TÜKRÜK BEZİ HASTALIKLARINDA KULLANILAN TANI YÖNTEMLERİNİN DEĞERLENDİRİLMESİ

Giriş: Tükrük bezi tümörleri, organlarının embriyolojik fizyolojik özellikleri, anatomik komşulukları nedeniyle özel öneme sahiptir. Bu önemden dolayı tedavi planlaması özenle yapılmalı ve anamnezle fizik muayenenin yardımcı tanı yöntemlerine başvurulmalıdır. Bunlar laboratuar, radyolojik siyalografik, sitolojik ve histopatolojik yöntemlerdir. Materyal ve Metod: Bu çalışmada tükrük bezlerinde hastalık olan 50 olguya anamnez ve fizik muayeneden sonra siyalografi, ultrasonografi, bilgisayarlı tomografi ve ince iğne aspirasyon biyopsisi uygulandı. Bu tekniklerin her birinin tanı koymadaki yararlarını inceledik. Bulgular: Çalışmamızda total olarak ultrasonografiyi % 86.2, bilgisayarlı tomografiyi %75, ince iğne aspirasyon biyopsisini % 68.7, siyalografi % 61.5 oranında tanı koydurucu olarak bulduk. Yine yaptığımız çalışma sonucunda akut sialoadenitis, kronik sialoadenitis ve tümör grupları arasında kan amilaz seviyesi arasında fark bulunmamıştır. Sonuç: Tükrük bezi hastalıklarında dikkatli bir anamnez ve ayrıntılı bir fizik muayeneden sonra ilk uygulanacak yöntem ultrasonografi olmalıdır. Elde ettiğimiz bulgulara göre, kuşkuda kalınan, yerleşimi, yapısı ve yayılımı konusunda net bulguların gerektiği olgularda bilgisayarlı tomografi kullanılmalıdır. Taş ve buna benzer obstrüksiyon düşünülen olgularda siyalografi uygulanmalıdır. Ayrıca, neoplastik ve nonneoplastik kitlelerin ayrımı ve cerrahinin planlanmasına yardımcı olmak açısından ince iğne aspirasyon biyopsisi uygulanmalıdır.

Anahtar Kelimeler:

Tükrük bezi, siyalografi, bilgisayarlı tomografi, ultrason, İnce iğne aspirasyon biyopsisi

The evaulation of diagnostic methods used in salivary gland diseases

Introduction: Salivary gland tumors have got a special significance due to physiologic and embryologic characteristics of its organs and anatomical neighborhoods. Because of this significance, treatment planning should be done carefully and be used to the diagnostic methods with medical history and physical examination. These methods are laboratory, radiologic, sialographic, cytologic and histopathologic methods. Material and Method: In the present study, 50 cases, which had salivary gland disease, were performed sialography, ultrasonography (USG), computed tomography (CT) and fine needle aspiration biopsy (FNAB) were performed after medical history and physical examination. The benefits of these dianostic methods were evaluated. Results: In our study, it was found to be diagnostic as; 86.6 % in USG, 75 % in CT, 68.7 % inFNAB, and 61.5 in sialography, respectively. No statistically significant differences were found between acute sialoadenitis, chronic sialoadenitis and tumor groups in relation to blood amylase levels (p>0.05). Consequently, USG should be applied as the first method after a careful history and detailed physical examination in salivary gland disaseses. Conclusion: According to the our results, It should be used CT in cases, incurred in doubt and findings should be clear in relation to location, structure and spread. However, we should perform siyalography in cases who had suspected sialolitiasis or other similar obstruction. In addition, FNAB should be performed for differential diagnosis of the neoplastic and nonneoplastic lesions and to lead to the planning of surgery.

Keywords:

Salivary gland, Sialography, Computed tomography, Ultrasound, Fine needle aspiration biopsy,

