Sialolithiasis Research Articles

Relationship between volume of submandibular salivary stones in vivo determined with Cone-Beam Computer Tomography and in vitro with micro-Computer Tomography.

Background Successful removal of salivary stones depends on exact pretreatment information of the location, the size and shape of the stones. This study aimed to compare the volume of submandibular sialoliths determined by preoperative Cone-Beam Computer Tomography (CBCT) scans with the volume of the removed stones on micro-Computer Tomography (micro-CT) scans.Material and Methods In this study, using twenty-one submandibular sialoliths, the pretreatment volumes in-vivo measured on CBCT were compared to the volumes of removed stones determined by micro-CT scans. The volume measured on micro-CT scans served as the gold standard. Pre-operative CBCT’s and in-vitro micro-CT’s were converted into standard tessellation language models (STL-models) using an image segmentation software package. The CBCT and micro-CT images of the stones were subsequently metrologically assessed and compared to each other using reverse engineering software.Results Volumes of submandibular sialoliths determined by CBCT’s correlated significantly with volumes measured on micro-CT’s (Spearman’s coefficient r = 0.916). The interquartile range (IQR) for the volume measured with micro-CT was 117.23. The median is 26.41. For the volume measured with CBCT the IQR was 141.3 and the median 36.61. The average volume on micro-CT is smaller than on CBCT.Conclusions When using CBCT-scans for the detection of submandibular sialoliths one should realize that in-vivo those stones are actually a fraction smaller than assessed on the preoperative scan. This is important when cut-off values of sizes of stones are used in the pretreatment planning of stone removal. Key words:Salivary stone, sialolith, CBCT, micro-CT, volume.

A Case of Sialolithiasis of the Submandibular Gland System Mimicking a Salivary Gland Tumor Accompanied by Multiple Salivary Calculi

A Case of Sialolithiasis of the Submandibular Gland System Mimicking a Salivary Gland Tumor Accompanied by Multiple Salivary Calculi

Sialotripsy as a treatment option for patients with salivary stone disease

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. Improvement of minimally invasive methods of treatment of salivary stone disease, which does not lead to excision of the gland. 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). 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. 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.

Sialolith of The Submandibular Gland: A Case Report

Sialolithiasis is described as the existence of calcified structures in ducts of salivary glands and is the most widespread disease of the salivary glands. 80-95 % of sialoliths occur at the submandibular salivary gland. Sialoliths with an average frequency of occurrence of 12: 1000 are approximately twice as common in men as in women. Sialoliths may be diagnosed with clinical examination, conventional radiography, computed tomography and ultrasonography. Common clinical signs in cases of sialoliths include painless swelling, large swelling often accompanied by trismus associated with eating, symptoms ranging from moderate discomfort to severe pain. In this case report clinical, radiological signs and surgical therapy of salivary stone in the submandibular gland is represented.

Classification of submandibular salivary stones based on ultrastructural studies.

Sialolithiasis remains a clinical problem with unclear etiopathogenesis, lack of prevention methods, and only surgical treatment. An ultrastructure examination of submandibular sialoliths obtained from patients with chronic sialolithiasis was conducted using a scanning electron microscope and X-ray photoelectron spectroscopy. Based on the results, we divided sialoliths into three types: calcified (CAL), organic/lipid (LIP), and mixed (MIX). The core structure of the CAL and MIX is very similar. The core of the LIP has a prevalence of organic components. The intermediate layers' structure of the CAL is different from LIP and MIX. In LIP and MIX, the organic component begins to increase in intermediate layers rapidly. The structure of the superficial layers for all types of sialoliths is similar. We introduced a new classification of the submandibular salivary gland stones. Based on the results, it can be said that sialoliths type CAL and LIP have their separate path of origin and development, while MIX is formed as CAL stone, and the further pathway of their growth passes as LIP stones. Organic components were much more than inorganic in all layers of salivary gland stones, which highly prevents their dissolution in the patient's salivary gland duct.

Intraductal Lithotripsy in Sialolithiasis Using the Calculase III™ Ho:YAG Laser: First Experiences.

