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Objective: To perform a systematic review and meta‐analysis on the efficacy and safety of sialendoscopy in the treatment of obstructive diseases of the major salivary glands. Materials and Methods: We searched four databases for literature. The primary outcome assessed was the success rate. Secondary outcomes included the use of supportive devices, number of sialadenectomies and complications. Risk of bias was assessed. Meta‐analyses with subgroup analysis were performed. Results: In total, 91 studies were included, comprising 8218 patients undergoing 9043 sialendoscopic procedures. The majority of studies had a medium or high risk of bias. The incidence of sialadenectomy varied from 0% to 14%. No major complications were reported. Meta‐analysis revealed a weighted pooled success rate of 80.9%. Subgroup analyses showed the weighted pooled success rate in patients with sialoliths (89.6%), stenoses (56.3%), submandibular glands (88.3%), parotid glands (81.2%), patients treated by an endoscopic‐assisted transoral removal of a sialolith (86.3%), patients treated by a combined approach of the parotid gland (78.2%), patients with JRP (67.0%) and with RAIS (45.8%). Conclusion: The success rate of sialendoscopy did not considerably change in the last 9 years. Sialendoscopy is an efficient and safe procedure for the treatment of major salivary gland obstructive disease. [ABSTRACT FROM AUTHOR]

This report describes a rare case of recurrent head and neck desmoplastic neurotropic melanoma with perineural spread along the nervus mandibularis. An 87-year-old male presented with a rapidly growing mass on the right side of the chin, 4 years after surgical excision of a desmoplastic non-melanotic melanoma of the tip of the chin, with lymphadenectomy of the right side submental and submandibular areas. A panoramic X-ray showed extensive widening of the mandibular canal compatible with perineural tumour growth. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) images revealed intense pathological uptake in the recurrent tumour mass located in the right lower buccal fold, and linear pathological uptake in the mandibular canal. Although magnetic resonance imaging is considered the standard of reference, recognition of perineural spread on 18F-FDG PET/CT is important, as it usually leads to a change in patient management from cure to palliation and may avert further diagnostic procedures. [ABSTRACT FROM AUTHOR]

A 12-year-old boy was referred with a painless swelling of the labial gingiva. The swelling was caused by the antihypertensive amlodipine, which he used because of arterial hypertension due to a chronic kidney disease. The treatment consisted of discontinuation of the causative drug after which the swelling of the gingiva slowly subsided.

Ulceration is a common presenting sign of a wide spectrum of diseases of the oral cavity involving many etiologic factors, such as trauma, infection, neoplasms, medication, and immune related disorders, ranging from self-limited lesions to life-threatening diseases. In most cases, a proper diagnosis can be established based on medical history and clinical features only. Early diagnosis is important as oral ulcerations might be a manifestation of a systemic disease or sometimes even due to a malignant process.

Lichen planus is an inflammatory disorder of the skin and/or mucosa. Immune dysregulation, infections, environmental and genetic factors play a role in its pathogenesis. Clinically, there are 6 important distinctive manifestations. The mucosal subtypes manifest inside the mouth, oesophagus, genitalia and - although less often - the nose, ear canal, tear duct and conjuctiva. The non-mucosal subtypes occur on the skin, scalp (hair follicles) and nails. Patients may suffer from several subtypes of lichen planus. Unfamiliarity with the different manifestations may lead to a delay in diagnosis and thus to insecurity and distress in patients. The advice to all healthcare providers is to ask patients with lichen planus about symptoms of all subtypes and clinically inspect the skin and mucosa, or to refer the patient to a dermatologist.

White lesions of the oral mucosa may be caused by various disorders. In most instances of white lesions, diagnoses can be made solely on clinical grounds. When the clinical diagnosis is not compatible with a known disease, the term leukoplakia is used. This is of importance since the yearly malignant transformation rate of oral leukoplakia into a squamous cell carcinoma is 2-4%. The presence and degree of epithelial dysplasia is the most important predictor for malignant transformation.

