Search

Sialolith is the most common obstructive pathology of the salivary gland. Submandidular glands are most commonly affected in its parenchyma. This case report describes a patient presenting with an unusually large submandibular gland sialolith, where sialography was performed locating the lesion. Etiology, diagnosis and various treatment modalities available for management of salivary gland calculi depending on their site and size are also discussed in this case report. Keywords: Sialolith, Submandidular gland, Sialography

Zusammenfassung Hintergrund Der Erfolg der Sialendoskopie hängt von mehreren Faktoren ab. Im Jahr 2008 wurde die Lithiasis-Stenosis-Dilatation (LSD) -Klassifikation zur genaueren Beschreibung des Stein-Gang-Verhältnisses eingeführt. Neben dem Nutzen der LSD-Klassifikation untersuchten wir weitere prä- und intraoperativ erhobene Einflussfaktoren auf den Erfolg der Sialendoskopie bei Sialolithiasis. Methode PatientInnen mit Sialolithiasis der Glandula submandibularis und Glandula parotis, die zwischen September 2018 und März 2020 eine primäre Sialendoskopie erhielten, wurden retrospektiv untersucht. Die Steingröße, Steinlokalisation und LSD-Klassifikation wurden unter anderem als prognostische Einflussfaktoren untersucht. Ergebnisse Insgesamt wurden 37 PatientInnen retrospektiv untersucht. Eine erfolgreiche Steinextraktion wurde bei 12/37 (32 %) PatientInnen durchgeführt. Bei Erfolg betrug die mediane Steingröße 3,7 mm, verglichen mit 10 mm bei Misserfolg (Mann-Whitney-Test; p Schlussfolgerung Distal lokalisierte Steine und Steine kleiner als 5 mm in einem ansonsten unauffälligen Gangsystem können als prognostisch günstige Faktoren angesehen werden. Zukünftige Studien sollten anhand größerer Datenmengen die LSD-Klassifikation, das Volumen der Steine und deren Gangorientierung bzw. deren Abstand von der Papille untersuchen.

Background and Objectives Proximal submandibular stone is not a rare disease. The aim of this study is to evaluate the surgical outcomes of 3 different ways to treat proximal submandibular stone: intraoral removal of stone (IORS) with sublingual gland (SLG) resection, IORS without SLG resection and submandibular gland (SMG) resection.Subjects and Method We prospectively reviewed the surgical outcomes of IORS with SLG resection group (22 patients), IORS without SLG resection group (35 patients) and SMG resection group (22 patients). To evaluate the surgical outcomes, we analyzed the location and size of stones, mean operation time, mean hospital stay, mean postoperative degree of pain based on a visual analog scale (0–10), and incidence of complications.Results There were no significant differences between the mean diameter of stones and length from the hilum to stones. The mean operation time was shorter in the IORS without SLG resection group than that in IORS without SLG resection group, and was significantly shorter than that of the SMG resection group. The mean hospital stay of the IORS without SLG resection group was also shorter than that of IORS with SLG resection group, and was significantly shorter than the SMG resection group. IORS without SLG resection group felt less pain than IORS with SLG resection group and SMG resection group. Four patients who underwent IORS without SLG resection experienced transient and mild SMG swelling, and mild paresthesia was noted on the same side. All patients recovered within 3 months. Intraoral removal of proximal SMG stones exhibited several advantages over SMG resection in terms of hospital stay, mean operation, time and postoperative pain.Conclusion Based on our results, we suggest that IORS without SLG resection be selected as the primary procedure for the removal of proximal submandibular stones rather than SMG resection.

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.Retrospective chart review.Ultrasound is frequently used to size salivary calculi and make treatment decisions, but the accuracy of measurements from this modality has not been validated.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.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).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.2C.

