Partial facial paralysis induced by sialolithiasis of the parotid gland: a case report.

BACKGROUND: Facial paralysis due to parotid sialolithiasis-induced parotitis is a unusual clinical phenomenon that has not been reported in prior literature. This scenario can present a diagnostic challenge due to its rarity and complex symptomatology, particularly if a patient has other potential contributing factors such as facial trauma or bilateral forehead botox injections as in this patient. This case report elucidates such a complex presentation, aiming to increase awareness and promote timely recognition among clinicians. CASE PRESENTATION: A 56-year-old male, with a medical history significant for hyperlipidemia, recurrent parotitis secondary to parotid sialolithiasis, and recent bilateral forehead cosmetic Botox injections presented to the emergency department with right lower facial drooping. This onset was about an hour after waking up and was of 4 h duration. The patient also had a history of a recent ground level fall four days prior that resulted in facial trauma to his right eyebrow without any evident neurological deficits in the region of the injury. A thorough neurological exam revealed sensory and motor deficits across the entirety of the right face, indicating a potential lesion affecting the buccal and marginal mandibular branches of the facial nerve (CN VII). Several differential diagnoses were considered for the lower motor neuron lesion, including soft tissue trauma or swelling from the recent fall, compression due to the known parotid stone, stroke, and complex migraines. An MRI of the brain was conducted to rule out a stroke, with no significant findings. A subsequent CT scan of the neck revealed an obstructed and dilated right Stensen's duct with a noticeably larger and anteriorly displaced sialolith and evidence of parotid gland inflammation. A final diagnosis of facial palsy due to parotitis secondary to sialolithiasis was made. The patient was discharged and later scheduled for a procedure to remove the sialolith which resolved his facial paralysis. CONCLUSIONS: This case emphasizes the need for a comprehensive approach to the differential diagnosis in presentations of facial palsy. It underscores the potential involvement of parotid sialolithiasis, particularly in patients with a history of recurrent parotitis or facial trauma. Prompt recognition of such uncommon presentations can prevent undue interventions, aid in timely appropriate management, and significantly contribute to the patient's recovery and prevention of long-term complications.

Rate of Submandibular Gland Atrophy Secondary to Chronic Sialolithiasis.

The rate of salivary gland atrophy secondary to chronic obstructive sialolithiasis has not been well-documented. The combination of 5 imaging studies over 12 years in a patient with repeat imaging for an unrelated pathology provides a unique opportunity to assess glandular atrophy over time. We hope that this case will support previous literature with an in vivo representation of the rate of glandular atrophy.

«Omepralith»: un modelo de simulación novedoso para el entrenamiento en sialoendoscopia / “Omepralith”: A novel simulation model for training in sialoendoscopy

Introducción: No existen modelos de entrenamiento previamente descritos para aprender o enseñar cómo extraer litiasis de los conductos salivales. Es por ello que presentamos un novedoso modelo de simulación que nos permite representar fielmente el proceso de extracción endoscópica de litiasis mediante sialoendoscopia. Materiales y métodos: Se desarrolló un modelo de simulación utilizando la cabeza de un cerdo, se utilizaron esferas de omeprazol para simular la existencia de litiasis en los diversos conductos de cada glándula salival y se utilizó una cesta Dormia para entrenar la extracción del modelo de litiasis. Resultados: Veintisiete residentes en formación y/o jóvenes especialistas han entrenado con éxito esta técnica utilizando este modelo. Veintiséis (96,3%) consideraron útil el modelo para entrenar el uso de cestas, siendo todos ellos capaces de capturar la esfera de omeprazol en el conducto salival. Se obtuvo un porcentaje de satisfacción mediante una encuesta anónima de 92,25 sobre 100 puntos. Conclusión: Describimos un novedoso modelo de simulación mediante esferas de omeprazol, que permite al cirujano practicar cómo realizar el diagnóstico y tratamiento de la enfermedad obstructiva de glándulas salivales en un entorno libre de riesgos, garantizando la reproducibilidad de la técnica en condiciones similares a las de la práctica habitual.(AU)

