Sialolithiasis Research Articles

Evaluation of the Relation of Smoking, Gallstones, and Renal Stones With Sialolithiasis in Patients Referred to Oral Medicine and ENT Department of Tabriz University of Medical Sciences

Background: The exact mechanism of the formation of salivary gland stones is unknown. Elucidating pathophysiology of the formation of salivary stones might prevent both their formation and the need for implementing invasive surgical procedures. Therefore, this study aimed to evaluate the effects exerted by some etiological factors on the formation of salivary gland stones. Methods: In this case–control study, the records of 80 patients with sialolithiasis were studied as a census from April 2011 to June 2019. These patients were referred to the Oral Medicine and the ENT departments of Tabriz University of Medical Sciences. The control group consisted of the same number of the patients with no sialolithiasis. Two groups were compared in terms of stone size, smoking, gallstones, and renal stones. Chi-squared, independent t-test, and Mann-Whitney U test were adopted to examine the quantitative variables. The data were analyzed using SPSS 17. Statistical significance was set at P<0.05. Results: Overall, 96.2% of sialoliths were found in the submandibular gland, of which 78.8% were single. Moreover, 32.5% of the patients with a history of sialolithiasis were smokers, whereas this frequency was 23.8% in the control group. In the case and control groups, 2.5% and 5% of the patients had a history of renal stones, respectively. Only one patient who had undergone a surgical procedure to remove salivary gland stones had a history of gallstones, while none of the patients in the control group had a history of gallstones. Conclusions: The results showed that the formation of salivary gland stones was not associated with smoking, history of renal stones, and gallstones. Furthermore, it was found that the numbers and sizes of salivary stones were not affected by smoking.

The Translational Role of MUC8 in Salivary Glands: A Potential Biomarker for Salivary Stone Disease?

Mucin (MUC) 8 has been shown to play an important role in respiratory disease and inflammatory responses. In the present study, we investigated the question of whether MUC8 is also produced and secreted by salivary glands and whether it may also play a role in the oral cavity in the context of inflammatory processes or in the context of salivary stone formation. Tissue samples from parotid and submandibular glands of body donors (n = 6, age range 63–88 years), as well as surgically removed salivary stones from patients (n = 38, age range 48–72 years) with parotid and submandibular stone disease were immunohistochemically analyzed targeting MUC8 and TNFα. The presence of MUC8 in salivary stones was additionally analyzed by dot blot analyses. Moreover, saliva samples from patients (n = 10, age range 51–72 years), who had a salivary stone of the submandibular gland on one side were compared with saliva samples from the other “healthy” side, which did not have a salivary stone, by ELISA. Positive MUC8 was detectable in the inter- and intralobular excretory ducts of both glands (parotid and submandibular). The glandular acini showed no reactivity. TNFα revealed comparable reactivity to MUC8 in the glandular excretory ducts and also did not react in glandular acini. Salivary stones demonstrated a characteristic distribution pattern of MUC8 that differed between parotid and submandibular salivary stones. The mean MUC8 concentration was 71.06 ng/mL in female and 33.21 ng/mL in male subjects (p = 0.156). Saliva from the side with salivary calculi contained significantly (15-fold) higher MUC8 concentration levels than saliva from the healthy side (p = 0.0005). MUC8 concentration in salivary stones varied from 4.59 ng/mL to 202.83 ng/mL. In females, the MUC8 concentration in salivary stones was significantly (2.3-fold) higher, with an average of 82.84 ng/mL compared to 25.27 ng/mL in male patients (p = 0.034). MUC8 is secreted in the excretory duct system of salivary glands and released into saliva. Importantly, MUC8 salivary concentrations vary greatly between individuals. In addition, the MUC8 concentration is gender-dependent (♀ > ♂). In the context of salivary stone diseases, MUC8 is highly secreted in saliva. The findings support a role for MUC8 in the context of inflammatory events and salivary stone formation. The findings allow conclusions on a gender-dependent component of MUC8.

Patient Outcomes After Unsuccessful Endoscopic Sialolith Extraction.