Sialolithiasis is a common disease that affects the major salivary glands and can occur at any age. Parotid glands are rarely involved and, even rarer are the cases of sialoliths larger than 10 mm. This report presents the rare case of a giant parotid sialolith associated with facial cellulitis in a 75-year-old man. The treatment involved initially non-surgical approach followed by a minimally invasive surgery to restore health and function. The treatment protocol was completely successful and proved effective in clinical and surgical management of giant parotid sialolith associated with facial cellulitis. La sialolitiasis es una enfermedad común que afecta las glándulas salivales más grandes y puede ocurrir a cualquier edad. Las glándulas parótidas casi nunca están afectadas y, aún más raros, son los casos de sialolitos de más de 10 mm. Este reporte presenta el caso de un sialolito parotídeo gigante raro asociado a celulitis facial en un hombre de 75 años. El tratamiento involvió un enfoque inicialmente no quirúrgico seguido de una cirugía mínimamente invasiva para restaurar la salud y la función. El protocolo de tratamiento fue totalmente exitoso y demostró ser efectivo en el manejo clínico y quirúrgico del sialolito parotídeo gigante asociado con celulitis facial. A sialolitíase é uma doença comum que afeta as glândulas salivares maiores e pode ocorrer em qualquer idade. As glândulas parótidas raramente são envolvidas e, mais raros ainda são os casos de sialolitos acima de 10 mm. Este relato apresenta o caso de um raro sialolito parotídeo gigante associado à celulite facial em um homem de 75 anos. O tratamento envolveu uma abordagem inicialmente não cirúrgica seguida por uma cirurgia minimamente invasiva para restaurar saúde e função. O protocolo de tratamento foi totalmente bem-sucedido e se mostrou eficaz no manejo clínico e cirúrgico do sialolito parotídeo gigante associado à celulite facial.

Background Salivary gland calculi are common in adults but rare in the paediatric population. It accounts for only 3% of all cases of sialolithiasis. Parotid ductal calculus is rare as compared to submandibular ductal calculus. Case presentation A 3-year-old boy presented with acute painful right parotid swelling with pus discharge from the Stensen duct. Computed tomography revealed calculus obstructing the parotid duct causing proximal ductal dilatation and parotid gland and masseter muscle oedema. The child was treated with conservative measures, and subsequently the swelling and calculus resolved. Conclusions Small parotid duct calculus in children may be successfully treated with conservative measures which obviate the need for surgery. We discuss the management of parotid sialolithiasis in children and conduct literature search on the similar topic.

Sialolithiasis, the most common salivary gland pathology, is caused by calculi in the gland itself and its duct. While patients with small sialoliths can undergo conservative treatment, those with standard-size or larger sialoliths require sialolithotomy. In the present case study, we removed two sialoliths located beneath the mucosa in the posterior and anterior regions of Wharton's duct, respectively. For the posterior calculus, we performed sialolithotomy via an intra-oral approach; thereafter, the small anterior calculus near the duct orifice was removed by hydraulic power. This method has not previously been reported. There were no complications either during the operation or postoperatively, and the salivary function of the gland remained normal.

Sialolithiasis is a pathological process that affects the major salivary glands. It consists of calcifications that obstruct the parenchyma of the gland and / or the lumen of the ducts. The 37 years old female patient, VBB, leucoderma, attended the stomatology service with a complaint of swelling in the floor of mouth, which she noticed 10 years ago. The clinical and radiographic exams indicated a diagnosis of multiple sialolithiasis in the left submandibular gland duct. Surgical intervention was indicated in this case. Amongst all sialolithiasis cases, 80% affect the submandibular glands. Of these, 70% are isolated sialoliths. Only 5% of cases present more than 3 calcifications. This study aims to report the diagnosis and treatment of a rare case of multiple sialoliths located in the duct of the submandibular gland, which were surgically removed via intraoral access.

Objetivo: O objetivo deste estudo foi avaliar os aspectos radiográficos das glândulas salivares maiores na sialografia e seu grau de inflamação com as características individuais dos pacientes. Métodos: Trinta imagens radiográficas de ambas as glândulas parótidas e submandibulares de 25 pacientes submetidos a exames de sialografia foram analisadas retrospectivamente. O teste qui-quadrado foi realizado para correlacionar o grau de inflamação de cada área das glândulas salivares com as variáveis categóricas: sexo, tipo e lado da glândula afetada. A correlação de Pearson foi realizada para correlacionar o grau de inflamação entre o ducto principal e o ducto intraglandular e o parênquima. Resultados: Não houve relação estatisticamente significante entre o grau de inflamação de nenhuma das partes das glândulas salivares e as variáveis categóricas no teste qui-quadrado (p>0,05). O grau de inflamação no ducto principal teve uma fraca correlação com o grau de inflamação no ducto intraglandular (p0.05). The grade of inflammation in the main duct had a weak correlation with the degree of inflammation in the intraglandular duct (p

