Sialendoscopy for treatment of major salivary glands diseases: a comprehensive analysis of published systematic reviews and meta-analyses

Abstract Objectives: Sialendoscopy is a minimally invasive procedure used to diagnose and treat obstructive salivary gland diseases. Previous studies in the topic have shown mixed results. The present study aimed to evaluate the efficacy and safety of sialendoscopy through previous systematic reviews for different outcomes of several diseases. We also aimed to assess studies' methodological quality and heterogeneity. Methods: We conducted a comprehensive systematic literature search of Pubmed, Embase, Lilacs and Cochrane Library. We included systematic reviews and meta-analyses that used sialendoscopy to treat both lithiasic and alithiasic salivary glands diseases. Data extraction included studies' characteristics and results. We assessed studies' methodological quality using the AMSTAR-2 (A Measurement Tool to Assess systematic Reviews 2) tool. Results: 13 studies were included in the review, being 9 in adult populations and 4 in pediatric populations. Sialendoscopy proved to be effective at the treatment of different lithiasic and other obstructive diseases, but with important heterogeneity. The technique was also considered highly safe in most studies. However, studies had a critically low quality of evidence. Conclusions: Most studies demonstrated high efficacy and safety of sialendoscopy, but with critically low quality of evidence. We still lack randomized studies in this field, and future systematic reviews on the topic should follow current guidelines to improve conduction and reporting.

Escisión de Glándula Submandibular por Sialoadenitis Crónica Esclerosante Asociada a Sialolito en el Conducto Submandibular / Submandibular Gland Excision Due to Chronic Sclerosing Sialadenitis Associated With Sialolith in Submandibular Duct

La sialoadenitis crónica esclerosante puede extenderse desde una sialoadenitis focal hasta una cirrosis completa de la glándula. Aparece entre los 40 y 70 años de edad y afecta principalmente a la glándula submandibular. Se asocia con sialolitos y agentes infecciosos inespecíficos. La causa más frecuente de sialolitiasis es la formación de cálculos macroscópicamente visibles en una glándula salival o en su conducto excretor, de los cuales el 80 % al 90 % provienen de la glándula submandibular. Esta predilección probablemente se deba a que su conducto excretor es más largo, más ancho y tiene un ángulo casi vertical contra la gravedad, contribuyendo así a la estasis salival. Además, la secreción semimucosa de la misma es más viscosa. El sitio principal de ubicación de los litos en el conducto submandibular es la región hiliar con un 57 %. La sintomatología típica de la sialolitiasis es el cólico con tumefacción de la glándula y los dolores posprandiales. Reportamos el caso de un paciente masculino de 55 años, quien ingresa al servicio de Cirugía Oral y Maxilofacial del Hospital General Balbuena de la Ciudad de México por presentar un aumento de volumen en la región submandibular izquierda de consistencia dura y dolorosa a la palpación de 15 días de evolución, acompañada de aumento de temperatura en la zona compatible con un absceso. Los estudios de imagen reportan un sialolito en la región hiliar del conducto submandibular de 2,0 x 1,7 x 1,0 cm. Debido a su localización y tamaño, el tratamiento ideal en estos casos es la escisión de la glándula junto con el lito previo drenaje del absceso e inicio de terapia antibiótica doble.

Chronic sclerosing sialadenitis can range from focal sialadenitis to complete cirrhosis of the gland. It appears between 40 and 70 years of age and mainly affects the submandibular gland. It is associated with sialoliths and nonspecific infectious agents. The most common cause of sialolithiasis is the formation of macroscopically visible stones in a salivary gland or its excretory duct, of which 80 % to 90 % come from the submandibular gland. This predilection isprobably due to the fact that their excretory duct is longer, wider and has an almost vertical angle against gravity, thus contributing to salivary stasis. In addition, the semimucous secretion of it is more viscous. The main location of the stones in the submandibular duct is the hilar region with 57 %. The typical symptomatology of sialolithiasis is colic with swelling of the gland and postprandial pain. We report the case of a 55-year-old male patient, who was admitted to the Oral and Maxillofacial Surgery Service of the Hospital General Balbuena in Mexico City due to an increase in volumen in the left submandibular region that was hard and painful on palpation of 15 days of evolution, accompanied by increased temperature in the area compatible with an abscess. Imaging studies report a 2.0 x 1.7 x 1.0 cm sialolith in the submandibular duct hilar region. Due to its location and size, the ideal treatment in these cases is excision of the gland together with the stone previous drainage of the abscess and initiation of dual antibiotic therapy.

