[A PhD completed. More insight into the origin and composition of salivary stones]. / Serie: Hora est. Meer inzicht in het ontstaan en de samenstelling van speekselstenen.

Salivary stones are hardened, stony calcifications that primarily develop in the drainage duct of a salivary gland. They can lead to obstruction of the saliva flow, resulting in swelling and pain. Since the aetiology of salivary stones remains largely unclear, this was further investigated in this PhD study. A case-control review of patient records showed that systemic diseases and lifestyle factors most likely do not play a role in their occurrence. The biochemical composition of salivary stones removed by oral-maxillofacial surgeons was examined, revealing that large salivary stones have a different inorganic composition than small salivary stones. Several salivary proteins were detected in submandibular salivary stones, including lysozyme, s-IgA, and -amylase. Clumping together of these proteins may play a role in the initial formation of salivary stones.

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

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

Rapid development of a salivary calculus in submandibular gland and its potential causes in a young victim following Russell's viper bite.

Russell's viper bites are known to cause a range of haemotoxic, neurotoxic, myotoxic, cytotoxic and nephrotoxic complications. However, the impact of Russell's viper bites as well as bites from other venomous snakes on sialolithiasis has not been previously reported. Here, we present an interesting case where a Russell's viper bite induced the rapid development of a calculus in submandibular gland in a 10-year-old boy. Upon admission, the victim did not show any symptoms of swelling and/or pain around his oral cavity. He received antivenom treatment to normalise his coagulation parameters, however, on day three he developed swelling and extreme pain around his right mandibular region. An ultrasound investigation revealed the presence of a calculus in his submandibular gland, which was removed using a minor surgical procedure. The histopathological examination revealed this as a poorly calcified salivary calculus, which is composed of cell debris, mucopolysaccharides and lipids. The mechanisms behind its rapid development following a snakebite are unclear although this could be linked to excessive inflammation or modifications to the composition of saliva induced by venom toxins or other unknown factors. This report reveals an unusual complication induced by a Russell's viper bite and alerts clinicians who treat snakebites to be aware of such envenomation effects. Moreover, this will lead to novel research to explore the relationship between venom toxins and functions of salivary glands.

Patient Outcomes After Unsuccessful Endoscopic Sialolith Extraction.

OBJECTIVE/HYPOTHESIS: To evaluate clinical outcomes following failed endoscopic extraction of salivary calculi and to assess any relation between clinical outcome and calculi location, number, size, and mobility. If sialendoscopy fails to extract the calculus, subsequent spontaneous passage of the calculus out of the ductoglandular system or secondary effects of sialendoscopy could mitigate the clinical impact of a residual sialolithiasis. STUDY DESIGN: Prospective observational study. METHODS: Prospective comparative study of endoscopic procedures for sialolithiasis performed in the Manukau Surgery Center, in Auckland, New Zealand, from 2010 to 2020. The recurrent symptoms and the variables related to the need for additional surgical intervention for salivary calculi were analyzed. RESULTS: Among the 465 sialendoscopy procedures, 154 (33.1%) were for obstructive sialolithiasis. Among these, there were 30 (19.4%) with unsuccessful stone extraction with re-operation for these failures performed in 14 of the 27 failed submandibular cases (52%) and 2 of the 3 parotids (66.7%). Location of calculi was a significant factor in predicting the need of further surgery. Patients with perihilar stones were 5 times more likely to have a failed procedure (P = .001). If the stone was intraglandular, the likelihood increased to 8.5 times (P = .005). The likelihood for a revision procedure increased almost 11 times if the stone was intraglandular (P = .004). Calculi size, mobility, multiple calculi, and presence of concurrent stenosis did not correlate with need for further surgery. CONCLUSIONS: A significant proportion of "failed" sialendoscopy did not require further intervention. Stone location was a significant factor in predicting a failed procedure and the need for re-intervention. Laryngoscope, 132:1029-1033, 2022.

Salivary calculi microbiota: new insights into microbial networks and pathogens reservoir.

Sialolithiasis represents the most common disorders of salivary glands in middle-aged patients. It has been hypothesized that the retrograde migration of bacteria from the oral cavity to gland ducts may facilitate the formation of stones. Thus, in the present study, a microbiome characterization of salivary calculi was performed to evaluate the abundance and the potential correlations between microorganisms constituting the salivary calculi microbiota. Our data supported the presence of a core microbiota of sialoliths constituted principally by Streptococcus spp., Fusobacterium spp. and Eikenella spp., along with the presence of important pathogens commonly involved in infective sialoadenitis.

