Magnetic Resonance Sialography Research Articles

Non-invasive imaging for predicting labial salivary gland biopsy outcomes in patients with suspected primary Sjögren syndrome.

To identify the value of salivary gland ultrasound (SGUS) combined with magnetic resonance imaging (MRI) and magnetic resonance sialography (MRS) in predicting the results of labial salivary gland biopsy (LSGB) in patients with suspected primary Sjögren syndrome (pSS), and construct a nomogram model to predict LSGB results. A total of 181 patients who were admitted with suspected pSS from December 2018 to April 2023 were examined and divided into a training set (n = 120) and a validation set (n = 61). Baseline data of the two groups were examined, and the value of SGUS, MRI, and MRS in predicting LSGB was analyzed. Multivariate logistic analysis was used to screen for risk factors, and nomogram prediction models were constructed using these results. In the training set, the SGUS, MRI, and MRS scores of patients in the LSGB + group were higher than those in the LSGB - group (all P < 0.001). The positive prediction value (PPV) was 91% for an SGUS score of 3, and 82% for MRI and MRS scores of 2 or more. We developed a nomogram prediction model based on SGUS, MRI, and MRS data, and it had a concordance index (C-index) of 0.94. The Hosmer-Lemeshow test (χ2 = 3.17, P = 0.92) also indicated the nomogram prediction model had good accuracy and calibration for prediction of LSGB results. A nomogram model based on SGUS, MRI, and MRS results can help rheumatologists decide whether LSGB should be performed in patients with suspected pSS.

Comparison of the distribution of the Bartholin and/or Rivinus salivary ducts assessed with magnetic resonance-sialography in patients with ranula and in healthy subjects.

The distribution and drainage of the sublingual gland ducts have various patterns that might be related to sublingual gland-related diseases, including ranula. This study aimed to elucidate the characteristics of the distribution of Bartholin and/or Rivinus ducts in patients with ranula using magnetic resonance (MR) sialography. In this retrospective cross-sectional study, the distributions and drainage patterns of sublingual gland ducts on MR sialography were classified in 74 subjects without sublingual gland-related disease as confirmed by both medical history and clinical examination and 15 patients with ranula, respectively. All patients had visited Kyushu Dental University Hospital from July 2015 to June 2022 to undergo MR imaging. Data on the distributions and drainage patterns of the sublingual gland ducts, including the characteristics of the Bartholin and/or Rivinus ducts, were then statistically compared between subjects without sublingual gland-related disease and patients with ranula. The images were assessed by an experienced oral and maxillofacial radiology specialist certified by the Japanese Society for Oral and Maxillofacial Radiology. The distributions (five groups) and drainage patterns (three patterns) of the sublingual gland ducts on MR sialography were classified in reference to previous studies, with some modifications in all subjects without sublingual gland-related disease and patients with ranula. A significant difference in the distribution of the ducts (P<0.001), with a low number of patients exposing an undetected canal or Rivinius duct, was found in the group of patients with ranula (P<0.05). Regarding drainage patterns, no patient with ranula presented a Rivinius duct only. A significant difference in the drainage patterns of the sublingual gland ducts on MR sialography was observed between subjects without sublingual gland-related disease and patients with ranula (P=0.001). The present results suggest that the distribution of the sublingual gland ducts, mainly, the Bartholin duct, may be related to ranula formation. These findings also demonstrate that MR sialography contributes well to preoperative evaluation and is effective for assessing the complex excretory distribution of the sublingual gland ducts.

A retrospective study of magnetic resonance sialography imaging applied in the prognostic evaluation of chronic obstructive parotitis.

Magnetic resonance sialography (MRS) can be used to clearly examine the main duct of the parotid and is widely applied in the diagnosis of chronic obstructive parotitis (COP). However, there are few studies on the classification, treatment options and prognosis of COP using MRS. Clinical and imaging data were retrospectively collected from 41 patients with COP between January 2010 and December 2020 at the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine. All patients underwent MRS and were treated with intraductal irrigation. The patients were divided into 2 groups according to the presence or absence of symptomatic relapse during the 6-month follow-up period. The imaging features of parotid MRS included three parts: gland volume, stenosis classification and dilatation classification. The location/length of dilatation, the widest diameter of the dilated duct, and the condition of the branch ducts were also recorded and compared between the groups. A mean of 14.8±12.3 irrigations were performed. There were 15 patients with recurrence and 26 without recurrence. There was no significant difference in the parotid volume (P=0.460), stenosis grade (P=0.738) or maximum diameter of dilatation of the branch duct (P=0.723) between the recurrence and non-recurrence groups. Statistically significant differences were found in dilatation classification (P=0.009), length of dilatation (P=0.043), condition of the branch ducts (P=0.017) and dexamethasone use (P=0.031). MRS is an available diagnostic and grading modality for COP. The imaging features and classification of the parotid main duct in MRS could be helpful for treatment selection. Patients who accept irrigation could be less likely to experience recurrence with a low dilatation grade and no branch duct dilatation.

