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.

Paying attention to the protection of the function organ of submandibular gland / 中华口腔医学杂志

Submandibular gland is an important human function organ. With the wide application of sialoendoscope and new understanding of IgG4 related sialadenitis, a lot of submandibular glands which were previously considered to be removed are preserved. However, some submandibular glands which might be preserved are still unfortunately sacrificed. Therefore, we advocate the popularization and promotion of new knowledge and techniques and should pay more attention to the protection of the function organ of submandibular gland.

Submandibular sialolithiasis with CT and scintigraphy: CT values and salivary gland excretion in the submandibular glands

PURPOSE: Sialolithiasis is one of the most prevalent large obstructive disorders of the submandibular glands. The aim of this study was to investigate submandibular sialolithiasis with computed tomography (CT) and scintigraphy, with a particular focus on the relationship between CT values of the submandibular glands and their excretion rate. MATERIALS AND METHODS: Fifteen patients with submandibular sialolithiasis who underwent CT and salivary gland scintigraphy were included in this study. The relationship between the CT values of submandibular glands with and without sialoliths and salivary gland excretion measured using salivary gland scintigraphy was statistically analyzed. Dynamic images were recorded on the computer at 1 frame per 20 seconds. The salivary gland excretion fraction was defined as A (before stimulation test [counts/frame]) / B(after stimulation test [counts/frame]) using time-activity curves. RESULTS: The CT values in the submandibular glands with and without sialoliths was 9.9±44.9 Hounsfield units (HU) and 34.2±21.8 HU, respectively (P=.233). Regarding the salivary gland excretion fraction using scintigraphy, the A/B value in the submandibular glands with sialoliths (1.09±0.23) was significantly lower than in the submandibular glands without sialoliths (1.99±0.57, P=.000). CONCLUSION: Assessments of the CT values and the salivary gland excretion fraction using scintigraphy in the submandibular glands seem to be useful tools evaluating submandibular sialolithiasis.

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...

Rigid swelling of sublingual caruncle area due to the salivary gland duct obstruction by a sialolith

Sialolithiasis is the presence of calculus within the ductal system of a salivary gland. Among the diagnostic methods are inspection, palpation, checking the amount of saliva secreted and the identification of a sialolith. The authors present the case of a 37-year-old female patient with edema of the submandibular area and a bulging sublingual caruncle due to a calculus that obstructed the salivary gland ostium.

Penetração espontânea de objeto metálico em glândula submandibular: relato de caso / Spontaneous penetration of a metalic object in the submandibular gland: case report

Introdução: A obstrução de um ducto salivar por corpo estranho, em que ocorre inflamação crônica e fibrose de glândulas salivares, é de denominada sialoadenite. A obstrução de um ducto salivar por passagem retrógrada acidental de um corpo estranho é muito rara. Revisão de Literatura com Diagnóstico Diferencial: Alguns tipos de corpos estranhos em glândulas salivares já relatados na literatura: cerdas de escova de dente, fios de cabelo, espinha de peixe, semente de girassol, palha e até mesmo lascas de unhas. Esses corpos estranhos se alojam nas glândulas passando pelos ductos salivares gerando o quadro de sialoadenite cujos principais sintomas são: dor, edema e endurecimento da glândula acometida, além de diminuição da secreção salivar. Alguns dos diagnósticos diferenciais que devem ser considerados diante desses sintomas são: síndrome de Sjögren, sialolitíase, sialoadenite aguda e neoplasias de glândulas salivares. Apresentação de Caso Clínico: J.C.S., 32 anos, masculino, procurou atendimento médico com queixa de dor e abaulamento em região submandibular direita há 7 dias, depois de “chupar” um grampo aberto que “desapareceu” no assolho de sua boca. Discussão: O caso foi analisado sob alguns aspectos, para compara-lo com outros casos já relatados na literatura, como: idade, sexo, exames realizados, tratamento adotado, hábitos incomuns como “chupar grampos”. Comentários Finais: Para fazer o diagnóstico de sialadenite por corpo estranho é essencial fazer uma boa anamnese e inspeção da glândula e, assim, conseguir excluir outras hipóteses.

