Rate of Submandibular Gland Atrophy Secondary to Chronic Sialolithiasis

The rate of salivary gland atrophy secondary to chronic obstructive sialolithiasis has not been well-documented. The combination of 5 imaging studies over 12 years in a patient with repeat imaging for an unrelated pathology provides a unique opportunity to assess glandular atrophy over time. We hope that this case will support previous literature with an in vivo representation of the rate of glandular atrophy.

Meibography guided intraductal meibomian gland probing using real-time infrared video feed

PurposeTo evaluate use of infrared meibography video to visualise meibomian gland probing and correlate probe findings of intraductal space with meibography images.MethodsVideos were reviewed and probe findings recorded of 996 probed gland orifices from 38 lower lids.Results996/997 (99.9%) of gland orifices were successfully probed with 91.8% revealing probe location. There were no false passages. 14% (140/997) of all gland orifices showed whole gland atrophy (WGA) with 99.3% (139/140) probed to 1 mm. Cumulative probe findings for all WGA (not differ significantly from non-WGA) showed 106 (76%), 21 (15%) and 12 (9%) glands with fixed, non-fixed and no resistance (NR), respectively. Lids without WGA showed increased NR/total glands probed while lids with WGAs (≥5) showed increased NR/WGA compared with lids with only 1–4 WGAs (p=0.011, p=0.005, respectively, Mann-Whitney U test) suggesting bimodal NR profile. Visualisation of microtube placement was successfully obtained for therapeutic injections and retrieval of meibum specimens.ConclusionVideo confirmed intraductal location and safety of devices. For 73% of non-WGA and 76% of WGAs as well as proximal ducts of glands with proximal atrophy, probing released fixed resistance restoring ductal integrity. A bimodal profile of NR suggests it is found with less diseased gland ducts as well as more advanced atrophic gland disease. Gland and ducts appeared flexible but not distendable while periglandular tissue appeared spongy. Visualisation of devices enables whole or localised gland therapy and meibum specimen retrieval, elegantly raising future research, therapeutic and regenerative opportunities.

Imaging in Chronic Pancreatitis

Chronic pancreatitis (CP) is a chronic progressive process which can cause irreversible damage to both the exocrine and endocrine systems of pancreas. There are various imaging modalities available to evaluate CP of which ultrasonography ( USG), computed tomography (CT), and magnetic resonance imaging (MRI) are most commonly used. USG is used as a screening modality which can show various changes of CP and its complications. However, the information obtained from USG can be limited because of the patient’s body habitus. CT is the workhorse modality which can provide comprehensive information and it is the best modality to detect calcification. MRI, on the other hand, is excellent in demonstrating the pancreatic parenchyma and the ductal system. Alcohol-related pancreatitis is the commonest cause which can show gland atrophy, ductal dilatation, and calcifications. Other less common causes include hereditary and genetic mutation–related pancreatitis. There are other special types of pancreatitis such as autoimmune pancreatitis and groove pancreatitis that have characteristic features on imaging.