Transoral removal of submandibular hilar lithiasis: results on the salivary duct system, glandular parenchyma, and quality-of-life recovery

Objective(s)To confirm that hilar transoral submandibular sialolitectomy (TOSL) is the first treatment option for submandibular hilar lithiasis (SHL) in terms of glandular parenchyma recovery, salivary system restoration, and patient quality of life (QoL) improvement.MethodsDepending on whether the stone was easily palpable, TOSL was carried out with or without sialendoscopy. For the first time in the literature, Magnetic Resonance Sialography (MR-Si) was performed before and after TOSL, to evaluate stone characteristics, glandular parenchyma status, hilum dilation and main duct recanalization. Radiological data was examined independently by two radiologists. COSQ, a recently validated and specific questionnaire, was used to assess associated QoL.ResultsBetween 2017 and 2022, 29 TOSL patients were examined. With a high interobserver correlation, MR-Si was confirmed as a very useful radiological test in the pre- and post-surgical evaluation of SHL. The salivary main duct was completely recanalized in all cases. The presence of lithiasis was found in 4 patients (13.8%). After surgery, the majority of patients (79.31%) had hilum dilation. There was a statistically significant improvement in parenchyma status, but no significant progression to glandular atrophy. After surgery, COSQ mean values always improved (22.5 to 4.5).ConclusionsTOSL is the ideal surgical technique for the management of SHL, resulting in improved parenchymal inflammatory changes, recanalization of Wharton’s duct, and enhancement patients’ QoL. As a result, before removing the submandibular gland, TOSL should be considered as the first treatment option for SHL.

Value of magnetic resonance imaging and sialography of the parotid gland for diagnosis of primary Sjögren syndrome

To evaluate the utility of magnetic resonance imaging (MRI) and magnetic resonance sialography (MRS) for diagnosis of primary Sjögren syndrome (pSS) singly or integrated with 2016 American College of Rheumatology (ACR)/European League Against Rheumatic Diseases (EULAR) classification criteria. The diagnostic efficiencies of MRI, MRS, and labial salivary gland biopsy (LSGB) were evaluated. The prediction model was established by multivariate analysis. Finally, performance of the ACR/EULAR criteria was evaluated after addition of MRI + MRS or replacement of original items by MRI + MRS. The combined use of LSGB + MRI + MRS provided the greatest diagnostic value. MRI and MRS grade had positive correlations with disease duration and pathological grade of the labial gland (both P < 0.001). MRI and MRS grade had positive correlations with xerostomia severity and negative correlations with unstimulated salivary flow rate (both P < 0.001). The consistency of MRI grade and MRS grade in the diagnosis of parotid gland lesions was poor (κ=0.253, P < 0.001). The diagnostic efficiency of our prediction model (AUC 0.906) was similar to that of criteria from the ACR/EULAR (AUC 0.930). Adding MRI + MRS to the ACR/EULAR criteria improved the sensitivity (92.3% vs 90.8%), whereas the specificity remained the same (88.9% vs 89.1%). Replacing LSGB by MRI + MRS in the ACR/EULAR criteria decreased both sensitivity and specificity (88.1% vs 90.8% and 86.4% vs 89.1%, respectively). The combined application of MRI and MRS has ideal clinical application value in the diagnosis of early-stage pSS. Validity of the ACR/EULAR criteria remains high after incorporation of MRI + MRS.

Correlations of MR Sialographic Gradings with the Clinical Measures of Sjögren's Syndrome.

