Sialolith In Duct Research Articles

Giant Sialolith in the Wharton′s duct causing sialo-oral fistula: A case report and review of literature

Sialolithiasis is the most common salivary gland disease accounting for more than 50% of the cases. Majority of salivary calculi occur in the submandibular gland and its duct. It has male predilection and is often seen in adults. Majority of the calculi are less than 10 mm in size. Calculi > 15 mm in size are considered giant. Giant sialoliths within the parenchyma of the salivary glands are frequently reported in the literature, but they are uncommon in the salivary ducts. The purpose of this article is to report a case of giant sialolith in the Wharton's duct of a 65-year-old male, which had caused sialo-oral fistula. Literature in English language on giant sialolith in Wharton's duct is reviewed since 1990. Also etiology, pathogenesis, clinical features, diagnosis and management aspects are discussed.

Unusually large sialolith of Wharton′s duct

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.

Micromorphology and Chemical Composition of a Sialolith in the Submandibular Gland Duct

Sialolith is one of the most common pathologic conditions found in the salivary glands. The mechanisms responsible for the formation of sialoliths have not been elucidated so far. In this article, the chemical composition and micromorphology of a sialolith of a 58-year old female patient suffering from chronic sialoadenitis of the submandibular gland was analyzed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). In a SEM evaluation, the highly mineralized amorphous core surrounded by lamellar and concentric structures was revealed, however no foreign body, organic material, or signs of microorganism were observed in the core of the sialolith. EDX analysis showed the central core was composed of only Ca, O and P, and that a high level of C was detected near the central area as well. These results indicated that the inorganic composition of the sialolith was hydroxyapatite crystals, and that inorganic and organic substances existed around the central cores. This study suggests that the sialolith was composed mainly of hydroxyapatite crystals and the formation of the nucleus of the sialolith in the submandibular gland duct was secondary to sialadenitis, which favors the growth of an inorganic crystalline nucleus.

Scanning electron microscope and x-ray diffraction analysis assisting the diagnosis of a sialolith in the parotid duct

assisting the diagnosis of a sialolith in the parotid duct Ana Carolina Prado Ribeiro, DDS, MS, Adriele Ferreira Gouvea, DDS, PhD, Marcio Ajudarte Lopes, DDS, PhD, Mario Jose Romanach, DDS, MS, PhD student, and Pablo Agustin Vargas, DDS, PhD, Piracicaba, Brazil DEPARTMENT OF ORAL DIAGNOSIS, ORAL PATHOLOGY DIVISION, PIRACICABA DENTAL SCHOOL, STATE UNIVERSITY OF CAMPINAS (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:e36-e38)

Sialolithiasis in a stump of Wharton's duct of an aplastic unilateral submandibular gland

The article by Koo et al.3 describes two cases in which a sialolith was present in Wharton's duct and the corresponding submandibular gland had been replaced by fat. In one of the cases, a blind end to Wharton's duct was identified proximal to the sialolith at operation. The authors considered that these cases represent the formation of a sialolith in Wharton's duct of a congenitally absent submandibular gland. However, they mention that ‘atrophy of the submandibular gland resulting from recurrent sialadenitis with a previously formed sialolith should also be considered’, and this is undoubtedly the case; for it is now established that sialadenitis is primary and causes the formation of sialoliths, which sometimes lead to complete atrophy of the corresponding gland and its replacement by fat, which can occur without any symptoms.

Study on Calcified Structure of Sialolith in Duct as a Key to Know How to Prevent Stone Formation

Salivary calculus is an ectopic calcification of high frequency in oral region. Many previous reports on the composition and structure of salivary calculus only showed apatite crystal as the main constitution but were not sufficient to clarify the formation mechanism. In this study, structural properties of the salivary calculus were investigated by the high-reproducibility non-destructive method such as optical microscope, micro-CT, micro-FT-IR and micro-XRD. In some cases, SEM, BSI, and EDS analysis were also carried out. The results showed that the salivary calculi were grouped into three by structure, and grouped into three or four by chemical composition and crystal components. The difference in structure and composition should be reflected by the formation mechanism.

自然排出をみた比較的大きな唾石の２例

Two rare cases of spontaneously discharged sialoliths are reported.Case 1: A 72-year-old man was referred to our clinic for painless swelling in the right submandibular region. Radiographic examination revealed an opaque mass in the right Wharton's duct. Although we recommended surgical treatment, he refused. Twenty months later, he came for re-examination bringing with him a sialolith. The sialolith had been spontaneously discharged from the right side of the oral floor. The size of the stone was 30×20×15mm. The form was egg-shaped, the surface was rough, and the color was yellowish white.Case 2: The patient was a 54-year-old woman complaining of swelling in the right submandibular region. Radiographic examination revealed a sialolith in the right Wharton's duct. The sialolith had been spontaneously discharged from the right side of the oral floor 2 weeks after her first visit. The size of the stone was 15×9×6mm. The form was eggshaped, the surface was rough, and the color was yellowish white.The sialolith was examined with a scanning electron microscope equipped with an electron probe X-ray microanalyzer. The cut surface of the stone consisted of concentric layers sorrounding a single central core. Calcium, phosphorus, and sulphur were detected as the main components of the sialolith.

Ultrasonic Dignosis of Submandibular Tumors

The submandibular region is masked by the mandible and submandibular gland, thus making it difficult to grasp its lesions. The region often gives rise to inflammatory lymphadenopathy and, the ultrasonic diagnosis can be difficult sometimes. In the present study, we performed ultrasonography on the submandibular region of cases with known pathological diagnoses. Studies regarding ultrasonic diagnosis of (1) disease of the submandibular gland, (2) submandibular lymphnodes and (3) sialolith were carried out. This report reviews the problems and possible changes. A satisfactory accuracy rate of 82% was achieved for the diagnosis of disease of the submandibular gland. Percentage of accurate diagnosis of submandibular lymph node metastasis was considerably lower compared to other regions of the neck. Detection of sialolith in the warthin's duct was also low owing to the structure of the submandibular region. When ultrasonography was performed by pressuring the floor of the oral cavity, it was possible to observe the changes in the size, form, and position of the lesions. Thus, ultrasonography can be considered as a very effective diagnostic technique in that region.