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Zhao YN, Zheng DN, Qu LY, Xie XY, Liu DG, Yu GY. Removal of intraglandular calculi in Wharton's duct: clinical outcome and treatment algorithm. Int J Oral Maxillofac Surg 2024; 53:382-388. [PMID: 38092608 DOI: 10.1016/j.ijom.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 04/16/2024]
Abstract
The aim of this study was to propose a treatment strategy for intraglandular submandibular calculi based on calculus site. Seventy-three consecutive patients with impalpable intraglandular submandibular calculi were enrolled retrospectively. The calculi were classified as either post-hilar type, central type, or superficial type. Treatment approaches included transoral duct slitting (TDS), interventional basket retrieval (IBR), intraductal laser lithotripsy (ILL), and transcervical lithotomy (TCL). Complete calculus removal with gland preservation was achieved in 64 patients (87.7%). The success rate for post-hilar, central, and superficial calculi was 86.4% (51/59), 90.9% (10/11), and 100% (3/3), respectively. The treatment approach applied in patients with treatment success was TDS in 32 cases, IBR in 20, ILL in nine, and TCL in three. During follow-up (median 17.3 months), one patient experienced gland atrophy and three had ductal stenosis; the remaining 60 patients (93.8%, 60/64) had good clinical outcomes. In the eight failure cases operated by TDS, the deeply situated calculi could not be detached despite the parenchymal incision in five cases, while the procedure was ceased due to the patient's inability to cooperate in the other three cases. In the remaining failure case, the submandibular gland was sacrificed after calculus extraction via TCL. Application of the proposed treatment algorithm might help preserve gland function in patients with intraglandular submandibular calculi.
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Affiliation(s)
- Y-N Zhao
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, PR China
| | - D-N Zheng
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, PR China
| | - L-Y Qu
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, PR China
| | - X-Y Xie
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, PR China
| | - D-G Liu
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, PR China.
| | - G-Y Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, PR China
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Sodnom-Ish B, Eo MY, Mustakim KR, Cho YJ, Kim SM. Elemental characteristics of sialoliths extracted from a patient with recurrent sialolithiasis. J Korean Assoc Oral Maxillofac Surg 2024; 50:94-102. [PMID: 38693132 PMCID: PMC11063739 DOI: 10.5125/jkaoms.2024.50.2.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 05/03/2024] Open
Abstract
The exact mechanism of sialolith formation has yet to be determined. Recurrence of sialolithiasis is rare, affecting only 1%-10% of patients. The current study presents a case of recurrent stones that occurred twice on the right submandibular gland 6 months postoperative and 7 months after reoperation in a 48-year-old female patient. The stones were analyzed using histology, scanning electron microscopy, energy dispersive spectroscopy, and transmission electron microscopy (TEM). The first stone showed a three-layered structure with a poorly mineralized peripheral multilayered zone, highly mineralized middle layer, and the central nidus. The stones were composed of Ca, C, O, Cu, F, N, P, Si, Zn, and Zr. In TEM, compact bi-layered bacterial cell membrane was found on the peripheral layer and the central nidus of the stone as well as exosomes in the central nidus. The results demonstrated the essential components of sialolith formation, including bacteria, inflammatory exosomes, and exfoliated salivary epithelial cells that cooperatively underwent the pathogenetic progresses of central nidus formation, induction of compact zone calcification of the middle layer, and repeated subsequent deposition in the peripheral multilayer zone. The rapid recurrence could have resulted from residual pieces of a sialolith acting as the nidus of bacterial infection.
