Diagnóstico e tratamento de Sialolitíase: relato de caso / Diagnosis and treatment of Sialolithiasis: Case Report

Sialolitos são estruturas calcificadas, que se desenvolvem no interior do sistema ductal salivar, em decorrência da deposição de sais de cálcio ao redor de um acúmulo de restos orgânicos no lúmen do ducto glandular. Acometem, com mais assiduidade, a glândula submandibular e são a causa mais comum de inflamações agudas ou crônicas nas glândulas salivares maiores. Manifestam-se, com maior frequência, em indivíduos adultos de meia-idade, e os sinais e sintomas mais comuns são a dor e a tumefação local. Podem ser evidenciados por radiografias convencionais, tomografia computadorizada, ressonância magnética, ultrassonografia, cintilografia, sialoendoscopia e sialografia. O tratamento inclui a eliminação espontânea mediante orientações ou uso de medicamentos, ou a remoção cirúrgica do sialolito, sendo necessária, em alguns casos, a exérese da própria glândula. Este trabalho tem como objetivo relatar o caso clínico do paciente S.L.M, 44 anos de idade, sexo feminino, caucasiana, atendida na clínica de Cirurgia Bucal da Universidade Federal Fluminense, apresentando um sialolito no sistema ductal da glândula submandibular do lado esquerdo. A paciente foi submetida à remoção cirúrgica do sialolito sob anestesia local, sem maiores intercorrências... (AU)

Sialolites are calcified structures that develop inside the salivary ductal system, due to the deposition of calcium salts around an accumulation of organic remains in the lumen of the glandular duct. They have a more frequent involvement of the submandibular gland and are the most common cause of acute or chronic inflammation in the major salivary glands. They occur more frequently in middle-aged adult patients and the most common signs and symptoms are local pain and swelling. They can be evidenced by conventional radiography, computed tomography, MRI, ultrasonography, scintigraphy, sialoendoscopy and sialography. Treatment includes spontaneous elimination, from guidelines or use of medications, or surgical removal of sialolite, in some cases, the excision of the gland itself. This study aims to report the clinical case of the patient S.L.M, 44 years old, female, Caucasian, attended at the Oral Surgery Clinic of the Federal Fluminense University, presenting a sialolite in the ductal system of the left submandibular gland. The patient was submitted to surgical removal of the sialolite, under local anesthesia, without major intercurrences... (AU)

Diagnosis and treatment of congenital dilatation of Stensen's duct.

OBJECTIVES/HYPOTHESIS: This study aimed to describe the diagnosis and management of congenital dilation of Stensen's duct (CDSD) in seven cases. STUDY DESIGN: Retrospective study. METHODS: We collected data including medical records, radiology, and histopathology findings and follow-up for seven patients (four males) with CDSD. The mean age was 23.9 years (range, 2-72 years). RESULTS: The clinical features of CDSD were the primary presentation of painless swelling in the cheek without an obvious cause that was unilateral or bilateral and occurred at any age, and a swelling along Stensen's duct. In patients without a history of inflammation, aggressive massage of the swelling could produce abundant intraoral salivary flow. Parotid sialography demonstrated a dilated Stensen's duct with a smooth margin but no obvious obstruction. All seven patients underwent superficial parotidectomy including the intact Stensen's duct. No patient showed recurrent swelling after a follow-up of 6 to 65 months. CONCLUSIONS: CDSD is an uncommon congenital disorder of the parotid gland. Management with parotidectomy is effective.

The influence of saliva flow stimulation on the absorbed radiation dose to the salivary glands during radioiodine therapy of thyroid cancer using 124I PET(/CT) imaging.

