Sialendoscopy plus laser lithotripsy in sialolithiasis of the submandibular gland in 64 patients: A simple and safe procedure.

OBJECTIVE: To demonstrate the safety and efficiency of holmium laser-assisted lithotripsy during sialendoscopy of the submandibular gland using a retrospective, interventional consecutive case series. METHODS: We performed 374 sialendoscopies between 2008 and 2015 and evaluated all patients regarding clinical symptoms, clinical findings, therapy and outcome. We performed 109 procedures of holmium laser-assisted lithotripsy in 64 patients whose sialoliths measured 5 mm or more in diameter. In addition to retrospective case note reviews, we performed telephone interviews of all patients in January 2017. RESULTS: We performed 374 consecutive submandibular gland sialendoscopy procedures in 276 patients between 2008 to 2015. Sialolithiasis had either previously been diagnosed, or symptoms highly suggestive of sialolithiasis of the submandibular gland presented in 197 patients. Holmium laser-assisted Laser lithotripsy was performed in 109 cases (64.9%). Smaller mobile concrement was removed directly either by forceps or wire basket, or following marsupialisation of the submandibular duct. This was the case in 88 patients (29.1%). Three patients (0.8%) required surgical removal of the submandibular gland due to early abscess. The majority of patients (n = 374 procedures; 90.1%) remained symptom-free after two or more years following intervention. In the remaining procedures (n = 37 procedures; 9.9%), patients reported discreet postprandial problems but did not seek medical attention. In total, we managed to preserve the submandibular gland and avoid open surgery in 99% of patients through endoscopic management of submandibular concrement and duct stenosis. CONCLUSION: Holmium laser-assisted lithotripsy is a simple, safe, and effective procedure for treating patients with sialolithiasis of the submandibular gland. Removal of the gland is rarely required, and removing the gland without prior sialendoscopy is no longer recommended. It should be offered to all patients with submandibular gland sialolithiasis, or such patients should be referred to the appropriate centre for sialendoscopy before submandibulectomy is considered.

Accessory submandibular duct sialolithiasis identified during sialendoscopy.

We describe a unique case of a 62-year-old patient with recurrent right submandibular sialadenitis. He initially appeared to have extensive sialolithiasis of the right submandibular duct on computed tomography imaging and examination, but sialendoscopy demonstrated a normal-appearing right submandibular duct. An accessory duct posterior and parallel to the normal duct was identified at the time of sialendoscopy and was found to have extensive sialolithiasis, which required removal by both an endoscopic and intraoral technique. To the best of our knowledge, this is the first report of sialolithiasis of an accessory submandibular duct identified at the time of sialendoscopy; the other few reported cases in the literature are based primarily on findings from traditional sialography or magnetic resonance sialography. Identification of accessory salivary ducts requires intraoperative consideration of this entity during sialendoscopy. Open approaches to sialolithiasis, however, may be aided by appropriate preoperative imaging.

Giant Sialolith of Submandibular Duct.

Sialolithiasis is one of the most common diseases of salivary glands and commonly involves submandibular gland and ducts. "Giant sialoliths" typically measure more than 15 mm in any dimension. Here, an unusual case of sialolith in submandibular duct is reported which progressed into a giant sialolith in six months' time is reported. A 42-year-old man presented with complaints of recurrent pain and swelling in the right submandibular area. A large stone was palpable intraorally within the Wharton's duct and intra-operatively, an elongated giant sialolith of 50 mm length was found which is the second largest to be published till date.

[Calcifications of the parotid space. A review]. / Calcifications de la loge parotidienne. Mise au point.

INTRODUCTION: Parotid lithiasis is the main cause of calcifications in the parotid space. However, there are many other less known causes. The aim of our study was to point out the non-lithiasic causes of calcifications in the parotid space. MATERIAL AND METHODS: We conducted an exhaustive review of the literature by mean of PubMed, using the keywords "parotid" and "calcification" and limiting our analysis to the original articles in humans published in English and in French. Articles reporting about microscopic calcifications and who were not dealing with parotid calcifications were excluded. RESULTS: Twenty articles met the inclusion criterions. Tumoral and non-tumoral local causes and systemic causes of parotid calcification were found. The way they revealed was variable. The main tumoral local causes were pleomorphic adenomas, salivary duct carcinomas and adenocarcinomas. The main non-tumoral local causes included vascular malformations and calcified parotid lymph nodes. The main systemic causes were chronic kidney diseases, HIV infection, chronic alcoholism, elevated levels of alkaline phosphatase and auto-immune diseases. DISCUSSION: Eighteen different etiologies of parotid space calcifications could be identified. First line exploration of these lesions relies mainly on conventional radiography and ultrasound examination that are easily available. CT scan remains the reference examination.

