Recent progress in the treatment of intractable sialolithiasis / 北京大学学报(医学版)

Sialolithiasis occurs in approximately 0.45% to 1.20% of the general population. The typical clinical symptom manifests as a painful swelling of the affected glands after a meal or upon salivary stimulation, which extremely affects the life quality of the patients. With the development of sialendoscopy and lithotripsy, most sialoliths can be successfully removed with preservation of the gland. However, sialoliths in the deep hilar-parenchymal submandibular ducts and impacted parotid stones located in the proximal ducts continue to pose great challenges. Our research center for salivary gland diseases (in Peking University School and Hospital of Stomatology) has used sialendoscopy for 17 years and treated >2 000 patients with salivary gland calculi. The success rate was approximately 92% for submandibular gland calculi and 95% for parotid calculi. A variety of minimally invasive surgical techniques have been applied and developed, which add substantial improvements in the treatment of refractory sialolithiasis. Further, the radiographic positioning criteria and treatment strategy are proposed for these intractable stones. Most of the hilar-parenchymal submandibular stones are successfully removed by a transoral approach, including transoral duct slitting and intraductal basket grasping, while a small portion of superficial stones can be removed by a mini-incision in submandibular area. Impacted stones located in the distal third of parotid gland ducts are removed via "peri-ostium incision", which is applied to avoid a cicatricial stenosis from a direct ostium incision. Impacted parotid stones located in the middle and proximal third of the Stensen's duct are removed via a direct mini-incision or a peri-auricular flap. A direct transcutaneous mini-incision is commonly performed under local anesthesia with an imperceptible scar, and is indicated for most of impacted stones located in the middle third, hilum and intraglandular ducts. By contrast, a peri-auricular flap is performed under general anesthesia with relatively larger operational injury of the gland parenchyma, and should be best reserved for deeper intraglandular stones. Laser lithotripsy has been applied in the treatment of sialolithiasis in the past decade, and holmium ∶YAG laser is reported to have the best therapeutic effects. During the past 3 years, our research group has performed laser lithotripsy for a few cases with intractable salivary stones. From our experiences, withdrawal of the endoscopic tip 0.5-1.0 cm away from the extremity of the laser fiber, consistent saline irrigation, and careful monitoring of gland swelling are of vital importance for avoidance of injuries of the ductal wall and the vulnerable endoscope lens during lithotripsy. Larger calculi require multiple treatment procedures. The risk of ductal stenosis can be alleviated by endoscopic dilation. In summary, appropriate use of various endoscopy-assisted lithotomy helps preserve the gland function in most of the patients with refractory sialolithiasis. Further studies are needed in the following aspects: Transcervical removal of intraglandular submandibular stones, intraductal laser lithotripsy of impacted parotid stones and deep submandibular stones, evaluation of long-term postoperative function of the affected gland, et al.

Sialolitiasis, sialoadenitis y sialoadenosis. Revisión de literatura y reporte de un caso clínico / Sialolithiasis, sialadenitis and sialadenosis. Review of literature and report of a clinical case

Introducción: la formación de sialolitos se considera la alteración más común en las glándulas salivales. Su origen aún no es claro en cuanto a qué provoca la obstrucción parcial o total del sistema de conductos salivales, con una predilección significativa en las glán - dulas submandibulares, lo que permite un desplazamiento retrógrado de bacterias a través del conducto salival hacia la glándula afectada, el cual se traducirá clínicamente como inflamación unilateral o bila - teral. El tratamiento para la sialolitiasis y sialoadenitis puede variar desde un manejo conservador hasta tratamientos que implican la remoción de la glándula salival afectada. La sialoadenosis difiere de las anteriores en su origen, ya que ésta no se considera inflamatoria ni neoplásica y no afecta la función glandular de excretar saliva. Presentación de caso clínico: se trata de paciente masculino con diagnósticos presuntivos de sialoadenitis y sialolitiasis, al cual se le realizó biopsia escisional de la glándula afectada, su estudio histo- patológico corroboró los diagnósticos mencionados anteriormente que además confirmó un diagnóstico de sialoadenosis. Conclusio- nes: la escisión de la glándula salival involucrada se realizará en casos diagnosticados de sialoadenitis y sialolitiasis con sialolitos de gran tamaño y procesos supurativos crónicos que no resuelven con antibioticoterapia (AU)

Diagnosis and Management of Submandibular Sialolithiasis.

