[Dystrophic calcification of the parotid salivary glands in Sjogren's disease]. / Distroficheskaya kal'tsifikatsiya okoloushnykh slyunnykh zhelez pri bolezni Shegrena.

This article discusses a rare clinical case of differential diagnosis between salivary stone disease and calcinosis, which developed against the background of autoimmune pathology. Diagnosis of these pathologies causes difficulties for practitioners, and treatment methods have fundamental differences. In this regard, the description of this case is relevant and significant. The algorithm of the main and additional research methods to confirm the diagnosis is described.

A Rare Case of Parotid Stone Adherence to the Facial Nerve.

This case report details a complex case of parotid gland sialolithiasis with stones adherent to the facial nerve, a scenario that presents a significant surgical challenge. Traditional sialendoscopy failed to address the condition in a 23-year-old female patient, leading to the adoption of a combined endoscopic transcutaneous approach. This method successfully resolved the condition without intraoperative complications, maintaining intact facial nerve function postoperatively. The case emphasizes the importance of individualized surgical strategy and expert technique in advanced parotid surgery, advocating this approach for similarly complex sialolithiasis cases.

Viral DNA in submandibular gland tissue with an inflammatory disorder.

Background: The etiology behind different types of chronic sialadenitis (CS), some of which exhibit IgG4 overexpression, is unknown. Further, IgG4-related disease (IgG4-RD) commonly affects the submandibular gland, but its relationship to IgG4-overexpressing CS, and the antigen triggering IgG4 overexpression, remain unknown. Materials and Methods: By qPCR, we assessed the presence of 21 DNA-viruses causing IgG4 overexpression in submandibular gland tissue from patients with IgG4-positive and IgG4-negative CS. Healthy submandibular glands and glands with sialolithiasis without CS were used as controls. We examined the distribution of HHV-7, HHV-6B and B19V DNA, within virus PCR-positive tissues with RNAscope in-situ hybridization (RISH). Results: We detected DNA from seven viruses in 48/61 samples. EBV DNA was more prevalent within the IgG4-positive samples (6/29; 21%) than the IgG4-negative ones (1/19; 5.3%). B19V DNA was more prevalent within the IgG4-negative samples (5/19; 26%) than the IgG4-positive ones (4/29; 14%). The differences in virus prevalence were not statistically significant. Of the IgG4-RD samples (n = 3) one contained HHV-6B DNA. RISH only showed signals of HHV-7. Conclusions: None of the studied viruses are implicated as triggering IgG4-overexpression in CS. Although our results do not confirm viral etiology in the examined conditions, they provide valuable information on the prevalence of viruses in both diseased and healthy submandibular gland tissue.

Elemental characteristics of sialoliths extracted from a patient with recurrent sialolithiasis.

The exact mechanism of sialolith formation has yet to be determined. Recurrence of sialolithiasis is rare, affecting only 1%-10% of patients. The current study presents a case of recurrent stones that occurred twice on the right submandibular gland 6 months postoperative and 7 months after reoperation in a 48-year-old female patient. The stones were analyzed using histology, scanning electron microscopy, energy dispersive spectroscopy, and transmission electron microscopy (TEM). The first stone showed a three-layered structure with a poorly mineralized peripheral multilayered zone, highly mineralized middle layer, and the central nidus. The stones were composed of Ca, C, O, Cu, F, N, P, Si, Zn, and Zr. In TEM, compact bi-layered bacterial cell membrane was found on the peripheral layer and the central nidus of the stone as well as exosomes in the central nidus. The results demonstrated the essential components of sialolith formation, including bacteria, inflammatory exosomes, and exfoliated salivary epithelial cells that cooperatively underwent the pathogenetic progresses of central nidus formation, induction of compact zone calcification of the middle layer, and repeated subsequent deposition in the peripheral multilayer zone. The rapid recurrence could have resulted from residual pieces of a sialolith acting as the nidus of bacterial infection.

Comparison of Chronic Sialadenitis Symptom Burden in Patients With Sialolithiasis Versus Stenosis Before and After Sialendoscopy.

