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The parotid duct has been reported to be the most common site of sialoliths in horses. In this case report, we described the first confirmed case of the equine sialolithiasis in Slovakia. The work was aimed to describe the transcutaneous approach to removing the sialolith, which manifested as a hard painless mass in the area of the maxillary cheek teeth, in a 14-year-old Slovakian warmblood mare. Pathological-anatomical and histological examination after extirpation confirmed the presence of parotid duct ectasia resulting from calculus. The mineral composition of the sialolith was determined with atomic absorption spectroscopy using X-ray powder diffraction. The sialolith was successfully extirpated transcutaneously, without complications or recurrence., (© 2024. The Author(s).)

Objective(s): To confirm that hilar transoral submandibular sialolitectomy (TOSL) is the first treatment option for submandibular hilar lithiasis (SHL) in terms of glandular parenchyma recovery, salivary system restoration, and patient quality of life (QoL) improvement., Methods: Depending on whether the stone was easily palpable, TOSL was carried out with or without sialendoscopy. For the first time in the literature, Magnetic Resonance Sialography (MR-Si) was performed before and after TOSL, to evaluate stone characteristics, glandular parenchyma status, hilum dilation and main duct recanalization. Radiological data was examined independently by two radiologists. COSQ, a recently validated and specific questionnaire, was used to assess associated QoL., Results: Between 2017 and 2022, 29 TOSL patients were examined. With a high interobserver correlation, MR-Si was confirmed as a very useful radiological test in the pre- and post-surgical evaluation of SHL. The salivary main duct was completely recanalized in all cases. The presence of lithiasis was found in 4 patients (13.8%). After surgery, the majority of patients (79.31%) had hilum dilation. There was a statistically significant improvement in parenchyma status, but no significant progression to glandular atrophy. After surgery, COSQ mean values always improved (22.5 to 4.5)., Conclusions: TOSL is the ideal surgical technique for the management of SHL, resulting in improved parenchymal inflammatory changes, recanalization of Wharton's duct, and enhancement patients' QoL. As a result, before removing the submandibular gland, TOSL should be considered as the first treatment option for SHL., (© 2023. The Author(s).)

Objectives: The present study was developed to evaluate the accuracy of in vivo ultrasound sizing for parotid and submandibular salivary gland calculi, as compared with ex vivo pathology sizing with a standard plastic ruler after extraction., Study Design: Retrospective chart review., Setting: Ultrasound is frequently used to size salivary calculi and make treatment decisions, but the accuracy of measurements from this modality has not been validated., Subjects and Methods: We evaluated and reviewed the charts and ultrasound examinations of 167 patients who underwent procedures for the treatment of sialolithiasis involving the parotid and submandibular glands. US examinations were performed between 2009 and 2016 in a tertiary-level hospital setting by the senior author. Measurements were collected from ultrasound evaluation before sialolithotomy, and pathology measurements were taken after removal. Ultrasound measurements in millimeters were compared with the measurements collected with a ruler. The differences were calculated and compared., Results: A total of 167 calculi measurements were compared. Good concurrent validity between pathology and ultrasound measurements was suggested by a Pearson correlation of 0.92 (95% CI, 0.887-0.937). On Bland-Altman plot, correlation of the difference between US and pathology measurements showed a mean difference of 0.095 mm (95% CI, -0.19 to 0.38 mm) with a limit of agreement ranging from -3.59 mm (95% CI, -3.84 to -3.34 mm) to +3.78 mm (95% CI, +3.53 to +4.03 mm)., Conclusions: Ultrasound is an accurate, relatively precise, and minimally invasive imaging tool for salivary gland sialolithiasis. Preoperative size of calculi can be used to guide management and clinical decision making., Level of Evidence: 2C.

