Hans P. van den Akker

Submandibular gland function following transoral sialolithectomy

Conflicting views exist with regard to surgical treatment of a salivary stone in the knee of the submandibular duct, the options being excision of the submandibular gland and transoral removal of the stone. The key question in this dispute is whether or not a gland with a stone in this position has suffered irreparable functional damage. To determine the extent of glandular recovery after transoral sialolithectomy, a clinical and scintigraphic study has been carried out in a consecutive series of twenty-one patients. The results show a return to normal function in the vast majority of these patients, which indicates that transoral removal of the stone is the treatment of choice.

Incidence and disease-free survival after surgical therapy of central giant cell granulomas of the jaw in The Netherlands: 1990–1995

The central giant cell granuloma (CGCG) of the jaw is a rare benign tumor with an unknown etiology. Epidemiologic data on CGCGs in a general population are not available, nor are data on the overall outcome of surgical therapy. In this article, an overview of these aspects in the Dutch population from January 1, 1990, until January 1, 1995, is presented.

Regression of central giant cell granuloma by a combination of imatinib and interferon: a case report

Central giant cell granuloma is a benign lesion of the jaws which is sometimes aggressive locally. The most common treatment is curettage,which has a high recurrence rate, particularly in more aggressive lesions. Other treatments such as interferon (IFN) and calcitonin have been described. We report a patient with Stickler syndrome and an aggressive central giant cell granuloma in the mandible. Initial treatment with calcitonin was not successful. A combination of IFN and imatinib, given for 9 months, initiated regression of the lesion that continued after treatment had ceased.

Embolization of an arteriovenous malformation of the mandible.

Abstract A case of arteriovenous malformation of the mandible successfully treated by only superselective embolization is reported.

Diagnostic imaging in salivary gland disease.

A review of the current status of salivary gland imaging is presented. The potentials and limitations of sialography, scintigraphy, ultrasonography, computed tomography, and magnetic resonance imaging are discussed so that a rational approach to their use can be adopted.

Absolute indications for salivary gland scintigraphy with99mTc-pertechnetate

In recent years salivary gland scintigraphy has gained widespread acceptance as a useful means for evaluating salivary gland disorders. An absolute indication for this procedure exists when the ductal orifice of one or several major salivary glands cannot be found or cannot be cannulated. Clinical conditions in which this problem occurs include technical failure to probe and cannulate the duct, developmental anomalies, obstructive disorders, traumatic lesions and fistulae and the need of postsurgical information after glandular excision or after ligation or repositioning of a major excretory duct. The clinical value of scintigraphy in these conditions is demonstrated by means of case presentations.

Use of sidestream dark-field (SDF) imaging for assessing the effects of high-dose melphalan and autologous stem cell transplantation on oral mucosal microcirculation in myeloma patients

BACKGROUND Oral mucositis (OM) is a common toxic side effect among patients receiving high-dose chemotherapy (CT) with autologous stem cell transplantation (ASCT) for hematologic malignancies. The aim of this study was to investigate changes in submucosal microcirculation in myeloma patients receiving high-dose CT with ASCT by assessing capillary density and microvascular structural integrity. METHODS Ten consecutive patients with multiple myeloma who underwent first-time CT treatment with high-dose melphalan (200 mg/m(2)) and ASCT were included in this study. Baseline buccal mucosa capillary density, expressed as the mean number of capillaries +/- SD per mm(2) (cpll/mm(2)), was measured with sidestream dark-field imaging after treatment was performed, after 30 and 60 minutes, and then on days 2, 4, 6, 8, and 14. A linear mixed model was used to examine capillary density over time and a P value of <.05 was considered to be statistically significant. RESULTS Baseline mucosal capillary density was 19 +/- 2.4 cpll/mm(2). Mucosal capillary density after melphalan infusion after 30 and 60 minutes and on days 2 and 4 showed no statistically significant differences. A decrease in capillary density with statistical significance was observed on days 6 (10 +/- 3.0 cpll/mm(2); P < .01) and 8 (12 +/- 4.9 cpll/mm(2); P < .01). On day 14, capillary density returned to near baseline value. CONCLUSIONS High-dose CT alters microvascular structural integrity and dysregulates tissue perfusion in the oral mucosa by decreasing the number of perfused submucosal capillaries in the oral mucosa. The findings of this investigation suggest that acute CT toxicity alters oral microcirculation and may be an important mechanism responsible for driving early mucosal barrier disturbances associated with CT-induced OM.

Acinic cell carcinoma of the sublingual gland. Scintigraphy in pre-operative evaluation.

A case of acinic cell carcinoma of the sublingual gland with an unusual clinical history is reported. Dynamic scintigraphy with 99mTc-pertechnetate is recommended for pre-operative evaluation of a large swelling in the floor of the mouth.

An integrative approach for comparing microcirculation between normal and alveolar cleft gingiva in children scheduled for secondary bone grafting procedures

OBJECTIVE The aim of this study was to compare microcirculatory parameters in normal versus alveolar cleft gingiva in children selected for secondary bone grafting procedures. STUDY DESIGN This study included 11 consecutive patients with complete unilateral alveolar clefts who required secondary bone grafting procedures. In a split-mouth design, noninvasive real-time simultaneous measurements among tissue oxygen saturation (StO2), hemoglobin level (rHb), and blood flow parameters were obtained from normal and alveolar cleft gingiva using spectrophotometry and laser Doppler flowmetry. Subsequent noninvasive capillary density measurements and tissue microangioarchitecture were assessed using sidestream dark-field imaging. RESULTS There were no significant differences in StO2 and rHb between normal and alveolar cleft gingiva. Blood flow, blood flow velocity, and capillary density were significantly decreased in alveolar cleft gingiva (P < 0.05). CONCLUSIONS Alveolar cleft reconstructions alter gingival microperfusion properties, and microvascular changes adapt to conserve peak oxygen saturation.