OBJECTIVE: To define symptomatology and responses to treatment in chronic sialadenitis from sialolithiasis versus duct stenosis and establish a minimal clinically significant difference (MCID) in the validated Obstructive Salivary Problem Impact Test (SPIT). STUDY DESIGN: Prospective, cohort. SETTING: Tertiary-care center. METHODS: Patients completed the SPIT questionnaire at presentation and 3 to 6 months after surgery. SPIT scores and domains were compared between patients with symptomatic sialolithiasis and those with stenosis of a major salivary gland. RESULTS: Seventy-nine patients completed the SPIT, including 43 (54%) with sialolithiasis and 36 (46%) with stenosis. Stenosis patients displayed greater baseline scores compared to sialolithiasis patients (45.4 ± 19.9 vs 33.3 ± 18.5, P < .013). Frequency and severity of gland swelling and pain (21.9 ± 8.9 vs 17.1 ± 9.6, P = .02) and functional/psychosocial impact subscores were greater in the stenosis versus sialolithiasis groups (18.0 ± 10.9 vs 11.3 ± 9.4, P < .01). For 43 patients who underwent surgical intervention, SPIT scores improved at 3 to 6 months postoperatively in all domains (-18.6 ± 19.4, P < .01). Degree of improvement did not differ between sialolithiasis versus stenosis groups (-22.0 ± 20.9 vs -13.3 ± 15.8, P = .13). The MCID in SPIT score was found to be -13 points. A postoperative SPIT score of less than 10 suggested symptom resolution. CONCLUSION: When compared to sialolithiasis, chronic salivary obstruction from stenosis is associated with greater baseline SPIT scores, indicating poorer sialadenitis-related quality of life due to greater symptom frequency and functional impact. Based on SPIT survey outcomes, a score decrease of 13 points or SPIT score <10 represent significant symptom improvement.

Microbiomic association between the saliva and salivary stone in patients with sialolithiasis.

Salivary stones, known as sialoliths, form within the salivary ducts due to abnormal salivary composition and cause painful symptoms, for which surgical removal is the primary treatment. This study explored the role of the salivary microbial communities in the formation of sialoliths. We conducted a comparative analysis of microbial communities present in the saliva and salivary stones, and sequenced the 16S rRNA gene in samples obtained from patients with sialoliths and from healthy individuals. Although the diversity in the saliva was high, the essential features of the microbial environment in sialoliths were low diversity and evenness. The association of microbial abundance between stones and saliva revealed a positive correlation between Peptostreptococcus and Porphyromonas, and a negative correlation for Pseudomonas in saliva. The functional potential differences between saliva and stones Bacterial chemotaxis and the citrate cycle were negatively correlated with most genera found in salivary stone samples. However, the functions required for organic compound degradation did not differ between the saliva samples. Although some microbes were shared between the sialoliths and saliva, their compositions differed significantly. Our study presents a novel comparison between salivary stones and salivary microbiomes, suggesting potential preventive strategies against sialolithiasis.

Partial facial paralysis induced by sialolithiasis of the parotid gland: a case report.