Sjögren syndrome (SS) features salivary gland architectural changes such as ductal deformities and fat deposition secondary to inflammatory cell infiltrates; however, the anatomical and pathophysiological correlations of SS remain to be determined. This study aimed to determine the correlations of imaging findings based on the magnetic resonance (MR) sialography with the clinical and laboratory aspects of SS patients. We evaluated the MR sialographic findings of two pairs of parotid glands (PGs) and submandibular glands (SMGs) from 41 SS patients. The distinct MR sialographic features were then compared with the clinical symptoms, biological (anti-SSA/Ro antibody positivity), histological (labial gland focus score), and functional (salivary flow and scintigraphy) data. Ductal deformities such as sialectasis in the PG ducts were exclusively observed in SS, and fat replacement in SMGs was more distinct in patients with SS than in non-SS sicca patients. Of the 82 PGs and SMGs from 41 SS patients, the grade of sialectasis in PGs on MR sialographic images and fat stage in SMGs showed strong correlations with anti-SSA/Ro-positivity. PG sialectasis was found more frequently in patients with dry mouth and decreased salivary gland function. A significant correlation was found between fat deposition in PGs and SMGs and decreased salivary gland function. These results suggest that MR sialography is a reliable, adjunctive anatomical and functional study to assess SS. Detail aspects of sialectasis and fat accumulation encountered on MR sialography in SS patients can help physicians assume the disease status in SS. 3 Laryngoscope, 133:307-316, 2023.

Mass on the Floor of the Mouth in a Teenager.

Mass on the Floor of the Mouth in a Teenager.

Comparative Study of Multiple High-Signal-Intensity Spots on 3D and 2D Magnetic Resonance Sialography for Patients with Sjögren's Syndrome.

We investigated the sensitivities of 2-dimensional (2D) magnetic resonance sialography (MR-S) and unilateral sagittal and axial 3-dimensional (3D) MR-S using a surface coil and their combination in diagnosing patients with Sjögren's syndrome (SS). We retrospectively analyzed the 3D and 2D MR-S results of 78 patients with SS. We evaluated the sensitivities of multiple high-signal-intensity spots and staging on MR sialograms and analyzed the efficient imaging methods and cross section for diagnosing patients with SS. The sensitivities of MR-S for detecting abnormal findings (i.e., MR-S stage 1 or higher) were as follows: 65 cases (83.3% [95% confidence interval (CI): 73.2–90.8]) for unilateral sagittal 3D MR-S; 62 cases (79.4% [95% CI: 68.8–87.8]) for axial 3D MR-S; 66 cases (84.6% [95% CI: 74.7–91.8]) for combined unilateral sagittal and axial 3D MR-S; and 32 cases (41.0% [95% CI: 30.0–52.7]) for bilateral sagittal 2D MR-S. The ratio of the abnormal finding of MR-S was tested using the two-tailed Fisher's exact test. Unilateral sagittal, axial, and combined unilateral sagittal and axial 3D MR-S showed significantly higher sensitivity than bilateral sagittal 2D MR-S, respectively (P < 0.001). Most cases upstaged by 3D MR-S were those positive (stage 1 or higher) among the stage 0 cases detected by 2D MR-S. Axial 3D MR-S, compared with 2D MR-S, understaged four cases, which was due to the imaging range of the axial 3D MR-S. We concluded that a single unilateral sagittal 3D MR-S was sufficient and axial 3D MR-S was unnecessary for SS staging. T1- and T2-weighted images are essential for investigating the salivary glands in patients with SS. Therefore, we also concluded that bilateral sagittal 3D MR-S of the parotid glands in addition to T1- and T2-weighted imaging is necessary, sufficient, and most efficient for precise MR imaging examination of the salivary glands, including diagnosing SS.

Radiological imaging features of the salivary glands in xerostomia induced by an immune checkpoint inhibitor

The clinical features of xerostomia induced by immune checkpoint inhibitors (ICI) are similar to those of Sjögren’s syndrome (SS), whereas the immunohistological and serological features are known to differ from those of SS. However, the radiologic imaging features of salivary glands are not yet well known. We report a case of a 56-year-old male patient diagnosed with ICI-induced xerostomia. The patient underwent various imaging examinations to investigate the condition of the salivary glands, which indicated the following: (1) less specific findings on contrast-enhanced computed tomography, (2) mixed with intermediate and low signal intensity on both T1-weighted and fat-suppressed T2-weighted magnetic resonance imaging and poor “salt and pepper” appearance on magnetic resonance sialography, and (3) multiple ovoid hypoechoic areas with hyperechoic bands without acute sialadenitis on ultrasound. These radiologic imaging findings suggested remarkable lymphocyte infiltration, which could be a characteristic of ICI-induced xerostomia.