A sialolitíase é uma doença não neoplásica mais comum que afeta as glândulas salivares, atribuída a obstrução de glândulas salivares ou seu ducto, pela formação de um ou mais cálculos. É uma doença que ocorre mais em glândulas salivares maiores, sendo a submandibular a mais acometida. A etiologia pode estar associada ao pH básico e a anatomia dos ductos bastante tortuosos e ascendentes. Descrever o caso clínico de um sialolito de extensa dimensão em glândula submandibular e o diagnóstico através de exames clínicos com auxílio de exames de imagem. Paciente gênero feminino, compareceu ao Serviço de diagnóstico bucal da extensão de estomatologia - SERPROBEM do Centro Universitário Cesmac para avaliação, queixando-se de lesão no assoalho bucal esquerdo. Foram solicitados exames complementares de imagem: ultrassonografia, telerradiografia lateral e radiografia convencional (panorâmica e oclusal), tendo a presença de massa mineralizada em região submandibular. Foi realizada excisão cirúrgica, com preservação da glândula submandibular. Com a associação de exames clínicos e de imagem, pode-se facilmente identificar casos de sialolitíase.

Resume Introduction Les techniques mini-invasives (TMI) doivent etre privilegiees pour le retrait des lithiases parotidiennes. Elles regroupent la sialendoscopie, la lithotripsie extracorporelle et la taille endobuccale. En cas d’echec, un abord combine intra- et extra-oral peut etre realise. Le but de ce travail etait d’evaluer l’efficacite et les complications de ces abords combines. Materiels et methodes Une etude retrospective a ete realisee sur des patients pris en charge entre 2006 et 2015. Tous les patients majeurs presentant une ou plusieurs lithiases parotidiennes et chez lesquels les TMI classiques avaient echouees ont ete inclus. L’âge et le sexe des patients, le nombre, la taille et la localisation des lithiases, la reussite ou non de l’intervention, la survenue de douleurs, de gonflements ou d’infections ont ete releves. Resultats Neuf patients ont ete inclus (âge moyen : 56 ans). Le recul moyen etait de 48 mois. Quatre-vingt-huit pour cent des patients presentaient une seule lithiase. Neuf lithiases ont ete extraites par abord combine. Le diametre moyen des lithiases etait de 8,5 mm et 33 % d’entre elles etaient localisees a la jonction tiers moyen-tiers posterieur du conduit parotidien. Tous les patients presentaient des episodes retentionnels pluriquotidiens preoperatoires avec des coliques (55 %) et des hernies salivaires (100 %). Deux patients presentaient une complication infectieuse a type de sialadenite et perisialodocholite. Soixante-quinze pour cent (9/12) des lithiases ont ete extraites. Les complications ont ete 1 fistule, 1 paresie faciale, 3 recidives. Sept patients sur 9 (77 %) ont ete completement soulages apres l’intervention. Discussion La chirurgie par abord combine des lithiases parotidiennes est indiquee en cas d’echec des TMI lorsque les symptomes alterent la qualite de vie.

Sialendoscopy is gaining in popularity in treating calculus disease. The delicacy of the instrument and the diameter of the salivary ducts are factors that limit the ability to achieve complete success. There is also continued speculation regarding the utility of the procedure, especially among clinicians who are masters of conventional methods like sialadenectomy and sialodochotomy.To assess the efficacy of sialendoscopy over conventional methods in treating sialolithiasis.A prospective case control study was conducted in a tertiary care centre; this study involved 50 patients of sialolithiasis, and it extended over a 36-month period. All had undergone treatment, either by conventional methods or interventional sialendoscopy. All patients with nonpalpable calculi smaller than 6 mm underwent interventional sialendoscopy. Failed sialendoscopies and larger nonpalpable calculi were removed through sialadenectomy. The outcome variables studied included calculus removal, postoperative symptoms, and gland preservation.The success rate in terms of calculus removal by sialendoscopy was 88%, versus 100% by sialadenectomy. The salivary gland was preserved in 88% of the cases in the sialendoscopy group. Only 12% of patients were symptomatic.Sialendoscopy was effective in removing calculi of various sizes; it was definitely superior to conventional methods. Sialadenectomy should be reserved for cases either not suitable for sialendoscopy or in which there was an intervention failure.