To evaluate clinical outcomes following failed endoscopic extraction of salivary calculi and to assess any relation between clinical outcome and calculi location, number, size, and mobility. If sialendoscopy fails to extract the calculus, subsequent spontaneous passage of the calculus out of the ductoglandular system or secondary effects of sialendoscopy could mitigate the clinical impact of a residual sialolithiasis. Prospective observational study. Prospective comparative study of endoscopic procedures for sialolithiasis performed in the Manukau Surgery Center, in Auckland, New Zealand, from 2010 to 2020. The recurrent symptoms and the variables related to the need for additional surgical intervention for salivary calculi were analyzed. Among the 465 sialendoscopy procedures, 154 (33.1%) were for obstructive sialolithiasis. Among these, there were 30 (19.4%) with unsuccessful stone extraction with re-operation for these failures performed in 14 of the 27 failed submandibular cases (52%) and 2 of the 3 parotids (66.7%). Location of calculi was a significant factor in predicting the need of further surgery. Patients with perihilar stones were 5 times more likely to have a failed procedure (P=.001). If the stone was intraglandular, the likelihood increased to 8.5 times (P=.005). The likelihood for a revision procedure increased almost 11 times if the stone was intraglandular (P=.004). Calculi size, mobility, multiple calculi, and presence of concurrent stenosis did not correlate with need for further surgery. A significant proportion of "failed" sialendoscopy did not require further intervention. Stone location was a significant factor in predicting a failed procedure and the need for re-intervention. Laryngoscope, 132:1029-1033, 2022.

Interobserver and intraobserver variability in the radiological assessment of sialolithiasis using cone beam computed tomography.

Background Data regarding the inter- and intraobserver variability in the radiological assessment of sialolithiasis using cone beam computed tomography are missing in the current literature. This study assessed the inter- and intraobserver variability in the radiological assessment of sialolithiasis using cone beam computed tomography (CBCT).Material and Methods In 107 patients, 130 salivary glands (65 parotid and 65 submandibular) with clinical signs of obstruction were assessed by four independent observers; 2 residents OMFS and 2 experienced OMFS. The observers analyzed the CBCT images and determined the absence or presence of one or more salivary stones in the affected gland. This procedure was repeated after three months.Results Interobserver agreements showed kappa values of 0.84 for the parotid gland, and 0.93 for the submandibular gland. Intraobserver agreements for the whole group reported kappa values between 0.83 - 0.95. There was no significant difference between residents and experienced OMFS.Conclusions Due to the good inter- and intraobserver agreement, CBCT appears to be a reproducible imaging modality for detecting salivary stones in patients with signs and symptoms of obstructed parotid and submandibular glands. Key words:Salivary gland calculi, cone-beam computed tomography, observer variation.

Sialotripsy as a treatment option for patients with salivary stone disease

Background. The pathologies of the salivary glands are very diverse. Salivary stone disease occupies a special place among diseases of the salivary glands of a non-neoplastic nature. The incidence of salivary stone disease is extremely extensive and accounts for up to 85% of all pathologies of the salivary glands.Objective. Improvement of minimally invasive methods of treatment of salivary stone disease, which does not lead to excision of the gland.Material and methods. On the basis of the Clinics of the Samara State Medical University of the Ministry of Health of Russia, in the period from 2010 to 2020, a clinical group was formed, consisting of 193 patients with salivary stone disease of various localization. The age of the patients ranged from 16 to 84 years. All patients were therapeutically examined at the preoperative stage, voluntary informed consent was signed. Shockwave sialotripsy was performed in 95 patients of the main group (in 64 patients the calculus was located in the submandibular salivary gland, in 31 patients – in the parotid salivary gland). For lithotripsy, we used a lithotripter apparatus "Edap" (France) and "Wolf" (Germany).Results. The analysis of the results obtained as a result of the study made it possible to draw a conclusion about reasonably better results of removal of calculi in the ducts of the salivary glands using the lithotripter "Swiss LithoClast® Master" (Switzerland). At the first visit and the therapeutic effect of the lithotripter, all patients suffering from bouts of salivary colic showed complete cessation.Conclusion. Thus our study, which was devoted to the study of the results of various methods of treating patients with salivary stone disease showed that sialolithotripsy using special narrowly targeted devices for crushing and subsequent excretion of salivary calculi allows to achieve the best results at present.

Intraductal Fragmentation in Sialolithiasis Using Pneumatic Lithotripsy: Initial Experience and Results.