BACKGROUND: Facial paralysis due to parotid sialolithiasis-induced parotitis is a unusual clinical phenomenon that has not been reported in prior literature. This scenario can present a diagnostic challenge due to its rarity and complex symptomatology, particularly if a patient has other potential contributing factors such as facial trauma or bilateral forehead botox injections as in this patient. This case report elucidates such a complex presentation, aiming to increase awareness and promote timely recognition among clinicians. CASE PRESENTATION: A 56-year-old male, with a medical history significant for hyperlipidemia, recurrent parotitis secondary to parotid sialolithiasis, and recent bilateral forehead cosmetic Botox injections presented to the emergency department with right lower facial drooping. This onset was about an hour after waking up and was of 4 h duration. The patient also had a history of a recent ground level fall four days prior that resulted in facial trauma to his right eyebrow without any evident neurological deficits in the region of the injury. A thorough neurological exam revealed sensory and motor deficits across the entirety of the right face, indicating a potential lesion affecting the buccal and marginal mandibular branches of the facial nerve (CN VII). Several differential diagnoses were considered for the lower motor neuron lesion, including soft tissue trauma or swelling from the recent fall, compression due to the known parotid stone, stroke, and complex migraines. An MRI of the brain was conducted to rule out a stroke, with no significant findings. A subsequent CT scan of the neck revealed an obstructed and dilated right Stensen's duct with a noticeably larger and anteriorly displaced sialolith and evidence of parotid gland inflammation. A final diagnosis of facial palsy due to parotitis secondary to sialolithiasis was made. The patient was discharged and later scheduled for a procedure to remove the sialolith which resolved his facial paralysis. CONCLUSIONS: This case emphasizes the need for a comprehensive approach to the differential diagnosis in presentations of facial palsy. It underscores the potential involvement of parotid sialolithiasis, particularly in patients with a history of recurrent parotitis or facial trauma. Prompt recognition of such uncommon presentations can prevent undue interventions, aid in timely appropriate management, and significantly contribute to the patient's recovery and prevention of long-term complications.

In-office Transoral Hilar Sialolithotomy: A Cost-Effective and Patient-Centered Procedure.

Transoral sialolithotomy performed in-office under local anesthesia is routinely performed for distal submandibular stones. We demonstrate the senior author's novel practice of in-office transoral sialolithotomy for hilar and intraglandular stones. A review of cases performed by the senior author revealed similar rates of complication and stone recurrence as those reported in the literature from removal under general anesthesia. Laryngoscope, 2024.

Recurrent Sialolithiasis following Intraoral Deep Hilar/Intraparenchymal Stone Removal from Wharton's Duct.

(1) Background: Submandibular gland (SMG) sialolithiasis treatment has shifted significantly, favouring minimal invasiveness. Nonetheless, transoral stone removal remains viable for distal, deep hilar, and intraparenchymal stones. However, data are limited regarding recurrence and revision surgery; (2) Patients/Methods: This retrospective study included 226 patients with SMG stones treated using Wharton's duct slitting and marsupialisation over nine years; 138 had deep hilar or intraparenchymal stones, while 88 had distal stones. Of the former group, 18 experienced symptom recurrence post-surgery, 12 with stones and 6 with duct stenosis; (3) Results: Of the 126 patients without recurrent stones, 71% were male and 29% were female. Their mean age was 51.02 ± 9.36 years. The stones of the 126 patients without recurrence had a diameter of 8.3 mm ± SD: 4 mm, which was significantly smaller than those of the patients who experienced recurrence (13.8 mm ± SD: 2.4 mm; p < 0.05). The mean estimated stone growth recurrence rate was 8.4 ± SD: 1.8 mm per year. A secondary operation was performed 34 ± SD: 14.7 months after the first. Of the patients with recurrence, 91.7% were treated under general anaesthesia. The preferred treatment for 58.4% of patients was intraoral revision operation; the remainder underwent total gland resection. The mean follow-up period was 43 ± SD: 18 months; (4) Conclusions: The rate of revision surgery was relatively low. In recurrent SMG sialolithiasis, new stones may grow faster than the primary stones, which are already larger than those in patients without recurrence. The slitting and marsupialisation of Wharton's duct can treat recurrent cases.

Indications for Submandibulectomy Within a 20-Year Period.