Submandibular gland is the most common site of stone formation among all the salivary glands, owing to its long duct, mucus rich saliva and antigravity flow. Swelling and pain on eating is its most common presentation. Most salivary stones are made up of calcium phosphates, and only a few contain pure organic material. Surgical removal is required, and the route of surgery is planned according to the site and size of the stone.METHODSWe conducted a cross sectional study on 25 consecutive patients with a clinical diagnosis of submandibular sialolithiasis. Thorough history taking and clinical examination was followed by ultrasound scan to confirm the diagnosis and establish the site and size of the stone. Stone procured after removal was analysed chemically in the biochemistry laboratory.RESULTSOut of 25 patients, calculi in 11 cases were found in the intraglandular part of the submandibular gland and in 14 cases in the intraductal part of the gland. Out of the 14 cases with stone in the intraductal part, in 4 cases the stone was removed with the help of sialagogues and milking due to the very small size of the stone; whereas, in 10 cases the stone was removed intraorally with marsupialisation of the duct under local anaesthesia. In 11 cases the gland had to be removed along with the stone. As per the biochemical analysis, calcium and phosphate stones were the commonest in our study followed by oxalate calculi. Obtained results showed that the studied salivary stones had almost 10% association with nephrolithiasis. The salivary pH was acidic in 10 cases and alkaline in 15 cases.CONCLUSIONSCharacteristic history, thorough clinical examination and ultrasonic examination help us in the diagnosis of sialolithiasis. The site and size of the calculus is the deciding factor for the surgical plan. Biochemically stones are invariably composed of calcium and phosphates. Simultaneous occurrence of sialoliths and renal calculi was purely by chance or as a comorbidity needs to be studied more in a larger study group.

Parotid sialolithiasis with Stenson’s duct stricture: a rare case report

Sialolithiasis is the most common disease that affects the major salivary glands and occurs mainly in the submandibular gland (80-90%), and to a lesser degree in the parotid gland (5-20%). In literature many papers have been published regarding the parotid calculi and their treatment. However, data on salivary duct strictures management is less with variable opinion. We present a case of 45-year-old female with swelling of right parotid for 6 months, USG showed duct calculi with sialadenitis and sialogram showed large duct calculi with high grade strictures. Duct calculi was removed by intra-oral approach and parotidectomy was done as endoscopic management of strictures failed. This was highlighted case as parotid duct calculi along with high grade strictures are rare.

Analysis of efficiency of sialendoscopy in patients with sialolithiasis

The aim of this research was to analyze 106 clinical observations in which sialendoscopy was performed for diagnosis and treatment patients with sialolithiasis. This research showed, that endoscopy of the major salivary gland ductal system allows to obtain information not only on a sialolith, but also on a condition of ductal system. The obtained data define a method of further treatment. Sialendoscopy can be used not only as diagnostic method, but also as an independent method for sialolith removing or as an assistance. The possibility of sialolith removing depends on its mobility, the size of salivary stone, localization and a salivary duct condition.

Sialolito de grandes dimensões em ducto de glândula submandibular: relato de caso / Sialolite of large dimensions in submandibular gland duct: case report

Introdução: Os sialolitos são calcificações, que ocorrem no interior dos ductos ou nas glândulas salivares. De origem desconhecida, tal afecção constitui uma das mais comuns, que acometem as glândulas salivares, podendo ter tamanhos diversos e localizações. Os sialolitos maiores de 15 mm são considerados raros, podendo gerar uma diminuição da qualidade de vida do paciente em virtude de alterações funcionais da glândula salivar acometida. O diagnóstico de tal afecção é realizado por meio do exame clínico associado a radiografias e, se necessário, tomografia computadorizada na busca de uma maior elucidação do caso. Atualmente, existem diversas modalidades de tratamento para os sialolitos, que irá depender de sua localização e dimensões, variando desde tratamento conservador, com utilização de hidratação e sialogogos à remoção cirúrgica do sialolito. Relato de caso: Este artigo científico tem como objetivo relatar o caso clínico de um raro sialolito de aproximadamente 37 mm, localizado no ducto de Wharton em paciente geriátrico. O caso foi conduzido por remoção cirúrgica do sialolito com a confecção de uma nova desembocadura para o ducto. Considerações Finais: Após 2 anos de proservação, a região de assoalho bucal apresenta sinais de normalidade com relação a fluxo salivar e estruturas anatômicas adjacentes, sem apresentar recidiva da lesão... (AU)

