Sialolito gigante do ducto da glândula submandibular: relato de caso / Giant sialolith of submandibular gland duct: case report

Introdução: A sialolitíase é um distúrbio da glândula salivar que afeta 12 em cada 1.000 indivíduos adultos. É caracterizada pela deposição de minerais dentro de seu ducto ou parênquima, sendo a glândula submandibular a mais afetada. Os sialolitos têm tamanhos variados, quando maiores que 15 mm são raros e relatados como sialolitos gigantes. Sialolitos gigantes dentro do parênquima glandular ou porção proximal do ducto são geralmente tratados de forma invasiva por via extraoral com excisão da glândula associada. Relato de caso: Este estudo relata um caso incomum de um paciente diagnosticado com sialolito salivar gigante localizado na porção proximal de um ducto da glândula submandibular, assintomática, tratado por remoção cirúrgica por via intraoral, minimizando riscos potenciais e obtendo sucesso no tratamento. Considerações finais: Mesmo sialolitos localizados em regiões mais profundas do ducto submandibular, o acesso intraoral pode ser uma alternativa viável e de menor risco... (AU)

Introduction: Sialolithiasis is a disorder of the salivary gland that affects 12 out of 1,000 adult individuals. It is characterized by the deposition of minerals within its duct or parenchyma, with the submandibular gland being the most affected. Sialolites have varying sizes, when larger than 15 mm they are rare and reported as giant sialolites. Giant sialoliths within the glandular parenchyma or proximal portion of the duct are usually treated invasively by the extraoral route with excision of the associated gland. Case report: This study reports an unusual case of a patient diagnosed with giant salivary sialolith located in the proximal portion of a submandibular gland duct, asymptomatic, treated by intraoral surgical removal, minimizing potential risks and achieving treatment success. Final considerations: Even sialoliths located in deeper regions of the submandibular duct, intraoral access can be a viable and less risky alternative... (AU)

Sialolitiasis submandibular gigante, extracción quirúrgica y reparación ductal: reporte de caso / Giant submandibular sialolithiasis, surgical removal and ductal repair: case report

Introducción: la patología litiásica de las glándulas salivales forma parte de un grupo de afecciones que perjudica el sistema de drenaje normal de la saliva hacia la cavidad oral, ocasionando lesiones múltiples sobre la glándula afectada. Se realizó el reporte de un caso clínico con esta patología que, por el tamaño del lito, se considera extremadamente rara en nuestro medio. Método: se realizó el reporte de caso y revisión de la literatura (estudios radiológicos, historia clínica y hallazgos clínicos); además, el paciente firmó el consentimiento para esta publicación. Resultados: un paciente masculino de 38 años remitido de consulta externa con un cuadro clínico de 1 semana de dolor, edema y tumefacción en la región submandibular izquierda asociado con una secreción sialopurulenta por la cavidad oral. En la radiografía (Rx) oclusal estricta y en la tomografía axial computarizada (TAC) de cuello contrastado se evidenció una lesión litiásica de más o menos 4,5 x 1,8 cm de diámetro, de característica radiolúcida, a nivel del conducto de wharton. Se dio un manejo quirúrgico por otorrinolaringología maxilofacial, consistente en sialolitotomía y antibioticote- rapia por 10 días, con las cuales se obtuvieron buenos resultados. Conclusiones: la litiasis gigante a nivel del sistema salival (glándula, conductos) es una patología poco común en nuestro medio y está involucrada en el desarrollo de múltiples patología de tipo inflamatorio recurrente de la glándula involucrada, lo cual afecta la calidad de vida de los pacientes. Por esta razón, el diagnóstico y manejo debe ser oportuno para evitar complicaciones, como una infección profunda del cuello; en nuestro caso, el manejo fue oportuno con una extracción quirúrgica por la vía oral del cálculo y la reparación del conducto de wharton del lado izquierdo.