To report the first experiences with a newly available Ho:YAG laser system for the treatment of salivary stones. A retrospective study in a tertiary referral center was conducted. Patients diagnosed with sialolithiasis were treated in Erlangen using the Calculase III™ Ho:YAG laser (Karl Storz, Tuttlingen, Germany). Preset parameters had a frequency of 4 Hz and energy of 0.8-1.2 J, resulting in 3.2-4.8 W. Following total fragmentation, one to two serial sialendoscopies were performed to achieve complete fragment clearance. A total of 55 stones in 49 patients were treated; 17 stones in 15 submandibular glands and 38 in 34 parotids. In total, 61 laser lithotripsies (range 1-3 per stone) were performed using various modes (long, short, and burst) and with preset parameters of 4 Hz and energy of 0.8-1.2 J, resulting in effective power of 3.2-4.8 W. Complete fragmentation was achieved in all the accessible stones. Sialendoscopes, fibers, or the mode used had no significant influence on success rates. A multimodal therapy concept was employed to treat stones in 12.24% of the cases; 95.92% of the patients were ultimately stone-free, and all became symptom-free. All glands were preserved. The new Calculase III™ Ho:YAG laser was effective in the treatment of sialolithiasis with no increased risk of complications in the patients or damage to the sialendoscopes. Clinical factors such as the type of gland involved, or the location and size of stones had a greater impact on success rates than the technical or preset parameters. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Clinical management of Sialadenitis

Within the area of salivary gland pathology, obstructive sialadenitis is the most common inflammatory condition of the salivary glands.1
 It has been well established in the literature that salivary calculi occur most commonly in the submandibular gland, whereas fewer cases are found in the parotid gland, while the sublingual gland and the minor salivary glands form no more than 2% of cases.2
 The early treatment of sialadenitis is usually conservative and involves hydration, anti inflammatory medication in conjunction to antibiotics when a bacterial infection is suspected. However, when initial treatment fails, further intervention is needed.
 The traditional external approach is sialadenectomy. However, with this exists the potential for injury to the lingual and facial nerves. Further complications including bleeding, infection and an unsightly scar are also found with this procedure.3,4
 Sialendoscopy is a relatively new technique that only became available once optics had improved to the extent that fiber-optic endoscopes could be miniaturized to a diameter of 0.9 mm to 1.6 mm. This has ushered in a new era for the management of sialadenitis, particularly in cases where sialadenitis was caused by salivary duct obstruction.
 It must be noted that in South Africa, there are currently no generally accepted guidelines on the management of sialadenitis secondary to salivary ductal obstruction as well as in the role of sialendoscopy within the treatment algorithm.

Neutrophil Extracellular Traps Promote the Development and Growth of Human Salivary Stones.

Salivary gland stones, or sialoliths, are the most common cause of the obstruction of salivary glands. The mechanism behind the formation of sialoliths has been elusive. Symptomatic sialolithiasis has a prevalence of 0.45% in the general population, is characterized by recurrent painful periprandial swelling of the affected gland, and often results in sialadenitis with the need for surgical intervention. Here, we show by the use of immunohistochemistry, immunofluorescence, computed tomography (CT) scans and reconstructions, special dye techniques, bacterial genotyping, and enzyme activity analyses that neutrophil extracellular traps (NETs) initiate the formation and growth of sialoliths in humans. The deposition of neutrophil granulocyte extracellular DNA around small crystals results in the dense aggregation of the latter, and the subsequent mineralization creates alternating layers of dense mineral, which are predominantly calcium salt deposits and DNA. The further agglomeration and appositional growth of these structures promotes the development of macroscopic sialoliths that finally occlude the efferent ducts of the salivary glands, causing clinical symptoms and salivary gland dysfunction. These findings provide an entirely novel insight into the mechanism of sialolithogenesis, in which an immune system-mediated response essentially participates in the physicochemical process of concrement formation and growth.

Modified Marionette Technique for Unassisted In-Office Access to the Submandibular Duct.

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PYOGENIC GRANULOMA IN THE FLOOR OF THE MOUTH

Pyogenic granuloma is defined as a non-neoplastic proliferative process, probably due to local irritation or trauma, with the gingiva being the site most affected (75% to 85%). A 64-year-old woman was examined, and the presence of increase in volume in the floor of the mouth on the left side, with a 2-month evolution, extending from the edentulous region of the teeth 34 to 37, painful at palpation, associated ulcer with raised borders and yellowish pseudomembrane was observed. An occlusal radiograph of the mandible was performed, and salivary calculus was not present. The clinical characteristics led to the presumptive diagnosis of squamous cell carcinoma or lymphoma, so an incisional biopsy was performed. In the histopathologic examination submucosa with numerous neoformed vessels with intense neutrophils infiltration was observed, and the final diagnosis was pyogenic granuloma. The treatment was total surgical excision of the lesion, and the patient was followed up with no recidivism.

