Saliva plays an important role in supporting upper gastrointestinal tract function and oral well-being. Salivary dysfunction mainly manifests with a decrease in salivary flow. Among varieties of quantitative methods, salivary scintigraphy is a relatively noninvasive, well-tolerated, reproducible, and objective approach for functional evaluation of salivary disorders, yet the lack of precise quantitative reference values and no standardized protocol limit its generalized utilization. In this article, we review the scintigraphic performance between the visual analysis and quantitative methods in predicting Sjögren’s syndrome and verify the potential aspects of the application in interpreting different disease entities and phases of functional salivary disorders.

Context: Cervical lymph node metastases are common in papillary thyroid carcinoma (PTC), causing recurrence and poor regional control, highlighting the need for accurate diagnostics. Although fine-needle aspiration with thyroglobulin washout (FNA-Tg) shows promise, its diagnostic performance and association with serum biomarkers across settings remain unclear. Objective: To assess the diagnostic performance of FNA-Tg for cervical lymph node metastases in PTC and its correlation with serum thyroglobin (s-Tg) and s-Tg antibody (s-Tg-Ab) levels. Data Sources: PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Ovid Medline were searched for relevant studies. Study Selection: Studies enrolling PTC patients with cervical lymphadenopathy who underwent FNA-Tg pre- or postthyroidectomy were included. Studies involving non-PTC populations or lacking sufficient data for 2 × 2 diagnostic table construction were excluded. Data Extraction: Data were independently extracted by 3 researchers, and study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Data Synthesis: FNA-Tg showed pooled sensitivity of 0.94 [95% confidence interval (CI), 0.91-0.96], specificity of 0.92 (95% CI: 0.88-0.94), and diagnostic odds ratio (DOR) of 174.20 (95% CI: 87.05-348.61), with an area under curve (AUC) of 0.98 (95% CI: 0.96-0.99). Postthyroidectomy, sensitivity increased to 0.96 (95% CI: 0.94-0.98), specificity to 0.93 (95% CI: 0.86-0.96), and DOR to 305.87 (95% CI: 127.99-730.93), with an AUC of 0.98 (95% CI: 0.97-0.99). In the group without thyroid gland present, sensitivity was 0.96 (95% CI: 0.93-0.97), specificity 0.93 (95% CI: 0.87-0.97), and DOR 300.27 (95% CI: 118.47-761.05), with an AUC of 0.98 (95% CI: 0.97-0.99). Likelihood ratio scattergrams and Fagan plots supported its discriminatory ability. FNA-Tg correlated weakly with s-Tg but not with s-Tg-Ab. Conclusion: FNA-Tg showed high diagnostic accuracy, especially after thyroidectomy, with minimal s-Tg-Ab interference, supporting its role in PTC surveillance.

Acute invasive fungal rhinosinusitis (AIFR) is a potentially lethal infection commonly found in immunocompromised patients. It is considered the most aggressive subtype of fungal sinusitis and can lead to severe morbidity and mortality. There was a significant increase in the incidence of AIFR in post-COVID-19 patients compared to AIFR cases before the COVID-19 pandemic. This study aimed to describe the clinical presentation of AIFR associated with COVID-19 illness. A retrospective study included 22 patients diagnosed with AIFR with a recent COVID-19 infection. The most frequent disease associated with AIFR was diabetes mellitus (95.5%). The mycological analysis identified infection caused by Aspergillus species in 72.7% of patients. Along with stabilizing hemodynamic parameters and controlling any comorbidities, all patients in the present study underwent combined surgical debridement followed by antifungal medications. The overall survival rate was 72.7%. The chance of developing a fatal outcome was significantly higher if meningitis presented initially (odds ratio 35.63, p < 0.05). The presence of meningitis upon initial diagnosis is related to a significantly higher chance of developing a fatal outcome and should be considered, especially in AIFR patients previously treated for COVID-19 infections. Early diagnosis, early use of antifungal agents, aggressive surgical debridement, and control of comorbid conditions remain crucial in managing AIFR.

Spontaneous cerebrospinal fluid (sCSF) leak from the skull base has been previously reported, but there are few reports of sCSF leak from the foramen rotundum due to its rare occurrence. This case report describes a 15-year-old male patient that presented with left side watery rhinorrhoea that had been present since he was 4 years of age and a history of repeated bouts of meningitis of unknown cause. A discharge sample from the nose tested positive for beta-2 transferrin. Preoperative computed tomography (CT) revealed a fistula between the cerebellopontine angle and the left sphenoid sinus. There was also a pseudo-Chiari malformation type I with ectopia of the cerebellar tonsil. Endoscopic transnasal surgery identified a leak from the foramen rotundum that was repaired using autologous material and a contralateral pedicle nasoseptal flap. At 6 months after surgery, the patient reported no recurrence of the CSF leakage. Postoperative CT imaging revealed that the cerebellar tonsil was back in the normal position, indicating that the preoperative Chiari malformation was possibly due to decreased CSF volume. This current case shows that a rare case of sCSF leak from the foramen rotundum can be effectively repaired using the endoscopic transnasal approach.

Aim: To evaluate feasibility of establishing a clinically applicable reference value through those unaffected salivary gland on sialoscintigraphic data obtained from patients presented with obstructive sialadenitis affected a single gland. Materials and methods: Ninety-one patients suffered from single salivary gland swelling, pain/tenderness and received sialoscintigraphic examinations were retrospectively enrolled. The quantitative data parameters, including the uptake ratio, maximal accumulation, maximal excretion, time to maximal (T _max) and time to minimal (T _min) activity of the affected and unaffected glands, were calculated for analysis. Data were also obtained and recorded for comparison from 50 patients who fulfill the American–European criteria for the diagnosis of Sjogren’s syndrome. Results: The maximal excretion appeared to be the best indicator for distinguishing affected and unaffected glands of obstructive diseases, for parotid and submandibular glands (P = 0.0002 and P < 0.0001, respectively). The area under the receiver-operating characteristic curve (AUC) is 0.82 for submandibular glands. In patients with Sjogren’s syndrome, the maximal excretion and T _min were the best parameters, for parotid (P = 0.002 and P < 0.0001, respectively) and submandibular glands (P < 0.0001 and P = 0.002, respectively). Uptake ratio was a good parameter for submandibular gland (P < 0.0001). The AUC of maximal excretion and uptake ratio for submandibular glands is 0.81 and 0.77, respectively. Conclusion: Quantitative data obtained from the unaffected glands of patients with obstructive sialadenitis could be used as reference values for the functional evaluation of salivary gland disorders with maximal excretion as one of the reliable parameters.