Submandibular ductal fistula: an obstacle to sialendoscopy.

IMPORTANCE: Submandibular fistula is a rare condition that presents diagnostic and treatment challenges. Accurate diagnosis may be achieved by means of thorough physical examination, proper imaging, and usually surgical exploration. We describe the clinical significance of aberrant submandibular ductal fistula or ostium and discuss our dilemmas during sialendoscopy in 2 patients with repeated submandibular glandular swelling. OBSERVATIONS: Two patients had submandibular ductal abnormalities. The first patient was found to have the ostium of the submandibular duct in an unusual anatomical location at the posterior floor of the mouth, which was identified during surgical exploration of the floor of the mouth. The second patient was found to have a submandibular ductal fistula into the floor of the mouth proximal to a calculus in the main duct (which was severely atrophic and could not be cannulated). CONCLUSIONS AND RELEVANCE: The precise etiology and pathogenesis of sialo-oral fistula formation are currently unknown but could be extrapolated from previously described syndromes involving ductal obstruction and inciting damage in other regions of the body. Consideration of submandibular fistula in the differential diagnosis may spare the patient morbidity of redundant invasive procedures.

Unilateral absence of submandibular gland secondary to stones. Aplasia versus early atrophy

Major salivary gland absence is a rare disorder. The cause of congenital absence of the salivary glands has not been determined, but it may be associated with ectodermal defects of the first and second branchial arches. Isolated absence of a unilateral submandibular gland is an unusual entity with less than ten cases reported in the literature.The etiopathogenesis of isolated absence of a major salivary gland without other developmental anomaliesis still unclear. The formation of a sialolith within the remaining Wharton’s duct, associated with isolated aplasia(versus atrophy) of a unilateral submandibular gland has been recently reported. We describe in this work two cases of sialolithiasis within the ipsilateral remaining Wharton´s duct in patients with isolated absence of a unilateral submandibular gland. In the cases reported, absence of the submandibular gland may have been the result ofthe complete acinar atrophy secondary to an early obstruction of Wharton´s duct (AU)

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The role of adenectomy for salivary gland obstructions in the era of sialendoscopy and lithotripsy.

Salivary gland ductal obstructions are common, being the most frequent nonneoplastic salivary disorders in adults. Salivary calculi are the main cause of obstruction. Traditional and invasive transcervical sialadenectomy is still the most widely used treatment for perihilar and intraparenchymal obstructive salivary diseases worldwide despite the well-known morbidity related to its functional, neurologic, and aesthetic sequelae. However, improved radiologic imaging, better optical systems and endoscopic devices, and the introduction of minimally invasive therapeutic options have allowed the development of conservative gland-preserving techniques for managing salivary gland obstructions, including extracorporeal shock wave lithotripsy, operative sialoendoscopy, video-assisted transoral and transcervical stone removal, and ductal rehabilitation through interventional radiology and sialoendoscopy. Through adopting a minimally invasive and multimodal policy, a significant number (74%-100%, technique dependent) of salivary calculi can be safely and successfully retrieved while leaving an intact and functional salivary gland system. Only 2% to 5% of patients require gland excision. However, long-term follow-up evaluations of obstructive symptom recurrence are needed before the ultimate benefits of a gland-preserving conservative approach and the residual role of adenectomy can be assessed.