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Abba M, Abramson A, Roitblat Y, Vaiman M. Topographic Positions of the Wharton's Duct Orifice in Children. J Oral Maxillofac Surg 2022; 80:1996-2002. [PMID: 36207007 DOI: 10.1016/j.joms.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Sialoendoscopic, orthodontic, and surgical interventions within the floor of the mouth require precise knowledge of the topography of the Wharton's duct orifices which is still lacking for the pediatric population. We aimed to establish a normative database for the topography of these orifices in children. METHODS The prospective cross-sectional analytic study was performed during January to December 2021. The distances between the mandible gonions and each orifice and the lingual frenulum were defined as primary outcome variables. The secondary outcome variables were the inter-position of the orifices and their location against the base of the tongue and the mandibular alveolar ridge. The segments of the cohort were classified by sex and age groups (4 to 7, 8 to 14, 15 to 17 years old) as the primary predictor variables. The data were evaluated by a 3-way ANOVA for analysis of selected distances with the level of significance at P ≤ .05. The correlation analysis between sex and locations of the orifices was performed using χ2 criterion (95% confidence interval) and r ≥ 0.60 was counted as a strong correlation. RESULTS The study involved 3,000 healthy children from 4 to 17 years of age. The orifices were symmetrical (89.3%), frenulum-independent (78.0%) openings that were usually located in the middle part of the floor of the mouth. The distance between the orifices varied from 0 mm in the frenulum-attached cases to 4.6 ± 1.8 mm for 4 to 7 years old, 7.6 ± 1.9 mm for 8 to 14 years old, and 9.1 ± 2.6 mm for 15 to 17 years old individuals. The orifices were attached to the frenulum (5.7%), were frenulum-related (16.3%), and frenulum-independent (78.0%). The sagittal asymmetry of the orifices was noted in 10.7%, and in 1.6% the lateral asymmetry was detected. No statistically significant sex-related differences were noted. CONCLUSION In the pediatric population, the Wharton's duct orifices are usually symmetrical frenulum-independent openings that are located in the middle part of the floor of the mouth. The distance between the orifices normatively varies according to sex and age. The size of the mandible does not influence the positions of the orifices. The position of the duct orifices must be established prior to submandibular sialoendoscopy, orthodontic interventions, frenotomy, and other oral surgeries.
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Affiliation(s)
- Michael Abba
- Attending Oral and Maxillofacial surgeon, Department of Oral and Maxillofacial Surgery, Barzilai Medical Center, Ashkelon, Israel.
| | - Alex Abramson
- Head, Oral and Maxillofacial Unit, Department of Oral and Maxillofacial Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Yulia Roitblat
- Research Fellow, Science Research Department, Alexander Muss High School in Israel (AMHSI) affiliated with Alexander Muss Institute for Israel Education (AMIIE), Hod HaSharon, Israel; Multidisciplinary Social Sciences, Bar Ilan University, Ramat-Gan, Israel
| | - Michael Vaiman
- Professor, Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Chen T, Szwimer R, Daniel SJ. The changing landscape of pediatric salivary gland stones: A half-century systematic review. Int J Pediatr Otorhinolaryngol 2022; 159:111216. [PMID: 35777140 DOI: 10.1016/j.ijporl.2022.111216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 04/06/2022] [Accepted: 06/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the evidence for pediatric sialolithiasis, including its demographic characteristics, diagnosis, and demonstrate the shift in its treatment paradigm. DESIGN A systematic review of sources from the Medline and Embase databases was conducted from inception to Dec 4, 2020. Two researchers independently extracted data and assessed quality. PATIENTS Patients under the age of 18 with sialolithiasis were included. MAIN OUTCOME MEASURES Study design, cohort size, age, sex, symptoms, stone characteristics, diagnostic modality and intervention were collected data points. RESULTS Forty-one studies with 243 patients were included in the review, of which 40 were case reports or series. Most stones were found in the submandibular gland (n = 210, 85.4%) and were single stones (n = 101, 71.1%). Average stone size was 7.7 mm. The most common diagnostic imaging modality used was ultrasound (n = 73, 47.4%), shifting from plain radiograph which was favoured in earlier years. Similarly, open gland excision was historically preferred, but since 2000, sialoendoscopy comprised 40.5% of all treatment modalities and continues to increase in prevalence, up to 52.1% by 2020. Extracorporeal shock wave lithotripsy was associated with the highest complication rate of 54.2%. CONCLUSIONS The pediatric sialolithiasis diagnostic and therapeutic landscape has changed with ultrasound replacing plain radiographs, and sialoendoscopy replacing submandibular gland excision. Further high-level quality evidence research is required to refine the indications, effectiveness, and safety of sialoendoscopy in pediatric sialolithiasis.