SIALOLITHIASIS IN A PEDIATRIC PATIENT—AN UNUSUAL CASE

Sialolithiasis is characterized by the formation of calcified structures within the salivary ductal system, mainly affecting the Wharton’s duct. The formation of salivary calculi may be related to chronic sialadenitis. Pain, infection, fever, and sublingual volume increase are common findings in these cases. The present study reports a case that differs from the usual prevalence. A 12-year-old male patient appeared in consultation reporting pain in the oral floor. After the clinical and images examination (cone beam volume tomography), sialolithiasis diagnosis was confirmed. To treat, sialagogues and the manual techniques were used without success. Thus, micromarsupialization and the excision of the calculi were performed as definitive treatment. The surgery was uneventful, and the patient had 6 months of observation, without signs of relapse. This case diverges from the literature and demonstrates that the treatment should be surgical when noninvasive therapies fail.

Clinical Entities that Mimic Salivary Inflammatory Disease

Sialadenitis due to salivary obstruction is associated with characteristic intermittent pain and swelling of the affected gland. Common etiologies of adult salivary obstruction include salivary duct stones or duct stenosis. However, various pathologic processes can mimic obstructive salivary gland symptoms. This is a case-based review of pathologies that may present similar to the signs and symptoms of salivary obstruction with gland inflammation. Multiple cases with pathologies mimicking inflammatory salivary gland disease have been reported and described. This review uses a case-based approach to highlight the clinical presentation, exam, and imaging findings of disorders that imitate sialadenitis in order to describe approaches for achieving accurate diagnoses. Cases involving nonobstructive salivary pathology are presented to demonstrate a broad differential diagnosis for facial and salivary gland swelling.

The treatment of sialolithiasis by sialolithotripsy

Aim. To study the effectiveness of treatment of sialolithiasis by sialolithotripsy.
 Methods. Between 2015 and 2018, extracorporeal shockwave lithotripsy of salivary stones of 39 patients was performed in the Nasreddin Tusi Memorial Clinic. The stone was located in the submandibular gland and its duct for 33 patients and the parotid salivary glands and its duct for 6 patients. The average age of patients was 503.38 (between 22 and 77).
 Results. Stone fragmentation as a result of sialolithotripsy was achieved in 36 (92.7%) of 39 examined patients (p=0.031). In 3 patients the stone was completely fragmented, but due to the narrow lumen of the main duct, it did not move away. In 3 patients with calculus size more than 2 cm, the stone was not fragmented. According to our results, the necessary effect was achieved in 85% of cases and was unachieved in only 15% of cases.
 Conclusion. Given the complexity of the surgical treatment in patients with salivary stone and potential postoperative complications, especially with the stone localization within the parotid gland, we concluded that extracorporeal shockwave lithotripsy is a promising alternative treatment for patients with salivary stone.

Sialoliths in Ipsilateral Bartholin`s and Wharton`s Duct: The First Clinical and Ultrasound Report

Sialoliths in sublingual gland is the rarest condition among sialolithiasis in other major salivary glands. Only in 0.4 percent of cases the salivary stone notes in sublingual gland. In our English literature review we count 8 articles which describe sialoliths located within or around the sublingual glands. Nevertheless, in none of those cases a simultaneous sialolithiasis of the submandibular and sublingual gland was noted. Although in one case the authors described a sonogram of sialolith in the sublingual gland, the sonogram of the gland and its ductal system was not presented. Here we present the first ever published clinical and ultrasound report of combined ductal sialolithiasis of sublingual and submandibular glands in a 78-yearold female. Also, Zhang et al`s classification of duct system patterns of the sublingual glands based on 60 cadaveric and 63 clinical cases is analyzed.

타석증의 최소침습적 수술

타석증의 최소침습적 수술

The intraoral approach for removal of hilar submandibular stones: a case series and review of the literature

Background: Salivary calculi are the most common cause of salivary duct obstruction, often occurring in the submandibular gland. In Australia, transcervical sialadenectomy is routinely performed for hilar submandibular gland stones. However, increasing overseas literature has demonstrated good recovery of glandular salivary function after removal of the obstructive calculus. This study aims to influence local practice and encourage the intraoral removal of hilar stones, by describing our intraoral technique and case series, as well as a review of the current literature.