Introduction: Sialoliths are calcifications that occur within the ducts or in the salivary glands. Of unknown origin, this condition is one of the most common that affects the salivary glands and may have different sizes and locations. Sialoliths larger than 15 mm are considered rare, and may lead to a reduction in the quality of life due to functional alterations of the affected salivary gland. The diagnosis of this condition is made through clinical examination associated with radiographs and, if necessary, computed tomography in the search for a better elucidation of the case. Currently, there are several treatment modalities for sialolites, which will depend on their location and dimensions, ranging from conservative treatment with hydration and sialogogs to the surgical removal of sialolite. Case report: This scientific article aims to report the clinical case of a rare sialolite of approximately 37mm, located in the Wharton duct in a geriatric patient. The case was conducted by surgical removal of the sialolite with the creation of a new outlet for the duct. Final considerations: After 2 years of proservation, the buccal floor region shows signs of normality with respect to salivary flow and adjacent anatomical structures and not presenting recurrence of the lesion... (AU)

Classification of Sialolithiasis by Location of Stones: Retrospective Review of 534 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To investigate epidemiological features of patients with sialolithiasis and to evaluate the difference in outcomes depending on its location. SUBJECTS AND METHOD: We included in the test 472 patients, or 534 cases, who were admitted to the Hallym University Sacred Heart Hospital between February 2006 and May 2017 with the diagnosis of sialolithiasis. The diagnosis of sialolithiasis was established by CT images; all of the cases were classified by the location of stones (orifice to stone/orifice to hilum: 0–0.25, type I; 0.25–0.5, type II; 0.5–0.75, type III; 0.75–1, type IV). RESULTS: The average size of stone was 7.2±4.8 mm and the mean patient age was 36.1±17.4 years old. According to the method described above, 534 cases were classified into the following: type I consisted of 188 cases (35.2%), type II consisted of 55 cases (10.2%), type III consisted of 92 cases (17.2%) and type IV consisted of 199 (37.2%). When comparing these types, stones in Type I were significantly smaller than other groups. There was a significant difference in the surgical method depending on the location of stones. Different complications such as swelling, bleeding, tongue discomfort, ranula, recurrence, etc. have been reported and, together, they statistically show meaningful differences in the distribution depending on types. CONCLUSION: The position of stone in Wharton's duct is important factor that can determine the method of surgical procedure or postoperative prognosis. We recommend 4 types classification of sialolithiasis and it can provide more specific diagnosis of disease and facilitate approach for treatment.

The influence of salivary pH and calcium/phosphate ions concentration on salivary gland stones' formation

Sialolithiasis is a multi-factorial pathology that accounts for more than 50% of salivary gland disease. However,the exact impact of salivary pH and calcium (Ca2+) and phosphate (PO43−) on the sialoliths' formation stillremains unknown. Materials and Methods: Seven removed sialoliths were put into flasks with artificial salivasolution that differed in concentrations of Ca2+ and PO43−. The changes in weights of sialoliths and alterations inpH had been measured for 13 weeks. Concentrations of Ca2+ and PO43− in the artificial saliva solution wereestimated at the beginning and at the end of the experiment. Results: Sialoliths' weight decrease was observedfrom the 2nd to 7th week. It occurred parallel with natural pH decrease (from 7 to 6.5 pH). Sialoliths’ weightsstarted increasing after pH was adjusted with NaOH. Analyzing the concentration changes of Ca2+ in everyflask, it was determined that from natural or double Ca2+ concentration, it decreased till similar amount (7–14times). Analyzing the concentration changes of PO43−, it was determined that from natural or doublePO43− concentration it decreased 24 times. Conclusions: Sialoliths' weights decreased parallel with natural pHdecrease and sialoliths grew when pH was adjusted. PO43− ions concentration decreased relatively more thanCa2+ ions concentration.

