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)

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.

Endoscopic management of sialolithiasis (a practical experience in 52 cases) / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the value of endoscopy in the diagnosis and treatment of sialolithiasis.</p><p><b>METHODS</b>Diagnostic and interventional sialoendoscopic procedures were performed in 52 patients with sialolithiasis (43 submandibular glands and 9 parotid glands).</p><p><b>RESULTS</b>Of the 34 sialoliths in the anterior and/or posterior part of the Wharton's duct, 24 were removed with basket retrieval; 2 removed with open surgery and basket retrieval, and 8 removed with open surgery under the guidance of endoscopy. Eight sialoliths in the hilum of the Wharton's duct were treated with open surgery. Of the 9 stone cases in the Stensen's duct, 3 was removed with basket retrieval, 3 was removed after opening-up of the ostium, 1 was treated with basket capturing and open surgery. The obstructive symptoms were improved in these cases during 1-24 months' follow-up.</p><p><b>CONCLUSIONS</b>Sialoendoscopy is a minimal invasive and efficacious technique for the diagnosis and treatment of sialolithiasis.</p>

Case Report: Parotid Sialolithiasis / 대한이비인후과학회지

Salivary duct lithiasis is a condition characterized by the obstruction of a salivary gland or its excretory duct due to the formation of calcareous concretions or sialoliths resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland. It most commonly involves submandibular gland (80 to 90%) and less frequently parotid (10 to 20%). The authors report 2 cases of parotid sialolithiasis. The first case involved a 46-year-old male patient complaining of the left parotid area pain and swelling, and presenting with a salivary calculus in the left parotid duct. When the patient was diagnosed, he refused surgical removal. The second case involved a 41-year-old male patient complaining of the right parotid area pain and swelling, and presenting with a salivary calculus in the right parotid duct. The sialolith was surgically removed under general anesthesia. In this paper, we also reviewed a series of concepts related to the etiology, diagnosis and treatment of sialolithiasis.

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.

Exames complementares por imagens no diagnóstico e no planejamento cirúrgico de patologias em glândulas salivares / Salivary glands diseases imaging to make diagnoses and surgical decisions

Mudanças no tamanho de uma glândula salivar podem indicar doenças sistêmicas. Porém, é difícil avaliar corretamente estas mudanças somente através de exame clínico. Métodos complementares podem auxiliar de forma fundamental no diagnóstico. Por causa da importância de se identificar pequenos cálculos nas glândulas salivares como a causa de um conjunto de sintomas, radiografias intrabucais etomografia computadorizada são os melhores exames para uma avaliação inicial. A sialografia pode ser utilizada na avaliação de sialoadenites crônicas. Os autores discutem estes e outros exames,como a cintilografia e a ultra-sonografia, no diagnóstico e no tratamento das patologias das glândulas salivares

A clinical study of submandibular gland excision

Salivary glands, major and minor, are susceptible to a wide variety of pathologic conditions. Excision of the submandibular gland is a surgical procedure often undertaken. The procedure is the treatment of choice for patients with neoplasm of the submandibular gland and those with non-neoplastic submandibular disorders which are not controlled with conservative medical measures. Extirpation of the submandibular gland may also be undertaken for diagnostic purposes. We evaluated 84 patients who had been admitted to the Dept. of oral and maxillofacial surgery of Pusan National University Hospital from January, 1989 to December, 2002 and had been performed submandibular gland excision. The results are as follows : 1. The patients undertaken the excision of the submandibular gland showed an age range of 16 to 71 years. The average was 49.1. 2. They consisted of 60 males(71.4%) and 24 females(28.6%), having 2.5 : 1 of genda ratio. 3. The most common symptom was swelling in 41 cases(48.8%), followed by the pain in 23 cases(27.4%). Other symptoms included mass, dysphagia, facial abnormaly and neck dyscinesia. 4. 42 cases(50.0%) showed sialadenitis and sialodochitis associated with salivary calculus. 5. According to the histopathologic study, all cases consisted of 17 neoplasmatic conditions(20.3%) and 67 non-neoplasmatic(79.7%). The neoplasmatic cases included 13 benign tumors and 4 primary malignant tumors. Sialadenitis and sialodochitis associated with or without salivary calculus were most marked, found in 50 cases(59.3%), in the non-neoplasmatic conditions. Pleoomorphic adenoma showed the highest frequency of the benign tumor.

