SALIVARY GLANDS - ALCOHOLIC SIALADENOSIS     Sialadenosis (sialosis, asymptomatic parotid hypertrophy) is defined as a persistent non-inflammatory bilateral painless soft symmetric enlargement of the parotid glands with infrequent involvement of the submandibular salivary glands. Swellings are caused by metabolic and secretory disorders of the glandular parenchyma. The entity is seen in a variety of endocrinopathies including diabetes, malnutritional syndromes and following the use of some medications. Clinically, sialadenosis is most commonly alcohol related, with approximately 40% of the alcoholics showing signs of parotid enlargement.   Sialadenosis is thought to originate from a dysregulation of the autonomic nervous system. Such neuropathies are part of a pattern often seen in alcoholism. Since sympathetic innervation of the parotid gland is concerned with protein synthesis and protein secretion, sympathetic denervation of the acinar cells leads to inhibition of this activity and intracellular accumulation of zymogen granules. Acinar cells may increase to as much as three times their normal size causing parotid enlargement. However, in cases of long standing alcoholism, the parotid gland swelling may be due to a fatty infiltration resulting from a disturbance in fat metabolism secondary to liver dysfunction. Accurate diagnosis requires differentiation from inflammatory or neoplastic salivary gland disease and mandates a search for liver pathology. When the classic signs of sialadenosis are coupled with an alcoholic history, diagnosis is facilitated. Confirmation of the clinical diagnosis can be clinched with imaging techniques -- sialography and CT scanning. The Salivary Gland Center (SGC) has found that the overall sialographic pattern is essentially normal. Nevertheless, because of the increase in parotid gland size and compression of the duct radicles by acinar swelling, a relative sparsity and thinness of ducts are visualized by the dye study. With CT scanning, a significant increase in parotid density, representing parenchymal hypertrophy, is usually evident. Conversely, late stage alcoholic patients show a decreased parotid density due to increased fat content.   Treatment is directed at the more serious complications of alcoholism. Some diminution in parotid swelling can be anticipated with abstinence and improvement in liver function. Total resolution is not the rule. 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