Introduction: There are no previously described training models for learning or teaching how to remove lithiasis from the salivary ducts. Therefore, we present a new simulation model to enable us to faithfully represent the process of endoscopic lithiasis extraction by sialoendoscopy. Materials and methods: A simulation model was developed using a pig's head, omeprazole spheres were used to simulate lithiasis in the various ducts of each salivary gland and a Dormia basket was used to train in extraction of the lithiasis model. Results: Twenty-seven residents in training and/or young specialists were successfully trained in this technique using this model. Twenty-six (96.3%) considered the model useful for training in the use of baskets; all of them were able to capture the omeprazole sphere in the salivary duct. A satisfaction rate of 92.25 out of 100 points was obtained through an anonymous survey. Conclusion: We describe a novel simulation model using omeprazole spheres, which allows the surgeon to practice how to diagnose and treat obstructive pathology of the salivary glands in a risk-free environment guaranteeing the reproducibility of the technique in conditions similar to those of normal practice.(AU)

Giant sialolith associated with Actinomyces infection, suggesting a new etiopathogenic correlation: a case report.

Sialolithiasis is a disorder of the salivary glands characterized by the presence of mineralized structures. The aim of this article is to contribute to the understanding of the etiopathogenesis of sialolithiasis based on data reported in the literature and the interpretation of scanning electron microscopic (SEM), histopathologic, fluorescence, and energy-dispersive X-ray spectroscopic (EDX) studies. The results of these analyses in a single case are presented. Fluorescence microscopy captured saliva flowing inside a giant sialolith, EDX analysis enabled the quantification of samples of minerals and characterized the chemical composition in the internal areas of the sialolith, and SEM images captured the external communications of the sialolith (ostia). Many theories have been proposed to explain sialolithiasis development, but few consider the role of saliva in its dynamic form. The authors propose that the triple synergism of microbiota, biofilm, and salivary dynamics plays a fundamental role in the development and intrinsic architecture of sialoliths, creating a cyclic sialolithic mineralization. This hypothesis is supported by the results of the laboratory studies in the present case.

Sialolithiasis-Do Early Diagnosis and Removal Minimize Post-Operative Morbidity?

Background and objectives: Sialolithiasis is an inflammation of a salivary gland due to obstruction of salivary flow by a sialolith. We aim to assess potential factors that may predict lower morbidity following endoscopically assisted per-oral sialolith removal. Materials and Methods: Retrospective cohort study. Retrospective review of 100 records of patients with sialolithiasis, following surgical sialolith removal. A single medical center (Department of oral and maxillofacial surgery-Rabin Medical Center, Beilinson & Hasharon-Israel) survey. Data were gleaned from the patient files based on a structured questionnaire. Factors that may predict morbidity were evaluated using linear regression equation. Results: 59 of the subjects were men and 41 were women. The mean age of the patients in the study was 50 ± 17.5 years. Sialolith volume and past antibiotic treatment were positively associated while age was negatively associated with hospitalization duration. Conclusion: Early sialolith diagnosis and removal may lower postoperative morbidity.

Parotitis on Ultrasound: The Pomegranate Sign.

The differential diagnosis for facial swelling is broad and can be a diagnostic challenge in the pediatric emergency department. We describe the first pediatric case of acute parotitis with sialolithiasis where the diagnosis was facilitated by point-of-care ultrasound.

Sialolithiasis with abscess: An uncommon presentation of a Ludwig's angina mimic.

Sialolithiasis represents the most common issue of the salivary gland, ranging from asymptomatic to airway compromising. In rapidly progressing, completely obstructive salivary stones, the presentation can mimic emergent oropharyngeal diseases, primarily Ludwig's angina. We present a case of a large and obstructive sialolith with abscess whose initial presentation was concerning for Ludwig's angina with impending airway compromise. While a common complaint, emergency providers should be aware of the nefarious presentation of an everyday complaint.

Sialolitiasis Parotídea. Dificultades en el diagnóstico. Presentación de un caso clínico y revisión de la literatura / Parotid Sialolithiasis. Diagnosing complexities. Case report and literature review