Role of magnetic resonance sialography in diagnosis of salivary gland diseases: a meta-analysis

Objectives To establish the diagnostic accuracy of magnetic resonance sialography (MRS) when compared with the gold standard conventional sialography (CS) in patients with suspected salivary gland disease. Background This is a systematic review and meta-analysis to compare both studies. CS is still considered the standard modality for assessing ductal abnormalities. MRS has been applied as an alternative. Methods We searched PubMed, Cochrane CENTRAL, Scopus, Science Direct, and Web of Science for all studies that compared MRS versus CS regarding radiological outcomes and diagnostic performance as primary outcomes. Combined outcomes were pooled as risk ratios in a fixed model or diagnostic odds ratio (DOR) in a random model, using Reviewer Manager 5.3 and Meta-DiSc 1.4 for Windows. Results Eight studies (n = 285 patients) were included in the final analysis. Our results showed that MRS was effective in the detection of main duct according to patients more than CS [risk ratio = 0.84, 95% confidence interval (CI), 0.71–1, P = 0.05). However, it showed no significant difference between the two groups in detection of main duct according to glands. Moreover, there are no significant differences between MRS and CS regarding detection of sialolithiasis, sialectasis, stenosis with stones, or strictures. The diagnostic performance in the detection of sialolithiasis according to glands was as follow: the pooled sensitivity was 0.88 (95% CI, 0.75–0.95), the pooled specificity was 0.98 (95% CI, 0.93–1.00), and the pooled DOR under random effect was 181.64 (95% CI, 39.420–837). Moreover, the diagnostic performance in the detection of the stenosis with stones according to patients was as follows: the pooled sensitivity was 0.727 (95% CI, 0.498–0.893), the pooled specificity was 0.979 (95% CI, 0.889–0.99), and the diagnostic odds ratio under random effect was 78.73 (95% CI, 2.18–508.81). Conclusion There is no difference between MRS and CS in radiological findings except in case of detection of main duct according to patients, which indicates that MRS is more effective in revealing the proper information about main salivary ducts. Moreover, MRS provides a noninvasive alternative to CS especially if acute sialadenitis is present or cannulation is not successful.

Parotid MR Sialography, Can it Help in Patients with Hepatitis C Virus Related Sicca Syndrome?

AbstractBackground: The Hepatitis C Virus (HCV) related sicca syndrome occurs in association with HCV infection in a range of 4-57%. Salivary gland chronic inflammation and B cell proliferation is triggered by HCV. MR sialography is a non-invasive method for salivary glands complex duct system combined with their parenchymal evaluation through conven-tional MR T2 images and source images.Aim of Study: To identify changes in parotid magnetic resonance sialography (MR Sialography) in HCV related sicca syndrome patients.Patients and Methods: Prospective study included 64 HCV related sicca syndrome patients (38 female, 26 male, mean age 44.6±10.5 years). All patients had performed parotid MR sialography. Severity of the disease was correlated with presence or absence of vasculitis and HCV disease duration.Results: MR sialography changes were found in 25% of patients, (12/32 and 4/32 in patients with and without vasculitis, respectively). Among patients with vasculitis, those with abnormal MR sialography had longer disease duration along with more severe form of the disease.Conclusion: Amongst HCV patients with vasculitis and longer disease duration, abnormal changes are identified on MR sialography.

Salivary Duct Injury on MR Sialography

Parotid duct injuries are uncommon, seen in about 0.2% cases of trauma and are difficult to demonstrate on conventional imaging. This case highlights the capability of magnetic resonance (MR) sialography to demonstrate the duct injuries non-invasively.

Quantitative Analysis of Parotid Gland Secretion Function in Sjögren's Syndrome Patients with Dynamic Magnetic Resonance Sialography.

