Sialolitectomía canicular por sialolito de gran tamaño / Canicular sialolithectomy of a giant sialolith

RESUMEN Introducción: La sialolitiasis es una afección frecuente de las glándulas salivales mayores que se manifiesta con mayor frecuencia en pacientes de sexo masculino. Objetivo: Presentar un caso clínico de una sialoadenitis por sialolitiasis de glándula submandibular, tratado exitosamente mediante sialolitectomía canicular intraoral. Caso clínico: Paciente de 45 años de edad atendido en el Departamento de Cirugía Maxilofacial de la Clínica de Especialidades "Manuel de Jesús Cedeño", Granma, Cuba, por presentar molestias en el suelo de la boca con aumento de volumen de consistencia dura, móvil y fácilmente desplazable. Radiográficamente, se observó una imagen radiopaca de bordes definidos, ovoide de aproximadamente 4 cm de largo y 2 cm de ancho. Se comprobó que se trataba de una sialoadenitis por sialolitiasis de la glándula submandibular derecha. Se trató la sintomatología mediante analgésicos-antiinflamatorios y antibióticos. Se realizó sialolitectomía canicular intraoral. Posteriormente se efectuó una recanalización del conducto lo que permitió la permeabilización de este. Conclusiones: La sialoadenitis por sialolitiasis es una afección con pronóstico favorable, pues cuando se realiza el tratamiento adecuado se logra que la glándula vuelva a su fisiología normal, lo que mejora la calidad de vida del paciente. En nuestro caso se realizó la remoción quirúrgica a través de sialolitectomía canicular intraoral, sin complicaciones. El paciente mostró excelente recuperación tras un mes de evolución, constituyendo un tratamiento satisfactorio a corto y largo plazo(AU)

ABSTRACT Introduction: Sialolithiasis is a common disorder of the major salivary glands which presents more frequently in male patients. Objective: Present a clinical case of sialadenitis due to sialolithiasis of the submandibular gland successfully treated by intraoral canicular sialolithectomy. Case report: A male 45-year-old patient attending the Maxillofacial Surgery Department at Manuel de Jesús Cedeño Specialty Clinic in Granma, Cuba, presents with discomfort on the floor of the mouth and a hard, mobile and easily movable mass of increased volume. Radiographic examination revealed a radiopaque oval-shaped image of well-defined edges, approximately 4 cm long x 2 cm wide. A diagnosis was made of sialadenitis due to sialolithiasis of the right submandibular gland. Symptoms were treated with analgesics / anti-inflammatories and antibiotics. Intraoral canicular sialolithectomy was performed. Rechanneling of the duct was then conducted to allow permeabilization. Conclusions: Sialadenitis due to sialolithiasis is a condition of a favorable prognosis. Appropriate treatment will have the gland return to its normal physiology, improving the patient's quality of life. In our case, surgical removal was conducted by intraoral canicular sialolithectomy without any complications. The patient had completely recovered after one month's evolution, the treatment being satisfactory both short- and long-term(AU)

Efectividad de la succión desembrozante en pacientes con procesos inflamatorios de las glándulas salivales mayores / Effectiveness of the depleting suction in patients with inflammatory processes of the major salivary glands

Introducción: Las inflamaciones agudas y crónicas pueden afectar las glándulas salivales mayores. Objetivo: Evaluar la evolución de los pacientes con procesos inflamatorios de las glándulas salivales mayores tratados con succión desembrozante. Métodos: Se realizó un estudio descriptivo de 49 pacientes con procesos inflamatorios de las glándulas salivales mayores, atendidos en la consulta de Cirugía Maxilofacial del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde septiembre del 2012 hasta junio del 2014. Se utilizó la aspiración quirúrgica para succionar los conductos de las glándulas salivales afectadas. Se estudiaron variables, tales como edad, sexo, glándula salival afectada, agente causal, sintomatología, sesiones de tratamiento y evolución ultrasonográfica. Resultados: Predominaron el grupo etario de 65 años y más (36,7 %) y el sexo femenino (59,2 %). La litiasis fue el factor causal de mayor incidencia y la glándula parótida la más afectada. Los pacientes evolucionaron satisfactoriamente luego de la segunda succión, lo cual demostró la existencia de cambios ultrasonográficos favorables. Conclusiones: La succión desembrozante es un procedimiento sencillo e inocuo que evita el proceder quirúrgico.