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Affiliation(s)
- Tanya Chen
- Department of Otolaryngology Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Rachel Szwimer
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Sam J Daniel
- Department of Otolaryngology Head & Neck Surgery, Montreal Children's Hospital, Montreal, Canada.
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Mathew J, Pothanikat JJK, Vinod Kumar RB, Padikadan NO, Arakkal NJ. Extremely Large Submandibular Sialolith Removal - A Case Report. Ann Maxillofac Surg 2022; 12:237-239. [PMID: 36874773 PMCID: PMC9976846 DOI: 10.4103/ams.ams_75_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 01/12/2023] Open
Abstract
The Rationale Sialoliths are calcified organic matter that form within the secretory system of the salivary glands. They rarely measure more than 1.5 cm. Giant sialoliths are rare and defined as a size of 3.5 cm or larger. Patient concerns Patient complained of the pain and swelling in the right submandibular area for two years with increase in size during meals. Diagnosis Based on the clinical and radiological investigations. Treatment Sialolith measuring 39 mm and weighing 7.02 g, was removed in a minimally invasive manner through transoral sialolithotomy using diode 810 µm LASER unit under local anaesthesia. Outcomes Patient was relieved of the preoperative symptoms and was on follow-up for one year. Take-Away Lessons Various newer treatment modalities are effective alternatives to conventional surgical treatment of sialoliths. However, transoral sialolithotomy remains the mainstay of management.
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Affiliation(s)
- Justin Mathew
- Department of Oral and Maxillofacial Surgery, The Malabar Dental College, Malappuram, Kerala, India
| | | | - R. B. Vinod Kumar
- Department of Oral and Maxillofacial Surgery, The Malabar Dental College, Malappuram, Kerala, India
| | - Naveen Odiyil Padikadan
- Department of Oral and Maxillofacial Surgery, The Malabar Dental College, Malappuram, Kerala, India
| | - Neeta Joy Arakkal
- Department of Oral and Maxillofacial Surgery, The Malabar Dental College, Malappuram, Kerala, India
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Aoun G, Maksoud C. Sialolith of Unusual Size and Shape in the Anterior Segment of the Submandibular Duct. Cureus 2022; 14:e24114. [PMID: 35444923 PMCID: PMC9009967 DOI: 10.7759/cureus.24114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/18/2022] Open
Abstract
Sialolithiasis is a common condition characterized by the formation of salivary stones or calculi, also known as sialoliths, within a salivary gland or its duct. Usually, sialolithiasis presents as salivary gland swelling with intermittent pain around mealtime. All salivary glands can develop sialolithiasis, yet it occurs most commonly in the submandibular gland. In this report, we describe an unusual large sialolith measuring 1.7 cm and uncommonly resembling a canine tooth. The sialolith was removed surgically via intraoral approach, and the salivary secretion was restored.
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Rodrigues GHC, Carvalho VJG, Alves FA, Domaneschi C. Giant submandibular sialolith conservatively treated. Autops Case Rep 2017; 7:9-11. [PMID: 28536681 PMCID: PMC5436915 DOI: 10.4322/acr.2017.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/10/2017] [Indexed: 11/23/2022]
Affiliation(s)
| | | | - Fabio Abreu Alves
- Stomatology Department - School of Dentistry - University of São Paulo, São Paulo/SP - Brazil
| | - Carina Domaneschi
- Stomatology Department - School of Dentistry - University of São Paulo, São Paulo/SP - Brazil
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Arslan S, Vuralkan E, Çobanog˘lu B, Arslan A, Ural A. Giant sialolith of submandibular gland: report of a case†. J Surg Case Rep 2015; 2015:rjv043. [PMID: 25848088 PMCID: PMC4385898 DOI: 10.1093/jscr/rjv043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Sialolithiasis is one of the most common diseases of salivary glands in middle-aged patients. Sialoliths are localized in submandibular glands in nearly 80% of the reported cases and they are classified as 'giant' in case any dimension exceeds 15 mm. Giant sialolith in submandibular gland is a rare disorder. Here, an unusual case of giant sialolith in submandibular gland is reported. A 42-year-old man referred with complaints of recurrent pain and swelling in the left submandibular area. Computerized tomography revealed a calcified mass of 42 × 17 mm size within the submandibular gland. Excision was performed in the submandibular gland and a giant sialolith of 35 mm length localized in the body of the gland was detected. The postoperative period was uneventful and the patient fully recovered.
