THE SALIVARY GLANDS AND SARCOIDOSIS     Sarcoidosis is a chronic systemic granulomatous disease of unknown origin with a special predilection for the lungs and hilar lymph nodes. The varied clinical symptomatology results from infiltration of specific organs. Because the initial manifestation is usually respiratory, an exogenous airborne agent is the suspected culprit.   Diagnosis is based upon radiologic identifications of both the distinctive lung infiltrates and hilar lymphadenopathy and biochemical changes. Final diagnosis awaits the histologic demonstration of the granulomas in other organ structures. Non caseating granulomas with a core of epithelioid and giant cells and a periphery of lymphocytes and fibroblasts are characteristic.   The Salivary Gland Center (SGC) has seen a varied clinical picture of salivary gland involvement in sarcoidosis. The spectrum can be classified into 4 symptom complexes. First, patients already diagnosed with sarcoidosis often develop salivary gland swelling. Usually, bilateral parotid gland swelling is seen. The glands tend to be firm, only slightly tender, and do not fluctuate in size when eating. Spontaneous resolution can be expected but steroids may be prescribed.   Second, although most cases of sarcoidosis do not have clinical sialadenopathy, biopsy of a labial salivary gland reveals granulomas in 58% of the specimens. The third pattern observed in known cases of sarcoidosis, uveoparotid fever (HeerfordtÌs Syndrome), is characterized by the triad of uveitis, parotid swelling and cranial nerve involvement.   Recently, the SGC has become aware of a fourth pattern of salivary gland involvement in sarcoidosis. Patients have been referred with bilateral salivary gland swellings (parotid or submandibular) who were unaware of their sarcoid disease. No subjective respiratory or other systemic complaints were present. Sarcoidosis was diagnosed when the patient was referred for chest films and was confirmed by histologic examination of salivary gland tissue. In these cases, sialadenopathy serves as a clinical herald of a clinically occult sarcoidosis. *********************   The SGC was developed because a void existed in the diagnosis and comprehensive care of patients with salivary gland problems and/or secretory dysfunction. Since the diversity of salivary gland problems presents challenges to the clinician, the SGC is available for referrals at Columbia Presbyterian Medical Center, 630 West 168th Street, New York City 10032, N.Y. Phone (212) 305-9982.   Louis Mandel DDS Director, Salivary Gland Center