Background: Type I interferon activation is a hallmark event in Sjögren's syndrome. L1 retroelements stimulate plasmacytoid dendritic cells, activating the type I interferons, and are regulated by various mechanisms, including the APOBEC3 deaminases. As L1s are potential trigger factors in autoimmunity, we aimed to investigate the immunohistochemical localization of L1 ORF2p and its inhibitor APOBEC3B protein in minor salivary glands of Sjögren's syndrome patients., Methods: Twenty minor salivary gland-tissue samples from 20 Sjögren's syndrome patients, classified according to Tarpley's histological criteria, and 10 controls were evaluated for L1 ORF2p and APOBEC3B expression via immunohistochemistry., Results: L1 ORF2p was expressed in 17/20 SS patients and all controls. APOBEC3B expression was observed in 15/20 Sjögren's syndrome patients, 5/5 chronic sialadenitis, and 3/5 normal minor salivary glands. Both antibodies stained the cytoplasm of the ductal epithelial cells. Negative staining was observed in the acinar cells. L1 ORF2p-positive immunostaining was significantly lower in Tarpley IV Sjögren's syndrome patients than controls (P = .039), and APOBEC3B-positive staining was significantly lower in Tarpley I compared to Tarpley II Sjögren's syndrome patients (P = .008) and controls (P = .035)., Conclusions: L1 ORF2p and APOBEC3B are expressed in the ductal epithelial cells of minor salivary glands that are among the key targets in Sjögren's syndrome. L1 ORF2p expression may promote the L1 ability to act as an intrinsic antigen in Sjögren's syndrome. The potential future use of L1 ORF2-reverse transcriptase inhibitors in autoimmunity supports further investigation of L1 epigenetic regulation by APOBEC3 enzymes., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Sialolithiasis is one of the most frequent form of calcifications in the maxillofacial area. 0.45% of the population is affected by symptoms caused by salivary calculi, though the estimated frequency including asymptomatic form may exceed 1% in adult population. Radiographs presenting a large portion of the maxillofacial region (panoramic radiography, computed tomography) could detect salivary calculi with high accuracy. The size of the sialoliths is usually less than 10 mm in diameter. Salivary calculi larger than 15 mm (considering the largest diameter) are classified as giant sialoliths and most of them are located in the submandibular gland or in its duct. Two unusually large submandibular salivary calculi cases are represented (diameters of 27 and 34 mm), whereas in one of the cases development and dimensional changes of the calculus are described via a seven years period. This case report represents diagnostic and therapeutic consequences in giant sialolithiasis and demonstrates possible differential diagnostic difficulties. Orv. Hetil., 2016, 157(49), 1967-1972.

Sialolithiasis is the most common disease of salivary glands. Its estimated frequency is 1.2% in the adult population. Sialoliths most commonly occur in the submandibular glands. The sublingual gland and minor salivary glands are rarely affected. The sialolith usually measures from 1 to <10 mm. Giant sialoliths are classified as those exceeding 15 mm in any one dimension. In literature, large sialoliths or megalith (> mm) of Wharton's duct have rarely been reported. This case report describes a patient presenting with an unusually large sialolith (megalith) of Wharton's duct, which was 37 mm ×16 mm in the size, the subsequent patient management, the etiology, diagnosis, and its treatment.

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.

Ca(2+) is secreted from the salivary acinar cells as an ionic constituent of primary saliva. Ions such as Na(+) and Cl(-) get reabsorbed whereas primary saliva flows through the salivary ductal system. Although earlier studies have shown that salivary [Ca(2+)] decreases as it flows down the ductal tree into the oral cavity, ductal reabsorption of Ca(2+) remains enigmatic. Here we report a potential role for the G protein-coupled receptor, calcium-sensing receptor (CSR), in the regulation of Ca(2+) reabsorption by salivary gland ducts. Our data show that CSR is present in the apical region of ductal cells where it is co-localized with transient receptor potential canonical 3 (TRPC3). CSR is activated in isolated salivary gland ducts as well as a ductal cell line (SMIE) by altering extracellular [Ca(2+)] or by aromatic amino acid, L-phenylalanine (L-Phe, endogenous component of saliva), as well as neomycin. CSR activation leads to Ca(2+) influx that, in polarized cells grown on a filter support, is initiated in the luminal region. We show that TRPC3 contributes to Ca(2+) entry triggered by CSR activation. Further, stimulation of CSR in SMIE cells enhances the CSR-TRPC3 association as well as surface expression of TRPC3. Together our findings suggest that CSR could serve as a Ca(2+) sensor in the luminal membrane of salivary gland ducts and regulate reabsorption of [Ca(2+)] from the saliva via TRPC3, thus contributing to maintenance of salivary [Ca(2+)]. CSR could therefore be a potentially important protective mechanism against formation of salivary gland stones (sialolithiasis) and infection (sialoadenitis).

