Management Of Sialolithiasis Research Articles

Simultaneous Application of Ultrasound and Sialendoscopy and its Value in the Management of Sialolithiasis.

Ultrasound (US) and sialendoscopy (SE) are routinely used in patients presenting with sialolithiasis in the submandibular (SMG) and parotid gland (PG). The objective was to assess the value of the simultaneous application of US and SE in the management of sialolithiasis. Retrospective study. Tertiary referral center for salivary gland diseases. Patients in whom US and SE as single investigation tools were neither conclusive nor useful in the management of sialolithiasis were investigated using both methods simultaneously (simUS + SE). Establishment of the final diagnosis and/or contribution to the planning/performing of treatment in sialolithiasis. 74 patients were examined by simUS + SE (58.1 % SMG and 41.9 % PG). In all patients (unclear) hyperechoic reflexes were assessed and/or localized by SE-controlled US navigation. 68.9 % of the patients were investigated for diagnostic or differential-diagnostic reasons including distinguishing extraductal from intraductal calcifications and/or to exclude residual stones after therapy. In 52.7 % simUS + SE was used to plan and/or perform further treatment, in 20.3 % to enable performing a combined approach (all PG) and in 29.7 % to evaluate and plan the most adequate therapy (mainly intraductal vs. extracorporeal shock wave lithotripsy, 68.2 % of these SMG). In two cases SE-controlled and US-guided stone extraction was performed. SimUS + SE is an innovative approach which proved to be very useful in managing sialolithiasis. It added valuable information regarding the establishment of a diagnosis or differential diagnosis, planning and performing the most adequate treatment, intraoperative control of therapy and postoperative follow-up.

Long-Term Outcomes of Sialendoscopy in the Management of Sialolithiasis and Idiopathic Chronic Sialadenitis with Ductal Scars.

We aimed to present the long-term outcomes and sialendoscopic findings in only patients with sialolithiasis and ductal scars in idiopathic chronic recurrent sialadenitis who experienced unsuccessful results with conservative treatment and were treated with sialendoscopy. We retrospectively analyzed the patients with a diagnosis of only sialolithiasis and ductal scars in chronic recurrent sialadenitis who underwent sialendoscopy between January 2011 and June 2016. We collected clinical and intraoperative data including patient age, sex, date of the procedure, the involved gland, operative findings and complications. Follow-up data included whether the symptoms were resolved or recurred and whether any further procedures were performed. Of a total of 38 patients, 16 were excluded from the study due to missing clinical or follow-up data, and analysis was conducted on 22 patients. Twelve were diagnosed with sialolithiasis, while the remaining 10 were diagnosed with idiopathic chronic sialadenitis and had ductal scars. Stone sizes ranged from 2 mm to 10 mm. Mean follow-up time was 39.5 months. The final success rate was 100%. Of the 10 patients with ductal scarring, five had scar in the parotid gland duct, and five in the submandibular gland duct. The mean follow-up time of all ductal scar patients was 47.1 months. The final success rate was 70%. Sialendoscopy is a minimally invasive method for the diagnosis and treatment of sialolithiasis and ductal scars of the salivary glands after failure of conservative treatments in adults.

Multiple Submandibular Duct (Whartons Duct) Stones

Obstruction is a common problem of major salivary glands, and most common cause is salivary calculi. The most frequent locations of sialolithiasis are submandibular gland and its duct. Wharton’s duct stones are frequently single, and multiplicity is uncommon. Additionally, radiologic imaging has an important role in the diagnosis and management of sialolithiasis. In this study, we presented a 40-year-old man who developed pain and swelling in right submandibular region, that CT scan showed six stones in right Wharton's duct.

Open surgical management of sialolithiasis

Sialolithiasis should be considered in the differential diagnosis of any patient with persitent or recurring salivary gland swelling or inflammation. It occurs most frequently in the Wharton duct followed by the Stensen duct, and rarely in the sublingual glands. Sialolithiasis typically presents with pain and swelling of the involved gland and is aggravated by eating. In the acute setting, patients with sialadenitis secondary to calculi are treated conservatively with antibiotics, and stones less than 2 mm may pass spontaneously. Sialendoscopy is now well established as a novel minimally invasive diagnostic and therapeutic modality for salivary gland stones. Sialoendoscopes can also be used in combination with several open surgical approaches to guide the extraction of large calculi. This article highlights the open surgical interventions that are frequently used in sialolithiasis management, when sialoendoscopy is not the most appropriate option, has failed, or is not available. They range from minimally invasive to open techniques. Mastering the anatomy of the salivary ducts and surrounding structures is of exquisite importance. The management of sialolithiasis should aim for gland-sparing procedures before considering gland excision.

Combined endoscopic and transcutaneous approach for immobile parotid stones

Conclusion: Salivary stones in the parotid gland that are not amenable to endoscopic extraction can safely be removed by a combined, endoscopic-external approach. Objective: Limitations for endoscopic removability of salivary stones from the parotid gland are immobile stones in the deeper salivary duct system. A combined endoscopic and transcutaneous approach gives access to these stones with possible preservation of the parotid gland. Methods: A total of 10 consecutive patients were treated using the combined approach for the management of sialolithiasis of the parotid gland. The patients had previously undergone a sialendoscopy under local anesthesia and were proven to have large, immobile salivary stones in the salivary duct. Results: In all patients, the procedure was successfully conducted with extraction of impacted stones. In 60% of the patients, a temporary stenting of the salivary duct was performed. All patients showed good clinical results with restored drainage of the salivary duct system and preserved gland function.