ObjectiveTo report initial experience in using a pneumatic lithotripter to treat salivary stones.Study DesignLevel IV retrospective study.SettingUniversity hospital and tertiary referral center.MethodsA pneumatic lithotripter was used to treat salivary stones after these were diagnosed. Probes with diameters of 0.7 mm were used. Total fragmentation was intended in all stones. Stone fragments were removed using several instruments in serial sialendoscopies to achieve complete stone clearance.ResultsA total of 62 patients with 77 stones were treated. Forty-three submandibular stones were treated in 34 patients, and 34 parotid stones were treated in 28 patients. An operating pressure of 2.5 bar and a single frequency mode were used. Complete fragmentation was achieved in all but one of the treated stones in both glands (98.7%). Among the patients, 90.32% became stone free and 100% symptom free. Multiple stones were treated in 24.19% of the patients, and multimodal therapy was also carried out in 24.19%. All of the glands were preserved.ConclusionsThe pneumatic lithotripter proved to be effective in the treatment of sialolithiasis. Stone size, location, and the gland involved were important clinical factors. The device was sufficient to achieve success without any increased risk for complications in the patients or damage to the sialendoscopes.

Обоснование целенаправленных исследований по разработке диагностических и дифференциально-диагностических тестов, применяемых при хронических сиалоаденитах. Обзор литературы

The last decades in maxillofacial surgery and surgical dentistry are marked by the fact that one of the most popular and frequently encountered research topics is the pathology of the salivary glands. Patients with this pathology make up 2.3-5.2% of the total number of persons hospitalized during the year in specialized inpatient departments. The spectrum of these diseases is wide and includes: malformations, traumatic injuries, inflammatory processes of both viral and bacterial nature, reactive dystrophic lesions, salivary stone disease, benign and malignant neoplasms. Sialoadenitis can occur in both acute and chronic forms. At the same time, the ways of penetration of the infectious agent were determined: hematogenic, lymphogenic, contact, intraductal. The most frequently diagnosed inflammatory pathology of the salivary glands is chronic sialoadenitis. The purpose of the study is to identify unsolved problems and determine the directions of further research based on the analysis of available domestic and foreign specialized literature on epidemiology, diagnosis and differential diagnosis of chronic sialoadenitis. Materials and methods. The analysis of specialized literature containing information on the epidemiology, diagnosis and differential diagnosis of chronic sialoadenitis was carried out. The article analyzes periodicals for the last 10 years, as well as basic manuals, monographs, and textbooks without a statute of limitations. The descriptive method is used for the analysis. Results and discussion. Chronic sialoadenitis and sialosis account for 42.0-54.4% of the total pathology of the salivary glands. This is due to: an increase in the number of neoplasms, including malignant ones both in the maxillofacial region and in the salivary glands; an increase in the number of patients with thyroid diseases who use radioactive iodine for therapeutic purposes, which also accumulates in the salivary glands, which causes the appearance of symptoms of xerostomia and sialoadenitis; a significant share of publications indicating the complexity of the differential diagnosis of chronic sialoadenitis and a large number of diagnostic errors. Conclusion. The presented material proves that the task of developing diagnostic and differential-diagnostic tests used in chronic sialoadenitis is socially significant and belongs to the category of priority and determines the need for its early effective solution. The development and implementation of new diagnostic and differential-diagnostic tests developed and scientifically based on the principles of evidence-based medicine, used in patients with chronic sialoadenitis, will reduce the number of complications, improve the quality of life of patients, and increase the level of specialized medical care to the population

Trans-oral robotic surgery for Hilo-parenchymal submandibular stones

Sialolithiasis represents a common benign disease of the major salivary glands. Conventional therapeutic approaches include trans-oral sialendoscopy removal of the stones, duct incision and marsupialization, and trans-cervical sialadenectomy. However, the recent technological innovations of endoscopic and robot-assisted surgery provide unique opportunities to treat submandibular salivary gland stones. During the last decade, surgical robots have been utilized to remove submandibular glands in patients with sialolithiasis. In addition, they have used surgical access methods such as trans-hairline and facelift incisions for superior cosmesis. Most salivary stones involve the submandibular gland (80%–90%), and the most frequent locations are the distal tract of the duct, the hilum, and the hilo-parenchymal area. Trans-oral robotic surgery (TORS) has been proposed for the removal of hilo-parenchymal submandibular stones. TORS appears to be a viable option specifically in cases of deep and nonpalpable stones, multiple and recurrent intraparenchymal stones as well as iatrogenic duct stenoses. In this article, we review and discuss The role of TORS in the treatment of hilo-parenchymal submandibular stones.