Objective:Saliva composition may affect sialolithiasis formation; thus, this study compared the salivary inorganic composition of sialolithiasis patients with that of healthy controls, and determined whether salivary inorganic composition changes after sialolithiasis surgery.Methods:The study included 40 patients with sialolithiasis and 40 matched healthy controls. Patients were examined before and after sialolithiasis surgery; controls were examined once. Flow rate and the inorganic saliva composition in unstimulated whole saliva were assessed.Results:Patients’ salivary flow prior to surgery was significantly lower compared to that of healthy controls, but equalised after surgery. Prior to surgery, patients’ saliva exhibited higher concentrations of calcium, magnesium, phosphorous compared to that of healthy controls. The concentration of most ions remained high after sialolithiasis surgery.Conclusion:Sialolithiasis patients had increased salivary concentrations of the ions that constitute the main inorganic phase of most sialoliths, and this may confer a risk for developing sialolithiasis.

We present the results of treatment of sialolithiasis of the submandibular and parotid glands using sialendoscopy and sialendoscopy-assisted surgery. Between 2009-2013, 397 consecutive patients (mean (range) age 48 (18-76) years) were treated for obstructive diseases of the major salivary glands (sialolithiasis n=239, 175 submandibular and 64 parotid). In a total of 175 patients with 191 stones in the submandibular gland treated by endoscopic retrieval or surgical release, 149 patients (85%) were rendered free of stones (by sialendoscopy alone n=82, and sialendoscopy with operation n=67) Twenty patients (11%) had residual stones and 6 patients (4%) required excisionof the gland. Sixty-four patients had 71 stones removed from the parotid gland by endoscopic retrieval or surgical release and 43 (67%) were free of stones (by sialendoscopy alone n=25, and sialendoscopy with operation n=18). Twenty patients (31%) had residual stones and one (2%) required removal of the gland. In the group of patients whose stones were removed endoscopically, the effectiveness of sialendoscopy was 87% and 85%, respectively. We confirm that sialendoscopy and sialendoscopy-assisted removal is the current treatment of choice for stones in the submandibular and parotid glands. The indications for excision of the gland are becoming less common as first-line treatment, although it is still indispensable in some cases.

Nonneoplastic disorders of the salivary glands involve inflammatory processes. These disorders have been managed conservatively with antibiotics, warm compresses, massage, sialogogues, and adequate hydration. Up to 40% of patients may have an inadequate response or persistent symptoms. When conservative techniques fail, the next step is operative intervention. Sialendoscopy offers a minimally invasive option for the diagnosis and management of chronic inflammatory disorders of the salivary glands and offers the option of gland and function preservation. In this article, we review some of the more common nonneoplastic disorders of the parotid gland, indications for diagnostic and interventional sialendoscopy, and operative techniques.

Sialolithiasis is a common salivary gland disease which has highest predilection rate in submandibular followed by parotid and sublingual glands. It results in mechanical obstruction of the salivary gland duct. The unique anatomy of the submandibular gland duct facilitates the deposition of mineral salts and leads to the formation of stones. We are presenting a unique case of submandibular calculus which was completely asymptomatic. On 2nd day after a mandibular incisor tooth extraction, patient presented with some hard object in her mouth. The stone was removed intraorally through the duct opening under local anaesthesia.

Sialolithiasis is the formation of calculi or sialoliths in the salivary gland. It is the most common benign condition of the salivary gland. Sialolithiasis can occur in all salivary glands. The submandibular gland is most commonly affected followed by the parotid gland. Calculi commonly measure less than 10 mm. Calculi of more than 15 mm are termed giant salivary gland calculi and are infrequently reported in the literature. Here, we report a case of unusually large submandibular gland calculus of 5 cm in greatest dimension which caused erosion of the oral cavity.