Suppurative minor salivary gland sialolithiasis

ABSTRACT Sialolithiasis is a common nonneoplastic disease of the major salivary glands that often affects the submandibular glands. Minor salivary gland involvement by sialolithiasis is uncommon, with only 273 cases reported. A long clinical history, acute symptoms, and mucopurulent discharge are unusual features of these cases. Herein, we report the case of a 63-year-old woman who complained of symptomatic nodular swelling of the buccal mucosa associated with purulent discharge for several days. The clinical history lasted 15 years, with episodes of asymptomatic non-suppurative swelling in the same area. The patient underwent surgical excision. The microscopic examination revealed chronic nonspecific sialadenitis associated with psammomatous calcifications, confirming minor salivary gland sialolithiasis. After 3 years of follow-up, the patient was free of symptoms. Patients with sialolithiasis are usually asymptomatic; however, swelling, pain, and fistula may be present in rare cases. The presence of purulent exudate should lead to the differential diagnosis of stomatitis glandularis, a rare inflammatory condition affecting the minor salivary glands. Sialolithiasis and stomatitis glandularis should be considered in the clinical differential diagnosis of symptomatic suppurative nodular swelling affecting the oral mucosa, and histopathological analysis is necessary for the diagnosis.

Sialolithiasis of the submandibular gland associated with stafne bone defect: case report / Sialolitíase da glândula submandibular associada a defeito ósseo de stafne: relato de caso

ABSTRACT Sialolithiasis is the formation of calcific concretions within duct of a salivary gland that affects the submandibular gland with greater prevalence. Stafne bone cavity is a rare mandibular defect of unknown etiology, which commonly presents glandular tissue inside. The aim of this work is to report the first clinical case of sialolithiasis of the submandibular gland with associated Stafne bone defect. Although most of Stafne bone cavity are associated with the salivary gland, there are no studies that prove the association between the two injuries, and further studies are needed to elucidate the relationship between the injuries.

RESUMO A sialolitíase é a formação de cálculos no interior do ducto de uma glândula salivar que acomete com maior prevalência a glândula submandibular. O defeito ósseo de Stafne é um defeito mandibular raro de etiologia desconhecida, que comumente apresenta tecido glandular no interior. O objetivo desse trabalho é relatar o primeiro caso clínico de sialolitíase da glândula submandibular com defeito ósseo de Stafne associado.Apesar da maioria dos desfeitos ósseos de Stafne estarem associado à glândula salivar, não há estudos que comprovem a associação entre as duas lesões, sendo necessários mais estudos para elucidar a relação entre as lesões.

Tratamento cirúrgico de sialólito no ducto da parótida: relato de caso / Surgical treatment of sialolite in the duct of the parotid: case report / Tratamiento quirúrgico de sialolito en el conducto del parótido: reporte de caso