Sialendoscopy and CT navigation assistance in the surgery of sialolithiasis.

BackgroundA sialendoscopy-assisted combined approach is well established in the surgery of sialolithiasis. In cases of proximal salivary stones, transcutaneous sialendoscopy-assisted extractions with parotid and submandibular gland preservation is the primary intention of treatment. We recently added computer tomography (CT) navigation to improve the results of this challenging surgery equally in both localizations.Patients and methodsAl l the patients who submitted to sialendoscopy and sialendoscopy-assisted procedures at the tertiary institution between January 2012 and October 2020 were included in the present study. From November 2019, CT navigation was added in cases with sialolithiasis and a presumably poor sialendoscopic visibility. We evaluated the parameters of the disease, diagnostic procedures, sialendoscopic findings and outcomes, with or without optical surgical navigation.ResultsWe performed 178 successful salivary stone removals in 372 patients, of which 118 were combined sialendos-copy-assisted approaches, including 16 transcutaneous proximal, 10 submandibular and 6 parotid stone operations. Surgical navigation was used in six patients, four times for submandibular and twice for parotid sialolithiasis. These were all non-palpable, sialendoscopically invisible or partially visible stones, and we managed to preserve five of the six salivary glands.ConclusionsThe addition of CT navigation to sialendoscopy-assisted procedures for non-palpable, sialendoscopically invisible and fixed stones is a significant advantage in managing sialolithiasis. By consistently performing sialendoscopy and related preservation procedures, we significantly reduced the need for sialoadenectomies in patients with obstructive salivary gland disease.

Sialoliths of Submandibular Gland and Wharton’s Duct: Orthopantomography

Orthopantomography (OPG), which is also known as panoramic radiography, pantomography, and panoramic imaging, proved its efficacy in infection, trauma, jaw lesions, tumor cases, etc. Calcification of the soft tissues in perimaxillary and perimandibular regions can also be visualized on OPG images. Reports clearly showed sialolith occurrence in the parotid gland in 10%, in submandibular gland in 83%, and in sublingual and minor salivary glands in 7%. Typically, sialoliths are visualized on the panoramic radiographs as radiopaque lesions. They are of round or oval shape, cylindrical or irregularly-shaped calcifications. Only in limited cases, sialoliths can be X-ray negative. The research data shows – from 10 to 20% the salivary stones are radiolucent. Digital OPG combines a lot of advantages. In summary, digital orthopantomography proved its efficacy in diagnostics of sialoliths located in the submandibular gland and its duct. Simultaneously, OPG is more than useful for diagnosis establishment and control of treatment for neighboring specialties.

MODERN METHODS OF DIAGNOSIS OF SALIVARY GLAND DISEASES

Among dental pathology, diseases of the salivary glands, according to a number of authors, range from 3 to 7%. Of these, salivary stones account for up to 30%, various forms of chronic sialadenitis and sialadenosis — up to 60%, congenital anomalies — up to 1% and tumors-up to 5% . Various methods of diagnosing diseases of the salivary glands do not fully meet the requirements of doctors to make a final decision on the choice of treatment for various diseases of the salivary glands, as result of which patients receive untimely or inadequate care. In this article, the authors consider modern issues of diagnosis and treatment of diseases of the salivary glands. The current state of the problem is studied, problems in this area identified and analyzed, and the need for further improvement of research methods and diagnostics of diseases of the salivary glands is justified.

Physiochemical characterization of a giant submandibular gland stone in a Nigerian patient

The incidence of sialolithiasis is about 12 cases per 1000 population and most cases occur in the submandibular gland, among adults in the 30–50 age groups. Since the early description of salivary calculus by Windsor in 1842, the etiology and exact mechanism of stone formation remain a subject of considerable research interest, while the chemical composition of analyzed stone often varies across studies globally. We analyzed the component elements and physiochemical morphology of a giant calculi extracted from the submandibular gland of an adult Nigerian. Our findings showed that the giant submandibular gland stone is rich in calcium (Ca), sodium (Na), potassium (K), iron (Fe), zinc (Zn), and manganese (Mn); while other elements occur in low or trace level.

MO112SYSTEMIC OXALOSIS IN PRIMARY HYPEROXALURIA TYPE 3 – ARE THE PATIENTS AT RISK?