Chronic parotitis with multiple calcifications: Clinical and sialendoscopic findings.

OBJECTIVES/HYPOTHESIS: To characterize clinical, imaging, and sialendoscopy findings in patients with chronic parotitis and multiple parotid calcifications. STUDY DESIGN: Retrospective review. METHODS: Clinical history, radiographic images and reports, lab tests, and operative reports were reviewed for adult patients with chronic parotitis and multiple parotid calcifications who underwent parotid sialendoscopy. RESULTS: Thirteen of 133 (10%) patients undergoing parotid sialendoscopy for chronic sialadenitis had more than one calcification in the region of the parotid gland. Seven patients (54%) were diagnosed with immune-mediated disease from autoimmune parotitis (positive Sjögren's antibodies or antinuclear antibodies) or human immunodeficiency virus (HIV) disease. The six patients (46%) who did not have an immune-mediated disorder had most calcifications located anterior or along the masseter muscle. Eight of 13 patients (61%) had at least one calculus found in the parotid duct on sialendoscopy. Four patients (38%) had multiple punctate calcifications within the parotid gland, all of whom had either autoimmune parotitis or HIV. None of the proximal or punctate parotid calcifications posterior to the masseter were visualized on sialendoscopy. CONCLUSIONS: Chronic parotitis in conjunction with multiple parotid calcifications is uncommon and was identified in 10% of our cohort. We contrast two classifications of parotid calcifications: 1) intraductal stones that cause recurrent duct obstruction and are often located within the main parotid duct along or anterior to the masseter and 2) punctate intraparenchymal parotid gland calcifications that are not visualized on sialendoscopy and may represent underlying inflammatory disease. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:1565-1570, 2017.

Post-sialendoscopy ductoplasty by salivary duct stent placements.

With damage to a duct or papilla after sialendoscopy, a stent may be necessary to prevent re-stenosis and for maintaining the salivary duct open after complete sialendoscopy. However factors affecting outcomes and complications after stent placement remain unclear. This study aimed to report preliminary experiences in salivary duct stent placement after sialendoscopy. Data from 35 procedures in 33 patients who received sialendoscopy with salivary duct stent placements at Mackay Memorial Hospital between October 2013 and June 2014 were recorded and compared for clinical data, as well as procedural techniques, findings, and outcomes. In the 35 stent placement procedures, the hypospadias silastic stent tubes were used in 27 and the Fr. 5 pediatric feeding tubes were used in the remaining eight. When the hypospadias silastic stent tubes were used for stenting, the stent obstruction and irritation rates were higher compared to those who used the Fr. 5 pediatric feeding tube (100 vs. 0 % and 67 vs. 33 %, respectively). None of the stents secured by a 5-0 nylon suture were complicated by dislocation but when the stents were secured by 6-0 nylon sutures, the dislocation rate went as high as 47.4 %. The duration needed for salivary duct stent placement might be potentially shortened to only 2 weeks. If a salivary duct stent is intended to be placed for a certain period before its scheduled removal, a suture strength equivalent or stronger than the 5-0 nylon suture should be considered for stent fixation.

Comparative analysis of sialendoscopy, sonography, and CBCT in the detection of sialolithiasis.

OBJECTIVES/HYPOTHESIS: The diagnosis of sialolithiasis is, along with clinical presentation, based on different imaging techniques and more invasive procedures such as sialendoscopy. The aim of the study was to analyze the potential of cone beam computed tomography (CBCT) for the diagnosis of sialolithiasis and to compare the results with those of sonography and sialendoscopy. STUDY DESIGN: Retrospective analysis. METHODS: The data of 43 patients with suspected sialolithiasis were evaluated retrospectively. All patients had CBCT and sonographic imaging and received sialendoscopy to confirm and possibly treat sialolithiasis. RESULTS: Sonography, CBCT, and sialendoscopy together indicated sialolithiasis in 33 patients. The mean maximum diameter of the extracted sialoliths did not significantly differ between the three diagnostics. Each diagnostic tool showed an excellent specificity and positive predictive value. Sensitivity and negative predictive value were best in sialendoscopy (94% resp. 83%), followed by CBCT (79% resp. 56%) and then sonography (70% resp. 47%). CONCLUSION: The results revealed that CBCT is capable of diagnosing sialoliths in general and tended to be more sensitive than sonography. However, in view of the radiation exposure, the use of CBCT must be critically weighed and should not be used as a primary option. LEVEL OF EVIDENCE: 4.