We present a case of submandibular duct calculi diagnosed using transoral sonography. Sonography is the first-line imaging modality of salivary gland calculi. However, it is performed via a transcutaneous approach, which is limited in identifying small salivary duct calculi. Using an intraoral transducer, transoral sonography can visualize the submandibular duct and detect the presence of small calculi, thus overcoming the limitations of transcutaneous sonography.

ResumoA sialolitíase é a desordem mais comum das glândulas salivares acometendo principalmente a glândula submandibular e o seu ducto. A maioria dos cálculos salivares é de pequenos tamanhos; no entanto, podem atingir grandes proporções, sendo considerados como sialolitos gigantes. O presente trabalho tem como objetivo relatar um caso de sialolito gigante localizado no ducto da glândula submandibular tratado através de remoção cirúrgica por acesso intraoral.AbstractSialolithiasis is the most common salivary disorder, predominantly affecting both the submandibular gland and the Wharton's duct. Most of the salivary calculi are small in size but can reach large proportions, called giant sialoliths. This paper aims to describe a case of giant sialolith located in the submandibular gland duct, which was treated by surgical removal using an intraoral approach.

Salivary gland calculi account for the most common disease of salivary glands. The majority of sialoliths occur in submandibular gland or its duct and they are a common cause of acute and chronic infections. This case report describes an asymptomatic patient presenting with a large submandibular duct sialolith, the subsequent non surgical management of the patient along with etiology, diagnosis and various treatment modalities available for the treatment of salivary gland calculi depending on their site and size.

Sialolithiasis is among the most common disease affecting the major salivary glands whereby the submandibular gland or its duct is affected in the majority of cases. We report a case of the surgical removal of a giant sialolith along with the submandibular gland using the transcervical approach and its clinical outcome.

La diffusione delle tecniche minimamente invasive per il trattamento dei calcoli salivari, quali la scialoendoscopia, ha permesso di ottenere un maggior tasso di preservazione della funzionalità ghiandolare, evitando le significative morbidità notoriamente associate alla parotidectomia superficiale. La scelta terapeutica è condizionata dalla dimensione, mobilità e posizione del calcolo così come dalla presenza di stenosi duttali. Verranno descritti i principi terapeutici inerenti la patologia litiasica, nonché due tecniche scialoendoscopico-assistite di rimozione dei calcoli salivari: la prima per via intra-orale, la seconda per via extra-orale.

The aim of this study was to review the advantages, limitations, and international interdisciplinary expert perspectives and contrasts of salivary gland endoscopy and transoral techniques in the diagnosis and management of salivary gland calculi and their adaptation in North America. The transition from transcervical approaches to strictly sialendoscopic approaches is a broad chasm and often not feasible. Sialendoscopy, sialendoscopy-assisted, intraoral, and transcervical approaches all have surgical value. Diagnostic sialendoscopy, interventional sialendoscopy, sialendoscopy-assisted, and transoral techniques have been a major step forward, not only in providing an accurate means of diagnosing and locating intraductal obstructions, but also in permitting minimally invasive surgical treatment that can successfully manage blockages precluding sialoadenectomy in most cases. A flexible methodology is required. Multiple or combined measured may prove effective.

The purpose of this study was to investigate etiologic factors for sialolithiasis in a population of patients from the United States.Retrospective, cohort study.Tertiary university.Charts for all patients diagnosed with sialolithiasis between January 2001 and February 2010 were retrospectively reviewed. Demographic factors, smoking history, comorbid medical conditions, and medication history were recorded. Statistical analyses were then performed on the collected data. Population prevalences of smoking, diuretic usage, cholelithiasis, and nephrolithiasis were obtained through literature review.A total of 153 patients with sialolithiasis were identified. Of these patients, 125 (82%) had submandibular sialolithiasis, and 28 (18%) had parotid sialolithiasis. Positive smoking histories were present in 67 individuals (44%). Both the current rate of smoking and the rate of a history of smoking were higher in our cohort when compared with the general population, although the differences did not reach statistical significance. Smoking history did not correlate with the size of the primary sialolith. Diuretic usage in the cohort was observed at a rate of 20%, higher than reported population rates of diuretic use of 8.7%. The prevalences of cholelithiasis and nephrolithiasis were not different from observed population rates.Sialolithiasis is an uncommon condition of unclear etiology. This study represents an initial attempt to quantify the prevalence of smoking and diuretic therapy in a population of patients with sialolithiasis.