Introducción: La sialolitiasis parotídea es una patología común de las glándulas salivales y puede dar lugar a atrofia glandular. Los sialolitos parotídeos son más raros que los submandibulares y su diagnóstico y tratamiento es más complejo, debido a la superposición de estructuras y a las dificultades de acceso. Caso clínico: Mujer, de 68 años, que acude con episodios inflamatorios recurrentes en la región geniana izquierda, coincidente con las comidas, y que, tras su paso por varios especialistas, acude a nuestro Servicio, en el que tras prescribir un CBCT con reconstrucción tridimensional se halla una pequeña estructura calcificada próxima a la parótida izquierda. Discusión: Los métodos de diagnóstico son variados y su utilización depende de la indicación. Entre las distintas pruebas figuran la resonancia magnética (RM), laa Tomografía Computerizada de Haz de Cono (CBCT) y la sialografía, siendo el método más eficaz de diagnóstico la combinación de estas. Los abordajes terapéuticos son diversos y dependen de multitud de factores, siendo los más utilizados la sialoendoscopia y el abordaje quirúrgico transoral. Conclusión: La sialolitiasis parotídea supone un reto, tanto diagnóstico como terapéutico, y es una situación clínica común por lo que en su tratamiento deben tenerse en cuenta muchos factores para elegir la alternativa que suponga una remoción completa del cálculo y pocas complicaciones a largo plazo

Introduction: Parotid stones are a common finding in salivary gland disorders and can lead to destruction of salivary tissue. Parotid calculi are rarer than submandibular calculi and their diagnosis and treatment are more challenging due to superimposition of hard structures and limited access. Clinical case: A female patient, 68 years old, is referred to our Service, after seeing different specialists, due to repeated inflammatory episodes of her left cheek area, which usually appear at mealtimes. After prescribing a CBCT with 3D reconstruction, a calcified structure can be seen next to the left parotid gland. Discussion: Diagnostic means are varied, and their use depends on their indication. Among diagnostic test, MRI, CBCT and sialography can be found, and usually combining them provides a more precise diagnosis. There are many therapeutical approaches, being sialoendoscopy and transoral approach the most common ones. Conclusion: Parotid sialolithiasis poses a diagnostic and therapeutic challenge, and it is a relatively common clinical situation, thus, treatment must be tailored to obtain complete stone removal and a minimum of long-term complications

Bacterial biofilm in salivary stones.

PURPOSE: To assess the susceptibility of salivary stones to bacterial biofilm formation, which may be involved in the development of salivary gland infection, and to investigate a relation between microbiological aspects and patient characteristics. METHODS: This prospective study comprises of 54 patients with sialolithiasis attended in Helsinki University Hospital during 2014-2016. A total of 55 salivary stones were removed, and studied for biofilm formation using fluorescence microscopy and sonication. The isolated organisms were quantified and identified using matrix-assisted laser desorption ionization time-of-flight mass spectrometry. RESULTS: Biofilm formation was confirmed on the surface of 39 (70.9%) stones. A total of 96 microorganisms were isolated from 45 salivary stones (81.8%). Two or more organisms were isolated in 33 (73.3%) cases. The main isolates were Streptococcus mitis/oralis (n = 27; 28.1%), followed by Streptococcus anginosus (n = 10; 9.6%), Rothia spp. (n = 8; 8.3%), Streptococcus constellatus (n = 7; 7.3%), and Streptococcus gordonii (n = 6; 6.2%). In all patients showing pre-operative (12 cases) or peri-operative (three cases) drainage of pus, the presence of biofilm was detected in microscopy (p = 0.004). Four patients showed post-operative infection, and in three of them (75.0%), the presence of biofilm was detected. Increased number of pus drainage was found among patients with reflux symptoms or use of proton-pump inhibitors. CONCLUSIONS: Salivary stones are susceptible to bacterial biofilm formation, which could be related with the development and severity of the inflammation and the refractory nature of the disease. Sonication of salivary gland stones could be a useful method for finding the etiology of the chronic infection.

A case of minor salivary gland sialolithiasis of the upper lip.