A 41-year-old patient presented with a sore tip of the tongue. The anterior side of the tongue had a red appearance showing a number of pronounced fungiform papillae and there were tooth impressions on the lateral sides of the tongue. This clinical picture is consistent with transient lingual papillitis. It has an unknown etiology. Local irritation might be a contributing factor. Transient lingual papillitis regresses spontaneously within a few weeks. Chronic lingual papulosis is a variant and shows enlarged filiform papillae; it can persist for years and is rarely painful. The cause of chronic lingual papulosis is similarly often unclear. Both conditions are very common, but often not recognized.

A periapical radiolucency, radiopacity or mixed lesion identified on a radiograph is usually caused by an inflammation of endodontic origin. However, a periapical lesion is sometimes caused by primary bone pathology, predominantly manifesting at the apices of the teeth. Various intraosseous lesions can also be projected across the apices, creating the impression of a causal relation with these teeth. An incorrect diagnosis can lead to 1 or more endodontic treatments being carried out unjustifiably. A thorough and detailed anamnesis, a complete extra- and intraoral clinical examination and the careful study of the radiographic imaging leads to a correct diagnosis in most cases. In this regard, knowledge of the differential diagnosis of periapical lesions is essential. In this article, the focus is on apparent periapical radiopacities and how they can be differentiated from each other.

A radiolucency, radiopacity or mixed lesion identified on a radiograph is usually the result of an inflammation of endodontic origin. However, a periapical lesion is sometimes caused by primary bone pathology, predominantly manifesting at the apices of the teeth. Various intraosseous lesions can be projected across the apices, creating the impression of a causal relation with these teeth. An incorrect diagnosis can lead to 1 or more endodontic treatments being carried out unjustifiably. A thorough and detailed anamnesis, a complete extra- and intraoral examination, and a careful examination of the radiological imaging will result in a correct diagnosis in most cases. Knowledge of the differential diagnosis of periapical lesions is essential. This article focuses on periapical radiolucencies due to overprojection of neoplastic pathology.

A radiolucency, radiopacity or mixed lesion, identified on a radiograph is usually the result of an inflammation of endodontic origin. However, a periapical lesion is sometimes caused by primary bone pathology, predominantly manifesting at the apices of the teeth. Various intraosseous lesions can be projected across the apices, creating the impression of a causal relation with these teeth. An incorrect diagnosis can lead to 1 or more endodontic treatments being carried out unjustifiably. A thorough and detailed anamnesis, a complete extra- and intraoral examination, and a careful examination of the radiological imaging will result in a correct diagnosis in most cases. Knowledge of the differential diagnosis of periapical lesions is essential. This article focuses on apparent periapical radiolucencies caused by overprojection of non-neoplastic pathology.

Background: Data regarding the inter- and intraobserver variability in the radiological assessment of sialolithiasis using cone beam computed tomography are missing in the current literature. This study assessed the inter- and intraobserver variability in the radiological assessment of sialolithiasis using cone beam computed tomography (CBCT)., Material and Methods: In 107 patients, 130 salivary glands (65 parotid and 65 submandibular) with clinical signs of obstruction were assessed by four independent observers; 2 residents OMFS and 2 experienced OMFS. The observers analyzed the CBCT images and determined the absence or presence of one or more salivary stones in the affected gland. This procedure was repeated after three months., Results: Interobserver agreements showed kappa values of 0.84 for the parotid gland, and 0.93 for the submandibular gland. Intraobserver agreements for the whole group reported kappa values between 0.83 - 0.95. There was no significant difference between residents and experienced OMFS., Conclusions: Due to the good inter- and intraobserver agreement, CBCT appears to be a reproducible imaging modality for detecting salivary stones in patients with signs and symptoms of obstructed parotid and submandibular glands.