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Affiliation(s)
- Buyanbileg Sodnom-Ish
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Mi Young Eo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kezia Rachellea Mustakim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Yun Ju Cho
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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Kallas-Silva L, Azevedo MFD, de Matos FCM, Petrarrolha SP, Dedivitis RA, Kulcsar MAV, Matos LL. Sialendoscopy for treatment of major salivary glands diseases: a comprehensive analysis of published systematic reviews and meta-analyses. Braz J Otorhinolaryngol 2023; 89:101293. [PMID: 37487402 PMCID: PMC10382863 DOI: 10.1016/j.bjorl.2023.101293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES Sialendoscopy is a minimally invasive procedure used to diagnose and treat obstructive salivary gland diseases. Previous studies in the topic have shown mixed results. The present study aimed to evaluate the efficacy and safety of sialendoscopy through previous systematic reviews for different outcomes of several diseases. We also aimed to assess studies' methodological quality and heterogeneity. METHODS We conducted a comprehensive systematic literature search of Pubmed, Embase, Lilacs and Cochrane Library. We included systematic reviews and meta-analyses that used sialendoscopy to treat both lithiasic and alithiasic salivary glands diseases. Data extraction included studies' characteristics and results. We assessed studies' methodological quality using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews 2) tool. RESULTS 13 studies were included in the review, being 9 in adult populations and 4 in pediatric populations. Sialendoscopy proved to be effective at the treatment of different lithiasic and other obstructive diseases, but with important heterogeneity. The technique was also considered highly safe in most studies. However, studies had a critically low quality of evidence. CONCLUSIONS Most studies demonstrated high efficacy and safety of sialendoscopy, but with critically low quality of evidence. We still lack randomized studies in this field, and future systematic reviews on the topic should follow current guidelines to improve conduction and reporting.
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Affiliation(s)
- Lucas Kallas-Silva
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Serviço de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Maria Fernanda Dias Azevedo
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Serviço de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Fátima Cristina Mendes de Matos
- Universidade de Pernambuco (UPE), Pernambuco, PE, Brazil; Vice-presidente da Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Brazil
| | - Silvia Picado Petrarrolha
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Cirurgia (Cirurgia de Cabeça e Pescoço), São Paulo, SP, Brazil
| | - Rogério Aparecido Dedivitis
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Cirurgia (Cirurgia de Cabeça e Pescoço), São Paulo, SP, Brazil; Ex-presidente da Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Brazil.
| | - Marco Aurélio Vamondes Kulcsar
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Instituto do Câncer do Estado de São Paulo (Icesp), Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Presidente da Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Brazil
| | - Leandro Luongo Matos
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Instituto do Câncer do Estado de São Paulo (Icesp), Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Clínica Cirúrgica, São Paulo, SP, Brazil; Diretor Científico da Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Brazil
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Shetty P, Prince J, Poojary D, P P, Suresh PK. Diagnostic conundrum in an ambiguous posterior mandibular osseous lesion: Case report and radiological review. Int J Surg Case Rep 2023; 106:108288. [PMID: 37148721 DOI: 10.1016/j.ijscr.2023.108288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Non-odontogenic osseous lesions of the mandible are relatively uncommon entities compared to odontogenic lesions. Although the posterior mandible is not a usual site, it is not rare either for these osseous lesions, making the diagnosis ambiguous, and if misdiagnosed leading to different treatment protocols. CASE PRESENTATION A 43-year-old female presented with a hard tissue lesion of the posterior mandible, misdiagnosed as a sialolith of the submandibular salivary gland in two other centers due to overlapping of symptoms, anatomic complexity, and inadequate investigations. The lesion was later diagnosed to be an osteoma of the posterior mandible with added investigations, and surgically excised. Histopathology confirmed the diagnosis. CLINICAL DISCUSSION A variety of hard tissue lesions are known to occur in the posterior mandible like Submandibular sialolith, Osteomas, Calcified Submandibular lymph nodes, Phlebolith, and Tonsillolith. However, due to the region's structural complexity, localization of a hard tissue lesion may not always be forthright, even with radiographs. Moreover, in cases with conflicting symptoms, as was in this case there are more chances of misdiagnosis. The reasons for such diagnostic challenges are deliberated with radiological review of posterior mandibular osseous lesions. Recommendations are also suggested for proper investigations, thereby management of these posterior mandibular osseous lesions. CONCLUSION Misdiagnosis of these posterior mandibular lesions may lead to the patient undergoing unnecessary surgical procedures as different lesions require different management. Differential diagnosis and adequate protocol for investigations are required.
