Relationship between volume of submandibular salivary stones in vivo determined with Cone-Beam Computer Tomography and in vitro with micro-Computer Tomography / Relación entre el volumen de cálculos salivales submandibulares in vivo determinado con tomografía computarizada de haz cónico e in vitro con microtomografía computarizada

Background: Successful removal of salivary stones depends on exact pretreatment information of the location, thesize and shape of the stones. This study aimed to compare the volume of submandibular sialoliths determined bypreoperative Cone-Beam Computer Tomography (CBCT) scans with the volume of the removed stones on micro-Computer Tomography (micro-CT) scans.Material and Methods: In this study, using twenty-one submandibular sialoliths, the pretreatment volumes in-vivomeasured on CBCT were compared to the volumes of removed stones determined by micro-CT scans. The volumemeasured on micro-CT scans served as the gold standard. Pre-operative CBCT’s and in-vitro micro-CT’s wereconverted into standard tessellation language models (STL-models) using an image segmentation software pack-age. The CBCT and micro-CT images of the stones were subsequently metrologically assessed and compared toeach other using reverse engineering software.Results: Volumes of submandibular sialoliths determined by CBCT’s correlated significantly with volumes mea-sured on micro-CT’s (Spearman’s coefficient r = 0.916). The interquartile range (IQR) for the volume measuredwith micro-CT was 117.23. The median is 26.41. For the volume measured with CBCT the IQR was 141.3 and themedian 36.61. The average volume on micro-CT is smaller than on CBCT.Conclusions: When using CBCT-scans for the detection of submandibular sialoliths one should realize that in-vivothose stones are actually a fraction smaller than assessed on the preoperative scan. This is important when cut-offvalues of sizes of stones are used in the pretreatment planning of stone removal.(AU)

A Prospective Observational Study of Complications in 140 Sialendoscopies.

Objectives To evaluate the incidence and nature of complications associated with diagnostic and interventional sialendoscopies and to report intervention failures in a prospective setup. Study Design Prospective observational study. Setting Academic tertiary care university hospital. Subjects and Methods Patients who underwent diagnostic or interventional sialendoscopy between October 2015 and December 2016 were prospectively enrolled. Patient data, operation-related factors, treatment failures, and complications were recorded into a database and analyzed. Results A total of 140 sialendoscopies were attempted or performed on 118 patients; 67 (48%) were for a parotid gland and 73 (52%) for a submandibular gland. The sialendoscopy was interventional in 81 cases (58%), diagnostic in 56 (40%), and not possible to perform in 3 (2.1%). A total of 21 complications were registered for 21 sialendoscopies (15%) and 21 patients (18%). The most common complication was infection, in 9 cases (6.4%). Other observed complications were salivary duct perforation (4 cases), prolonged glandular swelling (3 cases), transient lingual nerve analgesia (2 cases), basket entrapment (2 cases), and transient weakness in the marginal branch of the facial nerve (1 case). All complications were related to interventional procedures or papilla dilatation. Failure to treat occurred in 21 (15%) sialendoscopies: sialendoscopy itself was unsuccessful in 3 cases, and an intended intervention failed in 18 cases. Conclusion Complications in sialendoscopy are usually related to interventional procedures. The complications are mainly minor and temporary but lead to additional follow-up visits, further treatments, and sometimes hospitalization. Sialendoscopic procedures are safe but not free of complications.

Radiopacities of the Jaws: Interpretation and Diagnosis.

General dental practitioners are less confident at diagnosing radiopaque lesions of the jaws than radiolucent ones, possibly because the incidence of jaw radiopacities is comparatively low. The current review covers the majority of radiopaque lesions that are referred for a specialist opinion, and focuses on those lesions that occur commonly or those that mimic other diagnoses. The majority of radiopaque jaw lesions represent normal anatomy/normal variants or superimposed soft tissue calcifications that are typically of no clinical significance. Common pathological radiopacities of the jaws include sclerosing (condensing) osteitis, a response to low-grade chronic apical infection, and odontomes, a form of odontogenic hamartoma. The typical imaging appearances of these and other jaw radiopacities are discussed.

Adenoid cystic carcinoma of the parotid gland associated with salivary calculi: An unusual presentation.

Adenoid cystic carcinomas (ACC) of the head and neck are relatively rare tumors, consisting of approximately 10-15% of all salivary gland neoplasms. ACC, a slow-growing aggressive malignant tumor of salivary gland commonly seen in the submandibular, sublingual, minor salivary glands is seldom found in the parotid. Calculus, the common cause of salivary gland dysfunction is usually identified in submandibular salivary gland because of its duct anatomy and physiochemical characteristic serous secretion. We report an unusual case of co-existent presentation of ACC with salivary calculi in the parotid gland which is never been reported in the literature. Co-existence of ductal calculi and ACC is rare. Presence of parotid calculus could be due to long standing ductal obstruction by the slow-growing ACC of the parotid or other possibility is that the malignancy could have developed because of chronic irritation by parotid calculi. Confirmatory studies are required to understand its mutual pathological association.