Introdução: Os sialólitos são lesões mineralizadas nas glândulas salivares que causam obstrução total ou parcial do ducto, acometendo comumente a glândula submandibular. Sua abordagem varia de pouco invasiva à cirúrgicas, a depender do número, localização e dimensões dos cálculos. Objetivo: Esse estudo teve como objetivo relatar um caso clínico raro de sialólito no ducto da glândula parótida tratado através da remoção cirúrgica. Relato De Caso: Paciente compareceu ao ambulatório com história de dor e edema em face com 2 meses de evolução, referindo piora da sintomatologia após alimentação. Ao exame físico apresentou edema endurecido em região pré-auricular esquerda e ausência de drenagem no ducto da parótida ipsilateral. Foi realizado uma radiografia de tecidos moles com filme periapical, que revelou imagem radiopaca circunscrita sugestiva de um sialólito no ducto da glândula parótida esquerda. Assim, foi realizada excisão cirúrgica do cálculo seguida do reestabelecimento da patência ductal através da instalação de cateter venoso. Paciente evoluiu bem e segue em acompanhamento sem recidiva dos sinais e sintomas. Considerações Finais: O presente estudo revela que o diagnóstico precoce da sialolitíase e a escolha do plano de tratamento adequado estão associados a um bom prognóstico, e o reestabelecimento da patência ductal, quando danificado, é imprescindível para o sucesso do tratamento(AU)

Introduction: Sialoliths are mineralized lesions in the salivary glands that cause total or partial obstruction of the duct, commonly affecting the submandibular gland. It ranges from less invasive to surgical approach, depending on the number, location and dimension of the calculi. Objective: This study aimed to report a rare clinical case of a sialolith in the parotid gland's duct treated by surgical removal. Case Report: The patient attended the outpatient clinic with a history of pain and edema in the face with 2 months of evolution, reporting worsening symptoms after feeding. On physical examination, he had hardened edema in the left preauricular region and no drainage in the ipsilateral parotid duct. Soft tissue radiography with a periapical film was performed, which revealed a circumscribed radiopaque image suggestive of a sialolith in the left parotid gland's duct. Thus, the calculus's surgical excision was performed, followed by the reestablishment of the ductal patency through the installation of a venous catheter. The patient evolved well and is being followed up without recurrence of signs and symptoms. Final Considerations: The present study reveals that the early diagnosis of sialolithiasis and the choice of the appropriate treatment plan are associated with a good prognosis, and the reestablishment of ductal patency, when damaged, is essential for the success of the treatment(AU)

Introducción: Os sialolitos son lesiones mineralizadas en las glándulas salivales que causan obstrucción total o parcial del conducto, afectando comúnmente a la glándula submandibular. Su abordaje varía desde poco invasivo hasta quirúrgico, dependiendo del número, ubicación y dimensiones de los cálculos. Objetivo: Este estudio tuvo como objetivo reportar un caso clínico raro de sialolito en el conducto de la glándula parótida tratado mediante extirpación quirúrgica. Reporte de Caso: Paciente acudió a consulta externa con antecedente de dolor y edema en el rostro de 2 meses de evolución, refiriendo empeoramiento de la sintomatología tras la alimentación. A la exploración física presentaba edema endurecido en región preauricular izquierda y ausencia de drenaje en conducto parotídeo ipsilateral. Se realizó una radiografía de partes blandas con placa periapical, que reveló una imagen radiopaca circunscrita sugestiva de un sialolito en el conducto de la glándula parótida izquierda. Así, se realizó la escisión quirúrgica del cálculo seguida del restablecimiento de la permeabilidad ductal mediante la instalación de un catéter venoso. El paciente evolucionó bien y se le está dando seguimiento sin recurrencia de signos y síntomas. Consideraciones Finales: El presente estudio revela que el diagnóstico precoz de la sialolitiasis y la elección del plan de tratamiento adecuado se asocian a un buen pronóstico, y el restablecimiento de la permeabilidad ductal, en caso de daño, es fundamental para el éxito del tratamiento(AU)