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Affiliation(s)
- Premalatha Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India.
| | - Jefferson Prince
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India.
| | - Dharnappa Poojary
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India.
| | - Poorna P
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India
| | - Pooja K Suresh
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India
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Skalias A, Garefis K, Markou K, Nikolaidis V, Konstantinidis I. The effectiveness and safety of sialendoscopy for sialolithiasis in children: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:3053-3063. [PMID: 36781439 DOI: 10.1007/s00405-023-07877-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Sialendoscopy is a new, minimally invasive method that is becoming increasingly more popular than traditional methods for the treatment of sialolithiasis. In this systematic review and meta-analysis, the effectiveness and safety of this method in children with sialolithiasis are investigated. METHODS Inclusion criteria were children with sialolithiasis. The information sources were databases MEDLINE and PubMed Central (through PubMed), ScienceDirect, Cochrane Central Register of Controlled Trials (CENTRAL), citation indexes Scopus and Google Scholar, trial registries, and "gray literature". The last search was performed on September 18, 2022. The risk of bias in included studies was assessed using ROBINS-I tool (Risk Of Bias In Non-randomized Studies of Interventions). The pooled proportion of weighted means was calculated for the quantitative synthesis of available data. RESULTS The effectiveness of the method was estimated at 95.5% (95% CI 89.8-99.3%), from 13 studies including 133 cases. The safety was estimated at 97.2% (95% CI 91.8-100%), from 10 studies including 113 cases. CONCLUSION The limitations of this study, briefly summarized, are the small number of included studies, the fact that they are mostly retrospective, the difficult application of the guidelines suggested by the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane handbook due to the nature of this specific condition and intervention, and the difficulty in assessing reporting bias. The results of the current study indicate that sialendoscopy is an effective and safe method for the treatment of sialolithiasis in children and should be implemented in daily clinical practice.
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Affiliation(s)
- Antonios Skalias
- Department of Otorhinolaryngology, Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, Greece.
| | - Konstantinos Garefis
- 2nd Academic Otorhinolaryngology, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Konstantinos Markou
- 2nd Academic Otorhinolaryngology, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Vasileios Nikolaidis
- 2nd Academic Otorhinolaryngology, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Iordanis Konstantinidis
- 2nd Academic Otorhinolaryngology, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
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Kim DH, Kang JM, Kim SW, Kim SH, Jung JH, Hwang SH. Utility of Ultrasonography for Diagnosis of Salivary Gland Sialolithiasis: A Meta-Analysis. Laryngoscope 2022; 132:1785-1791. [PMID: 35043982 DOI: 10.1002/lary.30020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We hypothesized that ultrasonography for salivary gland stone detection would have a diagnostic accuracy similar to that confirmed by sialendoscopy, sialography, or surgery. Therefore, we evaluated the diagnostic characteristics of ultrasonography in terms of submandibular and parotid stone detection compared to confirmatory methods. METHODS We searched PubMed, Embase, the Web of Science, SCOPUS, and the Cochrane database to October 31, 2021. The risk of bias was evaluated using the QADAS-2 tool. RESULTS Ten studies involving 1393 patients were included in the analysis. The diagnostic odds ratio of ultrasonography was 162.6013 (95% confidence interval [CI] [53.9883; 489.7208] and I2 value 81.0%). The area under the summary receiver operating characteristic curve was 0.963. The sensitivity, specificity, negative predictive value, and positive predictive value were 0.8992 (95% CI [0.8534; 0.9318]; I2 = 79.9%), 0.9664 (95% CI [0.9290; 0.9844], I2 = 65.6%), 0.8076 (95% CI [0.7256; 0.8694]; I2 = 80.4%), and 0.9853 (95% CI [0.9629; 0.9943]; I2 = 77.4%), respectively. However, high-level among-study heterogeneity (I2 ≥ 50%) was evident, attributable to the inclusion of different glands. On subgroup analysis, significant differences in the negative predictive values (parotid gland only [0.9392], submandibular gland only [0.6718], and parotid and submandibular glands [0.8105]) were apparent. We found no significant among-study difference in the sensitivity, specificity, positive predictive value, or diagnostic odds ratio (P > .05). CONCLUSION Ultrasonography usefully detects submandibular and parotid gland stones. Ultrasonography of the parotid gland was associated with the highest diagnostic accuracy, but further clinical studies are needed. LEVEL OF EVIDENCE NA Laryngoscope, 2022.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jun Myung Kang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - So-Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jae Hoon Jung
