphometric investigations of the influence of botulinum toxin on the submandibular gland of the rat.

Abstract Immunohistochemical methods were used to study the effects of botulinum toxin A on the concentration of acetylcholinesterase in the submandibular gland of the rat. The toxin was injected into the glands of healthy adult female Wistar rats and immunohistochemistry performed on the excised organs. Morphometric measurements were also carried out to study changes of cell morphology after local applications of botulinum toxin A. Compared with untreated glands or glands injected with saline there was a decrease of acetylcholinesterase in the glands treated with botulinum toxin. As the cholinergic pathway of the autonomic nervous system plays an important role in eliciting secretion from the salivary glands, inhibition of secretion by local application of botulinum toxin could be considered a therapeutic option for the treatment of various diseases affecting salivary gland function.

Surgical management of benign tumors of the submandibular gland: A follow-up study

PURPOSE This retrospective study evaluated data pertaining to history, symptoms, diagnosis, and mode of therapy of patients treated for benign tumors of the submandibular gland. PATIENTS AND METHODS The records of 38 patients were reviewed. The patients were divided into three groups: pleomorphic adenoma (first operation), pleomorphic adenoma (second operation for recurrence), and other tumors. Follow-up was done by questionnaires sent to the patient and referring doctor. RESULTS The vast majority of patients treated (92%) had had either a first or second operation for pleomorphic adenoma. Follow-up revealed that recurrence did not develop in the group of patients with primary surgery. However, one patient undergoing surgery for recurrent pleomorphic adenoma developed two recurrences. Two patients suffered from slight weakness of the lower lip. CONCLUSION Tumor recurrence was found only in the cases of second operation after previous surgery for pleomorphic adenoma. Therefore, the first operation should extirpate the entire gland to minimize the risk of recurrence.

Über die operative Behandlung der chronischen Ohrspeicheldrüsenentzündung

Of 58 patients whose parotid glands were extirpated because of a chronic parotitis, 90% could be cured. The rate of success of this operation is reduced to 70-80% if its is based on those 31 patients alone who showed the typical symptoms of a chronic-recurrent parotitis. The incidence of persisting facial pareses is about twice as high as after removal of non-inflamed parotid glands. This figure is based on seven patients suffering, with one exception, from only slight disorders of innervation in the region of the angle of the mouth. In our opinion total parotidectomy is the method of choice for the treatment of chronic parotitis, if all attempts at conservative treatment have failed. We attribute our failures to remaining glandular parenchyma that was both inflamed and still secretory-active. To further improve the rate of success of parotidectomy, its combination with procedures suitable for occlusion of the duct system is proposed. In this way one should succeed in completely eliminating any secretory-active gland tissue.SummaryOf 58 patients whose parotid glands were extirpated because of a chronic parotitis, 90% could be cured. The rate of success of this operation is reduced to 70–80% if it is based on those 31 patients alone who showed the typical symptoms of a chronic-recurrent parotitis.The incidence of persisting facial pareses is about twice as high as after removal of non-inflamed parotid glands. This figure is based on seven patients suffering, with one exception, from only slight disorders of innervation in the region of the angle of the mouth.In our opinion total parotidectomy is the method of choice for the treatment of chronic parotitis, if all attempts at conservative treatment have failed. We attribute our failures to remaining glandular parenchyma that was both inflamed and still secretory-active. To further improve the rate of success of parotidectomy, its combination with procedures suitable for occlusion of the duct system is proposed. In this way one should succeed in completely eliminating any secretory-active gland tissue.ZusammenfassungVon 58 Patienten, deren Ohrspeicheldrüsen wegen einer chronischen Parotitis exstirpiert wurden, konnten 90% geheilt werden. Die Erfolgsquote der Operation sinkt auf 70–80%, wenn man nur die 31 Patienten, die das typische Beschwerdebild einer chronisch-rezidivierenden Parotitis aufwiesen, berücksichtigt.Die Rate persistierender Fazialisparesen ist etwa doppelt so hoch, wie nach der Entfernung entzündungsfreier Ohrspeicheldrüsen. Dabei handelte es sich um sieben Patienten, die allerdings bis auf eine Ausnahme nur an Innervationsstörungen im Mundwinkelgebiet litten.Die totale Parotidektomie stellt u. E. die Methode der Wahl zur Behandlung der chronischen Parotitis dar, wenn alle konservativen Behandlungsversuche fehlschlugen. Mißerfolge führen wir auf zurückgebliebenes entzündetes und noch sekretorisch aktives Drüsenparenchym zurück. Um die Erfolgsrate der Parotidektomie noch weiter zu verbessern, wird daher deren Kombination mit Verfahren zur Gangokklusion vorgeschlagen, wodurch sich alles aktive Drüsengewebe ausschalten ließe.

Possible involvement of parotid beta-adrenergic receptors in the etiology of sialadenosis

ZusammenfassungWir bestimmten die Konzentration der adrenergen β-Rezeptoren in den Ohrspeicheldrüsen der Ratte und des Menschen, sowohl im normalen Drüsengewebe als auch nach sympathischer Denervierung der Ratte und bei der Sialadenose des Menschen. Nach Denervierung und bei Sialadenose fanden sich wesentlich höhere Rezeptorkonzentrationen als in den entsprechenden gesunden Drüsen. Die mögliche Bedeutung dieser Befunde für die Ätiologie der Sialadenose des Menschen wird diskutiert.SummaryThe concentration of β-adrenergic receptors was determined in rat and human parotid glands, in normal tissue as well as after sympathetic denervation of the rat, and in human sialadenosis. Receptor levels were clearly elevated after denervation of the rat and in sialadenosis. The possible implications of these findings for the etiology of human sialadenosis are discussed.

The effects of tympanic neurectomy and chorda tympanectomy on experimentally induced parotid duct fistulae in rabbits

SummaryTo study the effects of parasympathetic denervation on the secretory activity of parotid fistulae, polyethylene catheters were introduced bilaterally into the parotid main excretory ducts of 10 rabbits, followed by unilateral parasympathectomy performed by segmental resection of the tympanic plexus and the chorda tympani nerve. Although salivary flow from the fistulae of the denervated parotid glands stopped up to 8 days earlier than that from the healthy (control) glands, the effect of parasympathectomy was not strong enough to recommend this operation as the method of choice for the clinical inactivation of persistent parotid fistulae.

Occlusion of Stenon’s Duct by Prolamine: a Possible Treatment of Chronic Parotitis?

The histological and biochemical (amylase, protein) consequences of occlusion by prolamine of the parotid duct were studied in 5 rabbits. Histological examination 2 weeks after occlusion revealed an a