Purpose: Different pathologies of the submandibular gland are an indication of submandibular gland excision-ranging from inflammatory causes and sialolithiasis to malignant tumors. The purpose of this study was to get an overview of the different indications for submandibular gland excision. Methods: The main goal of this study was to evaluate the different indications for submandibular gland excision during a 20-year period. In addition, epidemiological information and therapy concepts were investigated with a special focus on Tumor Lymph nodes Metastasis (TNM) classification and recurrence rate. Procedures during which the submandibular gland was removed while not being the primary cause for surgery (eg, neck dissection in Level Ib) were not included. Results: During the period of observation, 359 submandibular gland excisions were performed. The most common cause for submandibular gland excision was sialolithiasis (n = 129) with intraparenchymal stone localization. Up next were inflammatory causes (n = 115) in particular chronic submandibular sialadenitis followed by only a few cases of Sjögren's syndrome, sarcoidosis, and tuberculosis. In 115 cases, surgery was performed for tumors of the submandibular gland, with 88 of them being benign and 27 malignant. Malignancies were then divided into lymphomas (n = 9) and primary salivary gland malignancies (n = 18). Conclusion: This retrospective study of a large cohort of patients displays a representative overview of the indications for submandibular gland excision. Sialolithiasis was the most common underlying cause of gland excision. The malignancy rate in our cohort was lower than described in the literature.

What is the impact of previous cholelithiasis on sialolithiasis: A systematic review and meta-analysis.

Introduction: A sialolith is a salivary stone usually presenting with swelling and pain in the affected salivary gland, most commonly the submandibular gland. There have been speculations about the association between this condition and other systemic diseases, especially those forming stones, such as nephrolithiasis and cholelithiasis. This systematic review and meta-analysis aimed to summarize the studies assessing the relationship between cholelithiasis and sialolithiasis. Methods: PubMed/MEDLINE, Scopus, Web of Science, and Embase electronic databases were searched according to the keywords related to both disorders without any publication date or language restriction. Case-control and cohort studies evaluating the relationship between salivary and biliary stones were considered eligible. Quality assessment was performed following Newcastle-Ottawa Scale (NOS) for quality assessment of case-control studies. All meta and statistical analyses were performed with Comprehensive Meta-Analysis software. Results: Two studies fully complied with the defined eligibility criteria and were included, both of which were case-control studies using national-scale databases. In both surveys, the prevalence of previous gallstones in patients with sialolithiasis was compared to that of a control group. Though one of the studies found that there is no relationship between sialolithiasis and cholelithiasis, the meta-analysis revealed that previous cholelithiasis is significantly more prevalent among patients with sialolithiasis (P = 0.000), with an odds ratio of 2.04. Conclusion: It seems that cholelithiasis is significantly associated with an increase in salivary stone formation. Therefore, a thorough salivary examination in all patients declaring current or past cholelithiasis is recommended. However, more studies, especially prospective cohorts, are needed to make firmer conclusions.

Suture Stenting After Sialendoscopy: A Novel Technique That Reduces Risk of Recurrent Parotitis.

OBJECTIVE: Chronic sialadenitis is associated with decreased quality of life and recurrent infections. While sialendoscopy with stenting is effective in relieving symptoms of sialadenitis, currently available stents are rigid and poorly tolerated by patients, leading to early removal and potential for adverse scarring. This study examines whether sutures can be used as a stenting material to improve patient comfort and reduce recurrence risk. METHODS: This is a retrospective cohort study of a consecutive series of adult patients with chronic sialadenitis undergoing sialendoscopy with or without suture stenting. Data were collected between 2014 and 2018 with a 3-year follow-up period ending in 2021. The primary outcome measure was recurrence of sialadenitis within 3 years of surgery. Secondary outcomes were stent dislodgement and patient-reported discomfort. RESULTS: We included 63 patients with parotid sialadenitis of whom 28 underwent suture stenting and 35 did not receive stenting after sialendoscopy. Stents were well tolerated, with a mean duration of 34.5 days, and only 2 of 28 stents (7.1%) accidentally dislodged within the first week. Suture stenting significantly reduced symptom recurrence after sialendoscopy (OR = 0.09, 95% CI 0.02-0.45, p = 0.003; 3-year sialadenitis recurrence rate: 7.1% vs. 45.7%, p = 0.005). Cox multivariate regression for clinicodemographic variables showed an HR of 0.04 (95% CI 0.01-0.19, p < 0.001) for the risk of symptom recurrence. CONCLUSIONS AND RELEVANCE: Suture stenting after sialendoscopy is low cost, available across all institutions, well-tolerated by patients, and highly efficacious in reducing risk of recurrent sialadenitis after sialendoscopy. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:614-621, 2024.