Introduction: the lithiasic pathology of the salivary glands is part of a group of conditions that harms the normal drainage system of the saliva towards the oral cavity, causing multiple lesions on the affected gland, a report of a clinical case with this pathology was made. Due to the size of the stone it is considered extremely rare in our environment. Method: case report and review of the literature (radiological studies, clinical history, clinical findings) patient consent was signed for this publication. Results: a 38-year-old male patient referred from the outpatient clinic with a 1-week clinical picture of pain, swelling and edema in the left submandibular region associated with sialopurulent secretion from the oral cavity in the strict occlusal Rx and a contrast-enhanced neck CT revealed a lithiasic lesion with more or less 4.5 x 1.8 cm in diameter of radiolucent features at the level of the wharton duct, surgical management was given by maxillofacial ENT, consisting of sialolitotomy and antibiotic therapy for 10 days with good results. Conclusions: the giant lithiasis at the level of the salivary system (gland, ducts) is a rare pathology in our environment, is involved in the development of multiple pathologies of recurrent inflammatory type of the affected gland, affecting the quality of life of patients, so the diagnosis and management should be timely and avoid complications, such as deep neck infection; in our case, the management was timely with oral surgical removal of the calculus and repair of the wharton duct on the left side.

Analysis of efficiency of sialendoscopy in patients with sialolithiasis

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

Sialolito 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)

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.

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.

Sialolito de grandes dimensões no ducto da glândula submandibular / Large sialolith in the submandibular gland duct

O objetivo deste trabalho é descrever o caso de um sialolito de grandes dimensões em glândula submandibular. Paciente do sexo feminino, leucoderma, 53 anos, procurou o cirurgião-dentista queixando-se de xerostomia, dor e inchaço na região de assoalho bucal, principalmente observado durante as refeições. O exame físico revelou uma tumefação em região submandibular esquerda, sensível a palpação, além de aumento de volume intra-oral firme, na região sublingual esquerda. Ao ordenhar a glândula submandibular, houve saída de pus. A radiografia oclusal inferior evidenciou extensa imagem radiopaca extensa, bem delimitada, cilíndrica e alongada. A associação dos exames clínicos e radiográficos levou ao diagnóstico de cálculo salivar. Foi realizada excisão cirúrgica da lesão sob anestesia local, com preservação da glândula submandibular. O exame anatomopatológico do cálculo revelou, na macroscopia, uma peça cirúrgica de consistência dura e cor amarela medindo 2,2 cm de diâmetro e, na microscopia, a presença de laminações concêntricas de material calcificado. A paciente encontra-se em acompanhamento há 2 anos e 8 meses, sem queixas de função glandular ou fluxo salivar, sem aumento de volume e exame radiográfico sem alterações. Apesar das grandes dimensões do sialolito, sua localização próxima à saída do dueto permitiu um tratamento conservador com bons resultados para a paciente.

This paper aims to describe a case of a large submandibular sialolith. A 53-year-old Caucasian female looked for for her dentist complaining of xerostomia, pain and swelling in the floor of the mouth, mainly observed during meals. The physical exam revealed a tender swelling on palpation in the left submandibular region, and also a firm intraoral swelling was detected in the left sublingual region. It was possible to draw pus from the submandibular gland. Mandibular occlusal radiography showed an extensive cylindrical and elongated, well-defined radiopaque image in the floor of the mouth. The association of clinical and radiographic findings led to the diagnosis of salivary calculus. The lesion was submitted to surgical excision under local anesthesia and the submandibular gland was maintened. Macroscopic analysis revealed a yellow and hard in consistency specimen, measuring 2.2 cm in length, and microscopic analysis revealed the presence of concentric laminations of calcified material associated with . The patient is being followed up for 2 years and 8 months, with no complaints of salivary flow or gland dysfunction, without gland swelling and no radiographic changes. Despite it being a large sialolith, its location near the exit of the duct allowed a conservative treatment with satisfactory aesthetic and functional results for the patient.

