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This study was conducted to determine whether a secretome from mesenchymal stem cells (MSC) modulated by hypoxic conditions to contain therapeutic factors contributes to salivary gland (SG) tissue remodeling and has the potential to improve irradiation (IR)-induced salivary hypofunction in a mouse model. Human adipose mesenchymal stem cells (hAdMSC) were isolated, expanded, and exposed to hypoxic conditions (O2 < 5%). The hypoxia-conditioned medium was then filtered to a high molecular weight fraction and prepared as a hAdMSC secretome. The hAdMSC secretome was subsequently infused into the tail vein of C3H mice immediately after local IR once a day for seven consecutive days. The control group received equal volume (500 μL) of vehicle (PBS) only. SG function and structural tissue remodeling by the hAdMSC secretome were investigated. Human parotid epithelial cells (HPEC) were obtained, expanded in vitro, and then irradiated and treated with either the hypoxia-conditioned medium or a normoxic control medium. Cell proliferation and IR-induced cell death were examined to determine the mechanism by which the hAdMSC secretome exerted its effects. The conditioned hAdMSC secretome contained high levels of GM-CSF, VEGF, IL-6, and IGF-1. Repeated systemic infusion with the hAdMSC secretome resulted in improved salivation capacity and increased levels of salivary proteins, including amylase and EGF, relative to the PBS group. The microscopic structural integrity of SG was maintained and salivary epithelial (AQP-5), endothelial (CD31), myoepithelial (α-SMA) and SG progenitor cells (c-Kit) were successfully protected from radiation damage and remodeled. The hAdMSC secretome strongly induced proliferation of HPEC and led to a significant decrease in cell death in vivo and in vitro. Moreover, the anti-apoptotic effects of the hAdMSC secretome were found to be promoted after hypoxia-preconditioning relative to normoxia-cultured hAdMSC secretome. These results show that the hAdMSC secretome from hypoxic-conditioned medium may provide radioprotection and tissue remodeling via release of paracrine mediators.

Background A parotid abscess (PA) is a complication of an acute bacterial parotitis with a potentially life-threatening course. To date, data on the diagnosis and therapy of PA is sparse and mostly consists of case reports or case series. Therefore, this study aimed at comprehensively analyzing the microbiological spectrum and the therapeutic management in a bi-institutional setting. Methods A retrospective clinical chart review was performed to identify all patients surgically treated for PA at two tertiary care centers in Germany. Data on demographics, clinical management and microbiological data including species identification, pathogenicity, type of antibiotic therapy, adjustment of antibiotics, antibiotic sensitivity testing, and smear test results were extracted. Intervention-related variables and etiology were analyzed for their statistical association with outcome variables. Results Overall, 85 patients were included. Most patients (92.9%) underwent surgical incision. Around half of the patients (45.9%) were treated under local anesthesia. No facial nerve palsy was observed. The most frequently detected pathogens were Streptococci ( n  = 23), followed by Staphylococcus aureus ( n  = 6) including one case of methicillin-resistant Staphylococcus aureus . Most patients (68.2%) received an aminopenicillin ± beta-lactamase inhibitor as empiric antibiotic therapy. In 6 cases the antibiotic therapy was modified after receiving the antibiogram. Four patients (5.2%) presented with recurrent PA. Etiology was idiopathic (42.4%), followed by tumorous (12.9%), obstructive, and immunosuppressive (each 11.8%). Patients with a dental focus ( p  = 0.007) had a longer duration of hospitalization. Conclusion The results show that the surgical therapy of PA under local anesthesia is safe. A dental examination should routinely be performed to rule out a dental focus. Obtaining a microbiological specimen in order to modify antibiotic therapy if necessary and a histopathological specimen to rule out a tumorous etiology is obligate.

We present the first report of methicillin-resistant Staphylococcus aureus and Propionibacterium acnes parotid abscesses complicated by facial nerve palsy. Facial nerve palsy secondary to parotid gland abscess is rare, with only eight previously reported cases. Case reports and literature review concerning parotid abscess and facial nerve palsy presentation and management. Within two months, two female patients presented with parotid gland abscess complicated by unilateral facial paralysis. Both were treated with intravenous antibiotics and surgery. In the first case, methicillin-resistant Staphylococcus aureus was cultivated, in the other, Propionibacterium acnes was found. In the first case, facial nerve function did not recover. Parotid gland abscess can lead to facial paralysis. Both methicillin-resistant Staphylococcus aureus and Propionibacterium acnes may be involved. Ultrasonography or computed tomography is recommended to exclude a parotid abscess in patients presenting with suppurative parotitis.

