Symmetrical lymphomata of the lacrimal and salivary glands (Mikulicz's disease) / by S. Lewis Ziegler.

  • Ziegler, S. Lewis (Samuel Lewis), 1861-1926.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Symmetrical lymphomata of the lacrimal and salivary glands (Mikulicz's disease) / by S. Lewis Ziegler. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    preauricular glands may participate in this process. The sublingual glands (Fig. I, aa) and the glands of the palate (Fig. 2) have also been affected in many cases. Involvement of the Blandin-Nuhn glands may cause a distinct nodular swelling on the tip of the tongue. Occasionally some of the other glands have shown enlargement, but their interrelation has not been proved. Osier noted enlargement of the spleen, of the cervical chain, and of the tonsils in his case. Sandford reported hypertrophy of the tonsils and adenoid tissue of the pharynx. Haltenhoff found marked tonsillar enlargement. I have likewise noted enlarged tonsils in both of my cases. Such condi- tions were usually antecedent, however, and neither synchronous nor associated. Otherwise, no evi- Fig. 2.—Enlarged glands of the palate. (Mikulicz.) dence of a general lymphatic disturbance has been educed. The objective symptoms of this disease are chief- ly a dense, brawny swelling of the glands involved, nonpainful but sometimes tender to pressure, freely movable under the skin, but occasionally adherent to the subjacent tissues. The facial appearance is quite characteristic. There is a marked broaden- ing of the cheeks as in mumps, and partial ptosis on the temporal side, the drooping eyelids resembling those of a bloodhound. Elevation of the lid at the external canthus often reveals a downward displace- ment of the retrotarsal fold by the swollen and pendulous lacrimal gland (Fig. 3). Both parotid re- gions are occupied by a broad, oval tumor, which may be knobby or lobulated, and frequently dis- places the ear lobe upward and outward. The sub- maxillaries do not, as a rule, protrude on the skin