Endoscopy-assisted sialolithectomy for the calculus of the Stensen's duct / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the clinical effects of endoscopy-assisted sialolithectomy for the calculus in the Stensen's duct.</p><p><b>METHODS</b>From August 2005 to July 2013, 67 consecutive patients with calculus (or foreign bodies) in the Stensen's duct underwent explorative and interventional endoscopy in our hospital. The stones (or foreign bodies) were removed by endoscopy-assisted technique. After operation, the patients were followed-up periodically, and treatment effects were analyzed.</p><p><b>RESULTS</b>Among the 67 patients, the stones (or foreign bodies) were completely removed in 58 cases, and almost completely removed in 3 cases, with a success rate of 87% (58/67). Among the 61 stone-removed cases, treatment options included direct removal with aid of basket or forceps (24 cases), basket entrapment and opening-up of the ostium (21 cases), basket entrapment and mucosal incision near the ostium (8 cases), open removal via buccal incision (2 cases) and open removal via pre-auricular flap (6 cases). During the 6-90 months' follow-up of the 61 cases, 48 cases were asymptomatic, 7 had mild symptoms, 3 developed ductal obturation, 1 had numbness in the parotid region, and the remaining 2 were missed.</p><p><b>CONCLUSIONS</b>Endoscopy-assisted sialolithectomy is a safe and effective gland-preservation technique for the patients with parotid gland calculus.</p>

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.

Sialolithiasis in a 10 year old child.

Sialolithiasis is often observed in the oral region, and is caused by the development of a calculus in the salivary gland or duct. This disease is mostly seen in adults or young adults, and seldom develops in children. Of all the cases of sialolithiasis, only 3% are seen in the pediatric population. The clinical presentation typically consists of a painful swelling of the involved salivary gland at meal times, as the obstruction is most acute at this time. The clinical signs often lead to an easy diagnosis. The salivary gland most commonly affected is the submandibular gland. In this paper, we have reported the case of a 10 year old female with sialolithiasis of the left submandibular duct. The treatment consisted of the use of lemon and orange drop candies, which stimulated the salivary flow and in turn resulted in the expulsion of stone.

Sialoendoscopically-assisted sialolithectomy for the hilar stones of the Wharton's duct / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the clinical effects of sialoendoscopically-assisted sialolithectomy for the sialolithiasis in the hilum of the submandibular glands.</p><p><b>METHODS</b>Between December 2005 and March 2011, treated 80 cases of radiography-verified sialiolithiasis in the hilum of the submandibular glands, The patients included 42 males and 38 females aged from 13 to 68 years. All these patients underwent sialoendoscopic observation and sialoendoscopically-assisted sialolithectomy and were followed up periodically for 3 - 6 months after operation. The success rate of stone removal, postoperative complications and clinical effects were analysed.</p><p><b>RESULTS</b>The stones were completely removed in 71 cases, and almost completely removed in 5 cases, with a successful rate of 95% (76/80). Among 76 successful cases, 8 were treated by basket entrapment, 59 by intraoral open surgery and 9 by both of these two techniques. Within 3 - 6 months' follow-up, 1 case suffered temporary lingual nerve parenthesis and two suffered ranula formation.</p><p><b>CONCLUSIONS</b>Sialoendoscopically-assisted sialolithectomy is a safe and effective gland-preservation technique for the patients with the hilum of the submandibular glands.</p>