Sialolithiasis is the second most common disease of the salivary glands. Sialolithiasis accounts for the most common cause of salivary gland obstruction, leading to recurrent painful swelling of the involved gland, which often becomes worse while eating. Sialoliths can occur in any of the salivary glands but appear most frequently in the submandibular gland and its duct. Very few cases of giant submandibular sialoliths have been reported in the literature. This article reports two cases of unusually large submandibular sialoliths, with clinical and radiographical signs and management. The article also reviews the various diagnostic modalities and treatment options available.

Sialolithiasis is one of the most common pathologies of the submandibular gland; sialoliths account for about 80 percent of all salivary duct calculi. This report presents the unusual case of a large asymptomatic sialolith of the submandibular duct, initially diagnosed as a possible tumor. The giant sialolith was removed via an intraoral approach under local anesthesia. The etiology, pathogenesis, and management of such giant sialoliths are discussed.

Purpose: Obstructive submandibular sialadenitis is a relatively common disease in the clinic. The present study explored the cause and strategic management of chronic obstructive sialadenitis using sialoendoscopy and surgery., Patients and Methods: From January 2005 to October 2007, 128 patients with obstructive symptoms in the submandibular gland were diagnosed using sialoendoscopy and occlusal films, and the obstructions were removed using interventional sialoendoscopy, surgery only, or combined techniques, depending on the size, shape, site, and quality of the sialolith in the duct. The shape and structure of the hilus of the submandibular gland was observed using sialoendoscopy., Results: In the submandibular gland, the histologic features of 128 cases were identified endoscopically and radiographically. The endoscopic findings were of 3 types: sialolith in 114 (89%), mucus plug in 8 (6%), and stenosis in 6 (5%). Of 51 obstructions treated surgically, 47 were removed successfully, for a success rate of 92%. Of 63 obstructions treated using interventional sialoendoscopy, 52 were removed directly by sialoendoscopy, for a success rate of 83%. The unsuccessful cases were treated using sialoendoscopy or surgery. The obstructive symptoms were relieved in 12 of 14 patients without stones using dilation and irrigation under sialoendoscopy. Of the 114 patients with a stone, the sialoliths of 67 (59%) were located in the distal region (behind the first molar). The results showed that the more posterior the stone, the more difficult it was to remove. Three patients with treatment failure ultimately underwent resection of the gland. A basin-like structure in the hilus region was found in 86 (67%) of the 128 patients by sialoendoscopy. Finally, 5 patients were found to have a foreign body (fish bone) surrounded by a sialolith., Conclusions: Sialoendoscopy is a useful new technique, not to only detect the cause of obstruction in a submandibular gland, but also to treat the obstructive submandibular sialadenitis more effectively if incorporated with conventional surgical approaches., (Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

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.

This paper reviews the major clinical and radiographic features of sialoliths and illustrates these with an unusual case of multiple sialoliths within the submandibular gland duct. The differential diagnosis of other calcific structures both within and outside the salivary gland that may mimic a sialolith is also presented.

Purpose: To compare the visualization of salivary ducts by ultrafast magnetic resonance sialography (MR sialography) using an alternative surface coil and a conventional head-neck coil., Materials and Methods: In 11 healthy volunteers, ultrafast MR sialography (single shot turbo spin echo; acquisition time, 2.8 s) was performed before and after oral application of a sialogogue. Each subject received examinations with both a bilateral surface coil (SC) and a conventional head-neck coil (HNC). The depiction of parotideal and submandibular duct systems was graded from 1 to 5 (5 = poor) by four independent radiologists. ANOVA served for statistical analysis of duct rankings, and interobserver variability was determined by Intraclass Correlation Coefficient (ICC)., Results: With an excellent ICC of 0.96, both coil systems offered symmetric visualization of salivary ducts, and the image quality increased after oral application of sialogogue (p < 0.001). In total, the overall rating was worse for SC than for HNC (2.13 +/- 1.24 vs. 1.45 +/- 0.65, p < 0.001). SC was especially inferior in depiction of submandibular and extraglandular duct components compared to HNC (p < 0.001)., Conclusion: Most notably due to the reduced visualization of extraglandular and submandibular ducts, the specific surface coil used in this study was inferior in image quality and does not constitute a reasonable alternative to conventional coil systems.