Salivary Mucinous Adenocarcinoma Masquerading as Chronic Submandibular Sialolithiasis.

A patient with chronic submandibular sialolithiasis underwent conservative treatment with appropriate imaging and multiple biopsies that continually revealed chronic inflammation. Due to continued symptoms, the patient underwent eventual excision and finaly pathology revealed salivary mucinous adenocarcinoma, which is a rare and poorly understood salivary malignancy. Persistent diagnostic workup and a high suspicion for salivary gland lesions is important for appropriate diagnosis and treatment. More attention and research on this specific entity can help future clinicians better diagnose and treat patients with a similar presentation. Laryngoscope, 134:2258-2261, 2024.

Intraoral Microscopic Versus Robot-Assisted Sialolithotomy and Sialendoscopy for Submandibular Stones.

OBJECTIVE: Sialendoscopy has remained the standard of treatment for sialolithiasis; however, large stones impacted in the submandibular gland hilum often require an intra-oral combined approach. METHODS: Patients treated for submandibular hilar sialolithiasis from 2015 to 2021 at two tertiary centers were stratified into two groups based on the surgical technique: Intraoral Microscopic-Assisted Sialolithotomy (IMAS) versus Robot-Assisted Sialolithotomy and Sialendoscopy (RASS). We compared the characteristics of retrieved stones, surgical success rate, operative time, and post-operative complications in both techniques. True surgical success was defined as successful stone extraction without reoccurrence within 12 months. RESULTS: The RASS technique was attempted in 60 patients and successful in 56 (93.3%) cases whereas the IMAS technique was performed in 52 patients and successful in 48 (92.3%) cases. The longest dimension of the predominant retrieved calculi was 9.6 ± 3.1 mm (range, 5-18 mm) for the robotic technique and 10 ± 4.8 mm (range, 5-30 mm) for the microscopic technique. The operative time for the robotic technique excluding robot setup time was 70.6 ± 24.8 min compared to 61.9 ± 42.4 min for microscopic technique (p = 0.018). No major adverse outcomes were reported; however, temporary lingual paresthesia was found in ten robotic (16.7%) and five microscopic (9.6%) cases. CONCLUSION: The two techniques were comparable in terms of efficacy and safety for large stones. The robot has the advantage of intraoral high dynamic maneuverability and improved surgeon posture while the microscopic technique has the advantage of intraoral tactile feedback. The procedure was significantly shorter in duration with the microscope. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:2170-2176, 2024.

Holmium:YAG laser-assisted intraductal sialendoscopic lithotripsy under local anesthesia.

OBJECTIVES: This retrospective multi-institutional chart review study aims to present results from patients treated with Holmium:YAG laser-assisted sialendoscopic intraductal lithotripsy under local anesthesia. METHODS: Preoperative ultrasound and/or CT were used for location and measurement of the stones. Local anesthesia was applied in all patients, Marchal all-in- one 1.3 mm and Erlangen 1.6 sialendoscopes were used. The laser was used with power settings limited by discomfort or pain. Inclusion criteria were stone size (all >5 mm) and fixed stones. RESULTS: 42 patients, 48 stones were treated (30 males/12 females), 21 submandibular and 21 parotid. Ages ranged from 20 to 70 years (95 % CI: 43.37-51.58). Mean size was 6.2 mm (95 % CI: 5.71-6.72). Complete fragmentation was achieved in 66.7 % and incomplete in 33.3 %. Out of the incomplete fragmented 14 cases, seven (50 %) remained symptom free on follow-up. Maximum duration was 120 min. Minimum power settings of the laser was 4.8 Watts and maximum 18 Watts. Six patients expressed pain or discomfort that limited power increase and duration of the procedure. Total follow up time was 10 years. There were no major complications such as hemorrhage, nerve paresis or skin ulceration. CONCLUSION: The procedure is safe under local anesthesia, well tolerated by most patients and should be used in cases of small fixed and "intermediate-sized" stones as a single modality. Discomfort may limit power settings and duration. The later is the major disadvantage of the method.