PURPOSE: A serious side effect of high-activity radioiodine therapy in the treatment of differentiated thyroid cancer is radiogenic salivary gland damage. This damage may be diminished by lemon-juice-induced saliva flow immediately after 131I administration. The aim of this study was to assess the effect of chewing lemon slices on the absorbed (radiation) doses to the salivary glands. METHODS: Ten patients received (pretherapy) 124I PET(/CT) dosimetry before their first radioiodine therapy. The patients underwent a series of six PET scans at 0.5, 1, 2, 4, 48 and ≥96 h and one PET/CT scan at 24 h after administration of 27 MBq 124I. Blood samples were also collected at about 2, 4, 24, 48, and 96 h. Contrary to the standard radioiodine therapy protocol, the patients were not stimulated with lemon juice. Specifically, the patients chewed no lemon slices during the pretherapy procedure and neither ate food nor drank fluids until after completion of the last PET scan on the first day. Organ absorbed doses per administered 131I activity (ODpAs) as well as gland and blood uptake curves were determined and compared with published data from a control patient group, i.e. stimulated per the standard radioiodine therapy protocol. The calculations for both groups used the same methodology. RESULTS: A within-group comparison showed that the mean ODpA for the submandibular glands was not significantly different from that for the parotid glands. An intergroup comparison showed that the mean ODpA in the nonstimulation group averaged over both gland types was reduced by 28% compared to the mean ODpA in the stimulation group (p=0.01). Within each gland type, the mean ODpA reductions in the nonstimulation group were statistically significant for the parotid glands (p=0.03) but not for the submandibular glands (p=0.23). The observed ODpAs were higher in the stimulation group because of increased initial gland uptake rather than group differences in blood kinetics. CONCLUSION: The 124I PET(/CT) salivary gland dosimetry indicated that lemon juice stimulation shortly after 131I administration in radioiodine therapy increases the absorbed doses to the salivary glands.

Retention of lipiodol after parotid gland sialography.

There is limited information about the retention of lipiodol in the parotid gland after parotid gland sialography. This study assesses the prevalence of lipiodol retention after parotid sialography and determines if retention of lipiodol is related to the sialography technique or the underlying salivary gland pathology. Using the electronic hospital database (1996-2006), 66 out of 565 patients were identified who had additional maxillofacial radiographic examinations after the initial sialography. Additional radiographs up to October 2007 were included; these were orthopantomographic radiographs in all cases. In 28 patients (42%) signs of lipiodol retention were observed (mean radiographic follow-up: 15+/-13 months). Retention was characterized by small radiopaque spots in the periphery of the gland. Lipiodol retention was predominantly associated with a fausse route (n=8) or the presence of salivary gland disease (sialectasia; n=17). In 9 patients with signs of lipiodol retention, a series of radiographs was available. Lipiodol radiodensities decreased in size during 28 months, and could disappear gradually (follow-up 14-57 months). Despite the high frequency of retention of small depots of lipiodol for years after sialography in patients subjected to additional radiographic examinations, no clinically adverse effects were observed.

Lipiodol ultra-fluid - foreign body in the cheek.

We report a case in which iodinated oil (lipiodol ultra-fluid (UF)) leaked from an iatrogenic perforation of Stensen's duct and constituted a foreign body in the cheek. The distribution of contrast medium near the lower border of the mandible seems unusual. 2 years following sialography, the UF was still not being resorbed. No radiological signs of reactive inflammatory changes to the soft tissue were observed. We believe the contrast agent arrived beneath the skin, but external to the platysma, through a simple perforation in either the duct and/or the mucosa.

Lipiodol UF retention in dental sialography.

Lipiodol is a lipid based contrast medium and is very useful in sialography. It gives very fine images and clearly shows the details of the gland. It is viscous and has a relatively high iodine content. However, lipiodol UF drops sometimes remain in the salivary gland and in the adjacent tissues for a long time and may cause irritation. We report a case where lipiodol UF leaked from Stensen's duct and was not resorbed after a period of 70 months.

Morbidity from parotid sialography.

OBJECTIVE: Sialography is commonly used for the diagnosis of Sjögren's syndrome, although its invasive nature is often regarded as a serious drawback for routine usage. The aim of this study was to evaluate the morbidity and acceptability of parotid sialography using oil-based contrast fluid. STUDY DESIGN: Twenty-four consecutive sialographic procedures were evaluated in terms of morbidity and the patient's acceptance of the procedure, assessed with a standardized questionnaire. Information was also obtained by recording relevant physical parameters during the procedure. RESULTS: There was good acceptance of the sialographic procedure, and the morbidity was low. No signs of overfilling or false route were observed in any of the sialograms. On average, 0.74 mL of contrast fluid was infused with a velocity of 0.01 mL/s. The whole procedure was completed within 12 minutes. CONCLUSIONS: Parotid sialography appears less invasive than is often thought. It had a low morbidity rate and was well accepted by the patients.