Der Stellenwert der extrakorporalen Stoßwellenlithotripsie bei der Therapie der Sialolithiasis

Extracorporeal shock wave lithotripsy (ESWL) is now judged alongside other therapeutic alternatives like salivary gland endoscopy (SGE). The present analysis investigates the significance of ESWL within the scope of a defined treatment algorithm. A retrospective analysis of data obtained between 2003 and 2009. The results were analysed according to the therapeutic modality used. Successful treatment was defined as an absence of symptoms or stones at follow-up examination. During the period studied, 206 patients with parotid stones and 736 with submandibular stones underwent treatment. Among the latter group, 5 % were treated exclusively by SGE, 92 % underwent transoral stone removal and 3 % received ESWL. The long-term success rates were 93 %, 90 % and 94 %, respectively. Patients with parotid stones were treated in 78 % of cases by ESWL and 22 % underwent SGE exclusively. The overall long-term success rates here were 85 % and 98 %, respectively. ESWL remains an important therapeutic tool in the management of sialolithiasis. The method is particularly important as a gland-preserving tool in the therapy of parotid stones and selected cases of submandibular stones, even though it is not available in the US due to the lack of official equipment approval.

Sialendoscopy in the Diagnosis and Treatment of Sialolithiasis

Sialendoscopy and other gland-preserving techniques such as extracorporeal shockwave lithotripsy (ESWL), transoral stone removal, and combinations of these methods have fundamentally changed the therapeutic approach to salivary stones. Since 2003, all patients presenting with sialolithiasis have been diagnosed and treated with the same algorithm and routine salivary gland endoscopy (SGE). Case series with chart review of patients with sialolithiasis treated between 2003 and 2008 using an algorithm for gland preservation. Tertiary referral academic medical center. A total of 1154 patients with suspected sialolithiasis were identified and reviewed. Factors analyzed included stone location, size, surgical method, rate of stone clearance, complications, and rate of short- and long-term symptom resolution. Successful treatment was defined as freedom from symptoms at follow-up. Diagnostic sialendoscopy confirmed 221 parotid stones and 812 submandibular stones, of which 206 and 736, respectively, were treated. Transoral stone removal was the most frequently used method to remove submandibular stones (92%), with a smaller percentage able to be removed by SGE alone (5%) with long-term success rates ≥90%. Only 4% (29/736) required submandibular gland removal. Parotid stones were removed by SGE (22%), combined SGE and incisional technique (26%), or ESWL (52%), with long-term success rates of 98%, 89%, and 79%, respectively. Only 8 of 206 (4%) patients eventually required parotidectomy. Salivary gland endoscopy is an important diagnostic and therapeutic tool in the management of sialolithiasis but must be combined with additional techniques to ensure a high rate of stone clearance, symptom resolution, and gland preservation.

Retrograde Sialendoscopy: A New Technique for Avoiding Retained Ductal Stones

Recurrent infection from stones retained in Wharton's duct after submandibular gland resection warrants intraoperative attention to the duct remnant. Our hypothesis was that retrograde sialendoscopy would help ensure complete stone removal in submandibular gland removal for sialolithiasis. We reviewed 9 sequential cases of submandibular sialolithiasis treated surgically via open procedures at a tertiary care center by a single surgeon between November 2007 and December 2009. The review focused on the clinical history and intraoperative findings. We identified successful application of a new technique of retrograde sialendoscopy performed to detect and remove stones that were retained in Wharton's duct at the time of submandibular gland resection. An index case of complications from a stone retained after submandibular gland resection is presented in a sequential series of cases in which retrograde sialendoscopy was developed. Retrograde sialendoscopy is a novel technique that is useful as an adjunct to standard submandibular gland resection in the management of sialolithiasis.

Sialendoscopy in the Treatment of over 900 Sialoliths

Objective: Minimally invasive techniques have an increasing relevance for the treatment of sialolithiasis of the parotid and submandibular glands. Sialendoscopy can be used as both a diagnostic and therapeutic tool. Method: Retrospective data analysis for patients with a sialolithiasis of the parotid and submandibular glands who were treated between 2002 and 2008. Results: A total of 206 patients were treated because of sialolithiasis of the parotid gland, 98 (48%) by interventional endoscopy alone, and 108 (52%) by combined procedures. Patients with submandibular disease (736) were treated endoscopically alone in 7.5% (55); 92.5% (681) received a combined treatment together with sialendoscopy. The follow-up showed that 93% of the patients treated with endoscopy alone were free of symptoms. In the combined group 90% and 79% of the patients with sialolithiasis of the submandibular glands and parotid glands respectively were free of symptoms. Conclusion: Sialendoscopy is an important diagnostic and therapeutic tool in the management of sialolithiasis. It can be effectively used therapeutically as a single treatment option, and it improves the combined techniques. As a single treatment it plays a very important role in parotid gland stones.