Introduction: The acute and chronic inflammations can affect the major salivary glands. Objective: To evaluate the clinical course of patients with inflammatory processes of the major salivary glands treated with depleting suction. Methods: A descriptive study of 49 patients with inflammatory processes of the mayor salivary glands was carried out, they were assisted in the Maxillofacial Surgery service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from September, 2012 to June, 2014. The surgical aspiration was used to suck the tubes of the affected salivary glands. Some variables were studied, such as age, sex, affected salivary gland, causal agent, symptomatology, treatment sessions and ultrasonographic course. Results: There was a prevalence of the 65 and over age group (36.7 %) and the female sex (59.2 %). Lithiasis was the causal factor of more incidence and the parotid gland the most affected one. Patients had a favorable clinical course after the second suction, which demonstrated the existence of favorable ultrasonographic changes. Conclusions: Depleting suction is a simple and innocuous procedure that avoids operation.

An Unusual Case Of Self Extrusion Of A Giant Submandibular Sialolith

Sialolithiasis is the commonest benign disease of salivary glands.It usually occurs in the duct,leading to obstruction of salivary outflow and its associated consequences/symptoms.Of the salivary glands,the submandibular gland is the most frequently affected.Sialoliths usually measure around 5mm in maximum diameter.Calculi measuring greater than 15mm are giant sialoliths and have been rarely reported in literature.Diagnosis of calculi is based on history,examination and radiographic investigations.Management,which aims at the elimination of the calculus and restoration of normal salivary flow,may be either medical or surgical,depending on the site and size of the sialolith,and the condition of the gland.Self expulsion of a sialolith is an unusual occurrence.We report a rare case of a giant Wharton's duct sialolith with spontaneous extrusion into the oral cavity.

Sialólito Gigante em Ducto de Wharton: um caso incomum / Giant Sialolith in the Wharton Duct: An Unusual Case

A obstrução das glândulas salivares por cálculos acomete 90% dessas estruturas, apresentando geralmente tamanho menor que 1 cm. É encontrada, principalmente, nas glândulas submandibulares. Clinicamente, o paciente apresenta um aumento de volume na região referente à glândula salivar envolvida, podendo apresentar sintomatologia dolorosa e drenagem purulenta. O presente artigo relata um caso de sialólito gigante com 2,5 cm de diâmetro, em glândula submandibular, removido cirurgicamente, com preservação funcional da glândula submandibular. O tratamento pode variar de acordo com o tamanho, a forma e localização do cálculo... (AU)

The obstruction of the salivary glands by calculations affects 90% of these structures, usually exhibiting a size smaller than 1 cm. It is mainly found in the submandibular glands. Clinically, the patient presents an increase in volume in the region related to the salivary gland involved and may present painful symptoms and purulent drainage. The present article reports a case of giant sialolith with a diameter of 2.5 cm in the submandibular gland, which was removed surgically with functional preservation of the submandibular gland. The treatment may vary according to the size, shape and location of the calculus... (AU)

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.

Prevalencia de cálculos salivales en la glándula submaxilar evaluados mediante tomografía computarizada de haz cónico en pacientes de 18 a 70 años / Prevalence of salivary calculi in the submandibular gland evaluated by cone beam computed tomography in patients of 18 to 70 years old

Objetivo. Determinar la prevalencia de cálculos salivales en la glándula submaxilar, así como la prevalencia según edad, sexo, ubicación en el conducto y lado afectado, mediante la evaluación de tomografías computarizadas de haz cónico en pacientes de 18 a70 años. Materiales y métodos. Se evaluó 580 tomografías computarizadas de haz cónico (258 de pacientes de sexo masculino y 322 de pacientes de sexo femenino). Las tomografías pertenecieron al centro de diagnóstico maxilofacial y al centro de diagnóstico por imágenes. Se seleccionaron aquellas tomografías que cumplieron los criterios de inclusión, obteniendo la muestra por conveniencia. Resultados. Se observó la presencia de nueve cálculos salivales (1,6%), los cuales más de la mitad estuvieron localizados en el sector posterior del conducto con leve predilección por el lado izquierdo. También se apreció mayor prevalencia entre la cuarta y sexta década de vida. Conclusiones. La prevalencia de cálculos salivales evaluado mediante tomografía computarizada de haz cónico en nuestra población es 1,6%. Así mismo, se confirmó que esta enfermedad tiene mayor prevalencia en personas de 45 a 70 años, y en el sector posterior del conducto salival. Los resultados fueron similares entre ambos sexos, de igual manera sucedió con respecto al lado afectado.