Abstract Background and Aims Primary Hyperoxaluria type 3 (PH3) is said to be the less problematic form of PH and with low risk of chronic kidney disease (CKD) and end stage renal disease. However, a recent OxalEurope registry evaluation reported both urine and plasma oxalate levels in a comparable range as in PH1 and PH2 patients. In addition, PH3 patients remain symptomatic with recurrent kidney stones, even in adulthood, and 24% of the 95 patients evaluated were on CKD ≥ 2 at last follow up. Hence, it was speculated, that PH3 patients may also be on risk to develop systemic oxalate deposition. Method We retrospectively analyzed the imaging procedures performed so far in patients regularly seen at the German Hyperoxaluria Center, which included: eye exams; x-rays of the hand; bone MRI (3 Thesla of the left knee and proximal tibia); and Speckle tracking echocardiography using 2D Cardiac Performance Analysis VC (TomTec Imaging Systems GmbH, Germany), which measures changes in global longitudinal strain (GLS), an index of left ventricular contractibility. The normal range for GLS is ≤18%. All patients or parents signed an informed consent. Results From the 49 PH3 patients registered at the German Hyperoxaluria center, 12 pediatric and 4 adult patients are seen on a regular basis, at least twice a year, and the rest are followed in other centers. All the 16 patients were in stable kidney function and in no less than CKD 2. Eye examination was performed in six patients and was normal in all. Four patients received an x-ray of the left hand, which was normal in 3, but in one patient with a problematic clinical course (multiple stone removal procedures, decline in GFR), tiny sclerosing areas, although no true metaphyseal bands, were seen at caput MCP IV and the thumb. Therefore, MRI of the left knee and proximal tibia was performed in this and another patient, which showed no signs of systemic oxalate deposition. Speckle tracking echocardiography was done in 6 patients and was abnormal in one (GLS – 17.3 and left ventricular hypertrophy) and borderline in the twin sibling (GLS – 18.6). The patient with the abnormal GLS also had salivary stones in the parotid gland, as were also found in his other, older sibling in a routine x-ray of the jaw before orthodontic treatment. Conclusion Although this is currently only data of a small cohort of patients, the parameters available so far show, that systemic oxalate deposition may also occur in PH3. Based on our experience on PH1, we regard Speckle tracking echocardiography as the best parameter to detect early systemic calcium-oxalate depositions. Hence the reduction in global longitudinal strain, thus ventricular contractability, is a clear proof of such deposits. Of course, data in more patients are needed to elucidate the true risk of systemic oxalate deposition and we are therefore currently screening all our PH3 patients.

A Novel Approach for the Treatment of Sialolithiasis that Preserves Salivary Duct Anatomy.

The sialendoscopy era in the treatment of salivary gland stones has reduced the use of classical surgical methods. However, the miniature ducts and tools may cause difficulties in removing large sialoliths. Therefore, invasive combined oral surgeries or gland resection may be considered. We searched for the most suitable method in order to stay in line with the minimally invasive approach that preserves the ductus anatomy, and that can reduce the surgical fears of patients. The study included 84 cases (23 parotid and 61 submandibular) in whom stones were fragmented by pneumatic lithotripsy and removed between January 2015 and January 2020. The parotid cases comprised 7 females and 16 males, and the submandibular cases comprised 25 females and 36 males. Intraductal lithotripsy was performed using pneumatic lithotripter. This study has fourth level of evidence. Based on total number of cases (n = 84), success rate was 67/84 (79.7%) immediately after sialendoscopy, and overall success rate was 77/84 (91.6%). Based on number of stones treated (n = 111), our immediate success rate was 94/111 (84.6%), and overall success rate was 104/111 (93.7%). The success criteria were complete removal of the stone and fragments in a single sialendoscopy procedure and resolution of symptoms. We successfully treated salivary gland stones, including L3b stones, in our patient cohort with sialendoscopy combined with pneumatic lithotripsy. The lithotripsy method that we have adapted seems to be more useful and cost-effective compared to its alternatives. We were also able to preserve the ductus anatomy and relieve patients' concerns.Level of Evidence: Level IV.

Surgical Treatment of Sialolithiasis Leads to Improvement in the Complete Blood Count.