Salivary Gland Disorders in Children and Adolescents: A 15-year Experience

Abstract Introduction Diseases of the salivary glands are rare in children and adolescents, with the exception of viral-induced infections. Objective To determine the clinical course of the disease, the diagnostic procedures, the treatment and the outcome of all children and adolescents affected with salivary gland diseases at our clinic over a period of 15 years. Methods A retrospective chart review including a long-term follow-up was conducted among 146 children and adolescents treated for salivary gland disorders from 2002 to 2016. Results Diagnosing acute sialadenitis was easily managed by all doctors regardless of their specialty. The diagnosis of sialolithiasis was rapidly made only by otorhinolar- yngologists, whereas diagnosing juvenile recurrent parotitis imposed difficulties to doctors of all specialties - resulting in a significant delay between the first occurrence of symptoms and the correct diagnosis. The severity-adjusted treatment yielded improve- ments in all cases, and a full recovery of 75% of the cases of sialolithiasis, 73% of the cases of juvenile recurrent parotitis, and 100% of the cases of acute sialadenitis. Conclusions Due to their low prevalence and the lack of pathognomonic symptoms, salivary gland diseases in children and adolescents are often misdiagnosed, resulting in an unneces- sarily long period of suffering despite a favorable outcome following the correct treatment.

Multiple sialolithiasis in submandibular gland duct: a rare case report / Sialolitíase múltipla em ducto de glândula submandibular: um relato de caso raro

ABSTRACT Sialolithiasis is a pathological process that affects the major salivary glands. It consists of calcifications that obstruct the parenchyma of the gland and / or the lumen of the ducts. The 37 years old female patient, VBB, leucoderma, attended the stomatology service with a complaint of swelling in the floor of mouth, which she noticed 10 years ago. The clinical and radiographic exams indicated a diagnosis of multiple sialolithiasis in the left submandibular gland duct. Surgical intervention was indicated in this case. Amongst all sialolithiasis cases, 80% affect the submandibular glands. Of these, 70% are isolated sialoliths. Only 5% of cases present more than 3 calcifications. This study aims to report the diagnosis and treatment of a rare case of multiple sialoliths located in the duct of the submandibular gland, which were surgically removed via intraoral access.

RESUMO Sialolitíase é um processo patológico que acomete as glândulas salivares maiores e consiste em calcificações que obstruem o parênquima da glândula e/ou a luz dos ductos. A paciente VBB do sexo feminino, leucoderma, 37 anos, compareceu ao serviço de estomatologia com a queixa de aumento de volume do assoalho bucal esquerdo iniciado a 10 anos. Com os exames clínicos e radiográficos fechou-se o diagnóstico de uma condição rara de sialolitíase múltipla no ducto da glândula submandibular esquerda com indicação de tratamento cirúrgico. 80% dos casos de sialolitíase acometem as glândulas submandibulares e 70% são cálculos únicos. Apenas 5% dos casos apresentam mais de 3 calcificações. O presente trabalho tem como objetivo relatar um caso raro de sialolito múltiplo localizado no ducto da glândula submandibular e tratado através de remoção cirúrgica com acesso intraoral.

Patience Pays Off: A Case of Self Exfoliation of Large Parotid Sialolith

Sialolithiasis is one of the common diseases affecting the salivary glands. The submandibular gland is the most commonly affected gland among the three major salivary glands. The incidence of parotid sialolith is rare and when present, often demands surgical removal. Here, we report a rare case of a female patient presented with large sialolith indicated for surgical removal. However, surprisingly, it resulted in self-exfoliation eliminating the need for surgery as the patient had opted to wait.

Clinical study of endoscopy-assisted lithectomy of parotid gland calculi via a transoral approach / 中华口腔医学杂志

