THE SALIVARY GLANDS - DIAGNOSIS OF SJOGRENÌS SYNDROME     SjogrenÌs syndrome (SS) is a chronic autoimmune disease of unknown etiology whose presence is based upon clinical, laboratory, and histologic findings. The lacrimal and salivary glands of women in their fifth decade of life are particularly susceptible to this exocrinopathy. With the onset of xerophthalmia and xerostomia, a diagnosis of primary SS (sicca syndrome) is made. Secondary SS occurs when another connective tissue disease (rheumatoid arthritis, lupus erythematosus, etc) is present. Progression of SS to lymphoma has been reported.   Tests for a variety of objective criteria are employed to establish a diagnosis of SS. A positive Schirmer test (quantitation of tear production) vouches for a decreased lacrimation. Such a condition leads to a keratoconjunctivitis sicca whose characteristic ulcerations, when stained with rose bengal, can be visualized with a slit lamp.   Non specific serologic findings include hypergammaglobulinenia, rheumatoid factor, and antinuclear antibodies. However, SS patients usually develop the more specific autoantibodies, anti SS-A (Ro) and anti SS-B (La). The oral components of SS are diverse and include recurrent parotid swellings. With the adaptation of a Lashley suction cup to the parotid duct orifice, the Salivary Gland Center (SGC) can accurately measure salivary volume. The decreased salivation seen in SS results in complaints associated with dryness. Sialochemistry, performed by the SGC laboratory, reveals a diagnostic chemical profile. The SGC also can image the parotid via sialography. SS patients usually demonstrate dye distribution in a droplet pattern (sialectasis) rather than the normal linear branching of the duct system.   The gold standard for the diagnosis of SS is an accessory salivary gland biopsy from the lower lip. This affords the SGC an opportunity to Ïgo for the moneyÓ and directly scrutinize an affected organ (SuttonÌs law*). Microscopic examination involves a search for foci of 50 or more lymphocytes. One focus or more per 4 mm2 is considered positive for SS. *Willie Sutton, a notorious bank robber, when asked why he only robbed banks, answered because that's where the money is. See illustration... Willie in retirement. The Salivary Gland Center (SGC) was developed because a void existed in the diagnostic and comprehensive care of patients with salivary gland problems and/or secretory dysfunction. Since the diversity of these salivary conditions presents challenges to the clinician, the SGC is available for referrals. Louis Mandel, DDS Director, Salivary Gland Center (212) 305-9982