BACKGROUND: Sialolithiasis is the most common disease of the salivary glands. Sialolithiasis usually develops in the major salivary glands, and rarely in the minor salivary glands, with only 2% of all cases of sialolithiasis occurring in the minor salivary glands and sublingual glands. Sialoliths in the minor salivary glands result in few or no clinical symptoms and are seldom identified on imaging. CASE PRESENTATION: We report herein our experience with a case of minor salivary gland sialolithiasis in a 67-year-old woman. On examination, an elastic soft, mobile, and well-circumscribed mass was palpable within the left upper lip. Ultrasound examination revealed a hypoechoic mass with heterogeneous internal echoes. The mass was excised under local anesthesia. Based on histopathological findings, a diagnosis of minor salivary gland sialolithiasis was established. CONCLUSIONS: Diagnosis of minor salivary gland sialolithiasis is challenging due to the difficulty of detecting sialoliths on imaging. A well-circumscribed mass was detected in the upper lip, and ultrasound examination revealed a round lesion, raising the suspicion of a benign tumor. Other diseases that can develop at the upper lip are calcified lymph node, phlebolith, fibroma, pleomorphic adenoma, myxoma, vascular malformation, salivary gland tumor, non-specific sialadenitis, and malignant tumor. Surgical excision is the favored approach for confirming a diagnosis of intramucosal nodular lesions.

Pediatric Sialendoscopy for Recurrent Salivary Gland Swelling: Workup, Findings, and Outcomes.

INTRODUCTION:: Recurrent salivary gland swelling of the parotid and submandibular glands results in painful swelling in the pediatric population. There is no defined algorithm for workup and treatment of these disorders, resulting in wide heterogeneity and in some cases overuse of computed tomography (CT) imaging. Sialendoscopy (SE) is an interventional option for recurrent swelling of both glands; however, its effectiveness in the pediatric population is still being determined. OBJECTIVES:: To assess preoperative imaging utilization and benefit in the workup of recurrent pediatric sialadenitis, intraoperative SE findings, and postoperative outcomes after intervention with SE. METHODS:: Case-series with a 5-year retrospective chart review on children undergoing SE for recurrent sialadenitis. RESULTS:: Forty-nine SE procedures were performed on 38 parotid glands (PG) and 11 submandibular glands (SMGs) in 29 children. CT imaging findings were useful for identifying a stone or stricture and guiding surgical management in 45.5% of SMGs versus 2.6% of PGs ( P < .001). A stone was found in 45.5% of SMGs and none in PG ( P < .001). SE intervention such as balloon dilation or stone removal was performed in 54.6% of SMGs and 5.3% of PGs ( P < .001). 74% of parotid patients undergoing SE responded to 1 intervention with a cessation of recurrent gland swelling, while 26% required additional interventions. One hundred percent of SMG patients responded to first intervention. There was no improvement in the beneficial effect of SE with steroid injection ( P = .897) regardless of steroid used ( P = .082). CONCLUSION:: CT findings were found to be low yield for recurrent parotid swelling, and ultrasound is a recommended first-line step for PG pathology. SE is a recommended first-line intervention for SMG and parotid sialadenitis as demonstrated by 100% and 74% response rate to initial SE, respectively.

Unilateral Submandibular Gland Atrophy and Sialolithiasis Diagnosed on 99mTc-MIBI SPECT/CT in a Patient With Primary Hyperparathyroidism.

A variety of sequelae of elevated calcium levels are encountered in patients with underlying primary hyperparathyroidism, including stone formation such as calculi in the urinary tract and sialoliths in the salivary glands and ducts. We present a case of a 54-year-old woman with fatigue, myalgia, and poor concentration who was found to have hypercalcemia (corrected calcium, 11.2 mg/dL) and elevated parathyroid hormone level (112 pg/mL), laboratory values consistent with primary hyperparathyroidism. She underwent evaluation with a Tc-MIBI parathyroid SPECT scan that included x-ray CT acquisitions for anatomical localization and attenuation correction.

Sialolithiasis of an Accessory Parotid Gland Causing Mid-Cheek Pain.

A 52-year-old woman presented with a slightly painful swelling of the right cheek area without postprandial aggravation of the symptom last 1 week. On physical examination, an approximately 1.5 cm sized firm, slightly tender mass was palpated on the right mid-cheek region, and she did not show any abnormal findings on neurologic examination. Computed tomography showed a well-enhanced lesion with low density of internal portion in right cheek area, and tiny calcification was noted within internal low-density portion of cheek mass. These findings suggested sialolithiasis of an accessory parotid gland with duct dilatation. Mid-cheek pain with conservative medical treatment was resolved and has not occurred during 1 year follow-up.

Pediatric sialolithiasis is not related to oral or oropharyngeal infection: A population-based case control study using the Korean National Health Insurance Database.