Objective@#To investigate the indications and long-term outcomes of endoscopy-assisted removal of parotid gland calculi via a transoral approach.@*Methods@#From August 2005 to December 2016, 158 consecutive patients with parotid gland calculi underwent endoscopy-assisted lithectomy transorally. They included 71 males and 87 females, with an age of 5-84 years. The immediate safety and effectiveness were evaluated. After surgery, the patients were followed up, and gland function was analyzed on the basis of clinical manifestations, sialography, scintigraphy and sialometry. Postoperative sialograms were categorized into 2 types: ①type Ⅰ, the main duct was normal or had ectasia and stenosis, but no persistent contrast was seen on the functional film; ②type Ⅱ, the main duct had ectasia or stenosis, with persistent contrast media on the functional film.@*Results@#Under one endoscopic procedure, the stones (or foreign bodies) were completely removed in 134 cases and almost completely removed in 10 cases, with a success rate of 91.1% (144/158). Of the 144 successful cases, the treatment options included direct basket retrieval or forceps grasping in 77 cases, basket entrapment with direct ostium incision in 36, basket capture with perio-ostium incision in 23 and perio-ostium incision in 8 cases with impacted stones. In two of the initial 14 failure cases, the stones were discharged spontaneously 3 months after operation. During 3-120 months′ follow-up (mean 36 months) of the 146 patients, one had recurrent stone, two developed ductal obturation, 16 had mild symptoms, and the remaining 127 cases were asymptomatic. Of the postoperative sialograms in 34 stone-free patients 25 were type Ⅰ, 9 were type Ⅱ. Both scintigraphy and saliva flow rate indicated an improvement of the affected gland function in some degree (P<0.05).@*Conclusions@#Transoral endoscopy-assisted removal of parotid gland calculi is a safe and effective technique. It is mainly indicated for mobile stones in the main duct or impacted stones in the anterior third of the Stensen′s duct. Sialography, scintigraphy and sialometry show postoperative improvement of gland function in most of the cases.

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)

Diagnóstico e tratamento de Sialolitíase: relato de caso / Diagnosis and treatment of Sialolithiasis: Case Report

Sialolitos são estruturas calcificadas, que se desenvolvem no interior do sistema ductal salivar, em decorrência da deposição de sais de cálcio ao redor de um acúmulo de restos orgânicos no lúmen do ducto glandular. Acometem, com mais assiduidade, a glândula submandibular e são a causa mais comum de inflamações agudas ou crônicas nas glândulas salivares maiores. Manifestam-se, com maior frequência, em indivíduos adultos de meia-idade, e os sinais e sintomas mais comuns são a dor e a tumefação local. Podem ser evidenciados por radiografias convencionais, tomografia computadorizada, ressonância magnética, ultrassonografia, cintilografia, sialoendoscopia e sialografia. O tratamento inclui a eliminação espontânea mediante orientações ou uso de medicamentos, ou a remoção cirúrgica do sialolito, sendo necessária, em alguns casos, a exérese da própria glândula. Este trabalho tem como objetivo relatar o caso clínico do paciente S.L.M, 44 anos de idade, sexo feminino, caucasiana, atendida na clínica de Cirurgia Bucal da Universidade Federal Fluminense, apresentando um sialolito no sistema ductal da glândula submandibular do lado esquerdo. A paciente foi submetida à remoção cirúrgica do sialolito sob anestesia local, sem maiores intercorrências... (AU)

Sialolites are calcified structures that develop inside the salivary ductal system, due to the deposition of calcium salts around an accumulation of organic remains in the lumen of the glandular duct. They have a more frequent involvement of the submandibular gland and are the most common cause of acute or chronic inflammation in the major salivary glands. They occur more frequently in middle-aged adult patients and the most common signs and symptoms are local pain and swelling. They can be evidenced by conventional radiography, computed tomography, MRI, ultrasonography, scintigraphy, sialoendoscopy and sialography. Treatment includes spontaneous elimination, from guidelines or use of medications, or surgical removal of sialolite, in some cases, the excision of the gland itself. This study aims to report the clinical case of the patient S.L.M, 44 years old, female, Caucasian, attended at the Oral Surgery Clinic of the Federal Fluminense University, presenting a sialolite in the ductal system of the left submandibular gland. The patient was submitted to surgical removal of the sialolite, under local anesthesia, without major intercurrences... (AU)