An orbital sialocele developed in a dog following enucleation for protracted glaucoma. This eye had historically been treated for keratoconjunctivitis sicca by parotid duct transposition approximately 5 years previously, and the duct was ligated distally at the time of enucleation. One month following enucleation, the dog presented with a fluctuant conical-shaped swelling ventrolateral to the orbital socket. Surgical exploration revealed a dilated, fibrotic distal portion of the previously transposed parotid duct, and saliva, within the enucleated orbit. The distal portion of the duct and saliva-containing tissues from within the orbit were excised. The remaining proximal normal portion of the parotid duct was re-routed into the oral cavity. Clinicopathologic and histologic examination of the excised orbital contents and dilated portion of duct revealed a sterile sample of saliva and moderate chronic periductal fibrosis. At a 6-month re-evaluation there was no evidence of recurrence of the sialocele, and the parotid duct was functional.

A 44-year-old male patient presented with a complaint of dysphonia. On oropharynx examination, a polypoid mass was detected in the right vocal cord and firmness in the floor of the mouth, 3-4 cm in size. Computed tomography showed a stone in the right Wharton's duct. Saliva came out of the orifice of the Wharton's duct on palpation. The stone was removed transorally. Despite its huge size (30x20 mm), the patient had no complaint. No recurrence was seen during a follow-up period of 18 months with ultrasonography.

We describe the successful use of ultrasound-guided retrieval of a submandibular stone with a basket, in a 13-year-old child.

Sialolithiasis is the phenomenon of blockage of the salivary glands. It frequently is associated with swelling, pain, and infection of the affected gland. Clinically, sialolithiasis manifests as an increase in the size of the affected gland and increased salivary secretion that results in pain during eating. It occurs mainly in the submandibular gland and less frequently in the parotid gland. This article presents a case involving a 23-year-old woman with Down syndrome who demonstrated sialolithiasis in the parotid duct gland. The sialolith was radiographed and removed surgically.

A new method for the treatment of chronic sialodochitis and sialolithiasis is suggested for cases with essential dilatation of the duct in the intraglandular compartment of the parotid gland: the external wall of dilated duct is dissected and the two resultant parts are twisted inside and sutured to the internal wall of the dilated duct; the parotid duct is ligated at the site of its exit from the gland.

Objectives: We performed magnetic resonance (MR) sialography of parotid gland and/or submandibular gland ducts using three-dimensional fast asymmetric spin-echo (3D-FASE) sequencing. The objective was to make three-dimensional (3D) reconstruction images and virtual endoscopic views of the parotid gland ducts using MR sialography data sets of 3D-FASE sequences., Methods: We reviewed the MR sialography data sets with 3D-FASE sequencing of 10 control volunteers and six patients. Three-dimensional reconstruction images and virtual endoscopic views of the parotid gland and/or submandibular gland ducts were generated with maximum intensity projection (MIP), shaded surface display (SSD), and volume rendering techniques (VRT)., Results: The main parotid gland and/or submandibular gland ducts, large branches within the glands, and small branches were fairly well defined in a very short acquisition time on MR sialographic images with 3D-FASE sequencing in nine of the 10 healthy volunteers. The 3D-reconstruction images of the parotid gland ducts and/or submandibular gland ducts showed the entire length of the branch paths and complete images from all angles, and the virtual endoscopic views showed the endoluminal tracts of the main ducts and the large branches in nine. In the patient with Sjogren's syndrome, chronic sialoadenitis, and salivary calculi in the Wharton ducts, the MR sialographic images showed diffuse areas of punctate high signal intensity, dilatation of Stensen's duct, or stones of Wharton's duct, respectively. Furthermore, the 3D-reconstruction images of the salivary gland ducts showed the stenoses and stones in the branch paths and complete images from all angles, and the virtual endoscopic views showed the stenoses and stones in the endoluminal tracts of the main and large branches., Conclusions: Our initial experience showed that virtual MR endoscopy could be performed to observe the endoluminal tracts of parotid and submandibular glands. The clinical use of the virtual MR endoscopy for salivary gland ducts has not been established yet. Future applications of the 3D-reconstruction images and virtual endoscopic views using MR sialography data sets of 3D-FASE sequences are very attractive and further expansion of this field is expected.

