Management of a Submandibular Sialolith: A Case Report.

Sialolithiasis is a condition that is characterized by the obstruction of the salivary gland duct opening by calcified mineral deposits due to various factors discussed in this case report. The most common symptom associated with the pathology is difficulty in deglutition, which can often lead to dehydration due to poor water intake. This, in turn further increases the viscosity of saliva which further promotes the formation of sialoliths. The management is dictated by the location and size of the sialolith, and in this case report, the significance of conservative treatment is emphasized while acknowledging the importance of invasive treatment when necessary.

Clinical audit of ultrasonography for detecting sialoliths in the submandibular gland in paediatric patients: A comparison to computed tomography and magnetic resonance imaging.

Objectives: To compare the performance of ultrasonography with magnetic resonance imaging (MRI) and computed tomography (CT) for detecting submandibular sialoliths. Methods: Thirteen patients with suspected submandibular sialoliths who underwent ultrasonography and CT or MRI were included. Sialoliths were diagnosed using CT (11 cases) or MRI (two cases). The submandibular duct was classified into distal and proximal ducts based on the point around the mylohyoid muscle. Sialoliths located in the proximal duct were difficult to differentiate from those located within the submandibular gland (SMG). Therefore, the location of the sialoliths was classified as follows: within the SMG/proximal duct and within the distal duct. The ultrasound results were compared with CT/MRI results. Results: Of the 13 patients included, two had sialoliths in both the SMG/proximal duct and the distal duct, three had sialoliths in the SMG/proximal duct, and five had sialoliths in the distal duct on CT or MRI. In this small cohort, all five sialoliths in the SMG/proximal duct were detected by ultrasoonography; however, of the seven cases with sialoliths located in the distal duct, only three could be detected by ultrasonography. Conclusions: The incidence of sialoliths in the distal duct was higher than that in the SMG/proximal duct. Ultrasonography showed a good performance compared with CT/MRI in the SMG/proximal duct but not in the distal duct.

Sialolithiasis in the Left Submandibular Gland: A Case.

The most common illness affecting the salivary glands is submandibular gland sialoliths. The size of the sialolith and the patient's clinical history mainly influence how this salivary system abnormality is treated. This diagnosis is suggested by a history of salivary gland pain or swelling, particularly during mastication. Palliative therapy combined with conservative therapies, such as the milking of the ducts, can effectively treat small and accessible stones. When a stone or stones are large and inaccessible, surgical therapy should be considered if conservative approaches have not proven to be effective. A case of sialolithiasis affecting the left submandibular salivary gland is described in this article. Under local anesthesia, sialolith was removed following the opening of the duct. The wound was closed with sutures, and the patient was advised to practice tongue exercises and to maintain good oral hygiene.

Sialolithiasis: An Unusually Large Submandibular Salivary Stone.

Salivary stones are termed as sialoliths, and the condition is referred to as sialolithiasis. Pain and swelling in the affected area, especially after eating, occur often. Small, easily accessible stones may be managed with conservative methods, such as milking of ducts, along with palliative care, whereas bigger, more difficult-to-reach stones need surgical removal. In this article, we describe a case of sialolithiasis affecting the right submandibular salivary gland, which was treated by removing the gland and stone surgically. When big stones and the gland are removed extra orally, the results are favorable. Submandibular gland sialoliths are the most frequent kind of salivary gland illness. The treatment of this salivary system problem depends on the patient's clinical history, the size of the sialolith, and the degree of cooperation.

Enormous Asymptomatic Intraoral Sialolithiasis: A Case Report.

Sialolithiasis is one of the most common diseases of salivary glands. More than 80% of the sialoliths occur in the submandibular gland. While most of the calculi are less than 10 mm in size, 7.6% are larger than 15 mm and are classified as giant sialoliths. We demonstrate a rare case of asymptomatic giant sialolith in the left Wharton's duct with a total atrophy of the left submandibular salivary gland. A 48-year-old female patient presented with lumping sensation for 1 month. A left mouth floor mass was found accidentally during examination and was later revealed to be a painless sialolithiasis. Image study revealed a giant sialolith in the left Wharton's duct with duct dilatation and left submandibular gland total atrophy. She underwent transoral sialolithotomy with removal of a huge stone, measuring 3.5 × 1.4 cm in size. Sialolithiasis usually presents with typical symptoms of the involved salivary gland, and the size of calculi is usually less than 20 mm. This is a rare case report of an asymptomatic giant sialolith in the Wharton's duct, causing left submandibular salivary gland total atrophy, and its diagnosis and management.

A Rare Case of a Giant Sialolith Within Wharton's Duct.

