Copyright by Department of Oral & Maxillofacial Surgery
University of Dental Medicine, Yangon
Feel free to request to take it down this slide if you are copyright owner.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. The Pathogenesis of infection in oro-facial region due to odontogenic origin is a common clinical issue. bacterial invasion to deeper tissues usually a spread from diseased dental pulp. Recent evidences indicated a multi-microbial nature. The spread of infection is governed by the thickness of the investing bone and the anatomical relation of the tooth root to the attached muscle. Infection could spread from one facial space to another, and the condition may be aggravated to life threatening situations.
Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc.
Presented by Dr. Binaya Subedi
learn about salivary glands lesions in oral cavity. summary of each lesion in flash cards. mucocele can have to represenation depending on the situation. can be extravasation or retention
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. The Pathogenesis of infection in oro-facial region due to odontogenic origin is a common clinical issue. bacterial invasion to deeper tissues usually a spread from diseased dental pulp. Recent evidences indicated a multi-microbial nature. The spread of infection is governed by the thickness of the investing bone and the anatomical relation of the tooth root to the attached muscle. Infection could spread from one facial space to another, and the condition may be aggravated to life threatening situations.
Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc.
Presented by Dr. Binaya Subedi
learn about salivary glands lesions in oral cavity. summary of each lesion in flash cards. mucocele can have to represenation depending on the situation. can be extravasation or retention
The presentation explain white lesions in oral cavity and the classification the demonstrate the etiology, histopathology, diagnosis and treatment for each one.
The presentation explain white lesions in oral cavity and the classification the demonstrate the etiology, histopathology, diagnosis and treatment for each one.
Salivary glands Disorders and management.Manish Shetty
Short, brief description of the salivary gland disorders.
it explain the basic anatomy, physiology of the salivary glands.
all the 3 salivary gland are individually explained with appropriate management of it disorders.
CONTENT
INTRODUCTION
DEVELOPMENT
PAROTID CAPSULE
EXTERNAL FEATURES
RELATIONS
STRUCTURE WITHIN THE PAROTID GLAND
PAROTID DUCT
NERVE SUPPLY
LYMPHATIC DRAINAGE AND LYMPH NODES
FUNCTIONS OF PAROTID GLAND
ROLE OF PUBLIC HEALTH DENTIST
CONCLUSION
REFERENCES
The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands.
Instruments used in oral and maxillofacial surgeryCing Sian Dal
Instruments used in oral and maxillofacial surgery
Copyright (c) Prof. Dr. U Ko Ko Maung
Department of Oral and Maxillofacial Surgery
University of Dental Medicine, Yangon
Instruments used in oral and maxillofacial surgeryCing Sian Dal
Instruments used in oral and maxillofacial surgery
Copyright (c) Dr. Ko Ko Maung
Department of Oral & Maxillofacial Surgery
University of Dental Medicine, Yangon
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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3. Minor salivary glands
These lie just under
mucosa.
Distributed over lips,
cheeks, palate, floor of
mouth & retro-molar
area.
Also appear in upper
aerodigestive tract
Contribute 10% of total
salivary volume.
4. Sublingual Salivary glands
This is the smallest of the
major salivary glands.
The almond shaped gland lies
just deep to the floor of mouth
mucosa between the mandible
& Genioglossus muscle.
It is bounded inferiorly by the
Mylohyoid muscle
Sublingual gland has no true
fascial capsule.
It lacks a single dominant duct.
Instead, it is drained by
approximately 10 small ducts
(the Ducts of Rivinus)
5. Submandibular Gland
This gland lies in the
submandibular triangle
formed by the anterior and
posterior bellies of the
Digastric muscle and the
inferior margin of the
mandible.
The gland forms a ‘C’
around the anterior margin
of the Mylohyoid muscle,
which divides the gland into
a superficial and deep lobe.
6. Submandibular Gland……
Wharton’s duct empties
into the intraoral cavity
lateral to the lingual
frenulum on the anterior
floor of mouth
7. Parotid Gland
The parotid gland represents the
largest salivary gland
The following lists the
boundaries of the parotid
compartment:
•Superior border – Zygoma
•Posterior border – External
Auditory Canal
•Inferior border – Styloid
Process, Styloid Process
musculature, Internal Carotid
Artery, Jugular Veins
•Anterior border – a diagonal
line drawn from the
Zygomatic root to the EAC
8. Parotid Gland……
80% of the gland overlies
the Masseter and
mandible. The remaining
20% of the gland (the
retromandibular portion
This portion of the gland
lies in the Prestyloid
Compartment of the
Parapharyngeal space
9. Parotid Gland……
Stensen’s duct arises from the
anterior border of the Parotid
and parallels the Zygomatic
arch, 1.5 cm inferior to the
inferior margin of the arch.
It runs superficial to the
masseter muscle, then turns
medially 90 degrees to pierce
the Buccinator muscle at the
level of the second maxillary
molar where it opens onto the
oral cavity.