Sialólito Gigante em Ducto de Wharton: um caso incomum / Giant Sialolith in the Wharton Duct: An Unusual Case

A obstrução das glândulas salivares por cálculos acomete 90% dessas estruturas, apresentando geralmente tamanho menor que 1 cm. É encontrada, principalmente, nas glândulas submandibulares. Clinicamente, o paciente apresenta um aumento de volume na região referente à glândula salivar envolvida, podendo apresentar sintomatologia dolorosa e drenagem purulenta. O presente artigo relata um caso de sialólito gigante com 2,5 cm de diâmetro, em glândula submandibular, removido cirurgicamente, com preservação funcional da glândula submandibular. O tratamento pode variar de acordo com o tamanho, a forma e localização do cálculo... (AU)

The obstruction of the salivary glands by calculations affects 90% of these structures, usually exhibiting a size smaller than 1 cm. It is mainly found in the submandibular glands. Clinically, the patient presents an increase in volume in the region related to the salivary gland involved and may present painful symptoms and purulent drainage. The present article reports a case of giant sialolith with a diameter of 2.5 cm in the submandibular gland, which was removed surgically with functional preservation of the submandibular gland. The treatment may vary according to the size, shape and location of the calculus... (AU)

A Prospective Observational Study of Complications in 140 Sialendoscopies.

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

Radiopacities of the Jaws: Interpretation and Diagnosis.

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

Differential diagnoses of elevated lesions of the upper lip: An overview.

This paper comes with a purpose to help the clinician as how to arrive at a logical differential diagnosis when an upper lip mass is encountered in day-to-day practice. The labial mucosa is commonly traumatized. One must be aware of the type of structures contained in the mucosa of the area of a lesion as well as the patients habits since they may relate to a lesion presented for diagnosis. It also helps them to procure a sound knowledge of the lesions by describing the lesions according to their clinical appearance and to aid the clinician in arriving at a differential diagnosis by considering that certain lesions have a predilection for the upper lip. All clinically similar appearing lesions are discussed according to their relative frequency of occurrence. This paper covers only a minority of plethora of elevated lesions that may appear on the upper lip since almost any soft tissue lesion or neoplasm (benign and malignant) may occur here.

Sialendoscopy for salivary stones: principles, technical skills and therapeutic experience.

Obstructive sialadenitis is the most common non-neoplastic disease of the salivary glands, and sialendoscopy is increasingly used in both diagnosis and treatment, associated in selected cases with endoscopic laser lithotripsy. Sialendoscopy is also used for combined minimally invasive external and endoscopic approaches in patients with larger and proximal stones that would require excessively long laser procedures. The present paper reports on the technical experience from the Ear, Nose and Throat Unit of the Sant'Orsola-Malpighi Hospital of Bologna, and from the Department of Otorhinolaryngology of the University Hospital of Cagliari, Italy, including the retrospective analysis of the endoscopic and endoscopic assisted procedures performed on 48 patients (26 females and 22 males; median age 45.3; range 8-83 years) treated for chronic obstructive sialadenitis at the University Hospital of Cagliari from November 2010 to April 2016. The results from the Sant'Orsola-Malpighi Hospital of Bologna have been previously published. The technical aspects of sialendoscopy are carefully described. The retrospective analysis of the University Hospital of Cagliari shows that the disease was unilateral in 40 patients and bilateral in 8; a total of 56 major salivary glands were treated (22 submandibular glands and 34 parotids). Five patients underwent bilateral sialendoscopy for juvenile recurrent parotitis. 10 patients were treated for non-lithiasic obstructive disease. In 33 patients (68.75%) the obstruction was caused by salivary stones (bilateral parotid lithiasis in 1 case). Only 8 patients needed a sialectomy (5 submandibular glands and 3 parotids). The conservative approach to obstructive sialadenitis is feasible and can be performed either purely endoscopically or in a combined modality, with a high percentage of success. The procedure must be performed with dedicated instrumentation by a skilled surgeon after proper training since minor to major complications can be encountered. Sialectomy should be the "extrema ratio" after failure of a conservative approach.

Salivary lithotripsy in the era of sialendoscopy.