Objective: Giant salivary gland calculi (GSGC; >15 mm) are considered rare. Only 14 well-documented cases have been reported in the literature since 1942. The purpose of this study was to evaluate the imaging modality and treatment outcome of patients with GSGC., Study Design: Six personally observed subjects with GSGC were evaluated and treated. Occlusal film, panoramic radiograph, axial computed tomographic (CT) scan, and scintigraphy were used for imaging. Stone location, shape, and size were estimated on occlusal film, panoramic radiograph, and CT scans. Stones were removed with transoral sialolithotomy, and size was measured directly on the surgical specimen. Treatment outcome was evaluated with scintigraphy 2 months after surgery., Results: The mean age of the patients (all male) was 48 years (range, 25 to 61 years). Five subjects had stone in the submandibular gland, and 1 in the parotid gland. The mean stone size was 30 x 15.8 mm, as measured directly on the surgical specimen. The preoperative estimation of the stone size with occlusal film was limited to those located in the anterior portion of the duct. Panoramic radiograph was precise and comparable with the estimation with CT scan for all stones. In 5 of the 6 subjects, a nearly normal function of the glands was seen 2 months after surgery., Conclusion: GSGC of the submandibular or parotid glands is a disease that affects the middle-aged male patient. An occlusal film is a suitable imaging modality for stones, but estimation of size is limited to stones in the anterior duct portion. Panoramic radiograph and CT scan were comparable in precise preoperative estimation of stone size, regardless of stone location. Removal of the GSGC with the minimally invasive method, via the transoral sialolithotomy, is the treatment of choice, with reasonable results.

The occurrence of sialolithiasis in children is uncommon, while parotid sialoliths are rare. A case of parotid sialolith in a 9 year old child is reported.

Purpose: This article describes the use of endoscopy for diagnostic and surgical intervention in the major salivary glands of patients who have obstructive pathology, reviews past experience with this technique, and describes the microanatomy and pathophysiologic findings encountered during endoscopy of these glands., Patients and Methods: A total of 154 salivary glands (96 submandibular glands, 57 parotid glands, 1 sublingual gland) suspected of having obstructive pathology (89 males, 65 females; aged 5 to 72 years) were treated using a mini-endoscope. Most procedures were performed under local anesthesia in an outpatient clinic. All patients underwent preoperative and postoperative screening by routine radiography, sialography, and ultrasound. The indications for endoscopy were: 1) calculus removal that could not be performed by conventional methods, 2) screening of the salivary ductal system for residual calculi after sialolithotomy, 3) positive evidence of ductal dilatation or stenosis on the sialogram or ultrasound examination, and 4) recurrent episodes of major salivary gland swellings without known cause., Results: Of the 154 endoscopies performed, 9 were immediate failures as a result of technical problems. Of the remaining 145 glands, 112 had obstructions and 33 had sialadenitis alone. The success rate was 82% for calculus removal. Thirty-two percent of the submandibular and 63% of the parotid sialoliths, and the 1 stone in the Bartholin's duct, were undetected before sialoendoscopy. Multiple endoscopic findings were encountered. No major complications were noted., Conclusions: Sialoendoscopy is a minimal invasive technique for the diagnosis and removal of obstructive pathologic tissue in the major salivary glands.

A 49-year-old man with multiple sialoliths in the submandibular duct is described. One of the sialoliths was of remarkable size. This report is of interest because of the unusual size and weight of this sialolith and because of the patient's symptoms, which were relatively mild and of short duration.

This report documents an unusual case of buccal mucosa swelling due to a giant (25 x 13 mm), parotid duct sialolith. Review of the literature disclosed that this is the largest parotid sialolith ever reported. Diagnostic imaging and treatment are described.

In assessing new minimally invasive diagnostic techniques (duct endoscopy) and therapy (lithotripsy) of salivary gland disease, it is of importance to know the true dimensions of the secretory ducts. Twenty-five ducts of the parotid gland and 20 ducts of the sub-mandibular gland were examined histologically at different points of their anatomic course and their in vivo diameters were evaluated using a previously determined formalin-induced shrinking factor. The mean diameter of Stensen's duct at four different points along its length ranged between 0.5 mm and 1.4 mm, depending on the site. A narrowing at the middle of the duct was striking. In all preparations examined, the minimum width of the secretory duct was located at the ostium. In Wharton's duct the narrowest duct diameter was also identified at the ostium. The mean values for the duct diameters ranged between 0.5 mm and 1.5 mm. For diagnostic and therapeutic purposes, endoscopes, balloon catheters and stone-extraction baskets should conform as much as possible to physiological duct widths. A diameter of 1.2 mm should be considered the upper limit for duct instruments. Our findings also suggest that in the case of salivary stone lithotripsy the best results will be achieved when the maximum size of a stone fragment does not exceed 1.2 mm.