Sialolithiasis is the most common disease of salivary glands. It is a condition characterized by the obstruction of a salivary gland or its excretory duct due to the formation of calcareous concretions, resulting in salivary ectasia and even determining the subsequent dilatation of the salivary gland. The sialolith usually measure from 1 mm to less than 10 mm. They rarely measure more than 15 mm. Infrequently giant salivary gland calculi (GSGC) >15 mm have been reported in the literature. The submandibular gland and its duct appear to be the sites most susceptible to this disease. The aims of this article were: 1) report the cases of two patients suffering of sialolithiasis caused by giant salivary gland calculi occurring in the Wharton’s duct; and 2) present the results of the literature’s research on giant sialolith. The diagnostic approach of the two cases consisted of trans-occlusal endoral radiography, orthopantomography, CTscan. The patient’s glands were treated with conservative trans-oral surgical technique stone removal in both cases, performed under local anaesthesia. The glands recovered normal function quickly after removal of the stones. For the patients the morbidity associated with salivary gland calculi removal follow-up showed asymptomatic and normally functioning glands.

Resume Introduction La fragmentation des lithiases salivaires par lithotripsie extracorporelle (LEC) est decrite depuis les annees 1990. Nous avons souhaite en evaluer l’efficacite a travers une etude retrospective. Patient et methodes Nous avons revu les dossiers de 1571 patients (801 femmes et 770 hommes, de six a 85 ans) porteurs de sialolithiases traitees par LEC de 1995 a 2010. Mille trente et un etaient submandibulaires (65,6 %) et 540 parotidiennes (34,4 %). Le traitement consistait en une ou plusieurs seances de LEC espacees de trois a 24 mois. En l’absence de trouble de l’hemostase et d’infection, 3000 a 6000 impacts etaient delivres par seance. Des controles echographiques etaient pratiques regulierement et systematiquement. Resultats Une moyenne de six seances ont ete necessaires. Toutes les lithiases ont ete fragmentees dont 1056 (67,2 %) totalement et 515 (32,8 %) partiellement avec des fragments residuels de 1 a 6 mm. Apres traitement, 1446 patients (92 %) etaient asymptomatiques et 125 (8 %) ont continue a presenter des coliques salivaires, sans fragments residuels echographiquement visibles dans 82 % des cas. Les effets indesirables principaux ont ete les infections (628 patients, 40 %) resolutives sous antibiotherapie et corticotherapie, voire extraction des fragments sous anesthesie locale. Discussion Developpee depuis 20 ans, la LEC semble une excellente alternative a la chirurgie conventionnelle a condition d’en respecter les indications. Elle est tres efficace, ses inconvenients sont la longueur du traitement et la difficulte du reperage echographique qui rend la procedure operateur-dependant.

Die Sonographie ist unverzichtbar als Basisdiagnostik bei allen Erkrankungen der Speicheldrusen. Die Speicheldrusen eignen sich fur die Ultraschalldiagnostik, denn sie liegen relativ oberflachlich, sind gegenuber dem umgebenden Gewebe gut abgrenzbar, und ihre Echogenitat ist relativ charakteristisch. Der dynamische Untersuchungprozess weist hohe Reproduzierbarkeit, weder Strahlenbelastung noch Invasivitat und relativ niedrige Kosten bei hoher diagnostischer Aussagekraft auf. Durch Fortschritte der Gerate- und Schallkopftechnologie, wie Farbdopplersonographie mit und ohne Kontrastmittel, Tissue Harmonic Imaging und Elastographie haben sich diagnostische Aussagekraft und Indikationsspektrum erweitert. Bei einzelnen Krankheitsbildern liegen typische, wenn auch unspezifische sonographische Charakteristika vor. Zusatzlich kann mit der sonographisch gesteuerten Feinnadelpunktion gezielt Material fur eine zytologische Untersuchung unter direkter visueller Kontrolle gewonnen werden. Im Vergleich zu Verfahren wie der Magnetresonanztomographie oder der Computertomographie weist die Sonographie die hochste Sensitivitat in der Erkennung von Neoplasmen der Speicheldrusen auf.

