Clinical analysis and ultrasound study of allergy-related obstructive parotitis
LU Yifan,1, ZHANG Weiqian2, YU Chuangqi,1
1.Department of Oral Surgery, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai 200011, China
2.Department of Ultrasound, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
Objective ·To explore the clinical features of allergy-related obstructive parotitis (AROP) and the ultrasonic characteristics of its duct. Methods ·Patients diagnosed with AROP at the Oral Surgery Department of Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine from October 2020 to October 2022 due to recurrent swelling of parotid gland were included. Clinical data of the patients were retrospectively analyzed, including medical history, clinical manifestations, laboratory examinations and imaging examinations. Static ultrasound was used to display the morphological characteristics of the AROP duct, ultrasonic images were used to measure the inner diameter at the widest point of duct dilation, and the degree of duct dilation was graded. Dynamic ultrasound was used to show the morphological changes of the duct at the functional state of AROP patients. The value and ratio of duct widening were calculated, and the symptoms of parotid swelling were recorded. Results ·Thirty-seven patients were diagnosed with AROP and included in the study, including 9 males (24.3%) and 28 females (75.7%). The main clinical symptoms were recurrent swelling of parotid gland, skin itching and duct discharge of mucus plug. Thirty-two patients (86.5%) had a history of systemic allergic disease. The proportion of increased serum IgE concentration and peripheral blood eosinophil (PBE) absolute count was 59.5% and 43.2%, respectively. The static ultrasound results of 37 AROP patients were mainly manifested by duct dilation. The grading results of duct dilation degree were mild in 21 cases (56.8%), moderate in 10 cases (27.0%) and severe in 6 cases (16.2%). Seven patients with AROP underwent dynamic ultrasonography. Results showed that 4 patients were in the asymptomatic period and 3 patients were in the symptomatic period. Conclusion ·AROP is a type of chronic obstructive parotitis closely related to allergic reactions, and its diagnosis should be considered in many aspects. Ultrasound can effectively display the morphological characteristics of parotid duct, and can be used to assess the obstruction status of the duct, which is helpful for the diagnosis and follow-up of AROP.
LU Yifan, ZHANG Weiqian, YU Chuangqi. Clinical analysis and ultrasound study of allergy-related obstructive parotitis. Journal of Shanghai Jiao Tong University (Medical Science)[J], 2023, 43(5): 519-523 doi:10.3969/j.issn.1674-8115.2023.05.001
Note： A. In a patient with mild duct dilation, the parotid duct was 2.7 mm wide. B.In a patient with moderate duct dilation, the parotid duct was 3.8 mm wide. C.In a patient with severe duct dilation, the parotid duct was 6.3 mm wide. The yellow dotted lines show the overall shape of the duct, and the yellow arrows show the widest dilation of the duct.
Fig 1
Typical ultrasound images of 3 grading of duct dilation
Note： A. In an AROP patient in the symptomatic period, the parotid duct was dilated in the resting state with a width of 5.3 mm. B.After eating sour candy, the duct was significantly dilated with a width of 7.9 mm. The yellow dotted lines show the overall shape of the duct, and the yellow arrows show the widest dilation of the duct.
Fig 2
Dynamic ultrasound images of an AROP patient (symptomatic period)
Tab 2
表2
表2AROP患者的动态超声结果（n=7）
Tab 2 Dynamic ultrasound results of the AROP patients （n=7）
The study was designed by LU Yifan and YU Chuangqi. The data was collected and analyzed by LU Yifan and ZHANG Weiqian. The manuscript was drafted and revised by LU Yifan and YU Chuangqi. All the authors have read the last version of paper and consented for submission.
利益冲突声明
所有作者声明不存在利益冲突。
COMPETING INTERESTS
All authors disclose no relevant conflict of interests.
LEE L I, PAWAR R R, WHITLEY S, et al. Incidence of different causes of benign obstruction of the salivary glands: retrospective analysis of 493 cases using fluoroscopy and digital subtraction sialography[J]. Br J Oral Maxillofac Surg, 2015, 53(1): 54-57.
BAER A N, OKUHAMA A, EISELE D W, et al. Eosinophilic sialodochitis: redefinition of ‘allergic parotitis’ and ‘sialodochitis fibrinosa’[J]. Oral Dis, 2017, 23(7): 840-848.
HARKNESS P. Submandibular salivary disease: a proposed allergic aetiology[J]. J Laryngol Otol, 1995, 109(1): 66-67.
OKUDA M O Y, UNNO T. Sialodochitis fibrinosa (Kussmaul)[J]. Jibi to Rinsho (Otologia Fukuoka), 1975, 21: 635–639.
ZHU W X, CHEN Y, LIU D G, et al. Eosinophilic sialodochitis: a type of chronic obstructive sialadenitis related to allergy[J]. Laryngoscope, 2021, 131(3): E800-E806.
WANG Z J, ZHANG W Q, ZHENG L Y, et al. Ultrasound elastography in diagnosis and follow-up for patients with IgG4-related sclerosing sialadenitis[J]. Chin J Oral Maxillofac Surg, 2019, 17(3): 225-229.
FLORES ROBLES B J, BREA ÁLVAREZ B, SANABRIA SANCHINEL A A, et al. Sialodochitis fibrinosa (kussmaul disease) report of 3 cases and literature review[J]. Medicine (Baltimore), 2016, 95(42): e5132.
CHIKAMATSU K, SHINO M, FUKUDA Y, et al. Recurring bilateral parotid gland swelling: two cases of sialodochitis fibrinosa[J]. J Laryngol Otol, 2006, 120(4): 330-333.
RAY A, BURGIN S J, SPECTOR M E. A rare case of Kussmaul Disease (Sialodochitis Fibrinosa)[J]. J Case Rep Med, 2015, 4(1+3): 235894.
SHIMADA T, OKANO H, HISA Y. A case of severe dilatation of the parotid duct due to fibrinous sialodochitis[J]. Acta Otolaryngol, 2006, 126(10): 1112-1114.
POLLAK N, TEMPLER J W, ESEBUA M, et al. Episodic painful parotid swelling caused by sialodochitis with eosinophilic inflammation: a new entity[J]. Otolaryngol Head Neck Surg, 2009, 140(1): 132-133.
