Evaluation of parotid and submandibular salivary glands through magnetic resonance and clinical-laboratorial correlations in cronic form Chagas disease bearers / Avaliação das glândulas parótidas e submandibulares por ressonância magnética e correlação clínico-laboratorial em pacientes portadores das formas indeterminada e digestiva da doença de Chagas

Eveline de Lucena Oliveira Souza Leão

INTRODUCTION: Chagas disease is the most important endemic parasitosis in Latin America. The salivary glands onsets for this disease have been poorly studied. For MR (magnetic resonance) sialography has a better sensibility and specificity when compared to different methods and for not being invasive, it is used to identify glandular alterations in patients in the undetermined form, which possibility its reclassification to the digestive form. OBJECTIVES: Present work intends to evaluate the alterations found by MR sialography in Chagas disease patient bearers and correlate them with clinical and laboratorial data. CASUISTIC and METHOD: 180 Major salivary glands were studied in 45 patients by MR sialography divided into 3 groups: A Chagas disease bearers in the uncertain clinical form; B Chagas disease bearers in the digestive form; C Control group. Average ages were: 48; 55 and 50 years, respectively. Concerning sex, nine; 11 and 10 of the evaluated groups were feminine. Anatomical sequences were pondered in T1 and T2, as well as specific sequences for MR sialography T2 fast spin eco 2D and 3D. Specific clinical evaluation, sialometry, nasofibroscopy and blood dosages of amilasis were also evaluated. RESULTS: The parotids glands volumes for groups and expressed, varied for as presented: A (31.1 cm3); B (27.4 cm3); C (32.4 cm3) and for submandibular glands were: A (6.1 cm3); B (5.2 cm3) and C (7,0 cm3). A case was observed in group A and another one in group B, presenting gauging and an important fatty substitution for one of the glands. Main parotid ducts caliber or firstrate order, varied from: A (1.5mm) tortuosity and segmental dilation in one case; B (1.3mm) one of them not visualized and C (1.2mm). Submandibular main ducts presented calibers of: A (1.5mm); B (1.7mm) - one of them not visualized; C (1.3mm). Secondary salivary ducts of the parotid were not identified in: A (13.3%); B (20.0%); C (6.7%) and concerning to submandibular glands, only one case in group B was not identified. Tertiary salivary ducts of the parotid gland were not visualized in: A (43.3%); B (43.3%); C (33.3%) and for submandibular glands: The (40.0%); B (23.3%); C (20.0%). Saccular dilatation was observed in only one parotid of the group B. Among the clinical complaints, xerostomy was the most prevailing A (40.0%); B (53.3%); C (13.3%) p = 0,066. The sialometry after stimulus showed to be altered in the groups as follows: A (60.0%); B (86.7%) and C (53.3%) - <0,001. The main parotid duct diameter of individuals with normal amilasis was smaller than those in the ones with abnormal amilasis (p=0,046). CONCLUSION: The salivary gland volumes were smaller and there was enlargement in Wharton ducts caliber in patients infected by the disease, with statistical difference. There was alteration in the glandular and/or ductal morphology in five cases. Ductal branches of second and third order salivary glands in Chagas disease chronic form bearers were not visualized more often than in healthy patients. Xerostomy was the most reported complaint by patients infected by Tripanosoma cruzi, and there was a bigger association with abnormal pharyngeal nasofibroscopy. Sialometry after stimulus showed to be altered in the groups, especially in patients with chronic digestive form.

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