The aim of this study was to investigate the role of lower dentures in the development of distally located stenoses of Wharton's duct and to further identify contributing factors to this mechanism. In a database of 352 patients with submandibular gland obstruction, three patients with four obstructed glands with stenosis of the ostium of Wharton's duct suspected to be caused by a lower denture were identified and further retrospectively analysed by studying medical records, operation reports, and clinical photographs. In all three cases, the causative lower dental prosthesis was implant-retained. All affected sublingual caruncles were in close relationship with the implants or the implant bar. Initially, all patients were advised to leave out the lower denture for a period of several weeks. One patient was free of symptoms after this period and did not develop any complaints after adjustment and replacement of the prosthesis. Surgical treatment with posterior rerouting of the orificium of Wharton's duct was performed in the remaining two patients because of persistent signs of obstruction. All patients were free of symptoms after long-term follow-up. Although not frequently occurring, implant-retained dental prostheses seem to play a role in the development of some distally located stenoses of Wharton's duct., (Copyright © 2021 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Successful removal of salivary stones depends on exact pretreatment information of the location, the size and shape of the stones. This study aimed to compare the volume of submandibular sialoliths determined by preoperative 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-vivo measured on CBCT were compared to the volumes of removed stones determined by micro-CT scans. The volume measured on micro-CT scans served as the gold standard. Pre-operative CBCT's and in-vitro micro-CT's were converted into standard tessellation language models (STL-models) using an image segmentation software package. The CBCT and micro-CT images of the stones were subsequently metrologically assessed and compared to each other using reverse engineering software., Results: Volumes of submandibular sialoliths determined by CBCT's correlated significantly with volumes measured on micro-CT's (Spearman's coefficient r = 0.916). The interquartile range (IQR) for the volume measured with micro-CT was 117.23. The median is 26.41. For the volume measured with CBCT the IQR was 141.3 and the median 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-vivo those stones are actually a fraction smaller than assessed on the preoperative scan. This is important when cut-off values of sizes of stones are used in the pretreatment planning of stone removal.

A periapical radiopacity is frequently encountered by chance on a conventional periapical or panoramic x-ray. However, local pain and/or swelling in the area of a radiopacity is seldom seen. Here, we report on 2 cases of patients referred to the oral and maxillofacial surgeon with a painful periapical radiopacity in the lower jaw. The clinically and radiologically assumed diagnosis was a cementoblastoma, which was confirmed by histopathological examination following its surgical removal. A cementoblastoma is a rare, benign odontogenic tumor, mostly found in patients younger than 30. Treatment consists of surgical removal of the tumor, almost always together with the attached tooth. The recurrence rate after complete removal is approximately 12%. A cementoblastoma is clinically distinguished from other periapical radiopacities by local pain and sometimes swelling and radiologically by a relationship with the roots of a (pre)molar, a radiolucent rim surrounding the opacity, bone and/or root resorption and expansive growth.

Cat scratch disease is a usually harmless infectious disease caused by Bartonella henselae bacteria. These bacteria are transmitted to humans by a cat scratch or bite. Its typical presentation is a self-limiting lymphadenitis of regional lymph nodes, mostly in the neck. The disease is especially prevalent in children and young adults. Cat scratch disease can be associated with fever, headaches, and malaise, sometimes present itself atypically and in only a few cases expand as a disseminated disease. A swelling in the neck can be caused by many different disorders. In patients with lymphadenitis in the neck and a cat scratch or bite in their recent history, the probable diagnosis cat scratch disease can be made on the basis of clinical findings. Diagnostic testing should be performed when required. For patients with a typical manifestation of cat scratch disease, a wait-and-see policy can be considered. For patients with atypical manifestations, further diagnostic testing and treatment with antibiotics are recommended.

Important characteristics of Sjögren syndrome include a sensation of dry mouth, reduced saliva secretion and swelling of the large salivary glands, usually the parotids. Sjögren patients also run a significantly increased risk of developing a non-Hodgkin lymphoma, generally a so-called mucosa associated lymphoid tissue (MALT) lymphoma. Such a MALT lymphoma often develops in the parotid gland. In 2 cases patients presented with recurrent swellings of the parotid glands who developed both Sjögren syndrome and a MALT lymphoma in both of their parotid glands.

