[Sphingomonas paucimobilis infection with underlying submandibular sialolithiasis]. / Submandibüler sialolitiazis zemininde Sphingomonas paucimobilis enfeksiyonu.

Sphingomonas paucimobilis (S. paucimobilis), is a gram-negative, aerobic, non-fermentative, oxidase (+) and catalase (+) bacterium. Although S. paucimobilis is isolated very rarely, it can cause both nosocomial and community-acquired infections. A patient admitted to our clinic had a complaint of swelling in the right mandibular region and pain increasing while eating for the previous week. Bimanual palpation revealed a painful swelling of 1x1x1 cm in size inside the right Wharton's duct. Via massage over the right submandibular gland, a purulent drainage came up from the opening of the Wharton's duct and it was cultivated and S. paucimobilis was isolated. There was no ultrasonographic evidence of calculi in the duct or in the gland, but during the right submandibular gland massage, two stones came out through the Wharton's duct. The infection was observed to be eradicated with a 14-day ampicillin-sulbactam treatment. In the control examination after six months, there were no pathological signs or symptoms and the ultrasonogram was normal. As far as we know, this is the first sialadenitis case with underlying sialolithiasis where S. paucimobilis was isolated.

Salivary calculi: ultrastructural morphology and bacterial etiology.

Ultrastructural morphology of 16 salivary calculi was studied by means of transmission and scanning electron microscopy. The external surface was mostly globular or coarse, and on high magnifications and features could be divided into four main groups: a) amorphic calcified deposits covering extensive areas, b) other areas covered with crystals in a variety of arrangements, c) heavy accumulations of calcified rod-like and filamentouslike microorganisms, and d) platelet crystals in juxtaposition to calcified microorganisms in several areas. In most calculi the split area was found to be laminated. It is suggested that microorganisms have an important role in the formation and growth of salivary calculi.

The morphology of salivary calculi. A scanning electron microscopic study.

Salivary calculi are a common disorder in the submandibular gland duct system, but the etiology and pathogenesis of the concrements remain unclear. Ten submandibular gland calculi were examined in a scanning electron microscope after critical-point drying, fracturing, and gold coating. The surface of the calculi was built up of numerous knobs covered by a smooth and occasionally filamentous substance, probably of mucinous origin. Microorganisms were commonly found at the surface. The nuclei of the calculi, which were rather homogeneous, were surrounded by lamellated structures. Between the lamellae spheroid bodies, 20-100 microns in diameter, were present. These spheroid bodies are probably of mucinous origin, which together with an amorphous granulated substance builds up the matrix. Microorganism-like structures occasionally appeared at the interface between lamellae. Microorganisms can be an important factor by providing an organic matrix in the later phase of the pathogenesis of salivary calculi. However, the nuclei did not show morphological evidence of any particular factor explaining the etiology of salivary calculus.

Ultrastructure of salivary calculi.

Twenty-one submandibular salivary calculi from 19 patients were examined with the light and electron microscope. Adjacent to the peripheral parts of the calculi metaplastic squamous epithelium or connective tissue was seen in close contact to the mineralized matrix. Disintegrated cellular substances from these tissue components were in some cases found to condense in a peripherally located zone of the salivary calculi. The morphology of the examined salivary calculi varied extensively not only within each calculus but also from one calculus to another. High and low incidence of crystals gave rise to the lamellated pattern. In some cases the crystals were so abundant as to five a dense homogeneous appearance. In the central parts of the calculi spheroid bodies of very low electron density with a size ranging from 1 to 100micrometer were found in an amorphous matrix. The origin of these structures is discussed. In the peripheral parts of some calculi osmiophilic spherical bodies with an electron microscopical appearance similar to lipid granules as well as bacteria of cocci or coliform type were found. Degenerated bacteria might in some cases contribute in forming part of the peripheral organic matrix.

[Microanalysis of salivary calculi]. / Microanalyse des calculs salivaires.

Eight salivary calculi were sectioned along a plane of symmetry and the sections studied by microanalysis. Three different regions were observed: a central region with one or several strongly mineralized nuclei, a stratified, less mineralized region with a lower Ca/P ratio and finally a peripheral weakly calcified region. Although inclusions with high silicium or sulfur concentrations were found in all samples, their role in the genesis of calculus is not clear. Most often filamentous mineralized bacteria were observed by scanning electron microscopy on the external stone surface.

The gigantiform salivary calculus.

The size of salivary calculi may range from small particles to large concrements of several centimetres. One case of a gigantiform salivary calculus located in the Wharton duct of a 48-year-old man is presented. After surgical removal of the 3.6 cm long concrement, it was split into 4 parts. The different parts were used for routine histological studies, production of microradiographs of ground sections and for scanning electron microscopy. Decalcified sections disclosed a specimen made of a homogeneous central nucleus and a peripheral lamellation. The same morphological picture was seen on the microradiographs, where the nucleus showed dense mineralization, and the peripheral part alternating rings of high and low mineral content. Microorganisms, mostly thread-like organisms, were found throughout the entire calculus in specially stained sections. Scanning electron microscopy confirmed the histologic and microradiographic findings. The presence of microorganisms also in the nucleus of the calculus seems to be one important aetiological factor favouring the formation of this gigantiform concrement.

Crystalline structure of salivary calculi. A microradiographic and microdiffractometric study.

The crystalline substances localized in different areas of salivary calculi were identified by using microradiographic and X-ray microdiffractometric techniques. All 19 calculi analyzed had a general pattern of apatite which was recognizable both in the center and at varying distances from the core. In addition to apatite patterns, six of the calculi gave a diffraction pattern of whitlockite, which in all but one case was located in the central part of the calculi. The influence of various factors on the distribution of the crystalline substances of apatite and whitlockite within the calculi is discussed.