Objective. To determine the prevalence of salivary calculi in the submandibular gland, as well as the prevalence by age, sex, location on the canal and affected side, through the evaluation of cone beam computed tomographies in patients of 18 to 70 years old. Materials and methods. 580 cone beam computed tomographies were evaluated (258 of male patients and 322 of femalepatients). Tomographies were of the ôcentro de diagnóstico maxilofacialõ and ôcentro de diagnóstico por imágenesõ. Tomographies that accomplish the inclusion criteria were selected. The sample was obtained by convenience. Results. 9 salivary calculi (1.6%)was observed, more than half were located in the back left area. Also a higher prevalence between the fourth and sixth decades of life was obtained. Conclusions. The prevalence of salivary calculi evaluated by cone beam computed tomography in our populationis 1.6%. Also, this disease is more prevalent in people between 45-70 years old, and in the back area of the salivary canal. Similar results were obtained in each sex, the same happened with the affected side.

Sialendoscopy / 대한이비인후과학회지

Salivary gland obstruction excluding neoplastic cause is the most common complaint affecting this organ, and it is usually due to sialadenitis, salivary stones, stenosis, inflammatory, or autoimmune etiology. Traditionally, when conservative management fails, surgical intervention was required afterward. The last 20 years have seen rapid development of minimally invasive sialendoscopy in diagnosing and treating salivary gland duct obstructions. Sialendoscopy is an excellent procedure that allows endoscopic visualization of the salivary ductal system, and it also provides an alternative in treatment choice before considering an open surgery which usually make surgeons to hesitate due to its invasiveness and its related complications. The goal of treatment now is to remain a physiologically intact gland, and at the same time to resolve the obstruction of the gland. In this article, the authors reviewed the current status of minimally invasive sialendoscopy.

Perioperative nursing of 83 patients with sialolithiasis treated by sialoendoscope / 中华护理杂志

This paper introduces the perioperative nursing of 83 sialolithiasis patients undergoing sialolithectomy by sialoendoscope. The key points of successful nursing care were careful preoperative psychological nursing and equipment preparation, correct and skilled intraoperative cooperation, and early postoperative health instruction. As a result, all the patients underwent the surgery succesfully and recovered well except 3 cases who needed gland removal later.

Transoral Removal of Submandibular Stone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Traditionally, the treatment of choice for submandibular calculi that lie in the proximal duct or gland parenchyme has been sialadenectomy despite its risk. Recently, minimally invasive techniques including lithotripsy, sialendoscope have been reported, although these techniques have some limitations on large, infected calculi. The aim of this present review is to assess the transoral removal of submandibular calculi. SUBJECTS AND METHOD: The records of a hundred and sixty-three patients who underwent transoral removal of submandibular calculi between January 1, 1995 and July 31, 2004 were retrospectively reviewed. RESULTS: The complete removal of calculi was observed in 147 (90.2%) patients, partial removal with residual calculi in 8 (4.9%) patients and failure of removal in 8 (4.9%) patients. The removal rate of palpable calculi was significantly high. The removal rate of anterior, infection-free calculi was higher than the posterior and infected calculi, but there was no statistical significance. The size of calculi was not related with the removal rate of calculi. A hundred fifty-two (93.3%) of 155 patients in whom some or all of calculi were removed were free of symptoms of calculi. Symptoms were recurred in 19 patients after 2-68 (median 24) months and in 13 patients calculi were removed transorally again. CONCLUSION: The transoral removal of calculi is useful in preservation of the submandibular gland and effective in palpable calculi regardless of location, size, and combined infection.

Sialendoscopy for Salivary Duct Stone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sialendoscopy was introduced with favorable results in the management of salivary duct stones. We recently attempted this new procedure to diagnose and remove sialoliths for the first time in Korea. In this paper, we aimed to find out the clinical efficacy and limitations of sialendoscopy. SUBJECTS AND METHOD: Nine patients, 2 males and 7 females with the average age of 27, who consented to the trial of a new procedure were enrolled in this study beginning in April 2003. Diagnostic sialendoscopy was performed first, and then intervention was attempted after sialoliths were identified. A retrospective analysis was conducted on the characteristics of sialoliths, preoperative work-up, postoperative complications and outcomes. RESULTS: All but one case had sialoliths in the duct of the submandibular gland. In view of diagnostic sialendoscopy, the success rate was 100%, that is, we could detect sialoliths in all cases. In interventional sialendoscopy, however, the success rate was 44% (4 of 9 cases). In 3 cases, the basket broke down or got caught with the stone. Other complications such as salivary duct perforation, bleeding and nerve injury did not occur. CONCLUSION: Sialendocopy is a new, less invasive procedure to visualize the entire salivary ductal system for the diagnosis of salivary duct stone. However, interventional sialendoscopy for the removal of sialolith is a delicate and technically challenging procedure, requiring strict size criteria of the sialolith and much experience of the operator.