Sialoadenitis por sialolito inusual de la glándula submaxilar derecha en un adulto / Sialadenitis due to uncommon sialolith of the right submaxillary gland in an adult patient

Se presenta el caso clínico de un paciente de 45 años de edad, atendido en el Departamento de Cirugía Maxilofacial del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres por presentar molestias en el suelo de la boca con 3 años de evolución. Después de un estudio minucioso se comprobó que se trataba de una sialoadenitis por sialolitiasis de la glándula submaxilar derecha. Se realizó sialolectomía canalicular intrabucal. El cálculo extraído tenía forma cónica, más ancho en su porción posterior, de 3,8 cm de largo y 4,2 cm de circunferencia externa, color amarillo-verdoso y consistencia dura friable

The case report of a 45 years patient was presented. He was assisted in the Maxillofacial Surgery Department of Saturnino Lora Torres Clinical Surgical Provincial Hospital in Santiago de Cuba due to discomfort in the floor of the mouth with a course of 3 years. After a detailed study it was confirmed that it was a sialadenitis due to sialolithiasis of the right submaxillary gland. An intraoral canalicular sialolectomy was carried out. The stone removed had a conic form, wider in its posterior portion, 3.8 cm long and 4.2 cm in the external circumference, yellow-green color and friable hard consistency

Clinical application of cone-beam computed tomography in sialolithiasis diagnosis / 中华口腔医学杂志

Diagnosis of sialolithiasis usually needs the combination of clinical and imaging-based examination. The use of cone-beam computed tomography (CBCT) in patients with sialolithiasis has been increasing in dental practice in recent years. CBCT has some advantages in the diagnosis and treatment of sialolithiasis. However, CBCT should not be considered as the first choice for the diagnosis and treatment of sialolithiasis, and it is suitable to be used in the case of complex sialolithiasis which can not be diagnosed by traditional imaging methods. The research progress of the use of CBCT in the diagnosis of sialolithiasis is reviewed.

Removal of submandibular calculi by surgical method and hydraulic power with curved needle: a case report

Sialolithiasis, the most common salivary gland pathology, is caused by calculi in the gland itself and its duct. While patients with small sialoliths can undergo conservative treatment, those with standard-size or larger sialoliths require sialolithotomy. In the present case study, we removed two sialoliths located beneath the mucosa in the posterior and anterior regions of Wharton's duct, respectively. For the posterior calculus, we performed sialolithotomy via an intra-oral approach; thereafter, the small anterior calculus near the duct orifice was removed by hydraulic power. This method has not previously been reported. There were no complications either during the operation or postoperatively, and the salivary function of the gland remained normal.

Robot-assisted submandibular gland excision via modified facelift incision / 대한악안면성형재건외과학회지

BACKGROUND: The conventional transcervical resection for submandibular gland disease has some risks and an unsatisfactory cosmetic result. Recently, robot-assisted surgery has been developed as a plausible substitute for conventional surgery which provides an excellent cosmetic outcome. CASE PRESENTATION: The authors performed robot-assisted sialadenectomy via modified facelift incision using the da Vinci Xi surgical system (Intuitive Surgical Inc., CA, USA) with two endowrist arms (monopolar curved scissors and Maryland bipolar forceps) successfully in a 44-year-old female patient who suffered from sialolith and severe atrophic submandibular gland. CONCLUSIONS: If similar studies are done in the future, this robot-assisted sialadenectomy may become established as an alternative to existing disadvantageous surgical methods.

The application value of cone beam CT in the diagnosis of sialolithiasis / 实用口腔医学杂志

Objective:To find the better imaging method for the diagnosis of sialolithiasis by comparing the 3 different imaging methods.Methods:32 cases of salivary calculus were examined by sonography,X-ray and cone beam computed tomography(CBCT),the sensitivity,specificity,positive predictive value,negative predictive value were compared among the 3 methods.Results:The sensitivity and negative predictive value of cone beam computed tomography(95.8％ and 80％) was significantly higher than those of sonography(83.3％,50.0％) and X-ray(58.3％,20％)(P ＜ 0.05).Of three imaging methods there was no statistical difference in specificity and positive predictive value.Conclusion:CBCT is more sensitive than sonography or X-ray in the diagnosis of sialolithiasis.