Magnetic resonance imaging sialolithography: direct visualization of calculi in the submandibular gland using susceptibility-weighted imaging (SWI) at 3 Tesla.

Magnetic resonance imaging (MRI) sialolithography is a useful technique for evaluating acute and chronic sialadenitis. However, its major weakness is that stones are not imaged directly. We have developed an MRI technique that allows specific identification and localization of calculi within the submandibular salivary gland or duct. This test is noninvasive and does not require ionizing radiation or a sialogogue. By using 3-dimensional susceptibility-weighted imaging, one can probe MRI signal phase changes. Corrected positive filtered phase and magnitude images, acquired using susceptibility-weighted imaging, allowed identification and anatomical localization of calcified calculi in the submandibular gland with efficacy comparable to computed tomography.

[Imaging of salivary lithiasis]. / Imagerie des lithiases salivaires.

Lithiasis is the most common disease of salivary glands after mumps. The purpose of this review is to analyze the respective role of the different available imaging techniques for the diagnosis of lithiasis and related complications since the treatment of salivary lithiasis has evolved with the emergence of minimally invasive and non surgical techniques. In spite of its limitations, US represents an excellent first line imaging technique because it is non-invasive and widely available. Non contrast helical CT with multiplanar reconstructions seems to be the gold standard for the diagnosis of lithiasis, especially when small and poorly calcified since these may not be visible on standard radiographs. CT allows accurate characterization of the number and position of lithiasis. MR Sialography is increasingly replacing the more invasive conventional sialography for the non invasive visualization of the ductal system of major salivary glands even though conventional sialography has a higher spatial resolution.

Interventional sialography and minimally invasive techniques in benign salivary gland obstruction.

Salivary gland obstruction is the commonest complaint affecting this organ and is usually due to the development of salivary calculi, ductal strictures, or both. Imaging has a role in the diagnosis of the cause, extent, and effects of obstruction. In recent years, the role of radiology has evolved; techniques, such as salivary stone lithotripsy, and salivary stone extraction and balloon ductoplasty are carried out under imaging guidance. This article reviews the current status of minimally invasive salivary interventions.

Extracorporeal shockwave lithotripsy for salivary calculi in pediatric patients.

Salivary gland lithiasis is uncommon in pediatric patients. Color Doppler ultrasonography (US) enables an accurate diagnosis of lithiasis to be made without exposure to the radiation of traditional imaging techniques. The development of minimally invasive techniques in the ENT field has made salivary lithotripsy a feasible alternative to traditional invasive surgery. The safety and efficacy of shock wave lithotripsy for salivary calculi were evaluated in pediatric patients. Seven children (5 males; age 4-15 years) with single calculi (mean diameter 4.4 mm) of the submandibular (n = 4) and parotid glands (n = 3) underwent extracorporeal electromagnetic shock wave lithotripsy (EESWL). In four cases the stone was intraductal (two submandibular and two parotideal) and in the remaining three cases it was intraparenchymal (two submandibular and one parotideal). In one case sedative anesthesia was performed. The mean number of therapeutic sessions was five. Patients were followed up clinically and with US for 6-72 months (mean 32 months). Complete disintegration of the calculi was achieved in five cases while in two cases a residual fragment < 2 mm in diameter was observed. None of the patients had recurrence of calculi in the treated gland. Mild self-limited adverse effects (pain, swelling of the gland, self-limiting bleeding from the duct, cutaneous petechiae) were observed in four cases. Our data suggest that EESWL is effective, safe and well tolerated; the minimal invasiveness of the technique suggests that EESWL should be used as the primary approach to salivary calculi in pediatric patients. The continuous US monitoring enables the efficacy of EESWL to be evaluated during both treatment and follow-up, with only slight discomfort for the pediatric patient.

Interventional radiology in the removal of salivary calculi.

PURPOSE: To prospectively investigate the efficacy of a wire basket extractor in the retrieval of salivary calculi and establish selection criteria for suitable cases. MATERIALS AND METHODS: Twenty-five consecutive patients (14 male, 11 female; age range, 13-69 years) with salivary calculi (20 submandibular, five parotid) were treated by using a commercially available wire basket extractor with intermittent fluoroscopic guidance. RESULTS: Elimination of calculi was accomplished in 10 (40%) cases. In an additional seven (28%) cases, either part of the calculus was removed or whole calculi were removed with others remaining. Failure to retrieve any stone occurred in eight (32%) cases. The most common cause of failure was attachment of the calculus to the duct wall. CONCLUSION: Interventional radiology provides a useful adjuvant method of calculus removal and complements extracorporeal lithotripsy. Basket retrieval of calculi has low morbidity and is rapid and less invasive than traditional surgery. It is most effective in retrieving mobile stones in the extraglandular parotid and submandibular ducts.