Sialolithiasis is a common disease characterized by the formation of calculi within the salivary glands or their ducts. Although many cases of large stones located within the submandibular gland have previously been reported, the presence of a giant stone within Wharton's duct is extremely rare. We report the case of a patient who presented with an unusually large stone measuring about 6 cm in the greatest dimension located within Wharton's duct and causing local swelling and pain. The sialolith was successfully removed intraorally indicating that a minor procedure under local anesthesia can be a successful treatment modality even in the case of a giant sialolith.

Huge sialolith of the submandibular gland: a case report and review of literature.

The formation of stone in the ductal system of the salivary gland is termed sialolithiasis, with the submandibular gland being the most commonly affected. The precise aetiology is unknown but certain factors peculiar to the submandibular gland accounts for its likelihood of developing a calculous disease. Stones are classified based on their dimension, and may be silent or present with symptoms attributable to the size, location and complications. Here, a 50-year-old female who presented with a painless swelling in the left submandibular region that had grown slowly over the previous year, is reported. Following clinical and radiologic evaluation, left submandibular stone disease was preoperatively diagnosed. The patient underwent sialoadenectomy with transient palsy of the marginal mandibular branch of the facial nerve. Histopathology confirmed sialolith (2.7 cm) with severe squamous metaplasia of the duct. This presentation demonstrates some peculiar features attributable to the size, vertical orientation and location of the stone, in addition to the compression of the gland, thick fibrous capsule and significant squamous metaplasia of the duct. These findings require further evaluation for optimal treatment in view of the emerging trends for managing sialolithiasis.

Lactoferrin and the development of salivary stones: a pilot study.

Salivary stones (sialoliths) are calcified structures located in the ductal system of the major salivary glands. Their exact cause is not clear but in general they are characterized by concentric inorganic (hydroxyapatite) layers. The formation is a slow intermittent process which may result in enlargement of the sialolith causing obstruction of saliva secretion resulting in mealtime related pain and swelling of the affected salivary gland. Various studies reported the presence of organic material such as proteins and lipids in the core of sialoliths. In the present study the protein composition of twenty submandibular sialoliths was analyzed. It was found that proteins contributed on average 5% to the dry weight of submandibular stones whereby small salivary stones contained more extractable proteins than large salivary stones. Using a combination of SDS-PAGE gel electrophoresis and Western blotting, we identified α-amylase (in all stones; 100%), lysozyme (95%), lactoferrin (85%), secretory-IgA (75%), MUC7 (60%), complement C4 (60%) and C-reactive protein (35%). The presence, and the combinations, of lactoferrin, lysozyme, s-IgA and α-amylase in sialoliths was confirmed by ELISA. The gradually increasing size of a sialolith might provoke a local inflammatory response in the duct of the submandibular gland whereby the relatively low concentrations of lactoferrin and lysozyme may originate from neutrophils. The interaction of lactoferrin with s-IgA could contribute to the accumulation of lactoferrin in sialoliths. In summary, these results suggest a new pathophysiological role for lactoferrin, in the formation of sialoliths.

[Narrative review of imaging studies of calcifications of the submandibular gland]. / Revisión narrativa de estudios por imágenes de las calcificaciones de la glándula submandibular.

Sialolithiasis is one of the most common pathologies of the major salivary glands and occurs more frequently in the submandibular glands. Between 80 and 95% of sialoliths develop in the submandibular glands, between 5 and 20% in the parotid gland, and only 1% in the sublingual gland. Sialoliths form within the parenchyma and associated duct systems. In Wharton's duct (80-90%) and only 15% in the gland. Sialolithiasis is the cause of pain and inflammation of the salivary gland by obstructing the duct and preventing salivary secretion, before, during and after food.The objective of this article was to review the different diagnostic imaging methods used for the study of calcifications of the submandibular gland, based on different studies reported in contemporary scientific literature, in order to establish the correct diagnosis. A search of the literature was carried out in the main information sources including Medline (via PubMed), SEVIER, SCIELO, and LILACS, using the search terms with a date limitation of the last 5 years on average. The selected articles included information regarding the calcifications of the salivary glands. Imaging studies of salivary gland calcifications can be obtained with conventional radiographs, Sialography, Ultrasonography (US), Computed Tomography (CT) and Magnetic Resonance Imaging (MR).

Pivotal Role of Ultrasonography and Radiology in Diagnosing a Case of Sialolith.