The traditional management of obstructive salivary disorders has been replaced by minimally-invasive gland-preserving techniques including shock-wave lithotripsy, sialendoscopy, interventional radiology and endoscopically video-assisted trans-oral and cervical stone retrieval, of which sialendoscopy is considered to be the method of first choice. Primary endoscopically controlled stone extraction without prior fragmentation is only possible in 15-20% of cases; in more than 80%, fragmentation is necessary because of the size, impactation and location of the stone, or an alternative treatment such as transoral duct surgery or combined approaches are required. Moreover, about 10-20% of all stones cannot be adequately accessed by means of a sialendoscope or any alternative surgical method and, in such cases, extra-corporeal shock wave lithotripsy (ESWL) is the treatment of choice. However, in endoscopically accessible stones, ESWL is being gradually replaced by endoscopically assisted intra-corporeal techniques, including endoscopically guided laser and pneumatic intracorporeal lithotripsy. We describe the currently most widely used techniques for salivary lithotripsy, including ESWL, and endoscopically guided laser, electrohydraulic, electrokinetic and pneumatic intra-corporeal lithotripsy, and discuss their indications given the widespread use of advanced rehabilitative sialendoscopy and combined therapeutic approaches.

Endoscopic Salivary Stone Fragmentation with Pneumatic Lithotripsy in a Simulation Model.

OBJECTIVE: To evaluate the endoscopic fragmentation and removal of human salivary stones by employing intracorporeal pneumatic lithotripsy in a clinical simulation model of the submandibular gland. STUDY DESIGN: Simulation model evaluating endoscopic management of human salivary stones. SETTING: Laboratory. SUBJECTS AND METHODS: A flexible nitinol contact probe adapted to a CO2-driven handheld salivary pneumatic lithotripter was deployed through a sialendoscope to disrupt parotid (n = 1) and submandibular (n = 8) stones embedded in separate 3-dimensionally printed plastic models of the mouth and submandibular glands. Simulation included endoscopic removal of small stone fragments by standard basket retrieval supplement by irrigation and suction through a salivary duct introducer system. Correlations were made between stone volume and density with the duration of the procedures and number of pneumatic pulses required to disrupt and remove stone fragments. RESULTS: Among the 8 stones fragmented sufficiently to permit either full endoscopic removal (n = 7) or removal of the central portion leaving an adherent rind to the duct (n = 1), the average procedure time (32 minutes) and the average number of pneumatic pulses (98) correlated with stone density (range, 0.4-1.5 g/mL) and stone volume (range, 0.05-0.4 mL). One stone was sufficiently resistant to fragmentation as to prevent successful removal. CONCLUSIONS: Modification to the evolving technology of intracorporeal pneumatic management of nephrolithiasis was successfully applied in an ex vivo model to simulate management of sialolithiasis.

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

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

Prevalencia de cálculos salivales en la glándula submaxilar evaluados mediante tomografía computarizada de haz cónico en pacientes de 18 a 70 años / Prevalence of salivary calculi in the submandibular gland evaluated by cone beam computed tomography in patients of 18 to 70 years old

Objetivo. Determinar la prevalencia de cálculos salivales en la glándula submaxilar, así como la prevalencia según edad, sexo, ubicación en el conducto y lado afectado, mediante la evaluación de tomografías computarizadas de haz cónico en pacientes de 18 a70 años. Materiales y métodos. Se evaluó 580 tomografías computarizadas de haz cónico (258 de pacientes de sexo masculino y 322 de pacientes de sexo femenino). Las tomografías pertenecieron al centro de diagnóstico maxilofacial y al centro de diagnóstico por imágenes. Se seleccionaron aquellas tomografías que cumplieron los criterios de inclusión, obteniendo la muestra por conveniencia. Resultados. Se observó la presencia de nueve cálculos salivales (1,6%), los cuales más de la mitad estuvieron localizados en el sector posterior del conducto con leve predilección por el lado izquierdo. También se apreció mayor prevalencia entre la cuarta y sexta década de vida. Conclusiones. La prevalencia de cálculos salivales evaluado mediante tomografía computarizada de haz cónico en nuestra población es 1,6%. Así mismo, se confirmó que esta enfermedad tiene mayor prevalencia en personas de 45 a 70 años, y en el sector posterior del conducto salival. Los resultados fueron similares entre ambos sexos, de igual manera sucedió con respecto al lado afectado.

