Sialolitiasis, sialoadenitis y sialoadenosis. Revisión de literatura y reporte de un caso clínico / Sialolithiasis, sialadenitis and sialadenosis. Review of literature and report of a clinical case

Introducción: la formación de sialolitos se considera la alteración más común en las glándulas salivales. Su origen aún no es claro en cuanto a qué provoca la obstrucción parcial o total del sistema de conductos salivales, con una predilección significativa en las glán - dulas submandibulares, lo que permite un desplazamiento retrógrado de bacterias a través del conducto salival hacia la glándula afectada, el cual se traducirá clínicamente como inflamación unilateral o bila - teral. El tratamiento para la sialolitiasis y sialoadenitis puede variar desde un manejo conservador hasta tratamientos que implican la remoción de la glándula salival afectada. La sialoadenosis difiere de las anteriores en su origen, ya que ésta no se considera inflamatoria ni neoplásica y no afecta la función glandular de excretar saliva. Presentación de caso clínico: se trata de paciente masculino con diagnósticos presuntivos de sialoadenitis y sialolitiasis, al cual se le realizó biopsia escisional de la glándula afectada, su estudio histo- patológico corroboró los diagnósticos mencionados anteriormente que además confirmó un diagnóstico de sialoadenosis. Conclusio- nes: la escisión de la glándula salival involucrada se realizará en casos diagnosticados de sialoadenitis y sialolitiasis con sialolitos de gran tamaño y procesos supurativos crónicos que no resuelven con antibioticoterapia (AU)

Evidence of a microbial etiology for sialoliths.

OBJECTIVES: Sialolithiasis is the primary etiology for parotid and submandibular swelling, potentially resulting in discomfort, bacterial infections, and hospitalization. The etiology of sialolith formation is unknown. Currently, the proposed etiologies range from inflammation, coalescence of organic molecules, sialomicrolith formation, pH changes, and biofilm formation. In this study, we performed a descriptive analysis of images obtained through electron microscopy of sialoliths. Based on our findings and descriptive analysis, we hypothesize that sialolith formation is likely multifactorial and begins with biofilm formation. Biofilm formation then triggers a host immune response, and it is the interaction of biofilm with host immune cells and calcium nanoparticles that forms the nidus and creates a favorable environment for calcium precipitation. METHODS: Sialoliths were extracted from patients and imaged under light and scanning electron microscopy. Specimens for light microscopy were prepared using a diamond saw. Specimens for electron microscopy were freeze-fractured, thus providing an undisturbed view of the core of the sialolith. RESULTS: We were able to identify clear evidence of biofilm caves at the core of each sialolith. These biofilm caves were complex with the presence of bacteria and dehydrated extrapolysaccharide matrix, host cells (immune cells, platelets and erythrocytes), and calcium nanoparticles. CONCLUSION: The etiology of sialolith formation is likely multifactorial. We propose that biofilm formation within a single salivary gland or duct leads to local ductal injury, which results in the influx of host immune cells that interact with the biofilm and calcium nanoparticles, creating a scaffold upon which further calcium deposition can occur. LEVEL OF EVIDENCE: NA Laryngoscope, 130:69-74, 2020.

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.

Salivary calculi microbiota: new insights into microbial networks and pathogens reservoir.

Sialolithiasis represents the most common disorders of salivary glands in middle-aged patients. It has been hypothesized that the retrograde migration of bacteria from the oral cavity to gland ducts may facilitate the formation of stones. Thus, in the present study, a microbiome characterization of salivary calculi was performed to evaluate the abundance and the potential correlations between microorganisms constituting the salivary calculi microbiota. Our data supported the presence of a core microbiota of sialoliths constituted principally by Streptococcus spp., Fusobacterium spp. and Eikenella spp., along with the presence of important pathogens commonly involved in infective sialoadenitis.

Bacterial Biofilm in Salivary Gland Stones: Cause or Consequence?

OBJECTIVE: The pathogenesis of salivary calculi is not yet clear; however, 2 theories have been formulated: (1) "the classic theory," based on calcium microdeposits in serous and ductal acinous cells, successively discharged into the ducts; (2) "the retrograde theory," based on a retrograde migration of food, bacteria, and so on from the oral cavity to the salivary duct. The aim of the present study is to highlight the role of bacteria and biofilm in stone formation. STUDY DESIGN: Case series without comparison. SETTING: Laboratory of the Department of Anatomical Pathology. SUBJECTS AND METHODS: Traditional optic microscopy and scanning electron microscopy were carried out on 15 salivary gland calculi that were collected from 12 patients. A qPCR (quantitative real-time polymerase chain reaction) assay was performed to highlight the presence of bacterial DNA on each stone. RESULTS: Optic microscopy showed formations that-due to their size, shape, and Gram and Giemsa staining-seemed to be Gram-positive bacterial cells. PAS- (periodic acid-Schiff) and alcian-PAS-positive staining matrix was present around them. The ultrastructural observation of the material processed for scanning electron microscopy showed the presence of structures resembling bacterial cells in the middle of the stones, surrounded by soft, amorphous material. Results of qPCR showed the presence of bacterial DNA in the internal part of the tissue sample. CONCLUSIONS: The presence of bacteria and/or bacterial products resembling biofilm in salivary gland stones supports the "retrograde theory." This evidence may support the hypothesis that biofilm could be the causative effect of lithiasic formations.

Bacteria and pathogenesis of human salivary calculus.

The exact cause of salivary calculus formation is unknown and the aim of this study was to ascertain whether bacteria play a role. Sialoliths from nine patients with chronic obstructive sialadenitis of the submandibular gland were analysed. Bacterial gene fragments were amplified from DNA extracted from salivary calculi by means of polymerase chain reaction using a universal bacterial primer pair. Comparative 16S ribosomal RNA sequence analysis was used for identification. We detected and identified oral bacteria (predominantly Streptococcus species) in all samples. The present results suggest a potential role for bacteria in the etiopathogenesis of sialolithiasis.

[Submaxillary sialolithiasis due to Actinomyces israelii. A case report]. / Sialolitiasis submaxilar por actionomices Israelii. A propósito de un caso.

Actynomicosis of the submaxillary gland is a very uncommon infectious disease. In this article one case of submaxillary sialolithiasis by actynomices israelii in a young girl is presented. We discuss several aspects of its diagnosis and therapeutic possibilities and review the literature on the subject. We emphasize the interest and value of performing a microbacteriological, mineralogical and pathological study of the calculi.