Giant Sialolith of Submandibular Duct.

Sialolithiasis is one of the most common diseases of salivary glands and commonly involves submandibular gland and ducts. "Giant sialoliths" typically measure more than 15 mm in any dimension. Here, an unusual case of sialolith in submandibular duct is reported which progressed into a giant sialolith in six months' time is reported. A 42-year-old man presented with complaints of recurrent pain and swelling in the right submandibular area. A large stone was palpable intraorally within the Wharton's duct and intra-operatively, an elongated giant sialolith of 50 mm length was found which is the second largest to be published till date.

Causes, natural history, and incidence of salivary stones and obstructions.

Uncertainty about the causes and natural history of salivary stones (sialoliths) and other obstructions is being dispelled by clinical and experimental research. Sialoliths are now shown to be secondary to chronic obstructive sialadenitis. Microscopic stones (sialomicroliths) accumulate during secretory inactivity in normal salivary glands and produce atrophic foci by obstruction. Microbes ascend the main salivary duct during secretory inactivity and proliferate in atrophic foci and cause spreading inflammation, leading to inflammatory swelling and fibrosis that can compress large ducts. This leads to stagnation of secretory material rich in calcium that precipitates onto degenerating cellular membranes to form a sialolith.

Modern management of obstructive salivary diseases.

Over the last fifteen years, increasing public demand for minimally-invasive surgery and recent technological advances have led to the development of a number of conservative options for the therapeutic management of obstructive salivary disorders such as calculi and duct stenosis. These include extracorporeal shock-wave lithotripsy, sialoendoscopy, laser intra-corporeal lithotripsy, interventional radiology, the video-assisted conservative surgical removal of parotid and sub-mandibular calculi and botulinum toxin therapy. Each of these techniques may be used as a single therapeutic modality or in combination with one or more of the above-mentioned options, usually in day case or one-day case under local or general anaesthesia. The multi-modal approach is completely successful in about 80% of patients and reduces the need for gland removal in 3%, thus justifying the combination of, albeit, time-consuming and relatively expensive techniques as part of the modern and functional management of salivary calculi. With regard to the management of salivary duct anomalies, such as strictures and kinkings, interventional radiology with fluoroscopically controlled balloon ductoplasty seems to be the most suitable technique despite the use of radiation. Operative sialoendoscopy alone is the best therapeutic option for all mobile intra-luminal causes of obstruction, such as microliths, mucous plugs or foreign bodies, or for the local treatment of inflammatory conditions such as recurrent chronic parotitis or autoimmune salivary disorders. Finally, in the case of failure of one of the above techniques and regardless of the cause of obstruction, botulinum toxin injection into the parenchyma of the salivary glands using colour Doppler ultrasonographic monitoring should be considered before deciding on surgical gland removal.

Fístula cutánea parotídea de origen litiásico / Cutaneus fistulae of the parotid gland of litiasic origin

Presentamos el caso clínico de un varón de 63 años con fístula cutánea en la región parotídea izquierda secundaria a un cálculo intraparotídeo de gran tamaño. Los cálculos salivares son más frecuentes en la glándula submaxilar, y en su mayoría son de pequeño tamaño; la presencia de una fístula cutánea en su diagnóstico y tratamiento de la litiasis parotídea (AU)

[Recovery of submandibular gland function following transoral sialolithectomy].

OBJECTIVE: Investigate the recovery of the submandibular gland function following transoral sialolithectomy. METHODS: The glandular function of 26 patients who received the transoral sialolithectomy were investigated by sequential scintigraphy with 99m Tc pertechetate. RESULTS: Most glandular function recovers normal in short time after operation. Glandular infection, calculus diameter and patients's age could influence the recovery of function. CONCLUSION: In the treatment of sialolithiasis, breaking up the pathogenic process of calculus formation and effectively controlling the glandular infection are very important in preventing from the function reduction. After transoral sialolithectomy preserving the anatomical normal orifice of the duct, and using silivators may be very favorable for the function recovery.

[Implementation and indications for quantitative sialoscintigraphy]. / Durchführung und Indikationen der quantitativen Sialoszintigraphie.

BACKGROUND: Since its introduction in 1965 salivary gland scintigraphy has been an established method to simultaneously investigate excretion function in major salivary glands. In order to elucidate parenchymal function of salivary glands, several authors described various quantitative and semiquantitative methods. However, no standardized protocol for quantitative salivary gland scintigraphy has been established so far. METHODS: Therefore, in this paper we report on a standardized and validated acquisition protocol for salivary gland scintigraphy using 99mTc-pertechnetate. RESULTS: A normal data base for both parenchymal and excretion function is given in detail. In addition, the diagnostic value of salivary gland scintigraphy is reviewed in various clinical settings, such as mild parenchymal damage in beginning Sjögren's syndrome, proof of functional obstruction in sialolithiasis with and without parenchymal damage, and parenchymal damage following radioiodine treatment. In a second part, applications of salivary gland scintigraphy in current clinical research are described, and radiation protection of salivary glands in rabbits and patients treated with high doses of I-131 are discussed. CONCLUSIONS: Salivary gland scintigraphy is a study that is easily performed and well tolerated by the patient. It yields quantitative parameters for parenchymal function and excretion fraction.

Evaluation of submandibular gland function by sialo-scintigraphy following sialolithectomy.

Submandibular gland function following transoral sialolithectomy was examined by 99mTc-pertechnetate sialo-scintigraphy in 10 cases. An intraindividual comparison between the function of the treated gland and that of the contralateral normal gland was made using a time-activity curve. Although glandular recovery was not affected by the duration of symptoms or the existence of the symptom at mealtimes, it was inversely proportional to the size of the calculus. Furthermore, the prognosis was more favorable in patients when the anatomically normal orifice of the submandibular duct was preserved.