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.

Cálculo salivar / Salivary calculi

Relata-se o caso de paciente do sexo feminino com um cálculo salivar no conduto da glândula submandibular documentado na clínica de Pós-Graduação em Estomatologia da UFPB. Após confirmação diagnóstica por radiografia oclusal, tentou-se remover o cálculo por meio de estímulo por massagem, o que não foi possível. O sialolito foi retirado através de pequena incisão cirúrgica sob anestesia infiltrativa local e apresentou-se com cerca de um centímetro de diâmetro aproximadamente.

Minimally invasive techniques in the management of benign surgical salivary problems

Sialolithiasis is considered as the commonest underlying pathology for sialadenitis, commonly affecting submandibular salivary glands, to lesser extent parotid glands and rarely sublingual or minor salivary glands. Stenosis of secondary and tertiary ducts of the salivary ductal system can also precipitate suppuration of the salivary glands. Patients with history of sialadenitis were best investigated by ultrasound and/or sialography. Patient should be informed by a written consent that if the endoscopic trial failed, the procedure should be shifted to external sialoadenectomy. Interventional sialoendoscopy is a new procedure to visualize the salivary ductal system followed by stone extraction, fragmentation of big stones then extraction or dilatation of stenosed duct by metallic dilator or balloon catheter. The surgical duration ranged between 10-20 minutes, with limited complications as duct perforation requiring sialoadenectomy or duct stenosis with fibrosis that was detected in the routine postoperative ultrasound and/or sialograms. Being a simple outpatient ambulant procedure, sialoendoscopy avoids the risk of general anesthesia and the need to do maximum neck extension in patients suffering of neck problems

Sialoadenitis por sialolitiasis: reporte de un caso / Sialadenitis by sialolithiasis

La sialolitiasis constituye uno de los factores más comunes de disfunción de las glándulas salivales. El éxtasis de la secreción salival producida por la presencia de cálculos en el conducto, con una subsecuente infección bacteriana piógena es la causa más frecuente de sialoadenitis cronica. Se reporta un caso de sialoadenitis por sialolitiasis en la glándula submandibular izquierda, cuyo diagnostico inicial, por el servicio de urgencia del Hospital San Juan de Dios de Cali, fue absceso submandibular. Posteriores estudios, en el servicio de cirugía oral y maxilofacial de la misma institución, llevaron al hallazgo de sialoadenitis de glándula submandibular por retención de flujo e infección. El tratamiento de elección fue la excisión de la glándula por la evolución cronica. En el informe posterior de patología se reporto un proceso inflamatorio severo con el estroma densamente infiltrado de linfocitos formando folículos linfoicles. Acinos no funcionales, canaliculos dilatadas con metaplasia escamosa, formación de cavidades quísticas sin evidencia de malignidad.

Sialolitiasis is one of the most common factors included in salivary gland disease. The principal cause of chronic sialoadenitis is the presence of calculus into the duct which produce a consecuent infection because of estasis of salivary secretion. A case of sialoadenitis is reported. The patient was admitted at the San Juan de Dios Hospital, in Cali. The initial diagnostic was a submandibular absces, however the test revealed a sialoadenitis of submandibular gland because off fluid retention and infection. The treatment was the gland excision. The histopatologic findings reported a severe inflamatory proces in wich the stroma was densely infiltrated by lymphocites that were fonning lynphoids follicles, acines with no function, dilated ducts with scalymethaplasia, cystical cavities without malignancy. One week after the sugery, the patient reported unconfortable for eating and felt her mouth and throat dry. Two months after, she was in good condition.