Clinical, statistical and chemical study of sialolithiasis

INTRODUCTION: Sialolithes are initiated by localized deposition of calcified material in the salivary glands. And that may even cause various symptom especially swelling and pain. This study purposes to collect statistical data of sialolithiasis for clinical analysis. MATERIALS AND METHODS: Among forty seven patients who have visited Seoul National University Dental Hospital during 2004-2009, patients' age, sex, location and size of stone, radiodensity of stone, symptom, surgical procedure were investigated. Statistical correlation between size, location, symptom was evaluated. Chemical composition was analyzed for 3 sialolithes. RESULTS: The average age was 41.4 years. Sialolithiasis had slight female predilection (57.4%). Most cases occurred in the submandibular glands (91.5%). And most cases had radiopaque features (95.8%). The average size was 7.17 mm. The most frequent location of the stones were the duct orifice and the submandibular gland hilum (16 cases in each), followed by the middle part of the duct (n=8), the intraglandular area (n=4), and the proximal part of the duct (n=3). Eleven cases were asymptomatic. Thirty six cases had complaints of pain, swelling, hardness, and decrease in saliva flow (multiple symptoms). Various methods of surgery was performed. Two cases were self-removed. Thirty seven cases underwent procedure involving stone removal alone. Six cases underwent gland extirpation, and two cases underwent ductoplasty. CONCLUSION: There was no statistical correlation between size, location, and symptoms. Sialolith was composed of Ca (58.5-69.3%), P (30.7-35.7%), organic material, and trace inorganic material.

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.

Tratamiento de la sialolitiasis: informe de 22 casos / Treatment of sialolithiasis: report of 22 cases

La sialolitiasis es una patología obstructiva de las glándulas salivales caracterizada por la formación de cálculos en el interior del parénquima o del sistema ductal glandular. El presente estudio retrospectivo fue orientado a evaluar nuestros resultados en el tratamiento de esta afección. Se incluyeron 22 pacientes (12 mujeres, 10 hombres) tratados en nuestro hospital durante un periodo de 5 años. La edad promedio fue de 48,6 años. La glándula submaxilar se afectó en un 86,36 por ciento de los casos, mientras que la parótida lo hizo en un 13,64 por ciento. La sialolitiasis submaxilar se trató con submaxilectomía en 10 casos y con whartectomía para extraer el lito en 7. La sialolitiasis parotídea se trató con remoción intraoral del cálculo en un casoy con parotidectomía parcial en el otro. Se reigstró la expulsión espontánea del sialolito en 3 casos. Sólo se observaron complicaciones posteriores a subaxilectomía: hubo 2 casos de whartonitis, una parestesia transitoria del nervio lingual y una infección de la herida quirúrgica. En conclusión, el tratamiento de la sialolitiasis debe realizarse en función de la localización y tamaño de los cálculos presentes

Sialolitíase em ducto de glândula submandibular: relato de caso clínico / Sialolithiasis in submandibular gland duct: a clinical report

A sialolitíase é uma patologia que acomete as glândulas salivares maiores e menores, especialmente a submandibular. Geralmente, os cálculos salivares (sialolitos) não atingem grandes extensões, raramente ultrapassando 1 centímetro. O objetivo deste artigo é relatar um caso clínico de paciente portadora de sialolito no ducto de glândula submandibular, descrever suas características clínicas e radiográficas e fornecer informações de interesse clínico sobre o tratamento e prognóstico.

The sialolithiasis is a condition that affects the major and minor salivary glands, especially the submandibular. Generally, the calculations salivary (sialoliths) do not reach large, rarely exceeding 1cm. This paper report a case of patient with saliolith the duct of submandibular gland, describe their clinical and radiographic features in addition to providing information of interest on clinical treatmente and prognosis.

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.

unusual large submandibular gland calculus: a case report

Salivary gland stones [Sialothiasis] most commonly occur in the Submandibular duct. This report describes the case of a patient who had an unusual large Submandibular gland sialolith [calculus] that was completely obstructing the Submandibular gland duct and the use of the computed tomography [CT] as a diagnostic aid and a surgical guide. Patients with sialolithiasis require definitive surgical treatment in most cases, which results in an excellent prognosis

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.

Litiasis del conducto de Wharton en la glándula submaxilar derecha / Wharton's duct lithiasis in the right submaxillary gland

Se presenta una revisión bibliográfica actualizada sobre las características clínicas y radiográficas de las litiasis de las glándulas salivales mayores y especialmente de la submaxilar, así como también acerca de los criterios terapéuticos de esta afección. Como valor agregado se describe el caso de un paciente con litiasis múltiple en el conducto de la glándula submaxilar (cuadro clínico, tratamiento y evolución)