Analyze the characteristics of patients undergoing interventional sialendoscopy for sialolithiasis whose stones were not visualized intraoperatively.Case series with chart review.Tertiary care hospital.Patients (n = 276) undergoing sialendoscopy between June 2008 and December 2014 were reviewed for patient characteristics, imaging characteristics, and outcomes. Nonvisualization was defined as a sialolith that was documented on imaging preoperatively but not visualized intraoperatively during sialendoscopy, despite successful ductal cannulation and evaluation.A total of 337 sialendoscopy procedures were preformed. Preoperative imaging documented a sialolith in 203 (60%) cases. Nonvisualization occurred in 31 (15%) cases with sialolith. The parotid gland was involved in 58% (18 of 31) of nonvisualization cases, as opposed to 21% (43 of 203) of all sialolith cases. The submandibular gland was involved in 42% (13 of 31) of nonvisualization cases, as compared with 79% (160 of 203) of all sialolith cases. Nonvisualization occurred in 42% (18 of 43) of parotid cases versus 8% (13 of 160) of submandibular cases, a statistically significant difference (P.001). Parotid stones located posterior to the plane of insertion of the posterolateral edge of the masseter were significantly more likely to experience nonvisualization (73%) than those along and anterior to the masseter (25% and 0%, respectively; P = .009).Intraoperative nonvisualization of a sialolith is more likely to occur in the parotid gland. Proximal stone location may predict nonvisualization. These factors should be considered during treatment planning and counseling for patients with sialolithiasis.

BACKGROUND: Sialolith is a pathological calcification found inside salivary glands, composed principally of apatite crystals. The purpose of this study was to investigate detailed structural properties to gain insight into the formation of sialolith. METHODS: A 45 mm long sialolith from a human submandibular gland was studied using micro-FTIR and three types of X-ray diffraction (XRD) techniques: i) conventional, ii) micro-focus, and iii) “selected-area XRD” (SA-XRD). RESULTS: The longitudinal section of the sialolith showed a stratified structure perpendicular to the long axis. XRD and FTIR showed that the bulk of the sialolith was composed of carbonate hydroxyapatite. Micro-XRD revealed that crystal orientation was slightly different in each incremental zone. “SA-XRD” showed that the average unit cell dimensions of apatite crystals were different for each zone. CONCLUSION: These results suggest that the stratified structure in the sialolith was a result of intermittent and incremental additional growth reflecting compositional changes in the microenvironment.

The major and minor salivary glands of the head and neck are important structures that contribute to many of the normal physiologic processes of the aerodigestive tract. The major salivary glands are routinely included within the field of view of standard neuroimaging, and although easily identifiable, salivary pathology is relatively rare and often easy to overlook. Knowledge of the normal and abnormal imaging appearance of the salivary glands is critical for forming useful differential diagnoses, as well as initiating proper clinical workup for what are often incidental findings. The purpose of this review is to provide a succinct image-rich article illustrating relevant anatomy and pathology of the salivary glands via an extensive review of the primary literature. In Part 1, we review anatomy as well as provide an in-depth discussion of the various infectious and inflammatory processes that can affect the salivary glands.