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Zhao YN, Zhang YQ, Ye X, Meng Y, Xie XY, Liu DG. [Endoscopy-assisted transoral removal of deep hilar and intraparenchymal stones in the Wharton's duct]. Zhonghua Kou Qiang Yi Xue Za Zhi 2019; 53:826-831. [PMID: 30522206 DOI: 10.3760/cma.j.issn.1002-0098.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the different surgical approaches and long-term outcomes of endoscopy-assisted transoral removal of deep hilar and intraparenchymal stones in the Wharton's duct. Methods: From January 2008 to March 2018, 481 consecutive patients with deep hilar and intraparenchymal calculi in the Wharton's duct underwent endoscopy-assisted transoral removal at Deparment of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology. There were 250 males and 231 females. Their ages ranged from 9-86 years. We operated 476 patients under local anesthesia on an outpatient basis, and the remaining 5 were operated under general anesthesia. On the basis of ultrasonography, spiral CT, sialography and endoscopy, the calculi were classified into 4 types: hilum stones (located at the hilum or proximally with a distance <5 mm from the hilum), infra-hilum stones (intra-glandular stones with a distance of 5-10 mm from the hilum), intraparenchymal stones (with a distance ≥10 mm from the hilum), and multiple stones (concomitant hilum and intra-glandular stones). The treatment approaches included: hilum duct slitting, intraparenchymal duct slitting, submandibulotomy and intraductal retrieval. The success rate, immediate safety and effectiveness of different types of stones were evaluated. After surgery, the patients were followed up, and gland function was analyzed on the basis of clinical symptoms and signs. Results: The calculi sizes varied from 3 to 25 mm, with a mean of 7.8 mm. The calculi were located in the right submandibular gland in 259 patients, in the left submandibular gland in 219 patients and in bilateral glands in 3 patients. The calculi were successfully removed in 446 glands, with a success rate of 92.1% (446/484). The success rate varied according to the stone sites: 97.8% (363/371) for hilum stones, 64.4% (29/45) for infra-hilum stones, 4/16 for intraparenchymal stones and 96.2% (50/52) for multiple stones. The main treatment methods applied included hilum duct slitting in 347 glands, intraparenchymal duct slitting in 13, submandibulotomy in 4, intraductal retrieval in 73, and hilum duct slitting accompanied by intraductal retrieval in 9. Ductal breakage occurred in 2 glands. All patients complained of mild to moderate pain with a duration of 3-7 days. Nine had temporal lingual nerve injury. During 3-120 months' follow-up (mean 36 months) of the total 484 glands, 1.6% (7/446) developed ranula, 1.3% (6/446) experienced obturation of the main duct and 2.0% (9/446) had recurrent stones. The remaining 95.1% (424/446) glands were symptom-free with good function. Conclusions: Endoscopy-assisted transoral removal of deep hilar and intraparenchymal submandibular calculi is a safe and effective gland-preserving procedure. According to the depth, size and number of the calculi, variant surgical approaches should be attempted to maximize the success rate and to minimize the side effects.
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Affiliation(s)
- Y N Zhao
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Y Q Zhang
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - X Ye
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China(Present address: Department of Stomatology, Peking University Shenzhen Hospital, Shenzhen Guangdong 518036, China)
| | - Y Meng
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - X Y Xie
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - D G Liu
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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Ye X, Zhang YQ, Zhao YN, Meng Y, Liu DG, Zhang ZY. [Clinical study of endoscopy-assisted lithectomy of parotid gland calculi via a transoral approach]. Zhonghua Kou Qiang Yi Xue Za Zhi 2019; 54:17-22. [PMID: 30630254 DOI: 10.3760/cma.j.issn.1002-0098.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the indications and long-term outcomes of endoscopy-assisted removal of parotid gland calculi via a transoral approach. Methods: From August 2005 to December 2016, 158 consecutive patients with parotid gland calculi underwent endoscopy-assisted lithectomy transorally. They included 71 males and 87 females, with an age of 5-84 years. The immediate safety and effectiveness were evaluated. After surgery, the patients were followed up, and gland function was analyzed on the basis of clinical manifestations, sialography, scintigraphy and sialometry. Postoperative sialograms were categorized into 2 types: ①type Ⅰ, the main duct was normal or had ectasia and stenosis, but no persistent contrast was seen on the functional film; ②type Ⅱ, the main duct had ectasia or stenosis, with persistent contrast media on the functional film. Results: Under one endoscopic procedure, the stones (or foreign bodies) were completely removed in 134 cases and almost completely removed in 10 cases, with a success rate of 91.1% (144/158). Of the 144 successful cases, the treatment options included direct basket retrieval or forceps grasping in 77 cases, basket entrapment with direct ostium incision in 36, basket capture with perio-ostium incision in 23 and perio-ostium incision in 8 cases with impacted stones. In two of the initial 14 failure cases, the stones were discharged spontaneously 3 months after operation. During 3-120 months' follow-up (mean 36 months) of the 146 patients, one had recurrent stone, two developed ductal obturation, 16 had mild symptoms, and the remaining 127 cases were asymptomatic. Of the postoperative sialograms in 34 stone-free patients 25 were type Ⅰ, 9 were type Ⅱ. Both scintigraphy and saliva flow rate indicated an improvement of the affected gland function in some degree (P<0.05). Conclusions: Transoral endoscopy-assisted removal of parotid gland calculi is a safe and effective technique. It is mainly indicated for mobile stones in the main duct or impacted stones in the anterior third of the Stensen's duct. Sialography, scintigraphy and sialometry show postoperative improvement of gland function in most of the cases.