Comparison between Sialendoscopy and Conventional Methods in the Treatment of Sialolithiasis

Background: Sialendoscopy is gaining in popularity in treating calculus disease. The delicacy of the instrument and the diameter of the salivary ducts are factors that limit the ability to achieve complete success. There is also continued speculation regarding the utility of the procedure, especially among clinicians who are masters of conventional methods like sialadenectomy and sialodochotomy. Objective: To assess the efficacy of sialendoscopy over conventional methods in treating sialolithiasis. Methods: A prospective case control study was conducted in a tertiary care centre; this study involved 50 patients of sialolithiasis, and it extended over a 36-month period. All had undergone treatment, either by conventional methods or interventional sialendoscopy. All patients with nonpalpable calculi smaller than 6 mm underwent interventional sialendoscopy. Failed sialendoscopies and larger nonpalpable calculi were removed through sialadenectomy. The outcome variables studied included calculus removal, postoperative symptoms, and gland preservation. Results: The success rate in terms of calculus removal by sialendoscopy was 88%, versus 100% by sialadenectomy. The salivary gland was preserved in 88% of the cases in the sialendoscopy group. Only 12% of patients were symptomatic. Conclusion: Sialendoscopy was effective in removing calculi of various sizes; it was definitely superior to conventional methods. Sialadenectomy should be reserved for cases either not suitable for sialendoscopy or in which there was an intervention failure.

A rare case of large submandibular sialolith with spontaneous extrusion

Sialolithiasis is one of the commonest disease of salivary glands. Submandibular salivary gland or its duct is a major site of sialolithiasis and it is always leads to sialadenitis. However large sialolith formation and self-extrusion is a rare condition. A case of submandibular sialolithiasis is reported where patient presents with recurrent submandibular swelling and subsequently end up with a spontaneous extrusion. The mechanisms and management of the salivary gland calculi are also discussed.

Egresos hospitalarios debidos a enfermedades de las glándulas salivales, CCSS, Costa Rica 1997 al 2015

El siguiente estudio descriptivo analiza los casos informados sobre enfermedades de las glándulas salivales de la base de datos del Registro de Egresos Hospitalarios del Área de Estadística en Salud del la Caja Costarricense del Seguro Social, acontecidos durante los años 1997 al 2015, los cuales fueron analizados por los comportamientos de las variables epidemiológicas de tiempo, lugar y persona; estadística descriptiva. La finalidad de este artículo es investigar la casuística que propicie en el profesional en Odontología una herramienta para el diagnóstico precoz, que contribuya al establecimiento individual de la detección oportuna y las medidas de intervención adecuadas. Se registró un total de 1.606 casos de enfermedades de las glándulas salivales, según la Clasificación Internacional de Enfermedades CIE-10; dentro de los resultados obtenidos, la tasa por grupo de edad se concentró en la población de mayores de 65 años con una tasa de 8,28 x 10.000 habitantes; la tasa por localización geográfica en nuestro país fue de 4,34 por cada 10.000 habitantes en la provincia de Alajuela.

The following descriptive study analyzes the cases reported on diseases of the salivary glands of the database of the Registry of Hospital emerges of the Health Statistics Area of the Caja Costarricense del Seguro Social, which occurred during the years 1997 to 2015, which were analyzed by variables of behavior of epidemiological time, place and person, descriptive statistics. The purpose of this article is to investigate the casuistry that helps the professional in dentistry as tool for the early diagnosis that contributes to the individual establishment of the timely detection and the appropriate intervention measures. A total of 1,606 cases of diseases of the salivary glands were registered, according to the International Classification of Diseases ICD-10. Within the results obtained were the rate by age group were concentrated in the population over 65 with a rate of 8.28 x 10.000 inhabitants. The rate by geographic location in our country was 4.34 per 10,000 inhabitants in the province of Alajuela.