Simple SummarySialolithiasis is a disease in which inflammation and infection are caused in a salivary gland and its duct secretion system due to a formation of a sialolith (salivary stone) in the gland. Anemia of inflammation is a well described pathology where chronic inflammation causes a reduction in the red blood cell count is. In this study, we examined the complete blood count results of patients who underwent surgical removal of a sialolith and found that removal of the stone and cessation of the symptoms lead to an improvement in the complete blood count results. We believe that the improvement in blood count values after surgery is due to resolution of the anemia of inflammation. To our knowledge, this is the first report about the relationship between surgery for removal of a salivary stone and improvement in the wellbeing of patient expressed by blood count values.Sialolithiasis is a chronic disease in which a sialolith (salivary stone) causes recurrent inflammation of the affected salivary gland. Anemia of inflammation is a well-described pathology in which a chronic inflammatory disease leads to a reduction in the red blood cell count, hemoglobin and hematocrit values. In this retrospective cohort study, we aim to find whether removal of the sialolith and alleviation of the inflammation affect the complete blood count results. We examined data regarding forty-nine patients who underwent surgery for the removal of a submandibular gland sialolith using the duct-stretching technique. Complete blood counts two years before and after the surgical procedure were collected. The average pre-procedure and post-procedure values were calculated for each patient to establish the average blood profile. The pre- and post-procedure values were compared to evaluate the effect of the surgical treatment on the blood profile. We found that the average blood count values for patients with sialolithiasis were towards the lower end of the normal range. Post-surgery, a significant increase in hematocrit, hemoglobin and red blood cell count was observed, which was more pronounced in the older age group and in patients with co-morbidities. We conclude that sialolith removal surgery is associated with significant improvement in the complete blood count values, especially in the elderly and in patients and with co-morbidities. The speculated pathogenesis is relative anemia of inflammation.

Prognostic Factors for the Outcome of Salivary Gland Holmium: YAG Laser Intraductal Lithotripsy.

Holmium: YAG laser has gained its popularity throughout the years and is used to treat sialolithiasis, which helps to overcome the limitations of traditional sialendoscopic lithotripsy for larger-sized salivary stones. However, little information is available regarding factors predicting the success rate of Holmium: YAG laser intraductal lithotripsy. The purpose of this study is to investigate the factors affecting the success rates of Holmium: YAG laser lithotripsy for salivary stones treatment in a tertiary care hospital. A retrospective study conducted in patients receiving sialolithiasis surgery under sialendoscopy from May 2013 to March 2015 at Mackay Memorial Hospital, Taiwan. Data on various factors, including patients' age, gender, glands, size of largest stone, multiple stones (≥2 stones), location of the stone (distal duct, middle duct, proximal duct, and hilum), and operative time. The success of the surgery defined as patients without any complaints such as swelling or tenderness. Logistic regression and Fisher exact tests were employed to examine these factors on the success rate. Fifty-four patients who received sialendoscopy surgery with a mean age of 35.74 years old recruited. Logistic regression identified the operation time exceeding 210 minutes showed 23.497 folds higher odd ratio of having a result of operation failure (P < .05). The prolonged operation time is the sole independent factor affecting the successful outcome for salivary gland intraductal laser lithotripsy. We recommend operative time be no more than 210 minutes to increase the success rate in salivary gland Holmium: YAG laser intraductal lithotripsy.

УЛЬТРАЗВУКОВАЯ НАВИГАЦИЯ В ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ ПАЦИЕНТА СО СЛЮННОКАМЕННОЙ БОЛЕЗНЬЮ ОКОЛОУШНОЙ СЛЮННОЙ ЖЕЛЕЗЫ. КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Objectives. To analyze the possibility of using the technique of intraoperative ultrasound navigation on surgical treatment of patients with salivary stone disease of the parotid salivary gland (PSG). Material and methods. A retrospective analysis of three medical records of an in-patient treated at the department of maxillofacial surgery and operative dentistry in Gomel Regional Clinical Hospital during the period from 2019 to 2021 for salivary stone disease of PSG was made. Results. The results of clinical observation of treatment of a patient with sialolithiasis of the parenchymal part of the PSG are presented. Taking into consideration the complexity of surgical removal of sialolites of this localization, the patient was initially treated conservatively which was of no effect. Salivary stones were removed using intraoperative ultrasound navigation which made it possible to successfully perform the surgical intervention, reduce surgical trauma, create conditions for structural and functional recovery of the PSG and reduce the possibility of the disease relapse by improving intraoperative visual control. Conclusions. The use of the technique of intraoperative ultrasound navigation in the surgical treatment of patients with salivary stone disease of the parotid salivary gland allows to remove the concrement, minimizing the trauma to the tissues of the operated area and the organ itself, maintaining adequate blood flow and architectonics in it, which enables the reduction in the number of postoperative complications, relapses of the disease and positively affects the quality of patients’ life.