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Affiliation(s)
- X Ye
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 100081 Beijing, China Ye Xin is working on the Department of Stomatology, Peking University Shenzhen Hospital, Shenzhen 518036, China
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Virmani N, Dabholkar J. Primary Tubercular Sialadenitis - A Diagnostic Dilemma. Iran J Otorhinolaryngol 2019; 31:45-50. [PMID: 30783598 PMCID: PMC6368988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Involvement of the salivary glands in tuberculosis is rare, even in countries where tuberculosis is endemic. It can occur by systemic dissemination from a distant focus or, less commonly, as primary involvement. This article focuses on its myriad clinical presentations that pose a diagnostic challenge to the clinician. We discuss the schema of investigations required to confirm the diagnosis and the limitations faced in the low-cost setting of a developing country. MATERIALS AND METHODS Medical records, including history, physical examination and imaging findings, and the results of cytological, microbiological and histopathological studies of patients diagnosed with primary tubercular sialadenitis were retrieved and analyzed. RESULTS Seven patients were treated over a 2-year period. The most common mode of presentation was a painless mass of the involved gland in four patients. One patient each presented with chronic non-obstructive sialadenitis, sialolithiasis, and acute suppurative sialadenitis. Fine needle aspiration cytology was diagnostic in five out of seven cases (71.4%), while mycobacterial culture was positive in two patients (28.6%). In one patient, a diagnosis could only be reached on histopathological examination of the resected gland. CONCLUSION We recommend cytology studies, acid-fast bacilli staining, and mycobacterial culture as the initial investigation on the aspirate in suspected patients, while polymerase chain reaction should be reserved for negative cases. A high index of suspicion, early diagnosis, and timely institution of anti-tuberculosis treatment is essential for establishing cure. The role of surgery in diagnosed cases of tuberculosis is limited.
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Affiliation(s)
- Nitish Virmani
- Department of Otorhinolaryngology, Dr. Baba Saheb Ambedkar Hospital, Delhi, India.,Corresponding Author: Department of Otorhinolaryngology, Dr. Baba Saheb Ambedkar Hospital, Delhi, India. E-mail:
| | - Jyoti Dabholkar
- Department of Otorhinolaryngology, Seth G.S Medical College and KEM Hospital, Mumbai, India.
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Cho SH, Han JD, Kim JH, Lee SH, Jo JB, Kim CH, Kim BJ. Removal of submandibular calculi by surgical method and hydraulic power with curved needle: a case report. J Korean Assoc Oral Maxillofac Surg 2017; 43:182-185. [PMID: 28770160 PMCID: PMC5529193 DOI: 10.5125/jkaoms.2017.43.3.182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 08/27/2016] [Accepted: 09/16/2016] [Indexed: 11/07/2022] Open
Abstract
Sialolithiasis, the most common salivary gland pathology, is caused by calculi in the gland itself and its duct. While patients with small sialoliths can undergo conservative treatment, those with standard-size or larger sialoliths require sialolithotomy. In the present case study, we removed two sialoliths located beneath the mucosa in the posterior and anterior regions of Wharton's duct, respectively. For the posterior calculus, we performed sialolithotomy via an intra-oral approach; thereafter, the small anterior calculus near the duct orifice was removed by hydraulic power. This method has not previously been reported. There were no complications either during the operation or postoperatively, and the salivary function of the gland remained normal.