Sialolito em parênquima de glândula submandibular: relato de caso / Sialolite in parenchyma of submandibular gland: case report

Representando cerca de metade das patologias das glândulas salivares a sialolitíase é uma patologia não neoplásica, inflamatória, caracterizando-se por formação de cálculos no parênquima da glândula salivar ou nos ductos, obstruindo a passagem da saliva. É observada uma maior prevalência de acometimento nas glândulas submandibulares e em homens com idade acima de 40 anos. Considerada multifatorial, possui etiologia desconhecida. Apresenta-se assintomática em cálculos de tamanho reduzido, porém em grandes proporções surgem com sinais e sintomas. Radiograficamente é observado imagem radiopaca em região referente à glândula afetada. Esse trabalho tem como objetivo relatar um caso clínico de um sialolito associado a parênquima da glândula submandibular. Devido às proporções do sialolito associado à queixa da paciente o tratamento cirúrgico foi a melhor opção, alcançando sucesso no pós-operatório(AU)

Representing about half of the pathologies of the salivary glands sialolithiasis is a non-neoplastic, inflammatory pathology, characterized by the formation of calculi in the parenchyma of the salivary gland or ducts, obstructing the passage of saliva. A higher prevalence of involvement in submandibular glands and in men over 40 years old is observed. Considered multifactorial, it has unknown etiology. It is asymptomatic in calculations of reduced size, but in great proportions they appear with signs and symptoms. Radiographically, a radiopaque image is observed in a region related to the affected gland. This paper aims to report a clinical case of a sialolite associated with the submandibular gland parenchyma. Due to the proportions of the sialolito associated to the complaint of the patient the surgical treatment was the best option, reaching postoperative success(AU)

Endoscopy-assisted transoral removal of deep hilar and intraparenchymal stones in the Wharton′s duct / 中华口腔医学杂志

Objective@#To investigate the different surgical approaches and long-term outcomes of endoscopy-assisted transoral removal of deep hilar and intraparenchymal stones in the Wharton′s duct.@*Methods@#From January 2008 to March 2018, 481 consecutive patients with deep hilar and intraparenchymal calculi in the Wharton′s duct underwent endoscopy-assisted transoral removal at Deparment of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology. There were 250 males and 231 females. Their ages ranged from 9-86 years. We operated 476 patients under local anesthesia on an outpatient basis, and the remaining 5 were operated under general anesthesia. On the basis of ultrasonography, spiral CT, sialography and endoscopy, the calculi were classified into 4 types: hilum stones (located at the hilum or proximally with a distance <5 mm from the hilum), infra-hilum stones (intra-glandular stones with a distance of 5-10 mm from the hilum), intraparenchymal stones (with a distance ≥10 mm from the hilum), and multiple stones (concomitant hilum and intra-glandular stones). The treatment approaches included: hilum duct slitting, intraparenchymal duct slitting, submandibulotomy and intraductal retrieval. The success rate, immediate safety and effectiveness of different types of stones were evaluated. After surgery, the patients were followed up, and gland function was analyzed on the basis of clinical symptoms and signs.@*Results@#The calculi sizes varied from 3 to 25 mm, with a mean of 7.8 mm. The calculi were located in the right submandibular gland in 259 patients, in the left submandibular gland in 219 patients and in bilateral glands in 3 patients. The calculi were successfully removed in 446 glands, with a success rate of 92.1% (446/484). The success rate varied according to the stone sites: 97.8% (363/371) for hilum stones, 64.4% (29/45) for infra-hilum stones, 4/16 for intraparenchymal stones and 96.2% (50/52) for multiple stones. The main treatment methods applied included hilum duct slitting in 347 glands, intraparenchymal duct slitting in 13, submandibulotomy in 4, intraductal retrieval in 73, and hilum duct slitting accompanied by intraductal retrieval in 9. Ductal breakage occurred in 2 glands. All patients complained of mild to moderate pain with a duration of 3-7 days. Nine had temporal lingual nerve injury. During 3-120 months′ follow-up (mean 36 months) of the total 484 glands, 1.6% (7/446) developed ranula, 1.3% (6/446) experienced obturation of the main duct and 2.0% (9/446) had recurrent stones. The remaining 95.1% (424/446) glands were symptom-free with good function.@*Conclusions@#Endoscopy-assisted transoral removal of deep hilar and intraparenchymal submandibular calculi is a safe and effective gland-preserving procedure. According to the depth, size and number of the calculi, variant surgical approaches should be attempted to maximize the success rate and to minimize the side effects.