Introduction: The obstruction of a gland duct due to a foreign body, associated with chronic inflammation and fibrosis of the gland, is named sialadenitis. The obstruction of the salivary duct by retrograde passage of an accidental foreign body is pretty rare. Literature Review with Differential Diagnosis: Some types of foreign bodies in the salivary glands already reported in the literature: toothbrush bristles, hairs, fishbone, sunflower seed, straw and even splinters nail. These foreign bodies are lodged in the glands by passing through salivary ducts causing sialoadenitis, whose main symptoms are pain, swelling and hardening of the affected gland, and decreased salivary secretion. Some of the differential diagnosis to be considered due to such symptoms are: Sjögren’s syndrome, sialolithiasis, acute sialadenitis and salivary gland neoplasms. Clinical Case Report: J.C.S, 32 years old, male, complains of pain and swelling of the submandibular region since he “sucked” an opened clip and it “disappeared” in his mouth seven days ago. Discussion: Some aspects of the case were analyzed and compared with others studies of the literature, such as: age, gender, exams that are usually used, chosen treatment, besides unusual habits like “suck clips”. Final Comments: The diagnosis of sialadenitis due to foreign body needs a careful inspection of the gland and also a good anamnesis, to be able to exclude other hypotheses.

Stone of Stensen's Duct Removal by Modified Blair Incision / 대한이비인후과학회지

Parotid sialolithiasis accounts for 10 to 20% of all cases of sialolithiasis that involves the head and neck and presents management challenges for a variety of reasons. In this report, we present a rare case of removing a double stone in Stensen's duct by anexternal approach (open parotid sialolithotomy).

Parotid sialolithiasis in a two-year-old boy / 소아과

Sialolithiasis is caused by the obstruction of a salivary gland or its excretory duct by the formation of calcareous concretions or sialoliths; this results in salivary ectasia and provokes subsequent dilation of the salivary gland. Sialolithiasis is relatively common, accounting for 30% of salivary diseases; however, it is rarely observed in childhood. This case report describes a 2-year-old male patient who complained of a painful swelling over the right cheek, and presented with palpable stones and pus discharge from the orifice of the right Stensen's duct. Computerized tomography of the neck confirmed the diagnosis, and the patient received intravenous empiric antibiotics combined with intraoral sialolithotomy. We also provide a review of the spectrum of concepts regarding the pathogenesis, diagnosis, and treatment of sialolithiasis.

Sialolito gigante em ducto de Warton: relato de caso clínico / Giant sialolith in Warton's duct: a clinical report

Objetivo: Relatar o caso clínico de um sialolito gigante localizado no ducto de warton da glândula submandibular. Relato de caso: Paciente 59 anos, leucoderma com estado de saúde geral regular, compareceu ao serviço de cirurgia Buco-Maxilo do Hospital Santa Isabel/João Pessoa-PB com queixa de "inchaço abaixo da língua e dor quando maior salivação". Ao exame clínico intra-oral foi observado aumento de volume no trajeto do ducto de Warton no segmento de assoalho de boca e após realização de exame de imagem do tipo oclusal de mandíbula observou-se extensa imagem radiopaca em área ductal, concluindo-se assim o diagnóstico de sialolitíase do ducto de Warton. Foi realizado remoção cirúrgica sob anestesia local, com o restabelecimento da patência do ducto e normalidade do fluxo salivar. Conclusão: O diagnóstico e tratamento efetuado no relato de caso clínico descrito foram embasados na literatura e obtiveram eficácia clínica.

Objective: to report a clinical case of a giant sialolith found in the Warton's duct of the submandibular gland. Case Report: Patient 59 years, Caucasian with regular general state of health, attended the Oral and Maxillofacial Surgery service at the Santa Isabel Hospital, Joao Pessoa - PB complaining of "swelling under the tongue and pain when salivating. On intraoral clinical examination, we observed swelling in the path of Warton's duct in the mouth floor segment. After radiographical examination (mandibular occlusal radiograph), we found extensive radiopaque image in the ductal area, establishing therefore a diagnosis of sialolithiasis of Warton's duct. Surgical removal was performed under local anesthesia, with restoration of patency of the ducts and normal salivary flow. Conclusion: The diagnosis and surgical treatment described in this case report were supported by the literature and achieved clinical efficacy.

A Case of Multiple Sialoliths in Sublingual Gland Misdiagnosed as Sialoliths in Submandibular Gland / 대한이비인후과학회지

Sialolithiasis is a major cause of salivary gland dysfunction. The majority of sialolithiasis or salivary stones are found in the submandibular glands or in its duct. As such, the sublingual gland is a very rare site for stone formation. We described a 30-year-old woman with multiple sialoliths in the sublingual gland. These sialoliths were removed by transoral sublingual sialadenectomy. A total of 11 calculi were found.