A comprehensive analysis of sialolith proteins and the clinical implications

BackgroundSialolithiasis or salivary gland stones are associated with high clinical morbidity. The advances in the treatment of sialolithiasis has been limited, however, by our understanding of their composition. More specifically, there is little information regarding the formation and composition of the protein matrix, the role of mineralogical deposition, or the contributions of cell epithelium and secretions from the salivary glands. A better understanding of these stone characteristics could pave the way for future non-invasive treatment strategies.MethodsTwenty-nine high-quality ductal stone samples were analyzed. The preparation included successive washings to avoid contamination from saliva and blood. The sialoliths were macerated in liquid nitrogen and the maceration was subjected to a sequential, four-step, protein extraction. The four fractions were pooled together, and a standardized aliquot was subjected to tandem liquid chromatography mass spectrometry (LCMS). The data output was subjected to a basic descriptive statistical analysis for parametric confirmation and a subsequent G.O.-KEGG data base functional analysis and classification for biological interpretation.ResultsThe LC–MS output detected 6934 proteins, 824 of which were unique for individual stones. An example of our sialolith protein data is available via ProteomeXchange with the identifier PXD012422. More important, the sialoliths averaged 53% homology with bone-forming proteins that served as a standard comparison, which favorably compared with 62% homology identified among all sialolith sample proteins. The non-homologous protein fraction had a highly variable protein identity. The G.O.-KEGG functional analysis indicated that extracellular exosomes are a primary cellular component in sialolithiasis. Light and electron microscopy also confirmed the presence of exosomal-like features and the presence of intracellular microcrystals.ConclusionSialolith formation presents similarities with the hyperoxaluria that forms kidney stones, which suggests the possibility of a common origin. Further verification of a common origin could fundamentally change the way in which lithiasis is studied and treated.

Success rate and complications of sialendoscopy and sialolithotripsy in patients with parotid sialolithiasis: a systematic review.

To assess the success rate and complications of sialendoscopy and sialolithotripsy for parotid sialolithiasis. A total of 228 articles were identified by the electronic database search regarding the topics sialendoscopy and sialolithotripsy. Following independent then joint review of titles and abstracts, 109 articles were selected for the full review. Thirteen of these were chosen for data extraction from which 1285 patients with parotid salivary stones were identified. Extracted data included number of patients, age, gender, location, management, and outcomes. All articles combined, 1285 patients with parotid salivary stones were included with a successful treatment in 1139 patients. The success rated ranged from 71.4 to 100% with a mean of 88.7%. Both partial as complete success was achieved. Although minor complications were frequent, no major complications occurred. Sialendoscopy and sialolithotripsy are best suited as first choice treatment-if conservative therapy failed-for the management of parotid gland sialolithiasis. It is a valuable and feasible treatment option with no major complications. Selection of cases will ensure the best prognosis. Although there is no indefinite stone size, the smaller the calculus, the greater the probability of a symptom-free patient.

Ultrastructural analysis of the submandibular sialoliths: Raman spectroscopy and electron back-scatter studies

ABSTRACTThe aim of work was the epidemiological analysis of the occurrence of sialolithiasis of the submandibular gland in adults and the evaluation of the ultrastructure of salivary stones. The study sample consisted of 44 sialoliths. Analysis of the structure and chemical composition of sialoliths was performed using a Scanning Electron Microscope and Raman Spectroscopy. Comparing our results with the literature we can say that the epidemiology of sialolithiasis has not changed significantly over the past 50 years. A wide variety of sialoliths structure was observed. In 75% (33) cases a layered structure of salivary stones was observed, while in 25% (11) – homogeneous structure. The various distribution of organic and inorganic components was observed among all the analyzed sialoliths. Raman spectroscopy allows for preliminary analysis of the sialoliths structure with only a qualitative assessment of their composition, which significantly reduces the research value of this method. The presence of organic and inorganic compounds in the core and inner layers of the salivary glands stones confirms 2 basic theories of the formation of sialoliths: inflammation and deposition of the inorganic component as a result of disruption of saliva flow in the salivary glands.

Giant Sialolith of Wharton’s Duct - A Case report with review of literature

Sialolithiasis is the formation of calcific concretions within the parenchyma or ductal system of the major or minor salivary glands, but it most commonly affects the submandibular salivarygland. Sialolithiasis usually occurs in adults aged 30 to 60 years and causes pathognomonicpain during meals. The treatment of sialolithiasis depends on the size and location of thecalculi. In this article we present a case report of giant sialolith in the submandibular salivary duct and review of literature of various diagnostic and treatment aspects. Key Words : Salivary stone, Calculi, submandibular sialolithiasis, sialoadenitis