Sialolitíase em glândula salivar menor: relato de caso e revisão de literatura / Sialolithiasis in minor salivary gland: case report and literature review

A sialolitíase é uma afecção que se caracteriza pela obstrução da glândula salivar ou de seu ducto devido à formação de estruturas calcificadas acometendo predominantemente as glândulas submandibulares e muito raramente as glândulas salivares menores. O objetivo deste trabalho é realizar um relato de caso sobre sialolitíase em glândula salivar menor. Paciente do sexo masculino, leucoderma, 54 anos, se apresentou com queixa principal de "tumor na boca". O exame físico intrabucal revelou um nódulo localizado na mucosa labial do lado superior direito, próximo a comissura, único, medindo aproximadamente 2 centímetros no seu maior diâmetro. A ultrassonografia da região do lábio superior evidenciou a hipótese diagnóstica de corpo estranho. O diagnóstico diferencial e o clínico incluíram reação a corpo estranho. Foi realizada a biópsia excisional e durante o ato cirúrgico, foi encontrado um material endurecido, de aproximadamente 3 mm, de cor amarelada, que foi enviado para análise histopatológica, a qual revelou fragmento mineralizado compatível com sialolito. Com base nos achados clínicos e imaginológicos o diagnóstico foi de sialolitíase. Após três meses de acompanhamento, o paciente se apresentou sem evidência da doença. Esta revisão de literatura e o presente relato permitiram concluir que um exame clínico criterioso associado a exames imaginológicos adequados são essenciais para a obtenção de um diagnóstico clínico correto(AU)

Sialolithiasis is a condition characterized by obstruction of salivary gland or its duct due to formation of calcified structure, predominantly affecting the submandibular glands or, rarely, the minor salivary glands. The main objective is to report a case of sialolithiasis in the minor salivary gland on a male patient, leucoderma,54, and his main complaint was a "tumor in the mouth". Intraoral physical examination revealed a nodule located on labial mucosa of the upper right side of the mouth, near the commissure, single, and its diameter measuring approximately 2 cm. The ultrasound examination on the upper lip region resulted in a strange body. The differencial and clinical diagnosis was included strange body. During the excision biopsy surgery, a hardened material, measuring about 3 mm and yellowish was removed and sent for histopathologic exams and the diagnosis was sialolithiasis. After three mouths' follow-up, the patient was free of the disease. This literature review and the present case concluded that a careful clinical examination associated with imaging and histopathology examinations are essential for obtaining a correct clinical diagnosis(AU)

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.

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.

Comparison of the diagnostic performance of panoramic and occlusal radiographs in detecting submandibular sialoliths

PURPOSE: The aim of this study was to assess and compare the diagnostic performance of panoramic and occlusal radiographs in detecting submandibular sialoliths. MATERIALS AND METHODS: A total of 40 patients (20 cases and 20 controls) were included in this retrospective study. Cases were defined as subjects with a submandibular sialolith confirmed by computed tomography (CT), whereas controls did not have any submandibular calcifications. Three observers with different expertise levels assessed panoramic and occlusal radiographs of all subjects for the presence of sialoliths. Intraobserver and interobserver agreement were assessed using the kappa test. Sensitivity, specificity, accuracy, positive and negative predictive values, and the diagnostic odds ratio of panoramic and occlusal radiographs in screening for submandibular sialoliths were calculated for each observer. RESULTS: The sensitivity and specificity values for occlusal and panoramic radiographs all ranged from 80% to 100%. The lowest values of sensitivity and specificity observed among the observers were 82.6% and 80%, respectively (P=0.001). Intraobserver and interobserver agreement were higher for occlusal radiographs than for panoramic radiographs, although panoramic radiographs demonstrated a higher overall accuracy. CONCLUSION: Both panoramic and occlusal radiographic techniques displayed satisfactory diagnostic performance and should be considered before using a CT scan to detect submandibular sialoliths.

