Abnormal blood flow to the submandibular glands of patients with Sjogren'ssyndrome: Doppler waveform analysis

Objective. To assess abnormalities in blood flow to the submandibular gland s of patients with Sjogren's syndrome (SS). Methods. Doppler waveform analysis was performed on the facial artery to as sess blood inflow to the submandibular gland of 21 patients with primary SS and 69 healthy subjects. Blood flows were compared before and after secret ory stimulation with lemon extracts. Results. The facial artery of healthy subjects in the resting state exhibit ed a biphasic waveform with a high systolic peak and a prominent second pea k of compliance followed by a low diastolic flow. In contrast, the waveform of patients with SS was more uniform compared with the healthy subjects, s ubstantiated by decreased resistive and pulsatility indices, suggesting a h yperemic state of the downstream vascular bed. After stimulation of salivar y secretion, the facial artery of healthy subjects responded by decreasing resistive and pulsatility indices, waveform changes indicative of increased blood inflow to the submandibular gland. In contrast, the facial artery of patients with SS responded insufficiently to the stimulation, with the mag nitude of changes in the resistive and pulsatility indices being significan tly lower than those of the controls. Doppler waveform abnormalities were c orrelated with the severity of gland damage, supporting a close connection between abnormal blood inflow to the salivary gland and impaired secretory function in SS. Conclusion. Our findings suggest that blood inflow responses to secretory s timulation may be defective in the salivary glands of patients with SS.