Sialolithiasis: literature review and case report.

Sialolithiasis is a common disorder of the salivary ducts and glands. If a patient has pain and swelling in these regions, and (especially) a history of occurrence near mealtimes, this diagnosis should be considered. For accessible stones, conservative therapy of milking the duct, together with palliative therapy, should be attempted. If these therapies are unsuccessful, excision can be attempted if the sialolith is far enough anterior in the duct. Excision of the gland may be necessary if the sialolith is too far posterior in the duct or gland. This treatment may be indicated if recurrence is frequent. A fibrosed gland may not need to be excised. Lithotripsy shows promise as a nonsurgical treatment, but is relegated to larger medical centers and is not readily available. Occasionally, sialoliths exfoliate, as in the case presented.

Effect of mechanical dilation on nasotracheal intubation.

Various techniques, both chemical and mechanical, have been proposed to decrease trauma and hemorrhage associated with nasotracheal intubation. Nasotracheal intubation was performed on 44 healthy patients scheduled for oral surgical procedures to determine whether incremental dilation with nasopharyngeal airways helps to decrease nasal passage hemorrhage during nasotracheal intubation. Twenty men and 24 women were randomly assigned to dilated or nondilated groups. Repeated passage of the nasopharyngeal airway and nasotracheal tube over relatively friable nasal mucosa accounted for increased hemorrhage in the dilated group. For routine nasotracheal intubation of healthy patients, dilation with nasopharyngeal airways needlessly adds time, trauma, and hemorrhage to the induction of anesthesia.