Sialolithiasis is a condition that affects the salivary glands, which commonly occurs within the body of the submandibular gland or the Wharton duct. This condition is characterised by pain in the submandibular area after meals. Conservative therapies such as duct milking and palliative care can provide positive results for small, easily accessible calculi. This report describes the results of radiographic imaging of a 43-year-old patient with pain and swelling in the submandibular region. During the extraoral examination, a 1.5 cm wide diffuse swelling was present in the left submandibular region, and the left submandibular gland was tender and firm. In addition, a solitary, tender left submandibular lymph node was observed. Intraorally, the opening of the submandibular duct was erythematous and inflamed. The patient was advised for necessary investigations, including an orthopantomogram, cone beam CT, neck ultrasound, and left submandibular gland sialography. Ultrasonography was preferred over other imaging techniques due to its non-invasive nature and high accuracy, sensitivity, and specificity in diagnosing sialolithiasis. Timely management of sialolith is critical as delayed treatment can lead to serious consequences. A conclusive diagnosis of left submandibular sialolithiasis, accompanied by sialadenitis, was made based on clinical, radiographic, and ultrasound findings.

Detection and Management of Giant Submandibular Gland Sialolith.

Sialolithiasis is a disease process involving the formation of conglomerates of calcifications in the ductal system or the parenchyma of the salivary gland. The Submandibular gland is more vulnerable to form sialoliths than the other major salivary glands due to its salivary composition and anatomic factors. The management of sialolithiasis is determined by the dimensions and position of the calculi. Here, we discuss a case of a twenty eight mm submandibular sialolith managed by an intraoral approach.

Transoral removal of a hilo-parenchymal submandibular sialolith.

In sialolithiasis, the lithiasis is often large and located at the junction of the middle and posterior third of the duct, in the hilum region. In such cases, transoral approach for submandibular lithiases (TASL) is a useful treatment of choice in patients with large submandibular stones that can be palpated bimanually.

Giant submandibular sialolith: a case report.

Introduction: Salivary glands lithiasis (Sialolithiasis) is defined as calcified concretions in the salivary glands. Most common localization is in submandibular gland. Usually, submandibular stones are mainly located in Wharton's duct, whereas parotid stones are more often located in the gland parenchyma. Sialoliths are usually 5-10 mm in size, and stones more than 10 mm are unusual sizes. Exact etiology of sialolith formation is still unknown. Case Report: We discuss a case of a 70-year-old patient, presenting painful swelling and a giant submandibular gland sialolith successfully treated with open surgery. Conclusions: A careful anamnesis and physical examination of the patient are important in the diagnosis of sialolithiasis. In addition, several imaging techniques, such as panoramic X-rays and Ultrasound, can be applied. The management can be both medical and surgical.

Sialolith of Unusual Size and Shape in the Anterior Segment of the Submandibular Duct.

Sialolithiasis is a common condition characterized by the formation of salivary stones or calculi, also known as sialoliths, within a salivary gland or its duct. Usually, sialolithiasis presents as salivary gland swelling with intermittent pain around mealtime. All salivary glands can develop sialolithiasis, yet it occurs most commonly in the submandibular gland. In this report, we describe an unusual large sialolith measuring 1.7 cm and uncommonly resembling a canine tooth. The sialolith was removed surgically via intraoral approach, and the salivary secretion was restored.

Cost-analysis of in-office versus operating room sialendoscopy: Comparison of cost burden and outcomes.

PURPOSE: Office-based procedures in otolaryngology are increasingly utilized to increase efficiency, reduce cost, and eliminate risks associated with surgery. Gland-preserving surgical management of sialadenitis and sialolithiasis are often performed in the operating room, although many surgeons are moving this practice to clinic. We aim to determine the difference in patient charges and perioperative outcomes for salivary gland procedures performed in the clinic versus the OR. METHODS: Retrospective series of patients presenting with sialolithiasis, acute or chronic sialadenitis, and stricture between 2010 and 2019. Demographics, perioperative variables, setting, and charge data were collected. RESULTS: 528 patients underwent operative intervention (n = 427 office, n = 101 OR). Cohort demographics were comparable. Sialolithiasis was the most common presenting diagnosis in both cohorts. Both cohorts had similar rates of complete (p = 0.09) and partial (p = 0.97) response to treatment. A higher percentage of patients in the OR group reported no improvement (21.4 vs 12.2%, p = 0.034). Overall complications were similar (p = 0.582). Mean charges were statistically greater in the OR ($5560.35 OR vs $1298.33 office, p < 0.001). Operative time was significantly reduced in the office group (21.8 min vs 60.85 min, p < 0.001). CONCLUSIONS: Appropriately selected patients can be successfully treated in outpatient clinic without compromising patient safety or quality while significantly reducing the financial burden to patients and the healthcare system.

Computed tomographic appearance of sialoceles in 12 dogs.