OBJECTIVES: Poor oral hygiene is one of the risk factors for sialolithiasis particularly in adults; however the etiology of sialolithiasis in pediatric patients remains largely unknown. The purpose of this study is to identify the association between sialolithiasis and the oral/oropharyngeal infections in the pediatric population, as surrogate indicators for oral hygiene and retrograde infections to the affected salivary gland. METHODS: This was a population based case-control study using the Korean National Health Insurance Database. We identified 10,095 pediatric patients, diagnosed with sialolithiasis, as cases (study period 2011-2015) and 50,475 age/gender/residence matched subjects without sialolithiasis, but with unrelated diseases (e.g., simple trauma in extremities) were set as controls. Logistic regression analyses were conducted to evaluate the association of sialolithiasis with oral or oropharyngeal infections. RESULTS: The morbidity rate of sialadenitis was much higher in the cases than the controls (32.92% vs 0.72%, p < 0.0001). By contrast, the prevalence of oral or oropharyngeal infections (stomatitis, gingivitis, periodontitis, and pharyngo-tonsillitis) was significantly lower in pediatric sialolithiasis patients in all age (0-18) groups. The adjusted odds ratios of the multivariate analyses also confirmed significantly less prevalence of the oral and oropharyngeal infections in pediatric sialolithiasis patients. CONCLUSION: Oral or oropharyngeal infections were inversely associated with pediatric sialolithiasis, suggesting that pediatric sialolithiasis may result from the intrinsic factors of the salivary gland itself, not from oral or oropharyngeal infections.

Accuracy of Ultrasonography and Computed Tomography in the Evaluation of Patients Undergoing Sialendoscopy for Sialolithiasis.

Objective To determine the accuracy of the 2 most utilized imaging modalities in obstructive sialadenitis secondary to sialolithiasis-computed tomography (CT) and ultrasonography (US)-using sialendoscopic findings as a comparison standard. To review the impact of CT and US on the management of sialolithiasis managed with sialendoscopy alone and through combined approaches. Study Design Retrospective cohort study. Setting Quaternary academic referral center. Subjects and Methods All cases of patients undergoing sialendoscopy by a single surgeon for suspected parotid and submandibular gland pathology between the October 2013 and April 2016 were reviewed. Results Sixty-eight patients were in this cohort, of whom 44 underwent US, CT, and sialendoscopy; 20 underwent CT and sialendoscopy only; and 4 underwent US and sialendoscopy only. The sensitivity and specificity were 65% and 80% for US and 98% and 88% for CT, respectively. These 68 patients had 84 total stones addressed, with 79 being removed and 5 remaining in situ. The methods of stone removal were sialendoscopy alone (34 stones), open transoral approaches (36 stones), and an external approach: transcervical for submandibular and transfacial for parotid (11 stones). Conclusion US had a lower sensitivity (65%) than what has been reported in the literature (70%-94%), and the majority of missed stones were anterior Wharton's duct stones. These sialoliths were likely missed due to an incomplete examination. US and CT were complementary in this study, and the findings suggest that both modalities can be utilized to optimize the outcome of sialendoscopy and combined approaches.

Acute submaxillitis: Etiological data and etiological management.

OBJECTIVES: The objective of the present study was to test the hypothesis that acute submaxillitis involves salivary duct obstruction. Obstacle characteristics and treatment were analyzed. MATERIAL AND METHODS: Patients presenting with an episode of acute submaxillitis between 2009 and 2015 were retrospectively included. All underwent salivary duct imaging and/or sialendoscopy, with pathologic examination if the salivary gland was removed for etiologic diagnosis. For etiological treatment, if the causal lesion could not be treated by isolated sialendoscopy, surgery used a direct approach assisted by sialendoscope. In case of failure of these procedures, submaxillectomy was indicated. RESULTS: Twenty-nine patients were included, 28 of whom showed salivary duct abnormality. At least 1 calculus was found in 27 patients; calculi were usually single (n=20), situated in the mid-third (n=21), and large (mean 7.7mm). Ten patients showed stenosis, associated with salivary calculus in 9 cases. Twenty-five patients with salivary duct obstruction underwent sialendoscopy. Isolated sialendoscopy was used in 5 cases, and a combined approach in 13 cases. CONCLUSION: An episode of submaxillitis requires salivary duct exploration by sialendoscopy, to enable early treatment given the prevalence of associated calculi and high success rate of conservative management by sialendoscopy.