A 67-year-old man presented with a swelling on the right side of the mandible. Histopathological investigation of a biopsy revealed a peripheral dentogenic ghost cell tumour. Treatment consisted of thorough excochleation of the abnormality and 2 years after treatment, the patient was free of recurrence. In the literature, a distinction is made between peripheral and central dentogenic ghost cell tumours, which, like calcifying odontogenic cysts, are considered to be ghost cell odontogenic lesions. These are rarely occurring abnormalities, where the chances of recurrence after proper treatment are limited. The central dentogenic ghost cell tumour has a greater chance of recurring locally.

Sometimes it is difficult to diagnose temporal arteritis because the complaints may vary, change in intensity and are not always characteristic. The condition is a cranial form of giant-cell arteritis affecting large and medium-sized arteries. The first manifestation of temporal arteritis can be a sore tongue that does not manifest any abnormalities during a clinical investigation. In a later stage patients sometimes develop ulceration or necrosis of a part of one side of the tongue. Other symptoms can be a recently developed headache, jaw claudication and acute loss of vision. To diagnose temporal arteritis, histological investigation of a biopsy of the temporal artery is carried out. The treatment consists of long-term use of corticosteroids. A patient in your practice with inexplicable pain on one side of the tongue, without clinical abnormalities, or an ulceration of the tongue without an immediately apparent cause may have temporal arteritis.

Opacities in the orofacial soft tissue rather than the bone are frequently seen on panoramic radiographs. The differential diagnosis of these opacities is diverse and concerns frequently occurring disorders but also rare ones. Due to the diversity of diagnoses, the clinical interpretation of a soft tissue opacity is often difficult. A distinction is made among heterotopic calcifications, heterotopic ossifications, and foreign bodies. Heterotopic calcifications are subdivided into 3 groups, i.e. dystrophic, idiopathic and metastatic calcifications. In this article, stress is placed on the radiographic and clinical characteristics of heterotopic ossifications and foreign bodies, and how they can be recognised on a panoramic radiograph. Besides this, attention will be paid to the need for possible additional imaging techniques and indications regarding treatment option.

Opacities not in the bone but in the orofacial soft tissue, are frequently seen on panoramic radiographs. The differential diagnosis of these opacities is diverse and concerns frequently occurring disorders but also rare ones. Due to the diversity of diagnoses, the clinical interpretation of a soft tissue opacity is often difficult. A distinction is made among heterotopic calcifications, heterotopic ossifications, and foreign bodies. Heterotopic calcifications are subdivided into 3 groups, i.e. dystrophic calcifications, idiopathic calcifications, and metastatic calcifications. In this article, stress is placed on the radiographic and clinical characteristics ofidiopathic calcifications and how they can be recognised on a panoramic radiograph. Besides this, attention will be paid to the need for possible additional imaging techniques and indications regarding treatment options. Idiopathic calcification results from deposition of calcium salts in healthy tissue without an apparent cause. Calcium and phosphate levels in the serum are normal in these cases.

Opacities in the orofacial soft tissue rather than the bone are frequently seen on panoramic radiographs. The differential diagnosis of these opacities is diverse and comprises abnormalities both frequently seen and rare. On account of this diversity, the clinical interpretation of a soft tissue opacity is often difficult. Heterotopic calcifications, heterotopic ossifications, and foreign bodies are distinguished. Heterotopic calcifications are subdivided into 3 groups, i.e. dystrophic calcifications, idiopathic calcifications, and metastatic calcifications. In this article, the emphasis will be on radiological and clinical characteristics of dystrophic calcifications and how to recognize these on panoramic radiographs. In dystrophic calcification, calcium salts are deposited in chronically inflamedor necrotic tissue.