ObjectiveTo evaluate the secretory function of parotid glands by dynamic magnetic resonance (MR) sialography and determine the clinical performance of this technique in diagnosing and evaluating Sjögren's syndrome (SS) patients.Materials and MethodsThis study enrolled 29 healthy volunteers (25 women and 4 men; mean age, 34.8 ± 6.3 years; age range, 26–47 years) and 25 primary SS (pSS) patients (23 women and 2 men; mean age, 37.7 ± 7.9 years; age range, 25–50 years) with decreased secretory function. The volume of the parotid gland ducts was precisely measured for both groups at single pre- and 6 post-gustatory-stimulated phases. Time-dependent volume change ratio curves were generated, four parameters were derived from the curves: the slope of the increase in the first post-stimulation phase (slope1st), the peak value, the time-to-peak, the total saliva secretion post-stimulation. All values were used to quantitatively evaluate the secretory function of the parotid gland. The repeated measurement analysis, Mann-Whitney U test and receiver operating characteristic curve were applied.ResultsTime-dependent volume change ratio curves demonstrated that there is a statistically significant difference between the two groups (F = 8.750; p = 0.005). A quickly increasing curve was shown in the volunteer group, whereas a slowly increasing curve was shown in the pSS patient group. The slope1st, peak value and total saliva secretion post-stimulation of the patient group were significantly lower than those of the volunteer group (p = 0.005, p = 0.003, and p = 0.002, respectively). The time-to-peak between the two groups was not significantly different (p = 0.383). The slope1st can be used as a discriminator to diagnose SS patients (p = 0.015; odds ratio = 4.234; area under the curve = 0.726).ConclusionDynamic MR sialography is proven to be an effective method in evaluating salivary gland function and has a great potential in diagnosing and evaluating pSS patients.

Магнитно-резонансная сиалография – альтернативный метод исследования заболеваний околоушных слюнных желез

Магнитно-резонансная сиалография – альтернативный метод исследования заболеваний околоушных слюнных желез

An Update of Sialendoscopy and the Management of Benign Salivary Disorders in Children

We aim to provide a review of recent advances in the treatment of benign salivary gland disorders as well as an overview of these disorders. Sialendoscopy is increasingly being used to diagnose and treat a variety of salivary gland disorders. Magnetic resonance sialography is emerging as a salivary gland imaging modality. Transoral submandibular gland excision is an evolving technique that eliminates external scars and potentially decreases the risk to surrounding structures. Finally, developments in oral appliances have decreased sialorrhea avoiding surgical management. Sialendoscopy is an effective and minimally invasive method of diagnosing and treating benign salivary gland disorders. Other promising developments in this field are magnetic resonance sialography, transoral submandibular gland excision, and oral appliance therapy.

Magnetic Resonance Sialography and Salivary Gland Scintigraphy of Parotid Glands in Sjögren's Syndrome.

To assess the correlation between conventional magnetic resonance (MR) imaging and MR sialography of parotid glands with salivary gland scintigraphy in patients with Sjögren's syndrome. A retrospective study was conducted on eight patients with Sjögren's syndrome who underwent MR imaging and salivary gland scintigraphy. Conventional MR imaging techniques, such as T1-weighted images (T1WI), T2-weighted images (T2WI), and short TI inversion recovery images (STIR) were used for changes of fat signal in the parotid gland, while the MR sialography were used for ducts dilation of the parotid gland. Regarding scintigraphy, time-activity curves of each parotid gland were analysed. The salivary gland excretion fraction was defined as A (before stimulation test (counts/20 s)) and B (after stimulation test (counts/20 s)). Regarding characteristic appearances of fat signal, the A/B of parotid gland with homogeneous intensity distribution (3.51 ± 0.75) was higher than that with heterogeneous intensity distribution (1.56 ± 0.66, P = 0.001). Regarding MR sialographic stages, the A/B of parotid gland with stage 0 (3.51 ± 0.75) was higher than that with stage 1 (2.03 ± 0.86, P = 0.009) and with stage 2 (1.26 ± 0.25, P = 0.000). The results suggest that MR sialography of the parotid glands is a useful noninvasive tool for evaluating the decrease of salivary gland excretion in patients with Sjögren's syndrome.

Clinical outcomes and prognostic factors of sialendoscopy in salivary duct stenosis.