10. Parotid Gland……
Cranial Nerve VII divides it into 2
surgical zones (the superficial and
deep lobes).
After exiting the foramen, it turns
laterally to enter the gland at its
posterior margin.
The nerve then branches at the Pes
Anserinus (goose’s foot)
approximately 1.3 cm from the
stylomastoid foramen. The nerve
then gives rise to 2 divisions:
1)Temperofacial (upper)
2)Cervicofacial (lower)
11. Parotid Gland……
Followed by 5
terminal
branches:
1)Temporal
2)Zygomatic
3)Buccal
4)Marginal
Mandibular
5)Cervical
12. Functions of saliva include the
following:
It has a cleansing action on the teeth
It moistens and lubricates food during mastication
and swallowing
It dissolves certain molecules so that food can be
tasted
It begins the chemical digestion of starches through
the action of amylase, which breaks down
polysaccharides into disaccharides.
The saliva from the parotid gland is a rather thin,
watery fluid, but the saliva from the sublingual and
the submandibular glands contains mucus and is
much thicker.
13. Disorders of minor salivary Glands
Extravasation Cysts
Follow trauma
MSG with in lower
lip
Visible painful
swelling
Some resolve
spontaneously or
require surgery
14. Disorders of minor salivary Glands
MSG tumours are rare
but 90% are
malignant
Common sites include
Upper lip
Palate
Retromolar regions
Rare sites are
nose/PNS/Pharynx
15. Disorders of minor salivary Glands
Benign tumours present as
painless slow growing
swellings, overlying
ulceration is rare.
Malignant tumours have
firmer consistency and
have ulceration at later
stage
16. Disorders of minor salivary Glands
Benign tumors of palate < 1cm in size
are removed by excisional biopsy
When size larger than 1 cm prior
incisional biopsy is done
Malignant tumors are managed by
excision which may involve low-level
or total maxillectomy and immediate
reconstruction
17. Disorders of sublingual salivary
Glands
Problems are rare
Minor mucous retention cysts
Plunging ranula is a retention
cyst that tunnels deep
Nearly all tumours are
malignant
18. Plunging ranula
Rare form of retention cyst
May arise from SM/SL SG
Mucous collects around
gland
Penetrates Mylohyoid
muscle to enter neck
Soft painless fluctuant
dumb-bell shaped swelling
Surgical excision via neck
19. Disorders of sublingual salivary
Glands
Tumours are rare
90% are malignant
Wide excision and simultaneous neck
dissection
20. Disorders of submandibular salivary
Glands
Acute sialadenitis
Viral (Mumps)
Bacterial secondary to infection
More Common
Secondary to obstruction
Poor capacity to recover
Despite control with Abx
chronicity follows and requires
surgical excision
21. Chronic Sialadenitis
Commonly due to obstruction
following stone formation
80% salivary stones occur in SMSG
High mucous content
Acute painful swelling rapidly
precipitated by eating & resolves
within 1-2 hours
Enlarged bimanually palpable SMG
Marsuplisation/Excision
22. Tumors of Submandibular Salivary
Glands
Uncommon, slow growing, painless
Only 50% are benign
Even malignant tumours can be slow
growing
Pain is not a reliable feature
Investigations:
CT/MRI
FNAC
No open biopsy
23. Management
Small & encased within capsule
intracapsular excision
Large benign tumors– suprahyoid
excision
Malignant tumours require
concomitant neck dissection
24. Disorders of parotid Glands
Common causes of parotid swelling:
Mumps
Acute bacterial sialadenitis in dehydrated
elderly patients
Acute bacterial parotitis
Obstructive parotitis: causes swelling at
meal time
25. Parotid Tumours
Most Common is pleomorphic adenoma
(80-90%)
Low grade Tumors like acinic cell carcinoma
are not distinguishable from benign
High grade Tumours grow rapidly, are often
painful and have nodal metastasis
CT/MRI are useful
FNAC better than open biopsy
Tx should be excised & not enucleated
29. Sjogren Syndrome
Autoimmune condition causing
progressive degeneration of salivary
and lachrymal glands
The oral aspects of primary
Sjogren's syndrome consist of
mucosal atrophy (80% to 95%),
salivary gland enlargement
approximately 30 %),
The oral manifestations may include
xerostomia with or without salivary
gland enlargement, candidiasis,
dental caries and taste dysfunction.
30. Investigations
Sialometry
Sialography
Scintigraphy a radioactive tracer is given
by vein that is subsequently taken up by
the salivary glands and gradually
eliminated within the salivary fluid
Sialochemistry
Ultrasonogram
Labial or minor salivary gland biopsy
31. Management
Symptomatic
From the systemic drug treatment
standpoint, immunosuppressive therapy in
the form of corticosteroids or cytotoxic
drugs have proven effective, in particular
when symptoms are severe. A drug known
as Plaquenil has also proven to be helpful in
some cases with open questions remaining
as to the role of alpha interferon and
nonsteroidal anti-inflammatory drugs.