Giant sialolith of submandibular gland: case report

Introduction: The sialolith, also known as saliva stone or sialolithiasis is a calcified structure which develops inside the salivary ductal system or on the salivary gland parenchyma; it grows gradual, asymptomatic, and slowly. Most of the stones are sized less than 10 mm and only 7% of them are larger than 15 millimeters; those are considered giant salivary gland stones. Objective: This study aimed to report a case of two sialoliths that have merged, forming a giant sialolith, located in the Wharton duct in the left submandibular gland. Methods and Results: Clinical diagnosis was confirmed by occlusal and panoramic radiographs. A surgical removal was performed with intraoral incision under local anesthesia, through sialolith anchorage by suture thread and removal of two sialoliths, sized about 13 mm and 16 mm. Marsupialization suture was performed at the local where the incision was made, forming a new gland duct. Conclusion: The sialolithiasis treatment methods are very different and should be taken into account the affected gland, size and location of sialolith, always opting for the more conservative methods.

Solitary parotid duct sialolith in a patient with Sjörgren’s syndrome: Report of a case

@#Sjörgren’s syndrome is an uncommon chronic autoimmune disorder that affects exocrine glands. Sialolithiasis is an obstructive salivary gland disease which is also uncommon in the parotid salivary gland. The existing literature has documented the occurrence of multiple calcifications within the parenchyma of the parotid glands in patients with Sjörgren’s syndrome. This report describes the first case of right parotid duct solitary sialolith formation in a 64 year old female patient with Sjörgren’s syndrome. Whether the salivary stone encountered in this case represents an oral manifestation of Sjörgren’s syndrome or is just a co-incidental finding was discussed.

Sialolitos na glândula submandibular: relato de caso / Sialolitos the submandibular gland: a case report

A sialolitíase é uma alteração de glândula salivar que se caracteriza pela deposição de sais de cálcio dentro do ducto de uma glândula, ou mesmo no seu parênquima. A hipótese etiológica mais aceita é a de que os sialolitos se originam da deposição de sais de cálcio ao redor de restos orgânicos acumulados no interior do ducto, que por sua vez podem resultar de fatores como infecções, traumas, presença de corpos estranhos e de células epiteliais descamadas, além disso, a glândula mais atingida é a submandibular pela sua posição anatômica e composição salivar. O diagnóstico é feito através de exames clínicos e imaginológicos e o tratamento vai depender do tamanho e da localização do sialolito, podendo variar de estimulação da saliva até a remoção cirúrgica da glândula envolvida. Este estudo objetiva relatar um caso clínico de um paciente com dois cálculos presentes no ducto e um cálculo presente no parênquima da glândula submandibular. O tratamento proposto foi a cirurgia de exérese intraoral dos cálculos ductais e extra oral da glândula submandibular direita juntamente com o seu sialolito

The sialolithiasis is a change in salivary gland which is characterized by the deposition of calcium salts within the duct of a gland or the parenchyma. The etiological most widely accepted hypothesis is that the sialolitos arise from deposition of calcium salts accumulated around inside the duct, which in turn can result from factors such as infection, trauma, foreign bodies and cell debris organic desquamated epithelial furthermore, more submandibular gland is achieved by its anatomical position and salivary composition. Diagnosis is by clinical examination and imaging and treatment will depend on the size and location of sialólito, ranging from stimulation of saliva to the surgical removal of the gland involved. This study aims to report a case of a patient with two calculations present in the duct and a present in the parenchyma of the submandibular gland calculus. The proposed treatment was surgical excision of ductal intra oral and extra oral calculations of the right submandibular gland along with its sialolito

A Case of Fish Bone-Induced Submandibular Gland Stone / 대한이비인후과학회지

Sialolithiasis is the most common disorder associatd with major salivary glands. It may form in any salivary glands or ducts, but is reported to occur more often in the submandibular gland than in the parotid or sublingual gland. Although the pathogenesis is not perfectly revealed, there appear to be several factors that predispose the submandibular gland duct to be a common site of sialolithiasis. Sialolithiasis occurs as a consequence of the precipitation of calcium salts around a central nidus of desquamated epithelial cells, inflammatory cells, mucoid gels or foreign body. However, it is not a common thing that foreign body entered into the salivary duct through duct orifice may act as the initiating factor. We have recently experienced a case in a 52-year-old female, in which sialolithiasis seems to have formed due to a a foreign body, a fish bone, in the right submandibular gland duct.