Gland excision in submandibular sialolithiasis: a case report / Escisión glandular en sialolitiasis submandibular: reporte de un Caso

It has been shown that about 1 percent of the population suffers from calculi of the salivary glands; 80 percent of them occur in the submandibular gland. The aim of this paper is to present a clinical case of a 34-year-old patient, who was diagnosed with submandibular sialolithiasis and treated surgically for the total removal of the lesion and of the salivary gland, removing the swelling and acute pain. The diagnosis and treatment protocol for sialolithiasis of submandibular gland was carried out according to the latest guidelines, resulting in complete remission of the disease, without functional sequelae during the three months of postoperative follow-up...

Se ha demostrado que alrededor del 1 por ciento de la población padece de cálculos de las glándulas salivales, donde el 80 por ciento de ellos ocurren en la glándula submaxilar. El objetivo de este artículo es dar a conocer un caso clínico de una paciente de 34 años de edad, quien fue diagnosticada de sialolitiasis submandibular y tratada quirúrgicamente para la remoción total de la lesión, junto con la glándula salival, en donde se obtuvo como resultado la eliminación del aumento de volumen y el dolor agudo. El protocolo de diagnóstico y tratamiento para la sialolitiasis de la glándula submandibular fue llevado a cabo de acuerdo a los últimos lineamientos, obteniendo la remisión total de la patología, sin presentar secuelas funcionales durante los tres meses de seguimiento postoperatorio...

Sialolithiasis of minor salivary glands / Sialolitíase de glândulas salivares menores

Sialolithiasis, or salivary calculus, is a disease of the salivary glands, characterized by the formation of mineralized structures within the excretory salivary ducts or the glandular parenchyma. Approximately 80% occur in the submandibular gland, followed by the parotid and sublingual glands. Although rare, sialolithiasis can also occur in the minor salivary glands. Although the oral cavity and upper lip are the most common sites, they can develop in any region of the oral cavity that contains minor salivary glands. Treatment is based on surgical excision of the lesion, with a favorable prognosis. This study presents three cases of sialolithiasis of minor salivary glands of the upper and lower lip, addresses their clinical characteristics and correlation with microscopic findings, diagnosis and treatment plans. Etiology and factors that should be considered during diagnosis, appropriate treatment and improved prognosis are discussed in this study. .

A sialolitíase, ou cálculo salivar é uma doença de glândulas salivares, caracterizada pela formação de estrutura mineralizada no interior dos ductos salivares excretores ou no próprio parênquima glandular. A glândula submandibular é acometida em aproximadamente 80% dos casos seguida das glândulas parótida e sublingual. Embora raro o cálculo salivar também pode ocorrer em glândulas salivares menores. O lábio superior e a mucosa oral são os sítios de envolvimento de maior frequência, embora possam desenvolver-se em qualquer região da cavidade oral que contenha glândulas salivares menores. O tratamento baseia-se na remoção cirurgia, com prognóstico favorável. Este artigo apresenta três casos raros de sialolitíase de glândula salivar menor localizados em lábio superior e inferior, abordando as características clínicas e sua relação com os achados microscópicos, diagnóstico e formas de tratamento. A etiologia da lesão e fatores que devem ser considerados para o diagnóstico, tratamento adequado e um melhor prognóstico são discutidos neste estudo.