PDF

___

) Singh S, Garg N, Gupta S, Narwah N, Kalra R, Singh V, Sen R.. Fine needle aspiration cytology in lesions of oral and maxillofacial region:Diagnostic pitfalls, Journal of Cytology, 28(3), 93-97.2011.
) Colella G, Cannavale R, Flamminio F, and Foschini MP,, Fine-Needle Aspiration Cytology of Salivary Gland Lesions: A Systematic Review J Oral Maxillofac Surg 68:2146-2153, 2010.
) Jayaram G, Verma AK, Sood N, et al: Fine needle aspiration cytology of salivary gland lesions. J Oral Pathol Med 23:256,1994.
) Carrillo JF, Ramirez R, Flores L, RamirezOrtega MC, Arrecillas MD, Ibarra M, Sotelo R, Ponce-de-Leon S, and Onate-Ocana LF, Diagnostic Accuracy of Fine Needle Aspiration Biopsy in Preoperative Diagnosis of Patients With Parotid Gland Masses, Journal of Surgical Oncology 2009;100:133–138.
) Nanthakumar K, Mountz JM, Plumb VJ, Epstein AE, Kay GN. Functional assessment of pulmonary vein stenosis using radionuclide ventilation/perfusion imaging. Chest 2004;126:64551.
) Ghosh N, Tampieri D, Melancon D. Immediate evaluation of angioplasty and stenting results in supra-aortic arteries by use ofa Dopplertipped guidewire. AJNR Am J Neuroradiol 2004;25: 1172-6.
) Punwani S, Gillams AR, Lees WR. Noninvasive quantification of pancreatic exocrine function using secretin-stimulated MRCP. Eur Radiol 2003;13:273-6.
) Nakamoto Y, Tatsumi M, Hammoud D, Cohade C, Osman MM, Wahl RL. Normal FDG distribution patterns in the head and neck: PET/CT evaluation. Radiology 2005;234:879-85.
) Tanaka T, Ono K, Ansai T, Yoshioka I, Habu M, Tomoyose T, Yamashita Y, Nishida K, Oda M, Kuroiwa H, Wakasugi-Sato N, Okabe S, Kito S, Takahashi T, Tominaga K, Inenaga K, and Morimoto Y. Dynamic magnetic resonance sialography for patients with xerostomia, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:115-23.
) Kraft M, Lang F, Mihaescu A, Wolfensberger M, Evaluation of clinician-operated sonography and fine-needle aspiration in the assessment of salivary gland tumours, Clin. Otolaryngol. 2008, 33, 18–24
) Delozier HL, Spinella MJ, Johnson GD: Facial nevre paralysis with benign parotid masses.Annals otolaryngol 98: 644-47,1989.
) Bryne MN, Spector JG: Parotid massses,evaluation analysis and current management. Laryngoscop 98: 99-105,1983.
) Chen KTK,Bauer V:Noduler fascitis presentig as parotid tumor.Am J Otolaryngol 3:179181,1987.
) Zenk J,Iro H. Die Sialolthiasis und deren Behandlung.Laryngo-Rhino-Otol 2001;80(suppl):115-36.
) Marchal F,Becker M,Dulguerov P,et al. Specifity of parotid sialoendoscopy. Laryngoscope2001,111:264-71(GradeD).
) Nahlieli O,Baruchin AM. Endoscopic technique fort he diagnosis and treatment of obstructive salivary gland diseases.J Oral Maxillofac Surg 1999,57:1394-401.(Grade D)
) Nahlieli O,Baruchin AM.Long-term experience with endoscopic diagnosis and treatment of salivary gland inflammatory diseases. Laryngoscope 2000,110:988-93.(Grade D)
) Bruneton JN,Sicart M, Roux P et al: Indications for ultrasonography in parotid pathologies.ROFO 138:22-24,1983.
) Akın I,Esmer N,Gerçeker M, Aytaç S,Erden I,Akan H: Siyalographic and Ultrasonograghic analyses of major salivary glands.Acta Otolaryngol ( of stockh):11(3) 6006,1991.
) Hanafee WN:Sialography in radiology of the ear,nose and throat Eds.Valvassori GE et al.Georg Thieme Verlag, New York,1984.
) Webb AM: Cytologic diagnosis of salivary glan lesions in adult and pediatric surgical patients.Acta Cytol 17,51-8,1973.
) Woods JE,Chong GC,Beahrs OH: Experience With 1360 primary parotid tumors.Am J Surg 130:4602,1975.
) Klein K,Turk R, Gritzman N, Traxler M: The value of sonographhy in salivary gland tumors HNO.P71-5 Feb 37(2),1989. 165:183189,1987.
) N. Sriskandan,A.Hannah,D.C.Howlett.A study to evaluate accuracy of ultrasound in the diagnosis of parotid lumps and to reniew the sonographic features of parotid lesions- results in 220 patients.Clinical Radiology,UK,2010.
) Mancu so AA,Hanafee WN:Computed to in the tomography in the head and neck.Williams&Wilkins Baltimore,1982.
) Rabinov K, Kell T, Gordon PH: CT of the salivary glands. Radiol.Clin.North Am 22:145-59,1984.
) Casselman JW,Mancuso AA:Major salivary gland masses:Comparison of mr imaging and CT.Radiol
) Bryan RN, Miller RM, Ferryro RI, et al: Computed tomography of the major salivary glands.Am J Laryngol 139:547-554,1982.
) Golding S. Computed tomography in the diagnosis of parotid gland tumours.Brit J Radiol 55:182,1982.
) Som PM,Curin HD.Head and Neck Ġmaging,4th ed. St.louis,Missouri:Mosby.ISBN:0323-00942-5.
) Mavec P, Eneroth C.M,Frarzen S,Moberger G,Zajicek J:Aspiration biopsy of salivary glnd tümors.ActaOtolarygol 58:471-84,1984.
) Bono A, Chiesa F, Sala L, Azarelli A, Pilotti S,Diperto S: Fine needle aspiration biopsy inparotid masses.Tumors 69:417-421,1983.
) Pitts DB,Hilsinger RL JR, Karandy E, Ross JC,Caro JE: Fine- needle aspiration inthe diagnosis of salivary gland disorders in the community hospital setting.Arch Otolaryngol Head Neck Surg.May 1992.