Updated S2K AWMF guideline for the diagnosis and follow-up of obstructive sialadenitis--relevance for radiologic imaging.

The interdisciplinarily developed German S2k AWMF guideline for the treatment of obstructive sialadenitis represents a new standard in the guideline program of the AWMF, the German Society for Consultants and the clinical disciplines working in the field of diseases of the head and neck region. In the last few years new diagnostic and therapeutic possibilities have been established in obstructive chronic Sialadenitis offering individually optimized therapeutic strategies. Only a few years ago extirpation of the whole affected gland was the only relevant therapy option. Nowadays therapeutic options such as interventional sialendoscopy and extracorporeal shock-wave lithotripsy (ESWL) are available in combination with marsupialization or incision of the duct. If possible the focus is on preserving the main glandular duct. In the following article the relevant aspects for the diagnostic radiologic procedures are presented.

[The new S2k AWMF guideline for the treatment of obstructive sialadenitis in commented short form]. / Die neue S2k AWMF Leitlinie zur Behandlung der obstruktiven Sialadenitis in kommentierter Kurzform.

A new and interdisciplinary S2k AWMF guideline for the treatment of obstructive sialadenitis has been published. There have been several technical achievements, for instance in the field of ultrasonography, via sialendoscopy, or by MR-sialography, that have increased the possibilities for diagnosis and treatment of patients with obstructive sialadenitis. In the past, the treatment of choice in case of unsuccessful medical treatment was a complete extirpation of the affected salivary gland. Nowadays, using a variety of modern treatment options (like sialendoscopy, or extracorporeal shock-waves lithotripsy sometimes combined with salivary duct incision), it is possible in most patients, especially in cases of sialolithiasis, to preserve the affected gland. A functional recovery after gland-sparing surgery is described but more data is needed to finally evaluate the long-time results. The new guideline describes all relevant steps to diagnose an obstructive sialadenitis and values all diagnostic tools critically. Finally, all recommendable therapy options are described and valued, too.

Sialolithiasis in the duct of submandibular gland: a case report in patient with epidermolysis bullosa.

AIM: To describe the options of treatment to remove a sialolith associated with the submandibular gland duct in a patient with epidermolysis bullosa (EB). BACKGROUND: Treatment of patients with EB is very complex and involves a multidisciplinary team. This condition is characterized by a spectrum of blistering and mechanical fragility of the skin. One main feature of this disease is the esophageal constriction and possible constriction to the submandibular duct. This alteration may induce the formation of calculi in this duct, which is called sialolith. Once the sialolith obliterates the trajectory of the duct this will lead to a sialolithiasis. The calculi have to be removed. CASE REPORT: Seventeen years old female patient with dystrophic EB developed a sialolith at the submandibular duct. She has a limited mouth opening and her tongue was collapsed with mouth floor. The first choice of treatment was the lithotripsy, once this procedure is less invasive and a surgical remove could worse the collapsed tongue. She was with acute pain and with a great augmentation in the submandibular area. Once the patient was debilitated and has difficult to swallow she invariably needed to be hospitalized in order to receive intravenous medication. During the hospitalization the sialolith could be seen through the opening of the duct and the calculi was removed with local anesthesia. CONCLUSION: The treatment of sialolithiasis usually does not present major challenges, nevertheless if the sialolithiasis is associated with EB, the treatment became an extremely challenge. In this particular case the option of treatment was the less invasive. CLINICAL RELEVANCE: This case report has an enormous clinical relevance once there is no protocol to treat patients with EB and buccal diseases.

Chronic sclerosing sialadenitis or Küttner's tumor associated with a giant sialolith: a case report.

Chronic sclerosing sialadenitis (Küttner's tumor [KT]) is a chronic inflammatory salivary gland disease primarily affecting the submandibular gland. Sialolithiasis is considered the most common etiologic factor for KT. We report a case of KT associated with a giant sialolith of the submandibular gland and a secondary smaller sialolith in the associated submandibular duct.