[The x-ray changes in the parotid salivary glands of patients with Sjögren's disease]. / Rentgenologicheskie izmeneniia okoloushnykh sliunnykh zhelez u bol'nykh bolezn'iu Shegrena.

The data obtained upon sialography of the parotid glands (PG) in 28 patients with Sjogren's disease (SD) were compared to clinical SD manifestations, PG regional circulation and histological picture of the labial salivary glands. 24 patients exhibited classical sialography characterized by sialoectasias, enlarged ducts, obscure outlines of the latter. 4 sialograms displayed the duct narrowing, noncontrast parenchyma outlines, unclear images of sialoectasias. Severe xerostomia, marked dryness of the vermilion border, rare enlargement of the salivary glands and parotitis recurrences occurred more frequently in patients with narrow efferent PG ducts. These changes are attributed to vascular sclerosis, devascularization, stromal sclerosis and parenchymal PG atrophy.

Parotid sialography with a new Zonarc program.

The use of panoramic zonography with the Zonarc-MLA and LAT-PA program for parotid sialography is presented. It provides curved layer tomograms, and shadows of the bony structures are therefore not disturbingly superimposed on the image of the sialogram. The visibility in the retromandibular region tended to be better. Radiation doses in plain film radiography are up to 60 times higher than in Zonarc radiography.

Contrast media in sialography: a comparison of Lipiodol Ultra Fluid and Urografin 290.

A prospective, randomized study of 60 patients undergoing sialography was conducted to compare Lipiodol Ultra Fluid (UF) (Ethyl diiodostearate, May & Baker Ltd), with Urografin 290 (meglumine diatrizoate 52.1% w/v and sodium diatrizoate 7.9% w/v, Schering). The quality of the images, the clinical tolerance and the side-effects of contrast were compared. Both agents produced adequate opacification of ducts but poor intra-gland duct filling was seen in two patients examined with Lipiodol UF. There were significantly more side-effects (which were also more severe) in the Lipiodol group. It is concluded that Urografin 290 is the better contrast agent for sialography because of better filling of intra-gland ducts and greater clinical tolerance.

[Comparative study of Uromiron and 38% Lipiodol in sialography]. / Estudio comparativo de Uromiron y Lipiodol al 38% en sialografia.

A comparative study was undertaken to assess the properties of uromiron and lipiodol 38%, which are used as radiopaque materials in sialographic techniques, on 25 young adult outpatients of both sexes that were seen at the Dental School, University of Chile, Santiago. It was found that, although the radiopaque properties of uromiron were less than lipiodol 38%, the can be improved by increasing the amount of material injected into the duct system of the salivary glands. Likewise, uromiron exhibited a proper biological tolerance and a rapid emptying time, therefore the use of uromiron in sialographic techniques seems to be a proper alternative to lipiodol 38%.

Computed tomography of parotid masses.

Fifty-six patients with parotid masses, benign tumors in 22, malignant tumors 26 and other diseases 8, were examined by CT scan, which can differentiate intrinsic from extrinsic parotid lesions, especially deep lobe from parapharyngeal tumors and typical benign tumors from malignant ones, but may fail to differentiate aggressive benign tumors from low-grade malignant ones. CT sialography was done to detect the relation between the trunk of the facial nerves and tumor according to the band of normal parotid tissue between the tumor and posterior border of the mandibular ramus, and incremental dynamic CT with intravenous bolus injection of contrast medium to detect the relation between the tumor and carotid sheath. We conclude that the images of CT sialography are much better than those of plain CT and intravenous enhancement CT.

Effect of reserpine on salivary gland radioiodine uptake in thyroid cancer.

Nine patients with thyroid cancer were treated with reserpine in an attempt to reduce radiation exposure to the salivary glands from 100-150 mCi doses of I-131 therapy to thyroid remnants or metastases. Three control patients were not treated with reserpine but did receive 100-150 mCi of I-131. Parotid/background ratios of activity after radioablative doses of I-131 in patients not treated with reserpine were significantly higher than the patients treated with reserpine, and this was also true seven days after the radioablative dose. Combined therapy with reserpine, chewing gum, lemon candies, and hydration is suggested for the prevention of sialadenitis and xerostomia due to large doses of radioiodine.