Objective. To determine the prevalence of salivary calculi in the submandibular gland, as well as the prevalence by age, sex, location on the canal and affected side, through the evaluation of cone beam computed tomographies in patients of 18 to 70 years old. Materials and methods. 580 cone beam computed tomographies were evaluated (258 of male patients and 322 of femalepatients). Tomographies were of the ôcentro de diagnóstico maxilofacialõ and ôcentro de diagnóstico por imágenesõ. Tomographies that accomplish the inclusion criteria were selected. The sample was obtained by convenience. Results. 9 salivary calculi (1.6%)was observed, more than half were located in the back left area. Also a higher prevalence between the fourth and sixth decades of life was obtained. Conclusions. The prevalence of salivary calculi evaluated by cone beam computed tomography in our populationis 1.6%. Also, this disease is more prevalent in people between 45-70 years old, and in the back area of the salivary canal. Similar results were obtained in each sex, the same happened with the affected side.

Management of obstructive salivary disorders by sialendoscopy: a systematic review.

Our aim was to assess the effectiveness and safety of sialendoscopy as a diagnostic and therapeutic technique in the management of obstructive salivary disorders. We searched the following databases: MEDLINE, EMBASE, ISI Web of Knowledge, The Cochrane Library, and the National Health Service Centre for Reviews and Dissemination (up to April 2014). References from the studies included and from review articles were scanned. A study was eligible for inclusion if it was a fully published peer-reviewed report with original data, if participants included adult patients with obstructive disease of the major salivary glands, if the outcome variables gave information about the success rates of the procedure in terms of freedom from symptoms and absence of residual obstruction, and if the paper was published in English, French, Italian, Portuguese, or Spanish. The data were extracted and summarised in tables of evidence. We report weighted pooled proportions, 95% CI, and test results for heterogeneity. The weighted pooled proportion of success rates of the obstruction's resolution was 76% (95% CI 71 to 82) for 40 studies involving 2654 patients undergoing sialendoscopy alone, and 91% (95% CI 88 to 94) for the 23 studies and 1480 procedures made with sialendoscopy and a combined surgical approach. In general, few complications were reported and the rate of sialadenectomy was low (4.6%). This systematic review suggests that sialendoscopy is effective and safe for the diagnosis and treatment of patients with obstructive salivary gland disease.

[Surgical Simulation Models for Sialendoscopy]. / Trainingsmodelle für die Sialendoskopie.

OBJECTIVE: Different simulation models are in use to teach the technique of sialendoscopy. Only a few reports in literature deal with this topic with no comparison having been published, yet. We therefore asked sialendoscopy training course participants about our applied models by using a questionnaire. Material und Methods: A tube-, a pepper-, a porcine kidney-, and a pig head-model were developed as training models and used during 6 consecutive practical sialendoscopy courses from 2012 to 2014. Participants were asked to answer a questionnaire specifically designed to assess the value of the different training models. RESULTS: All respondents (n=61) rated all training models positively. However, porcine kidney- and pig head-models were described to be superior, especially with respect to realistic simulation. Intubation of the papilla can be practised sufficiently only in the pig head-model. The tube- and peppers-models have the advantage of being less expensive, easier to handle and cleaner. CONCLUSIONS: The models described are all useful in learning the sialendoscopy technique. However, they have distinct advantages and disadvantages making a combination of different models useful.

Role of saliva in the caries experience and calculus formation of young patients undergoing hemodialysis.

OBJECTIVES: The aims of this study were to investigate the caries experience, periodontal status, oral hygiene habits, and salivary parameters of children and adolescents undergoing hemodialysis (HD) and to compare them with their healthy counterparts. METHODS: Fifty-two HD patients were matched for age, sex, ethnicity, and social class with 52 healthy subjects for analysis of the number of decayed, missing and filled teeth, plaque and gingival index, dental calculus accumulation, measurements of pocket depth, clinical attachment level, gingival recession, and bleeding on probing. Stimulated saliva samples were collected to assess salivary flow rate, pH and buffer capacity, and salivary concentrations of calcium, phosphate, and urea by colorimetric method. RESULTS: HD patients had lower dental caries (p = 0.004), greater plaque and calculus accumulation (p = 0.001), and reported flossing less often than the controls (p = 0.013). Regarding salivary analysis, HD patients showed significantly higher values of pH, buffer capacity, and salivary urea concentration when compared to the controls (p = 0.001). CONCLUSION: HD patients had lower caries experience, higher accumulation of dental plaque, and calculus deposition than their healthy counterparts, probably due to the differences found in their salivary biochemical parameters. CLINICAL SIGNIFICANCE: A significant number of children and adolescents undergoing hemodialysis are candidates for kidney transplantation and should receive complete pre-transplant dental exams and dental treatment. Our results open the way for the development of an individualized dental protocol for these patients with preventive measures and treatment of the poor oral health in HD patients.