Purpose: The aim of this study was to evaluate an MR technique optimized for imaging of the parotid gland ductal system., Method: The pulse sequence was optimized in 10 volunteers to depict static or nearly static fluid in the parotid ductal system. A heavily T2-weighted fast SE sequence (TR 3,600 ms/TE 800 ms) with a slice thickness of 30-40 mm using an 8 cm surface coil allowed depiction of the fluid-filled parotid duct. Thirteen patients with benign as well as malignant parotid gland pathologies were examined: sialadenitis (n = 2), sialadenosis (n = 3), Heerfordt syndrome (n = 1), pleomorphic adenoma (n = 2), parotid carcinoma (n = 1), lymphoepithelial carcinoma (n = 1), cystadenolymphoma (n = 2), and non-Hodgkin lymphoma (n = 1)., Results: The heavily T2-weighted projection image yielded good quality sialographic images. The main duct and primary branching ducts were clearly depicted in all normal cases. The main duct was visualized in all patients. Intra- and extraglandular duct widening and ductal strictures were well depicted. Sialolithiasis with a calculus in the main duct was correctly demonstrated in one case., Conclusion: MR sialography is noninvasive and does not depend on duct cannulation or contrast agent injection. Initial experience with a thick slice projection technique indicates that MR sialography can be successfully applied to image the parotid gland ductal system.

Newly available minimally invasive methods have changed established treatment of human sialolithiasis during the past several years. After basic in vitro and in vivo investigations, two systems of shockwave treatment proved to be useful for clinical application: extracorporeal shockwave lithotripsy (piezoelectric system) and intracorporeal laser lithotripsy (using a rhodamine-6G dye laser). Following our clinical experiences with these methods a differential scheme for managing sialolithiasis is recommended depending on localization of the calculi and their maximal diameters. Submandibular stones are best treated by extra-corporeal lithotripsy if the stone is located in intraglandular parts or in the gland hilum. Stones of the hilum can also be treated by laser lithotripsy. In the distal parts and near the duct orifice, papillotomy and stone extraction should be tried independent of the stone size. If the stone is located in the intraglandular parts of the duct system or in the hilum and its diameter is over 12 mm, submandibulectomy is necessary. Calculi of the parotid gland should only be treated by extracorporeal lithotripsy, regardless of size and location.

The occurrence of sialolithiasis in children is uncommon, while parotid sialolithiasis in children is rare. A case of parotid sialolithiasis arising in a 4-year-old girl is presented.

Background: The effort to use minimally invasive strategies in the treatment of human sialolithiasis in principle seems to allow the clinical application of pneumatic lithotripsy because of the small diameters of the probes involved. While this kind of therapy is already used successfully in urology, we investigated the method during in vitro and animal experiments., Materials and Methods: The treatment of stones and tissue utilized the pneumatic lithotripter "Lithoclast". This system works with ballistic energy and is similar to a biologic "pneumatic hammer". Thirty salivary calculi were treated with pneumatic lithotripsy. Four submandibular salivary glands and their ducts were removed intraoperatively and were exposed to the pneumatic probes. Moreover, in two cases a salivary concretion was also implanted prior to pneumatic lithotripsy. In two rabbits the ducts of the parotid glands were ligated for 2 weeks. On the basis of the in vitro experiments, concretions were placed in two of the four salivary ducts. Following this, the pneumatic probes were inserted along the ducts and lithotripsy was completed., Results: All of the 30 salivary calculi were reduced to sizes smaller than 1.5 mm in diameter. No macroscopic or microscopic damage was detectable while the probe was in a duct. However, in both cases with implanted calculi retropulsion of fragments occurred consequent perforation of the ducts. After application of ballistic pulses along the duct, small periductal hematoma without any perforation were detected macroscopically. Microscopically, only small bleeding was observed along the submucosa and partial loss of epithelium was found. In contrast, the pulse application to the implanted concretions lead to destruction of the calculi with perforation of the ducts as well as hemorrhage in the surrounding tissue., Conclusions: The method of pneumatic lithotripsy used in the present study resulted in sufficient destruction of salivary calculi. In vitro and in vivo lithotripsy of duct implanted calculi led to perforation of the salivary duct in all cases. Because of these results, the clinical use of this technique to treat human sialolithiasis appears to be not justified.