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Affiliation(s)
- Selçuk Arslan
- Department of Otorhinolaryngology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey
| | - Erkan Vuralkan
- Department of Otorhinolaryngology, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Bengü Çobanog˘lu
- Department of Otorhinolaryngology, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ahmet Arslan
- Department of Otorhinolaryngology, Balıkesir Government Hospital, Balıkesir, Turkey
| | - Ahmet Ural
- Department of Otorhinolaryngology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey
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Hazarika P, Punnoose SE, Singh R, Arora S. Deep and unusual sialolithiasis of submandibular duct and gland: a surgical dilemma. Indian J Otolaryngol Head Neck Surg 2014; 65:309-13. [PMID: 24427589 DOI: 10.1007/s12070-012-0503-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 02/03/2012] [Indexed: 10/28/2022] Open
Abstract
Giant solitary submandibular duct calculus and multiple calculi of the gland are extremely rare. This occurrence along with more deep and proximally placed common calculi in submandibular gland may occasionally cause a dilemma in selection of the appropriate surgical approach in the present era of sialoendoscopic surgery. There is a high chance of fracture of the stone in a proximally placed stone in the gland followed by likely dissemination of fragments of the stone into the gland parenchyma during the procedure of sialoendoscopy which is a matter of grave concern. We authors believe that excision of the submandibular gland with the stone in such a situation should still be preferred as the gold standard of treatment leaving the ductal stone for endoscopic removal.
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Affiliation(s)
- Produl Hazarika
- Department of ENT, NMC Specialty Hospital, P.O. Box 6222, Abu Dhabi, UAE
| | - Seema E Punnoose
- Department of ENT, NMC Specialty Hospital, P.O. Box 6222, Abu Dhabi, UAE
| | - Rohit Singh
- Department of ENT and Head and Neck Surgery, Kasturba Medical College, Manipal, Karnataka India
| | - Sanjay Arora
- Department of ENT, NMC Specialty Hospital, P.O. Box 6222, Abu Dhabi, UAE
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Abstract
The formation of calcific concretions in the salivary duct or glands is a common disorder, especially in the submandibular glands. Most of the salivary calculi are small in size, in contrast to those that reach several centimeters, which are reported as megaliths or giant calculi in the literature. They may occur in any of the salivary gland ducts but are most common in Wharton's duct and the submandibular gland. This report presents clinical and radiographical sign of an unusually large sialolith. There was painless swelling on the floor of the edentulous mouth and patient was unaware of it. Radiographical examination revealed large irregular radio-opaque mass superimposed on right canine and premolar areas. This case report describes a patient presenting with an unusually large submandibular gland duct sialolith, the subsequent patient management, the aetiology, diagnosis and its treatment.
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Affiliation(s)
- Ali Iqbal
- Department of Oral and Maxillofacial Surgery, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
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Woo SH, Jang JY, Park GY, Jeong HS. Long-term outcomes of intraoral submandibular stone removal in children as compared with adults. Laryngoscope 2009; 119:116-20. [DOI: 10.1002/lary.20039] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
We report the case of a 48-year-old man who had an unusually large submandibular gland sialolith (2.6 cm in greatest dimension), which led to sialadenitis and subsequent abscess formation. We describe the management of this patient and review the literature with emphasis on the various modalities available for diagnostic imaging.