Stenoses of the salivary ducts-sialendoscopy based diagnosis and treatment.

Our aim was to analyse the nature of a sialendoscopy-based classification and present its use in the treatment of stenoses of Wharton's and Stensen's ducts. The classification of stenoses of Wharton's duct has not been published before. We did 133 sialendoscopies in 114 patients who presented with possible obstruction of the ducts to the tertiary centre for ENT at the University Department in Poznan. Twenty-seven patients had their parotid ducts treated, and 24 their submandibular ducts. Suspicion of stenotic changes of the ductal system was suggested during ultrasound examination. They were examined with semirigid endoscopes that enabled direct visualisation of the stenotic areas. A total of 69 stenoses were diagnosed in 51 patients. Stenoses were divided into three groups according to their site. Patients with stenosis of the salivary ducts were treated by dilatation of the stenotic area, intraductal steroid injections, and insertion of a stent for 14-21 days. Forty of the 51 reported considerable improvement, and 7 partial improvement. Four patients had no improvement. Sialendoscopy is a safe way to treat obstruction of the salivary glands. Short and medium term follow up show that it is extremely successful.

Advances in imaging of obstructed salivary glands can improve diagnostic outcomes.

INTRODUCTION: Obstruction of the major salivary glands is a relatively common condition defined as the blockage of the salivary outflow in the glandular ductal system. It can however mimic more aggressive pathology. METHODS: The most common cause of salivary obstruction is sialolithiasis, followed by ductal strictures. Salivary obstruction is clinically characterized by a food-related painful swelling of the affected gland, known as 'mealtime syndrome'. RESULTS: When obstruction is clinically suspected, the role of imaging consists of confirming the obstruction, identifying its cause, evaluating the position and extent of the obstruction and evaluating for associated complications. However, if imaging shows up signs of a tumour or other pathology which can mimic an obstructed gland clinically instead, the radiologist can alert the clinician accordingly to change the course and plan of treatment. Several imaging techniques are available for investigating the obstructed salivary glands. CONCLUSIONS: This review looks at the causes of obstruction and the use, diagnostic performance and practicality of the various imaging modalities. Importantly, an imaging approach algorithm for the evaluation of the obstructed salivary gland is also proposed.

Sialendoscopic findings in patients with obstructive sialadenitis: long-term experience.

During a 9-year period from October 2002 to October 2011, 561 patients with swelling in the submandibular gland (n=474) and parotid gland (n=87) were successfully studied using sialendoscopy, and the features and pathological changes of the duct evaluated and recorded. Abnormalities were noted in 552/561 cases (98%), and normal features in 9 (2%). The pathological changes in 467 submandibular glands were identified both endoscopically and radiographically, and endoscopic findings showed 3 types: sialolith (n=423, 91%), mucus plug (n=15, 3%), and stenosis (n=29, 6%). In 12 cases foreign bodies (fish bones) were found fixed in calculi. In 85 parotid glands the main pathological finding in the duct was stenosis (n=64, 75%, mucus plug (n=12, 14%), and sialolith (n=9, 11%). Several microstructures had been found on sialendoscopy, including sublingual opening, a basin-like structure in the hilar region, a sphincter phenomenon, and hyperplasia. Sialendoscopy can give direct information about the salivary duct, and in some cases indicate the possible mechanism of obstruction.

Parotid sialolithiasis.

Salivary dysfunction may be due to systemic diseases and medications. The development of sialoliths is a multifactorial event in which disturbance in secretion, microliths and bacteria may play a major role. A case of sialolith in the parotid gland of a 25-year-old man, with no relevant medical history is reported here.

Sialolithiasis in a 10 year old child.

Sialolithiasis is often observed in the oral region, and is caused by the development of a calculus in the salivary gland or duct. This disease is mostly seen in adults or young adults, and seldom develops in children. Of all the cases of sialolithiasis, only 3% are seen in the pediatric population. The clinical presentation typically consists of a painful swelling of the involved salivary gland at meal times, as the obstruction is most acute at this time. The clinical signs often lead to an easy diagnosis. The salivary gland most commonly affected is the submandibular gland. In this paper, we have reported the case of a 10 year old female with sialolithiasis of the left submandibular duct. The treatment consisted of the use of lemon and orange drop candies, which stimulated the salivary flow and in turn resulted in the expulsion of stone.