Background: Extracorporeal lithotripsy is now used routinely for the treatment of salivary duct stones. The question arose whether electrohydraulic intracorporeal lithotripsy, which is applied in urology and gastroenterology, might also be useful in the treatment of this disease. Before its possible clinical application the influence of electrohydraulic intracorporeal shock waves on salivary stones in vitro and any influence on the tissue in the head and neck region (in vivo) had to be investigated., Materials and Methods: In vitro experiments. Fifty-eight salivary stones and 11 extirpated human submandibular glands were treated by three different electrohydraulic devices. Animal experiments. Electrohydraulic shock waves were applied to the dilated Stensen's duct and other tissues (muscle, parotid gland, facial nerve) of six rabbits., Results: Of 58 salivary stones, 53 (91%) were fragmented, 39 (67%) with a remaining size of less than 1.5 mm and 14 (24%) more than 1.5 mm. In 5 cases (9%) no effects were seen at all. Fragmentation occurred independent of the mineralogical components of the stone and independent of the different lithotriptors used. The smaller the probe diameter and the larger the stone, the more shock waves were needed to achieve fragmentation. With the smaller probes the stones could not be fragmented completely. In human submandibular glands, extensive tissue lesions could be evidenced macroscopically and histologically after application of electrohydraulic shock waves in vitro. Application of electrohydraulic shock waves to the dilated parotid gland duct of rabbits led to perforations of the duct after 1-5 single pulses. Lesions of nerves and blood vessels could also be observed within the duct environment. This occurred with all of the different electrohydraulic devices, probe diameters and intensities used. In our opinion the damage produced is probably the result of both the direct effect of the plasma as well as the resultant stress wave., Conclusion: In view of the severe damage caused to different tissues, use of the described method for the treatment of stones in the narrow human salivary ducts should be greatly restricted.

A vivid example of parotid sialolithiasis diagnosed with an anterior-posterior radiograph and subsequently followed with a superficial parotidectomy is presented. The case presentation is preceded and followed by a discussion of the pathogenesis and treatment of such an abnormality.

Three cases with sialolithiasis of minor salivary gland are presented. The sialoliths were found on the left side of the upper lip (two patients) with local infection and on the right side of buccal mucosa (one patient) without any symptom. The histologic findings resulted from our own cases and the etiology are discussed extensively and a literature review is made as well.

Sialolithiasis occurs due to the calculous concretion in salivary ducts or glands, but it is rare in childhood. In this paper, a case of sialolithiasis with a submandibular duct calculus observed in a 2-year-old girl is reported. This case is one of the youngest, based on a review of the literature regarding sialolithiasis found in Japan. The retrospective survey was made in 30 cases of sialolithiasis in children under 10 years of age which were reported in the Japanese literature with clear descriptions of age, sex and location. The summaries are as follows: 1) Sex difference: The difference between males and females was in the ratio 16/14. There was no significant difference according to sex. 2) Location of the salivary calcul: In 27 cases they were found in the duct of the submandibular glands, and 3 cases in the parotid glands, and no cases in the sublingual glands. 3) Term before treatment: Most cases were treated within a month after the patients has noticed the symptom. 4) Removal method of salivary calculi: Salivary calculi were removed by means of intraoral incision in most cases. 5) Number of the removed calculi: In each of all cases, one calculus was removed. 6) Size of the removal calculi: The diameter of the calculi was less than 5.0 millimeters long in most cases.

The diagnosis and treatment of unusual surgical conditions of the neck in the newborn, infancy, and paediatric age-group are discussed. The median cervical cleft, the scalenus cervical rib syndrome, the cervical teratoma, changes of the thymus, tumour-like abnormalities of the large veins, calculus formation of the sub-mandibular salivary gland, severe traumatic and iatrogenic injury may all present difficult diagnostic and therapeutic problems.

Aggregated crystalloids and calculi, up to 600 to 700 micron in diameter, found in the parotid gland tissue taken from a patient with chronic recurrent parotitis were examined histopathologically and microanalytically. In part of the periphery of calculi which had lamellated structure, layers of crystalloids in continuation with calculi were observed; and diffuse deposition of von Kossa-positive fine granules was seen in the innermost area of the crystalloid-layers. By electron probe x-ray microanalysis, phosphorus, sulphur and calcium were principally detected within the innermost area of the crystalloid-layers. The result of the present study lends support to the possibility that crystalloids have some relation to the development of salivary calculi in the human parotid gland.