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Affiliation(s)
- Seong-Ho Cho
- Department of Oral and Maxillofacial Surgery, Department of Dentistry, Dong-A University Hospital, Busan, Korea
| | - Ji-Deuk Han
- Department of Oral and Maxillofacial Surgery, Department of Dentistry, Dong-A University Hospital, Busan, Korea
| | - Jung-Han Kim
- Department of Oral and Maxillofacial Surgery, Department of Dentistry, Dong-A University Hospital, Busan, Korea
| | - Shi-Hyun Lee
- Department of Dentistry, Graduate School of Medicine, Dong-A University, Busan, Korea
| | - Ji-Bong Jo
- Department of Dentistry, Graduate School of Medicine, Dong-A University, Busan, Korea
| | - Chul-Hoon Kim
- Department of Oral and Maxillofacial Surgery, Department of Dentistry, Dong-A University Hospital, Busan, Korea
| | - Bok-Joo Kim
- Department of Oral and Maxillofacial Surgery, Department of Dentistry, Dong-A University Hospital, Busan, Korea
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Won SJ, Lee E, Kim HJ, Oh HK, Jeong HS. Pediatric sialolithiasis is not related to oral or oropharyngeal infection: A population-based case control study using the Korean National Health Insurance Database. Int J Pediatr Otorhinolaryngol 2017; 97:150-153. [PMID: 28483226 DOI: 10.1016/j.ijporl.2017.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Seong Jun Won
- Department of Otorhinolaryngology-Head & Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Eunkyu Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hee Jung Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hyun-Kyung Oh
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head & Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Arnaud M, Gallucci A, Graillon N, Guyot L, Chossegros C, Foletti JM. [Combined approach for parotid lithiases: A 9 cases retrospective study]. J Stomatol Oral Maxillofac Surg 2017; 118:35-38. [PMID: 28330572 DOI: 10.1016/j.jormas.2016.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/26/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Minimally invasive techniques (MIT), including sialendoscopy, extracorporeal lithotripsy and intraoral approach, have to be preferred in parotid stones removal. In case of MIT failure, a combined intra- and extra-oral approach can be achieved. The aim of our study was to evaluate the efficacy and the complications of these combined approaches. MATERIALS AND METHODS A retrospective study has been conducted on patients treated between 2006 and 2015. All adult patients presenting with one or more parotid stones and in whom TMI failed have been included. Age and sex of the patients, number, size and location of the stones, result of the procedure, occurrence of pain, swelling, or infection have been recorded. RESULTS Nine patients were included (mean age: 56). Mean follow-up was 48 months. Eighty-eight percent of patients had an unique stone. Nine stones were extracted by combined approach. Mean diameter of the stones was 8.5mm and 33% of them were located at the junction between middle and posterior third of parotid duct. All the patients suffered preoperatively from daily retention symptoms, such as pain (55%) and swelling (100%). Two patients had an infectious complication (duct and/or gland infection). Seventy-five percent (9/12) of stones were removed. Complications consisted of 1 fistula, 1 facial paresis, 3 recurrences. Seven of 9 patients (77%) had a total relieve after surgery. DISCUSSION Surgical combined approaches for parotid stones removals are indicated after failure of MIT when symptoms affect quality of life.
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Affiliation(s)
- M Arnaud
- Pôle PROM, service de chirurgie maxillo-faciale, CHU de la Conception, AP-HM, 13005 Marseille cedex 5, France
| | - A Gallucci
- Pôle PROM, service de chirurgie maxillo-faciale, CHU de la Conception, AP-HM, 13005 Marseille cedex 5, France
| | - N Graillon
- Pôle PROM, service de chirurgie maxillo-faciale, CHU de la Conception, AP-HM, 13005 Marseille cedex 5, France
| | - L Guyot
- Service de chirurgie maxillo-faciale et plastique de la face, CHU Nord, AP-HM, 13915 Marseille cedex 20, France
| | - C Chossegros
- Pôle PROM, service de chirurgie maxillo-faciale, CHU de la Conception, AP-HM, 13005 Marseille cedex 5, France; CNRS, LPL UMR 7309, Aix-Marseille université, 13100 Aix-en-Provence, France
| | - J M Foletti
- Service de chirurgie maxillo-faciale et plastique de la face, CHU Nord, AP-HM, 13915 Marseille cedex 20, France; IFSTTAR, LBA UMR T 24, Aix-Marseille université, 13916 Marseille, France.