Patients with either benign or malignant parotid neoplasm are candidates for surgery, but patients with benign lymphoepithelial lesions of the parotid gland or Sjögren’s syndrome do not necessarily require surgical treatment. However, the diagnosis of benign lymphoepithelial lesion of the parotid prior to surgery is challenging. In this case series, we retrospectively analyzed the records of 11 patients presented between January 2006 and August 2007, with a solitary parotid mass diagnosed post-operatively as benign lymphoepithelial lesion or Sjögren’s syndrome. Our analysis suggested that findings from physical examination and CT and MRI scans in the absence of neoplastic cells on fine needle aspiration biopsy could be used to make the diagnosis of lymphoepithelial lesion preoperatively. In a prospective study from September 2007 to June 2008, using the lessons learned from the analysis of the previous 11 patients, we were able to diagnose all 6 cases of benign lymphoepithelial lesion or Sjögren’s syndrome preoperatively.

Many patients with human immunodeficiency virus present with atypical features. Early indicators of human immunodeficiency virus are scarce and hence most affected patients are diagnosed in the later stages of the disease, which is associated with poor prognosis. Salivary gland disease usually develops before acquired immunodeficiency syndrome, and is sometimes the first manifestation of human immunodeficiency virus infection. Salivary gland lesions include benign lymphoepithelial cysts of the parotid gland, which are seen in 3-6 per cent of patients. Many of the reported lesions are diagnosed on routine examination. This review aimed to highlight the association between parotid gland benign lymphoepithelial cyst and human immunodeficiency virus infection, in order to aid early diagnosis and management of the disease. Human immunodeficiency virus testing is recommended for patients with benign lymphoepithelial cysts, as this can often be the first indication of human immunodeficiency virus infection. Benign lymphoepithelial cysts are important diagnostic and prognostic indicators in human immunodeficiency virus infection.

Background Salivary fistulas are a well-known sequel of parotidectomy, and successful treatment with botulinum toxin has been demonstrated in individual cases. Here, we report on 12 patients with fistulas treated following parotidectomy for various indications. Methods and results Injection of botulinum toxin type A into the residual gland tissue was the initial treatment. After early intervention (within 6 weeks after development of the fistula), only one fistula remained (9 of 10 fistulas treated early only with botulinum toxin). One patient with early intervention did not want to wait for the botulinum toxin treatment to take effect and demanded early surgical revision, which was successful. In one patient with a permanent fistula, botulinum toxin treatment began 420 days after the operation and was unsuccessful. No side effects were evident after the treatment. Conclusion In summary, botulinum toxin injections into the parotid tissue remaining after surgery appear to be an effective treatment for salivary fistulas following parotidectomy.

Continuous positive pressure therapy (CPAP) is a mainstay of treatment of obstructive sleep apnea (OSA). A CPAP device pressurizes room air and blows it through a nasal or oronasal mask into the patients airway, preventing the dynamic collapse of the airway soft tissue structures. In order to apply a sufficient pressure, there has to be a seal between the CPAP mask and the patients facial structures.

The Parotid gland is rarely involved in tuberculosis, even in endemic countries. We report a case of a 26 year-old woman with no medical history, who presented with a swelling of the parotid lodge. Pathology performed after surgery found a tuberculous parotitis, and the patient received anti-tuberculous regimen with a satisfactory evolution. We discuss both diagnostic and therapeutic modalities for this infection.

To report a case of first branchial arch abnormality and the problems associated with misdiagnosis. A succinct literature review is included. Teaching hospital in Scotland. A 10-year-old girl presented with localised erythema and swelling in the left parotid region. This was treated with antibiotics and incision and drainage. She re-presented four years later with a history of recurrent discharge. A first branchial arch abnormality was suspected and a magnetic resonance imaging scan arranged. Imaging showed a fluid-filled sinus tract originating adjacent to the anterior wall of the cartilaginous left external auditory canal. The sinus tract was seen to extend anteriorly and inferiorly through the superficial lobe of the left parotid, and to open onto the left cheek lateral to the left masseter. The tract was explored and excised under general anaesthesia, via two separate incisions, with preservation of the facial nerve. The diagnosis of a first branchial arch abnormality is generally based on a high index of clinical suspicion, when a neck swelling is noted in a child. Magnetic resonance imaging is a useful modality for investigation, and helps to delineate the position of the tract and its relationship to the facial nerve.

The aim of the study was to determine the effectiveness of alcohol sclerotherapy in patients with human immunodeficiency virus related salivary gland disease. Prospective study investigating the effectiveness of alcohol as a sclerosing agent. Tertiary referral hospital. Eleven human immunodeficiency virus positive patients with benign lymphoepithelial cysts were included in the study, from July 2005 to September 2006. Alcohol sclerotherapy was performed under local anaesthesia, with alcohol infiltrated into the benign lymphoepithelial cysts. Alcohol injection sclerotherapy proved to be an effective, simple, cheap, ambulatory procedure for patients who did not qualify for antiretroviral treatment.