Sialolito na glândula submandibular: relato de caso clínico / Sialolith of the submandibular salivary gland: case report

Sialolitíase é caracterizada pela formação de cálculos salivaresque se desenvolvem no interior do sistema ductal salivar, decrescimento gradual, lento e assintomático. Acometem principalmenteas glândulas salivares maiores. O presente trabalhotem como objetivo relatar um caso de sialolito assintomático depequenas proporções, localizado na glândula submandibular,identificado casualmente em exame de Tomografia Computadorizadade Feixe Cônico (TCFC) para realização de cirurgiade colocação de implante. Devido ao tamanho do sialolito e daausência de sintomas, o caso foi tratado de forma conservadora,não necessitando de remoção cirúrgica.

Sialolithiasis is characterized by the formation of salivarycalculi that develop within the salivary ductal system of gradualgrowth, slow and asymptomatic. Affect mainly the salivaryglands. This paper aims to report a case of sialolith, with smallproportions, located in the submandibular gland and asymptomatic,which was identified incidentally when the patientunderwent a Cone Bean Computed Tomography (CBCT) examinationfor a surgery to implant placement. Due to the sizeof sialolith and the absence of symptoms, the case was treatedconservatively, not requiring surgical removal.

A Case of Transoral Approach of Multiple Sialolithiasis in Parotid Duct / 대한이비인후과학회지

Sialolithiasis is a condition characterized by the obstruction of a salivary gland or its duct due to the formation of calcareous material or sialoliths resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland or salivary duct. The most difficult cases involve sialoliths in the posterior part of the Stensen's duct, the presence of multiple stones with stenosis of the distal part of the duct. We report on a case of Stensen's duct abscess with multiple sialolithiasis in a 46-year-old man. The patient's cheek was swollen, and showed no evidence of any other lesions. The patient was treated with surgical removal of stones by the intraoral approach, sialodochoplasty and antibiotics therapy. There has been no recurrence nor duct problem during the 12 months period of follow up.

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.

Sialendoscopy: Endoscopic Diagnosis and Treatment of the Salivary Gland Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Obstructive lesion of salivary glands by salivary duct calculi and stenosis is the main inflammatory disease of major salivary glands. Recently, the sialendoscopy has been introduced for the diagnosis and intervention of salivary ductal disease. The purpose of this study is to assess the efficacy of the sialendoscopy for the treatment of inflammatory salivary gland diseases. SUBJECTS AND METHOD: Diagnostic and interventional sialendoscopy were performed in 19 patients (7 parotid glands, 12 submandibular glands), who had salivary duct calculi or recurrent sialadenitis without calculi from 2003 Sep. to 2004 Jun. Diagnostic sialendoscopy was performed for obstructive lesions and evaluation of ductal status. Interventional sialendoscopy was performed for the removal of salivary duct calculi and dilatation of duct stenosis in cases with calculi and stenosis. RESULTS: Diagnostic sialendoscopy was performed in all cases successfully. Sixteen glands had obstructive lesions and 3 glands had sialadenitis with no evidence of obstruction. Only one case with salivary duct calculi was failed. The remaining 10 calculi were removed with microforceps and basket with or without laser fragmentation. The average size of sialoliths was 5.2 mm and multiple stones were found in 2 cases. Five cases with stenosis of parotid and submandibular gland duct were dilated with balloon catheter or endoscopy sheath successfully. In the remaining 3 glands with no obstruction, the finding of ductal inflammation was identified. No major complications were noted. CONCLUSIONS: Diagnostic sialendoscopy is a new and minimal invasive technique for complete exploration of ductal system and evaluating salivary duct disease. Interventional sialendoscopy allows the extraction of salivary duct calculi in most cases and the dilatation of stenotic duct. This technique might be useful in preventing open gland surgery in well indicated cases.

Removal of a submandibular duct calculus with 'SNU Sialoop': Technical report / 대한구강악안면방사선학회지

Manufacturing method and technical procedure of 'SNU Sialoop', which was a new device designed for removal of sialolith, were introduced. Two cases about removal of Wharton' duct sialolith using SNU Sialoop were presented.