Clinical Outcomes of Salivary Gland Tumor Surgery: A 10-year-chart View

ABSTRACT Background Salivary gland tumors constitute about 3% of all head and neck tumors. We present a series of 104 cases of various salivary gland pathologies and the various modalities of surgeries done between January 2007 and July 2017. Materials and methods Total 104 patients with salivary gland tumors were included in this study, of which 76 patients had parotid tumors and 28 were submandibular gland tumors. The presence or absence of coexisting salivary gland stones, involvement or noninvolvement of ducts were all considered. Preoperatively, patients underwent fine needle aspiration cytology (FNAC) and imaging studies along with routine blood investigations. Results All patients underwent surgery and subsequent histopathological examination (HPE). The preoperative FNAC and postoperative HPE were not correlating in 6.5% of parotid tumors and in 3.5% of submandibular gland tumor. Anomalies in the fasciovenous planes were seen in 3% of the patients, which caused intraoperative difficulties. Postoperatively, five patients had salivary leak and three patients had neuropraxia, which was managed conservatively and the patients recovered subsequently between 3 months and 6 months postoperatively. Conclusion Surgery for salivary gland tumors has its own threats due to the close proximity of nerve, vessels, and ducts. Postoperative complications like nerve palsy is seen more common in malignant tumors in both parotid and submandibular gland tumors. A proper methodical assessment and awareness of the various anatomical anomalies intraoperatively may give good surgical outcomes in surgeries of salivary gland tumors. In our study, various anomalies were encountered and dealt appropriately. How to cite this article Vemuru T, Mohanty S, Manimaran V, et al. Clinical Outcomes of Salivary Gland Tumor Surgery: A 10-year-chart View. Int J Head Neck Surg 2021;12(1):11–14.

Ultrasound-guided sialo-irrigation for the treatment of chronic sialodochitis with sialolithiasis.

Sialolithiasis is one of the most common causes of salivary duct obstruction. In the last 20years, minimally invasive procedures like sialendoscopy, extracorporeal lithotripsy, and basket snaring are increasingly being used for the treatment of salivary gland duct stones. Sialo-irrigation of the salivary gland is an effective procedure for treating inflammation and providing symptomatic relief. This procedure can be employed for the treatment of sialolithiasis using the back pressure of instilled saline. Sialo-irrigation under ultrasound (US) guidance allows for dynamic studies showing real-time images during diagnostic or surgical procedure and can be used for the removal of sialoliths. In addition, it can also be used to remove primitive sialoliths and microliths by washing out the ductal system, which prevents the recurrence of sialoliths. The aim of this study was to propose a minimally invasive technique for sialolithiasis using US-guided sialo-irrigation.

Management of Sialolithiasis in the Submandibular Salivary Glands: A Case Report

Introduction: Sialolithiasis or salivary calculus is a salivary gland disease characterized by the formation of mineralized structures in the excretory salivary ducts or glandular parenchyma. About 80% occur in the submandibular glands followed by the parotid glands and sublingual salivary glands. Sialolithiasis can occur in the minor salivary glands, they can develop in any region of the oral cavity containing the minor salivary glands. Case report: A 78-year-old female patient presented with complaints of pain and lumps in the lower left jaw which often occurred 2 years ago. The lump gets bigger when eating spicy food and gets smaller when taking antibiotics, then the patient is treated for sialodenectomy and sialolithectomy. Discussion: History, clinical examination, and investigations in patients with sialolithiasis are very important to determine the appropriate treatment. Surgical management of sialolithiasis of the salivary glands has been recommended to reduce the likelihood of recurrence when compared to more conservative approaches, therefore it is the treatment of choice for these lesions. Conclusion: Salivary gland sialolithiasis is a rare occurrence, which may present diagnostic difficulties due to similar clinical characteristics with other lesions. Surgical management is performed to prevent sialolithiasis from growing bigger.