Salivary gland stones most frequently arise from the submandibular salivary gland. A giant stone is not common, since its diagnosis and treatment is usually performed before the lesion becomes enlarged. A male patient referred to our clinic with complaints of painful neck swelling, trismus and dysphasia. The patient was hospitalized with the diagnosis of deep neck infection, and antibiotherapy was initiated. Computerized tomographic evaluation showed an opacity in the first neck region. The patient was operated on under general anesthesia, and the cause of the opacity was a sialolith that reached dimensions of4x2x1.5 cm, leading to extreme dilatation of Wharton's duct. Turkish Başlık: Derin Boyun Enfeksiyonu Nedeni Olarak İhmal Edilen Dev Tükürük Bezi Taşı: Olgu Sunumu Anahtar Kelimeler: Tükürük bezi taşları; Tükürük bezi hastalıkları Tükürük bezi taşları en sık submandibular bezden kaynaklanır. Bezde enfeksiyona yol açabilir. Genellikle büyük boyutlara ulaşmadan tanı ve tedavisi yapılır. Bu nedenle dev boyuta ulaşması beklenmez. Kliniğimize boyunda ağrılı şişlik, ağzını açamama, yutma güçlüğü yakınmasıyla gelen erkek hastaya derin boyun enfeksiyonu tanısı kondu ve tıbbi tedavi için yatırıldı. Hastaya Bilgisayarlı Tomografi çekildi. Tomografide solda boynun birinci bölgesinde opasite görüldü. Enfeksiyonu gerileyen hasta ameliyat edildi. Opasitenin nedeni submandibuler bez kanalında aşırı genişlemeye yol açan yaklaşık 4x2x1.5 cm boyutuna ulaşmış taştı., Tükürük bezi taşları en sık submandibular bezden kaynaklanır. Bezde enfeksiyona yol açabilir. Genellikle büyük boyutlara ulaşmadan tanı ve tedavisi yapılır. Bu nedenle dev boyuta ulaşması beklenmez. Kliniğimize boyunda ağrılı şişlik, ağzını açamama, yutma güçlüğü yakınmasıyla gelen erkek hastaya derin boyun enfeksiyonu tanısı kondu ve tıbbi tedavi için yatırıldı. Hastaya Bilgisayarlı Tomografi çekildi. Tomografide solda boynun birinci bölgesinde opasite görüldü. Enfeksiyonu gerileyen hasta ameliyat edildi. Opasitenin nedeni submandibuler bez kanalında aşırı genişlemeye yol açan yaklaşık 4x2x1.5 cm boyutuna ulaşmış taştı.

Sialoliths are responsible for the obstruction of the secretion of saliva. They are rarely larger than 15 mm. More than 80% of the salivary gland calculi appear in the submandibular gland, but they can also be located in the glandular parenchyma and more frequently in the excretory duct. We report an asymptomatic large sialolith case in Wharton's duct of a 58-year-old man and its diagnostic imaging, surgical management and outcomes. For these reasons, we considered useful to report our case in the managing of a sialolith 35 mm in length and weighing 6.45 g located inside Wharton's duct and his treatment was by transoral sialolithotomy with preservation of the submandibular gland.

The management of salivary calculi in children may prove difficult for a number of reasons. Traditional investigations require ionizing radiation and in cases of sialography may be poorly tolerated. Similarly, any surgical treatment is likely to require general anesthesia and, in a number of cases, removal of the affected gland, which is associated with attendant risks. As an alternative, ultrasound and extracorporeal shock wave lithotripsy therapy offers low morbidity and outpatient procedures that are well tolerated, as illustrated by these 2 cases.

Objective To establish the annual incidence, and cost of treating, symptomatic salivary stones and sialoadenitis. Materials and methods Data relating to sialolithiasis and sialoadenitis were obtained from the Department of Health with respect to the 15 health regions in England during the period 1991–1995. These were analysed to obtain the mean incidence per annum. The proportions of each condition treated on an in-patient and out-patient basis were also calculated. A survey of hospital fees was undertaken to determine the national cost for treating these two conditions. Results In the period the mean incidence of hospital admission for symptomatic sialoadenitis and sialolithiasis in the 15 health regions in England was 27.5 (19–46) and 31.5 (26–37) per million population per annum respectively. During this time there was a slight shift toward day case treatment. Conclusions Based on hospital admission data for the period 1991–1995 the mean incidence of symptomatic sialolithiasis is relatively low, being at least 27 per million population per annum and possibly as much as 59 per million population per annum. This represents a cost to the National Health Service of up to £4,000,000 per annum.