Background: Salivary stones are calcified structures most often found in the main duct of the submandibular or parotid salivary gland. They contain of a core surrounded by laminated layers of organic and inorganic material., Material and Methods: Submandibular and parotid sialoliths (n=155) were collected at the department of Oral and Maxillofacial surgery of a general hospital between February 1982 and September 2012. The weight of the sialoliths was determined and the consistency was subjectively classified. Subsequently, the biochemical composition of the stones was determined by wet chemical methods or FT-IR spectrometry. Age and gender of the patients were retrieved from their medical records. Data were statistically analyzed using Fisher's exact tests., Results: Sialoliths are mainly composed of inorganic material. Carbonate apatite was identified in 99% of the stones, phosphate in 88%, calcium in 87%, magnesium in 68%, struvite in 44%, oxalate in 38% and carbonate in 35%. Solid salivary stones contain more frequently struvite than stones with a soft consistency (p=0.05). Larger stones (>100mg) contain more frequently carbonate (p=0.05). Stones from older patients (≥38years) showed an almost significant trend towards more frequent presence of phosphate (p=0.083)., Conclusions: The biochemical composition of submandibular and parotid sialoliths is related to stone-related factors, probably to age but not to the gender of the patient.

In a patient with myasthenia gravis, a life-threatening myasthenic crisis can occur, a complication of myasthenia gravis. The crisis can be triggered by, among other things, emotional stress, pain, infections and a reaction to medication. The policy for invasive dental treatment in a patient with myasthenia gravis must be aimed at preventing a crisis. Prior to the intervention, consultation with the neurologist in charge is necessary because sometimes optimisation of the medication or preventive measures are required. Treatment of a myasthenia gravis patient with amide local analgesic is possible; narcosis is also possible. Local anaesthesia (using amide local analgesic in minimal dosage) is preferred to narcosis. After the dental treatment, optimal pain management is crucial to limit the chance of a crisis.

This study aimed to assess the value of cone beam computed tomography (CBCT) in the detection of salivary stones in patients with signs and symptoms of salivary gland obstruction. A total of 142 major salivary glands were analysed in a cohort of 127 patients with signs and symptoms of salivary gland obstruction. CBCT scans were performed in order to determine the presence of one or more salivary stones. All glands were also investigated by sialendoscopy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for the submandibular gland, the parotid gland, and the whole group, based on the observers' abilities to diagnose the presence or absence of calculi in the CBCT scan using the sialendoscopy data as the gold standard. Fifty salivary stones were detected in the CBCT scans of the 142 glands analysed: 34 in the submandibular gland and 16 in the parotid gland. The sensitivity (94%), specificity (90%), positive predictive value (84%), and negative predictive value (97%) for the whole group were good to excellent, with an overall accuracy of 92%. CBCT appears to be an ideal first-line imaging modality for patients with signs and symptoms of obstructed major salivary glands., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

This report describes a rare case of recurrent head and neck desmoplastic neurotropic melanoma with perineural spread along the nervus mandibularis. An 87-year-old male presented with a rapidly growing mass on the right side of the chin, 4 years after surgical excision of a desmoplastic non-melanotic melanoma of the tip of the chin, with lymphadenectomy of the right side submental and submandibular areas. A panoramic X-ray showed extensive widening of the mandibular canal compatible with perineural tumour growth. (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) images revealed intense pathological uptake in the recurrent tumour mass located in the right lower buccal fold, and linear pathological uptake in the mandibular canal. Although magnetic resonance imaging is considered the standard of reference, recognition of perineural spread on (18)F-FDG PET/CT is important, as it usually leads to a change in patient management from cure to palliation and may avert further diagnostic procedures., (Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

A red or blue mucous membrane disorder of the oral cavity can arise in response to a local cause of irritation, as a cause of an inflammation reaction to an infection, an auto-immune reaction to a local factor, and as an expression of an underlying systemic disorder. Moreover, it can be an expression of a premalignant or malignant mucous membrane disorder. Knowledge about and recognition of the different red and blue mucous membrane disorders can hasten the diagnosis and possible treatment. In the case of a premalignant (erythroplakia) or a malignant mucous membrane disorder (squamous cell carcinoma), the prognosis is better with early diagnosis and treatment than at a later stage of the disease.

