Endoscopic observation and strategic management of obstructive submandibular sialadenitis.

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

[Asymptomatic salivary gland stone of unusual size in the Wharton's duct]. / Wharton kanalinda semptom vermeyen dev tükürük bezi tasi.

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

[Calcifications of the parotid space. A review]. / Calcifications de la loge parotidienne. Mise au point.

INTRODUCTION: Parotid lithiasis is the main cause of calcifications in the parotid space. However, there are many other less known causes. The aim of our study was to point out the non-lithiasic causes of calcifications in the parotid space. MATERIAL AND METHODS: We conducted an exhaustive review of the literature by mean of PubMed, using the keywords "parotid" and "calcification" and limiting our analysis to the original articles in humans published in English and in French. Articles reporting about microscopic calcifications and who were not dealing with parotid calcifications were excluded. RESULTS: Twenty articles met the inclusion criterions. Tumoral and non-tumoral local causes and systemic causes of parotid calcification were found. The way they revealed was variable. The main tumoral local causes were pleomorphic adenomas, salivary duct carcinomas and adenocarcinomas. The main non-tumoral local causes included vascular malformations and calcified parotid lymph nodes. The main systemic causes were chronic kidney diseases, HIV infection, chronic alcoholism, elevated levels of alkaline phosphatase and auto-immune diseases. DISCUSSION: Eighteen different etiologies of parotid space calcifications could be identified. First line exploration of these lesions relies mainly on conventional radiography and ultrasound examination that are easily available. CT scan remains the reference examination.

Device failure in sialoendoscopy: Intraoperative practical decision-making.

Sialoendoscopy has recently emerged as an alternative to gland excision in management of recurrent sialoadenitis and sialolithiasis. This technique has both diagnostic and therapeutic purposes. We report a case of unusual device failure during removal of a submandibular stone from Wharton's duct, which ultimately led to ductal avulsion. Sialoendoscopy is safe and effective in management of non-neoplastic major salivary gland disorders. Ductal avulsion can happen during mechanical procedures like stone removal or dilation of strictures. Failing to release the stone from the basket is very rare but can be problematic and lead to major complications.

Potential airway compromise secondary to impacted Wharton's duct calculus: a noteworthy phenomenon.

OBJECTIVES: This case report describes a patient who suffered an acute, severe complication of unilateral submandibular sialolithiasis, the disease process and management of these patients. CASE REPORT: A 70-year-old woman was under investigation for a recurrent, painful right submandibular swelling and subsequently presented with an acute exacerbation. She exhibited symptoms of acute submandibular sialadenitis, and also reported breathing difficulty and a change in voice quality. Computed tomography imaging showed that this was caused by a submandibular gland duct sialolith, with inflammation extending to the ipsilateral supraglottis. She was treated medically and the stone was removed when the inflammation had stabilised. CONCLUSION: This case highlights the need to thoroughly assess patients with neck swellings, especially when symptoms are atypical, to avoid life-threatening complications.

Clinicopathological study of myoepithelial sialadenitis and chronic sialadenitis (sialolithiasis).

To determine any overlap in pathological features between myoepithelial sialadenitis and chronic sialadenitis/sialolithiasis histological sections from 69 cases of myoepithelial sialadenitis (MESA) (n = 7) and chronic sialadenitis/sialolithiasis (n = 62) were reviewed over a 10 year period. Three of the cases with MESA contained calculi and four of those originally diagnosed as chronic sialadenitis/sialolithiasis showed epimyoepithelial island formation. The presence of calculi should not rule out a diagnosis of MESA, particularly in the parotid gland where calculi are uncommon; as the incidence of MESA may very well be underestimated and diagnosed as chronic sialadenitis, these patients, who are at increased risk of developing lymphoma, could be lost to follow up.

Numbness of half of the tongue.

We report a case of intermittent compression of he lingual nerve due to sialolithiasis and presenting with episodic unilateral numbness of the tongue. Removal of the obstruction has relieved the patient of symptoms over a 21 month period to date.

The role of computerized tomography in the diagnosis and therapy of parotid stones: a case report.

BACKGROUND: Small, semi-calcified parotid stones are difficult to diagnose as imaging can be extremely difficult. Understanding how to diagnose parotid stones is important to dentists, however, because people with this condition develop parotid swellings and may seek routine dental care. CASE DESCRIPTION: The authors describe a classic case of parotid sialadenitis secondary to a small lucent stone in Stensen's duct. They discovered the stone only because of the keen sensitivity of computerized tomography, or CT, to minimal amounts of calcific salts. The CT scan's ability to accurately locate the stone and its position within 1 centimeter of the orifice facilitated a successful intraoral surgical approach. CLINICAL IMPLICATIONS: CT can be a significant aid in early diagnosis and therapy of patients with parotid stones, who eventually develop sialadenitis. With early intervention, further gland degeneration and parotidectomy will be prevented.

Facial sinus formation secondary to a parotid duct calculus.

A case of facial sinus formation secondary to calculus obstruction of the parotid duct is reported. The aetiology and management of this condition are discussed.

Plunging ranula as a complication of intraoral removal of a submandibular sialolith.

Mucous cysts in the submandibular region--so-called 'plunging' ranula--are relatively uncommon. We report a case of a plunging ranula that complicated excision of an intraductal sialolith of the submandibular gland.

Submandibular sialolithiasis with concurrent sialoadenitis in a child.

Sialolithiasis is a relatively common condition in adults, but it is rarely observed in children. We report a case in a 7-year-old child with a sialolith in the anterior right Wharton's duct resulting in a submandibular sialoadenitis. Under local anesthesia the calculus was removed by means of a sialodochotomy. Post-operative recovery was uneventful and follow-up examinations showed recovery of the function of the affected gland.

[Diverticulum of the submandibular salivary gland ducts]. / Divertikuly protokov podnizhnecheliustnoi sliunnoi zhelezy.

Examinations of 125 patients with sialolithiasis showed abnormality of the submandibular duct (diverticulum with a sialolith in it) in 3 (2.4%) patients. The authors suggest that diverticulum of the submandibular duct is in fact a variant of its ectasia and can be regarded as a diagnostic nosological entity.