Diagnosis and management of sialolithiasis with a semirigid endoscope

The aim was to evaluate a semirigid endoscopic technique for diagnosis and management of sialolithiasis. Diagnostic and interventional sialendoscopic procedures were performed in 90 patients with sialoliths (78 submandibular glands and 12 parotid glands). Owing to its extreme flexibility and rigidity, the endoscope can be introduced easily into the ductal system. Sialoliths with a round or irregular shape were detected by endoscopy in all cases, including 84 radiopaque and 6 radiolucent stone cases. Of the 78 cases with sialoliths in the submandibular (Wharton's) duct, 14 were present in the hilum of the main duct, 34 in the premolar region of the duct, 24 in the molar region of the duct, and 6 in both the premolar and the molar regions of the duct. Among these cases, we could remove the stones intraductally in 44 cases by endoscopy alone. Additionally, 6 cases were treated with basket retrieval and endoscopic-assisted surgery, and the remaining 27 were treated with endoscopic-assisted surgery. Of the 12 cases of sialoliths in the parotid (Stensen's) duct, 9 were treated with basket retrieval and 1 with basket-capturing and open surgery via a buccal incision. In total, 87 of 90 cases were successfully treated, with (n = 34) or without (n = 53) endoscopic-assisted surgery. These patients were stone free at their last follow-up (3 to 30 months). The semirigid endoscope permits a better visualization of sialoliths and coexisting obstructive pathologies. With minimally invasive procedures, most stones in the main duct of the salivary gland can be removed using either an intraductal or an extraductal approach.

O.547 Schwannoma of the parotid glands, which policy?

Sialolithiasis should be considered in the differential diagnosis of any patient with persitent or recurring salivary gland swelling or inflammation. It occurs most frequently in the Wharton duct followed by the Stensen duct, and rarely in the sublingual glands. Sialolithiasis typically presents with pain and swelling of the involved gland and is aggravated by eating. In the acute setting, patients with sialadenitis secondary to calculi are treated conservatively with antibiotics, and stones less than 2 mm may pass spontaneously. Sialendoscopy is now well established as a novel minimally invasive diagnostic and therapeutic modality for salivary gland stones. Sialoendoscopes can also be used in combination with several open surgical approaches to guide the extraction of large calculi. This article highlights the open surgical interventions that are frequently used in sialolithiasis management, when sialoendoscopy is not the most appropriate option, has failed, or is not available. They range from minimally invasive to open techniques. Mastering the anatomy of the salivary ducts and surrounding structures is of exquisite importance. The management of sialolithiasis should aim for gland-sparing procedures before considering gland excision.

The management of sialolithiasis in 2 children through use of extracorporeal shock wave lithotripsy

The management of salivary calculi in children may prove difficult for a number of reasons. Traditional investigations require ionizing radiation and in cases of sialography may be poorly tolerated. Similarly, any surgical treatment is likely to require general anesthesia and, in a number of cases, removal of the affected gland, which is associated with attendant risks. As an alternative, ultrasound and extracorporeal shock wave lithotripsy therapy offers low morbidity and outpatient procedures that are well tolerated, as illustrated by these 2 cases. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88: 44-9)

New modalities in the management of human sialolithiasis

SummarySialolithiasis is the most common disease of the great salivary glands with an incidence of 1.2%. New minimal-invasive methods like extracor-poreal Shockwave application or intracorporeal laser lithotripsy have changed the established ways of treatment of human sialolithiasis during the last years. Twenty per cent of our patients (n = 402) suffered from parotid duct stones and 80% from submandibular duct calculi. The typical symptoms were post-prandial pain and swelling of the glands. Until now there has been no proof of a metabolic disorder which could be responsible for coincidental stone development (6%) in the urinary tract or the bile duct system. Concrements are diagnosed by B-scan ultrasonography in nearly 100% of all cases. After our basic in vitro and in vivo investigations two systems of Shockwave treatment are useful for clinical application: extracorporeal Shockwave lithotripsy (piezoelectric) and intracorporeal laser lithotripsy (Rhodamine-6G-dye-laser), both supported by auxiliary measures (slitting and widening of the duct, dormia-basket extraction, sialagogues and gland massage). Due to our experiences with these minimally-invasive methods a new management of sialolithiasis is recommended depending on the localization of the calculi and their maximal diameters. Submandibular stones should be treated by extracorporeal lithotripsy, if the stone is located in intraglandular parts or in the hilum. Stones of the hilum also can be treated by laser lithotripsy. In the distal parts and near the orifice papillotomy and stone extraction should be tried independent of the stone size. If the maximum diameter is more than 12 mm and the concrement is detected in the intraglandular parts of the duct system or deep in the hilum, sub-mandibulectomy is necessary. Calculi of the parotid gland should only be treated by extracorporeal lithotripsy, regardless of their size and location. Because of severe duct stenosis papillotomy is not indicated. Parotidectomy should be carried out only in cases reluctant to minimally-invasive measures.