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Chung MK, Jeong HS, Ko MH, Cho HJ, Ryu NG, Cho DY, Son YI, Baek CH. Pediatric sialolithiasis: what is different from adult sialolithiasis? Int J Pediatr Otorhinolaryngol 2007; 71:787-91. [PMID: 17336398 DOI: 10.1016/j.ijporl.2007.01.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 01/26/2007] [Accepted: 01/30/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the clinical characteristics of pediatric sialolithiasis, which are distinct from those of adult sialolithiasis. METHODS A total of 210 patients with sialolithiasis confirmed by surgical treatment were enrolled in the study from Samsung Medical Registry (1995-2005). Twenty-nine were pediatric patients (age < or =18 years) and 181 adult patients (age >19 years). Comparison of pediatric and adult sialolithiasis was performed in terms of subject characteristics, clinical manifestations, salivary calculi characteristics, treatment modalities and outcomes. RESULTS Postprandial recurrent swelling was the most frequent complaint in pediatric sialolithiasis patients, as similar as in adult patients. However, duration of symptoms was shorter in pediatric patients (mean 14.1 months versus 30.7 months, P=0.003). Most calculi were less than 1cm in pediatric patients (93.1%), compared to 56.3% of the adult patients (P=0.001). The calculi were located more in the distal duct (62.0%) than in proximal duct and gland in the pediatric patients, whereas 44.7% in the adult patients (P=0.038). CONCLUSION Because of large proportion of relatively small and distal sialolithiasis in pediatric patients, bimanual careful palpation of the oral cavity is mandatory to diagnostic approach for children suspicious of sialolithiasis. These findings also suggest that intra-oral approach is effective treatment procedure for most of sialolithiasis in children.
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Affiliation(s)
- Man Ki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea
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Waseem Z, Waseem BAZ, Forte V. An unusual case of bilateral submandibular sialolithiasis in a young female patient. Int J Pediatr Otorhinolaryngol 2005; 69:691-4. [PMID: 15850690 DOI: 10.1016/j.ijporl.2004.11.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2004] [Revised: 10/18/2004] [Accepted: 11/08/2004] [Indexed: 11/16/2022]
Abstract
Salivary calculi in the pediatric population comprise only 3% of all cases of sialolithiasis. In addition, the presentation of bilateral calculi in children is rare. The formation of stones in the salivary glands has been attributed to slow salivary flow, salivary stagnation and unknown metabolic events. There is no report in the literature of an association between dietary calcium intake and calculi formation. We describe the clinical findings and management in a patient with bilateral sialolithiasis thought to be linked to high dietary calcium intake and review the literature.
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Affiliation(s)
- Zeeshan Waseem
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ont., Canada
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Lozano Blasco J, López Segura N, Bonet Alcaina M, Herrero Pérez S, Seidel Padilla V, García-Algar O. Expulsión espontánea de un cálculo salival submandibular. An Pediatr (Barc) 2003; 59:393-5. [PMID: 14519307 DOI: 10.1016/s1695-4033(03)78200-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Sialolithiasis rarely occurs in children and usually affects the submandibular salivary gland. Because of its rarity, its clinical expression is frequently missed and diagnosis is delayed. We describe the case of a 9-year-old boy with submandibular sialolithiasis who presented spontaneous passage of a large salivary stone. We review the clinical findings and etiopathogenesis of sialolithiasis in children, as well as diagnostic imaging techniques and several therapeutic approaches to stone extraction.
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Abstract
Salivary gland calculi account for the most common disease of the salivary glands. The majority of sialoliths occur in the submandibular gland or its duct and are a common cause of acute and chronic infections. This case report describes a patient presenting with an unusually large submandibular gland sialolith, the subsequent patient management, the aetiology, diagnosis and various treatment modalities available for management of salivary gland calculi depending on their site and size.
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Affiliation(s)
- S J Siddiqui
- Maxillofacial Unit, Royal Hospital Haslar, Haslar Road, Gosport, Hants PO12 2AA, UK
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Nahlieli O, Eliav E, Hasson O, Zagury A, Baruchin AM. Pediatric sialolithiasis. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 90:709-12. [PMID: 11113815 DOI: 10.1067/moe.2000.109075a] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pediatric sialolithiasis is a rare condition. This article characterizes 15 cases in children between 5 and 14 years of age. The diagnoses of this condition were made with routine radiograph and ultrasound, as well as with sialography whenever possible. Sialoendoscopy was performed as a diagnostic and treatment modality. Thirteen of the 15 affected children were boys, and 12 of 15 cases occurred in the submandibular gland. We were able to diagnose 67% by our imaging methods; the remainder were diagnosed by clinical examination.
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Affiliation(s)
- O Nahlieli
- Oral and Maxillofacial Surgery Department, Barzilai Medical Center, Ashkelon, Israel.
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