This study aimed to analyze the clinical outcomes of sialendoscopy in patients with salivary duct stenosis and to investigate factors associated therewith. Retrospective case series. This study included 47 patients with salivary stenosis who underwent sialendoscopy between January 2014 and December 2015. Subjective symptom, salivary flow rate, salivary scintigraphy, and radiologic evaluation using magnetic resonance (MR) sialography were performed preoperatively; direct ductal findings were evaluated during sialendoscopy. Univariate and multivariate analyses of factors influencing the patient-reported outcomes (complete, partial, or no improvement at 3 months after sialendoscopy) were conducted. Stenosis severity was graded according to sialendoscopic findings. Seventeen patients were classified with grade I stenosis, 18 patients with grade II stenosis, and 12 patients with grade III stenosis. Symptoms completely disappeared in 21 patients (44.7%) after sialendoscopic procedures. In 19 patients (40.4%), symptoms were partially improved. Seven patients (14.9%) showed no improvement or worsening of symptoms. In univariate analysis, symptom score, stimulatory salivary flow rate, Tmin (time interval from stimulation to minimal count on salivary scintigraphy), type of stenosis on MR sialography, and sialendoscopic grade were found to be significantly associated with treatment outcomes. In multivariate analysis, Tmin , stenosis type of MR sialography, and sialendoscopic grade remained significantly associated with outcomes after sialendoscopy. Sialendoscopic procedures were found to be clinically satisfactory for relieving the symptoms of patients with salivary stenosis. Factors related to the severity of ductal stenosis such as Tmin , stenosis type of MR sialography, and sialendoscopic grade were significantly associated with the success of sialendoscopic treatment for salivary duct stenosis. 4. Laryngoscope, 128:878-884, 2018.

Modern management of paediatric obstructive salivary disorders: long-term clinical experience.

SUMMARYRecent technological improvements in head and neck field have changed diagnostic and therapeutic strategies for salivary disorders. Diagnosis is now based on colour Doppler ultrasonography (US), magnetic resonance (MR) sialography and cone beam 3D computed tomography (CT), and extra- and intracorporeal lithotripsy, interventional sialendscopy and sialendoscopy-assisted surgery are used as minimally invasive, conservative procedures for functional preservation of the affected gland. We evaluated the results of our long-term experience in the management of paediatric obstructive salivary disorders. The study involved a consecutive series of 66 children (38 females) whose obstructive salivary symptoms caused by juvenile recurrent parotitis (JRP) (n = 32), stones (n = 20), ranula (n = 9) and ductal stenosis (n = 5). 45 patients underwent interventional sialendoscopy for JRP, stones and stenoses, 12 a cycle of extracorporeal shockwave lithotripsy (ESWL), three sialendoscopy-assisted transoral surgery, one drainage, six marsupialisation, and two suturing of a ranula. Three children underwent combined ESWL and interventional sialendoscopy, and seven a secondary procedure. An overall successful result was obtained in 90.9% of cases. None of the patients underwent traditional invasive sialadenectomy notwithstanding persistence of mild obstructive symptoms in six patients. No major complications were observed. Using a diagnostic work-up based on colour Doppler US, MR sialography and cone beam 3D TC, children with obstructive salivary disorders can be effectively treated in a modern minimally-invasive manner by extracorporeal and intracorporeal lithotripsy, interventional sialendoscopy and sialendoscopy-assisted transoral surgery; this approach guarantees a successful result in most patients, thus avoiding the need for invasive sialadenectomy while functionally preserving the gland.

Diagnostic work-up in obstructive and inflammatory salivary gland disorders.

SUMMARYInflammatory and obstructive disorders of the salivary glands are caused by very different pathological conditions affecting the gland tissue and/or the excretory system. The clinical setting is essential to address the appropriate diagnostic imaging work-up. According to history and physical examination, four main clinical scenarios can be recognised: (1) acute generalised swelling of major salivary glands; (2) acute swelling of a single major salivary gland; (3) chronic generalised swelling of major salivary glands, associated or not with "dry mouth"; (4) chronic or prolonged swelling of a single major salivary gland. The algorithm for imaging salivary glands depends on the scenario with which the patient presents to the clinician. Imaging is essential to confirm clinical diagnosis, define the extent of the disease and identify complications. Imaging techniques include ultrasound (US), computed tomography (CT) and magnetic resonance (MR) with MR sialography.

Sialolithiasis in an Accessory Submandibular Gland Identified by Magnetic Resonance Sialography.

Accessory submandibular gland is a very rare anatomical variant. There have been only 6 reported cases of this entity in the English literature, only 1 of which was identified using magnetic resonance imaging. We report the case of a 39-year-old female with symptoms of left submandibular sialoadenitis who was diagnosed of sialolithiasis within the left accessory submandibular gland by magnetic resonance sialography (MR-Si). The calculus was palpated near the submandibular papilla and was extracted by an intraoral approach. One-year follow-up revealed no evidence of recurrence. This is the first case reported to date in the English literature of a patient with sialolithiasis within an accessory submandibular gland diagnosed by MR-Si.