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.

An Aberrant Case of Large Submandibular Gland Sialolith With Obstructive Sialadenitis in a Young Female.

Sialolithiasis is a major cause of salivary gland dysfunction. Submandibular sialolithiasis with obstructive sialadenitis is a relatively uncommon condition. Submandibular gland sialolithiasis with obstructive sialadenitis accounts for about 2% of all cases of sialadenitis. We are reporting a case of a 20-year-old female who presented with acute-onset swelling in the right submandibular region. The submandibular gland had a large calculus with pericalcular abscess development, which was clearly visible on pre- and post-contrast computed tomography. Subsequently, surgical excision of the lesion was performed, and calculus was removed.

Long-term rare giant sialolithiasis for 30 years: A case report and review of literature.

BACKGROUND: Sialolithiasis is one of the most common salivary gland disorders, most commonly affecting the submandibular gland. Submandibular sialolithiasis can be treated using non-invasive conservative measures and invasive treatments. Treatment selection was based on the ductal system anatomy and the size and location of the stones. This study aimed to review the updates on sialolithiasis treatment and compare the different management strategies of the variables. CASE SUMMARY: This report presents a case of a long-term, rare, and giant sialolithiasis within the submandibular gland parenchyma for 30 years in an older adult. Our patient presented with painless right submandibular swelling. Computed tomography revealed a calcified mass measuring 35 mm × 20 mm within the right submandibular gland. In this case, the infection and fibrosis of the affected gland and size of the stone did not provide us with other alternatives except for the excision of the involved gland. Thus, right submandibular sialoadenectomy was performed via the transcervical approach. After the surgery, the patient recovered without any complaints, side effects, or complications. CONCLUSION: Tailored management is important for preserving gland function, maintaining low risk, and reducing patient discomfort.

Coexistence of Adenoid Cystic Carcinoma and Sialolithiasis in Submandibular Gland: Case Report.

Sialolithiasis is the primary cause of swelling in the major salivary glands. The etiopathogenesis is not clear. Adenoid cystic carcinoma is a slow-growing salivary gland malignancy with a poor prognosis. There are only a few cases in the literature reporting the coexistence of sialolithiasis and adenoid cystic carcinoma. In this report, we present a case that was thought to have sialolithiasis in the foreground because of the calcified image on computed tomography, but was diagnosed with adenoid cystic carcinoma after excision, together with a discussion of the relationship between sialolithiasis and carcinogenesis.

Outcomes of the salivary-oral health impact profile (S-OHIP) for chronic salivary disorders.

PURPOSE: The Oral Health Impact Profile (OHIP) is a previously validated, concise, patient-friendly questionnaire used to determine the impact of oral diseases on patient quality of life. The present study seeks to examine the outcomes of a modified Salivary-OHIP (S-OHIP) survey in patients with chronic salivary disorders. MATERIALS AND METHODS: A prospective cohort of 67 patients with chronic salivary disorders and a control group of 16 patients undergoing septoplasty were surveyed using the modified Salivary-OHIP (S-OHIP) before surgery and six weeks following operative intervention. Additional factors analyzed included age, gender, etiology of salivary disease, general quality of life using the EQ-5D-5L, and general salivary symptoms. RESULTS: There was no difference between treatment and control groups with respect to age or gender. There was a significant difference between the groups regarding change in S-OHIP scores before and after surgery (p < 0.01). Salivary patients had a significant decrease in S-OHIP scores indicating improved salivary quality of life (p < 0.01), with a mean decrease in score of 9.5. The control group showed no change in S-OHIP score (p = 0.47). CONCLUSION: The S-OHIP allows for a specific, targeted survey of salivary symptoms and is a useful, patient-friendly tool to quantify symptomatic changes in patients with chronic salivary disorders. LEVEL OF EVIDENCE: Level III.