Published findings on the computed tomographic (CT) appearance of sialoceles are limited to brief descriptions from reported cases in eight dogs and one cat. The authors have seen sialoceles with CT characteristics that are not consistent with these previous reports. The purpose of this multicenter, retrospective, descriptive, case series study was to provide more detailed descriptions of the CT appearance of confirmed sialoceles in dogs. Dogs over a 10-year period with cytologically or histologically confirmed sialoceles and pre- and postcontrast CT studies of the head were included. Multiple qualitative and quantitative features were described for each sialocele with histological correlation. Twelve dogs with a total of 13 sialoceles were identified, including: seven cervical sialoceles, three complex (combined cervical and sublingual) sialoceles, two sublingual sialoceles, and one zygomatic sialocele. All sialoceles were characterized by fluid attenuating, non-contrast enhancing contents (median 18.5 HU) and soft tissue attenuating, contrast-enhancing walls. The external margins of all sialocele walls were smooth; however, the internal margins in six sialoceles were irregular with poorly defined nodular to frond-like protrusions. Mineralized foci of variable size (range < 1 mm to 4.8 mm) and attenuation (range 119 to 1253 HU) were present in seven sialoceles and histologically identified as sialoliths (three sialoceles) and osseous metaplasia (two sialoceles). A unique finding in the sialoceles in this study was the presence of intraluminal nodular to frond-like protrusions arising from the wall. This study also reports the CT appearance of cervical and complex sialoceles and sialocele mineralizations.

Painless Giant Submandibular Gland Sialolith: A Case Report.

Sialolithiasis is one of the most common diseases involving the salivary glands. It is a condition that occurs due to an obstruction in a salivary gland or its duct due to a calculus. The formation of a salivary stone is believed to be secondary to the deposition of mineral salts around a nidus, which is frequently associated with a recurrent bacterial infection. Patients with submandibular sialolithiasis usually present with acute swelling over the neck associated with pain, fever, and purulent intraoral discharge. The size of the calculus varies from <1 mm to a few centimeters. The frequency of sialolithiasis is relatively common. It is estimated to affect 12 in 1000 of the adult population. However, the occurrence of giant sialoliths, >15 mm in any diameter, is rare. Here, we describe our experience with a case of giant submandibular sialolithiasis measuring 25 mm presenting as a painless submandibular mass. The patient underwent submandibular gland excision followed by a full recovery.

Indications for the Use of Sialoendoscopy in Sialolithiasis.

The aim of the study is to determine indications for the use of sialoendoscopy in the diagnosis and treatment of sialolithiasis. MATERIALS AND METHODS: The study involved 115 patients with sialolithiasis, who underwent cone beam computed tomography, ultrasound diagnosis of the salivary glands, and sialoendoscopy, in addition to the standard general clinical examination. RESULTS: Sialoendoscopy makes it possible to detect a stone, determine its shape, relative size, mobility, and assess the condition of the salivary ducts. It is impossible to obtain this information by other methods, though it is very important for treatment decision making. The design of the sialoscope and its special instruments make it possible to proceed with sialolith extraction immediately after detecting it. CONCLUSION: The absolute indication for the use of sialoendoscopy is mobile calculi less than 5 mm in diameter (L1 according to F. Marchal's LSD classification). In case of immobile sialoliths less than 4-8 mm in size, located in the main duct (L2), endoscopy should be used as a method supplementary to ductotomy. When sialoliths are located in the distal parts behind the areas of bending or stricture (L3a and L3b), the use of endoscopy is not indicated.

Trial Proteomic Qualitative and Quantitative Analysis of the Protein Matrix of Submandibular Sialoliths.

Our studies aimed to explore the protein components of the matrix of human submandibular gland sialoliths. A qualitative analysis was carried out based on the filter aided sample preparation (FASP) methodology. In the protein extraction process, we evaluated the applicability of the standard demineralization step and the use of a lysis buffer containing sodium dodecyl sulfate (SDS) and dithiothreitol (DTT). The analysis of fragmentation spectra based on the human database allowed for the identification of 254 human proteins present in the deposits. In addition, the use of multi-round search in the PEAKS Studio program against the bacterial base allowed for the identification of 393 proteins of bacterial origin present in the extract obtained from sialolith, which so far has not been carried out for this biological material. Furthermore, we successfully applied the SWATH methodology, allowing for a relative quantitative analysis of human proteins present in deposits. The obtained results correlate with the classification of sialoliths proposed by Tretiakow. The performed functional analysis allowed for the first time the selection of proteins, the levels of which differ between the tested samples, which may suggest the role of these proteins in the calcification process in different types of sialoliths. These are preliminary studies, and drawing specific conclusions requires research on a larger group, but it provides us the basis for the continuation of the work that has already begun.