Pigmented oral lesions may be due to the most diverse disorders. A distinction can be made between non-melanin-associated and melanin-associated pigmentations. Some lesions may be diagnosed on the basis of medical history and clinical research. In focal pigmented lesions, histological examination is necessary to establish a definitive diagnosis. Most disorders are benign but some may be malignant melanomas.

Sialendoscopy: endoscopic approach to obstructive salivary gland defects Obstructive defects of the parotid and the submandibular gland often present themselves clinically by mealtime-related swelling of the affected salivary gland, the so-called 'mealtime syndrome'. Salivary ductal obstruction of the parotid and submandibular gland is predominantly caused by the presence of a salivary stone, a mucous plug, or by ductal stenosis. Until recently, diagnostic and treatment options for these obstructive salivary gland defects were restricted. Surgical removal of the affected salivary gland was often the treatment of choice. By applying sialendoscopy, a minimally invasive, semi rigid optical technique, it is possible to diagnose and treat obstructions which are found in the salivary ductal system. In many cases, therefore, the surgical removal of the salivary gland becomes unnecessary.

The general dentist is sometimes confronted with white lesions of the oral mucosa. Oral lichen planus is the most common oral white lesion. The diagnosis can usually be made on the basis of the clinical aspect, but is sometimes made more difficult by certain abnormalities in the oral mucosa which clinically resemble oral lichen planus or by abnormalities which cannot be distinguished from oral lichen planus but have a different origin. Those lesions are classified as oral lichenoid lesions. Malignant deterioration has been described in allforms of oral lichen planus lesions and oral lichenoid lesions. There is no known method to predict or prevent malignant transformation. Nor are there any studies examining the efficacy of frequent follow-up visits. It seems sensible, in keeping with the tendency in recent literature, to schedule annual check-ups for patients to be on the safe side. These follow-up visits may reasonably be performed in a general dental practice.

Leukoplakia of the oral mucosa is a potentially malignant disorder, which means that there is an elevated risk oftransformation into a squamous cell carcinoma. The term oral leukoplakia is a clinical diagnosis for a predominantly white lesion which is not immediately recognizable as another well definable lesion which is white in appearance. Oral leukoplakia is generally an asymptomatic disorder of the mucosa with a prevalence of less than 2 per cent in the adult population. Tobacco usage is considered to be the most important etiological factor. Malignant transformation into a squamous cell carcinoma occurs in about I per cent per year. A patient with oral leukoplakia is generally referred to an oral and maxillofacial surgeon, who takes a biopsy for a definitive histopathological diagnosis. The outcome of the histopathological study, which may vary from hyperkeratosis to invasive squamous cell carcinoma, will determine the treatment. It is preferable that every leukoplakia is removed to reduce the risk of malignant transformation. Long term follow-up is indicated. Follow-up may in some cases be performed by the general dental practitioner.

A 13-year-old patient spontaneously lost tooth 47. In addition, he had for several weeks experienced numbness of the lower lip and the chin on the right side, fatigue, weakness, loss of appetite, and weight loss. After extensive investigation he seemed to be suffering from a Burkitt lymphoma. Spontaneous loss of permanent teeth in children has an extensive differential diagnosis. Dentists should be familiar with this differential diagnosis as all possible diagnoses are related to serious pathologies. The differential diagnosis includes infectious, metabolic, naplastic, and odontogenic causes. Systematic history taking, physical examination and laboratory investigations will lead to a proper diagnosis.

White lesions of the oral mucosa may be due to highly diverse disorders. Most of these disorders are benign but some may be a malignant or premalignant condition. The disease is often confined to the oral mucosa. There are also disorders which are accompanied by skin disorders or systemic diseases. Many white oral mucosa disorders have such characteristic clinical aspects that a diagnosis can be made on clinical grounds only. When the clinical diagnosis is not clear, histopathological examination is carried out. Treatment depends on the histological diagnosis. In some cases, treatment is not necessary while in other cases, treatment is not possible since an effective treatment is not available. Potentially malignant disorders are treated.