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Kimura M, Enomoto A, Shibata A, Nishiwaki S, Umemura M. A Case of Sialolithiasis in a Minor Salivary Gland of the Buccal Mucosa. J Clin Diagn Res 2016; 10:ZD06-ZD07. [PMID: 28050512 PMCID: PMC5198465 DOI: 10.7860/jcdr/2016/21977.8766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/31/2016] [Indexed: 11/24/2022]
Abstract
Sialolithiasis is a common disease of the major salivary glands. In contrast, Sialolithiasis of Minor Salivary Glands (SMSG) is very rare. Only 2% of all cases of sialolithiasis develop in minor salivary glands and sublingual glands. Furthermore, the clinical and imaging features of SMSG frequently differ from those encountered in major salivary glands thus, hindering proper clinical diagnosis of SMSG. Histologically, SMSG is characterized by ductal ectasia (sometimes with deep cystic dilatation), acinar atrophy and periductal inflammation. Herein, we describe a patient suffering from SMSG in the left buccal region. Based on the clinicopathological findings of this case and a review of the literature, we propose that this entity should be included in the differential diagnosis of intra-mucosal nodules.
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Affiliation(s)
- Masashi Kimura
- Attending Staff, Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Atsushi Enomoto
- Associate Professor, Department of Pathology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Akio Shibata
- Attending Staff, Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Shusuke Nishiwaki
- Senior Resident, Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Masahiro Umemura
- Director, Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
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Kim DH, Song WS, Kim YJ, Kim WD. Parotid sialolithiasis in a two-year-old boy. Korean J Pediatr 2013; 56:451-5. [PMID: 24244214 PMCID: PMC3827494 DOI: 10.3345/kjp.2013.56.10.451] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 02/14/2013] [Accepted: 02/26/2013] [Indexed: 11/27/2022]
Abstract
Sialolithiasis is caused by the obstruction of a salivary gland or its excretory duct by the formation of calcareous concretions or sialoliths; this results in salivary ectasia and provokes subsequent dilation of the salivary gland. Sialolithiasis is relatively common, accounting for 30% of salivary diseases; however, it is rarely observed in childhood. This case report describes a 2-year-old male patient who complained of a painful swelling over the right cheek, and presented with palpable stones and pus discharge from the orifice of the right Stensen's duct. Computerized tomography of the neck confirmed the diagnosis, and the patient received intravenous empiric antibiotics combined with intraoral sialolithotomy. We also provide a review of the spectrum of concepts regarding the pathogenesis, diagnosis, and treatment of sialolithiasis.
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Affiliation(s)
- Do Hoon Kim
- Department of Pediatrics, Daegu Fatima Hospital, Daegu, Korea
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Martins R, Alves CAF, de Oliveira EM, Elias FM, de Campos AC. Intra-oral surgical access for the treatment of bilateral submandibular sialolithiasis: case report. Autops Case Rep 2012; 2:37-41. [PMID: 31528570 PMCID: PMC6735547 DOI: 10.4322/acr.2012.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 01/26/2012] [Indexed: 11/23/2022] Open
Abstract
Sialolithiasis is a disease that affects the salivary glands. It is characterized by the presence of calcified structures within the duct system or within the glandular parenchyma. Those calculi, or sialoliths, can obstruct normal salivary flow, potentially leading to infectious sialadenitis, with pain, local swelling, and purulent discharge. Treatment typically consists of the surgical removal of the calculus, often in conjunction with sialoadenectomy. The authors report an atypical case of bilateral submandibular gland sialolithiasis treated conservatively, using intra-oral access to remove the calculi.
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Affiliation(s)
- Ricardo Martins
- Department of Dentistry - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | | | - Fernando Melhem Elias
- Department of Dentistry - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil.,Department of Surgery - Prosthesis and Maxillofacial Trauma - Faculdade de Odontologia - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Antônio Carlos de Campos
- Department of Dentistry - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil.,Department of Surgery - Prosthesis and Maxillofacial Trauma - Faculdade de Odontologia - Universidade de São Paulo, São Paulo/SP - Brazil
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