Stenon's Duct Research Articles

Easiest and Secure Surgical Treatment for Sialocele Post Bichatectomy: An Innovation Surgical Technique

Introduction: Bichatectomy is one of the most common surgeries of the face, but in any of all the hands, it could be a complication, and the most difficult to treat is the Sialocele, so we made an easy way to treat it, and solve it. Surgical Approach: We present a case of a young female, after the bichatectomy in the 5th day the middle face a Tumor, so we decided to create a new stenon duct, with a drainaige in anatomical position, getting a good result at the moment. Discusion: The bichectomy has an important historical antecedent since in the beginning it was a surgery even without importance in the medical field. The removal of Bichat fat currently has more aesthetic than reconstructive purposes, so the increase of the Sialocele is more tan 3% independent the hands of the surgeon. Conclusion: During the complications of bichatectomy, we decide to create an alternative for the surgeons that are in training, and an easy way to solve it.

Comparison of different methods for evaluating the relationship between facial nerve and benign parotid tumors.

Objectives:The goals of benign parotid gland tumor resection are complete resection of the lesion and preservation of the facial nerve function. As the facial nerve cannot be directly visualized via imaging modalities, several methods, including the facial nerve line, Utrecht line, retromandibular vein, Stenon duct, and minimum fascia-tumor distance techniques, have been developed to estimate its location. However, there are no reports on their accuracy in determining tumor location. In the present study, we aimed to assess the diagnostic accuracy of these methods based on tumor location.Methods:This retrospective study analyzed medical records and histological reports of 359 patients with various types of benign parotid gland tumors who underwent a parotidectomy between April 2014 and March 2020. The tumor location was subdivided into the following sections: anterior, superior, inferior, and middle. The tumor location was estimated using five methods: facial nerve line, Utrecht line, retromandibular vein, Stenon duct, and minimum fascia-tumor distance. The final diagnosis of superficial or deep lobe tumor was made based on surgical findings.Results:Each method showed a higher accuracy for superficial tumors (was more than 90%) than for deep lobe tumors. In contrast, for deep lobe tumors, the accuracy of diagnosis with the facial nerve line, Utrecht line, and retromandibular vein methods was low, in the 30% range. Among all methods, the Stenon duct method had the highest accuracy in the diagnosis of deep lobe tumors. The SD method was most useful in cases where both the duct and tumors were detected. The minimum fascia-tumor distance method had the second highest diagnostic accuracy (63%); however, for anterior tumors, it tended to provide false negatives.Conclusions:All tested methods were useful in diagnosing superficial lobe tumors; however, they were not helpful in diagnosing deep lobe tumors, especially anterior tumors.

Alternative Approach to Traumatic Stensen’s Duct Injuries Accompanied by Glandular Involvement: Botulinum Toxin Injection to the Gland in Conjunction with Microsurgical Repair of the Duct in an Acute Setting

There is high tendency to ignore the diagnosis as the incidence of the injury of parotid gland and its duct is relatively rare. In order to prevent the long-term complications such as facial deformities, sialoceles, cutaneous fistulae, salivary gland cysts and gustatory sweating (Frey’s syndrome) and to restore the parotid gland functions, it is important for the duct injuries to be diagnosed and treated immediately. 3 patients consulted to Plastic Surgery Clinic from the Emergency Room of Hacettepe University following maxillofacial trauma was reviewed in this study. Exploration of the facial nerve and Stenon duct was planned for all patients within the first 72 hours following the injury. Following intraoral catheterization of the Stenon duct through the papilla with an epidural catheter, microsurgical end-to-end anastomosis was performed. Concurrently, 100 Units of botulinum toxin A was injected at standardized 8 points on the parotid gland. Postoperative MR sialography revealed patency in all patients at the end of postoperative first year. The mean postoperative parotid volume of the injured and non-injured sides were 19,82±10,55 and 17,79±10,98 respectively and the results were found to be comparable. Fibrillation potentials in the postoperative electromyography recordings and clinical examination demonstrated the nerve regeneration. In conclusion, botulinum toxin A is appears to be effective in both treatment of the injuries of the duct accompanied by glandular involvement in the acute setting, as well as prevention of the long term complications.

Sialolit: 3 olgunun klinik, radyografik ve ultrasonografik bulguları ile birlikte değerlendirilmesi

INTRODUCTION: Sialoliths (salivary gland stones) are calcified obstructions that occur in the salivary gland or duct. Sialolith is the most common disease of the salivary glands. Majority of the sialoliths occur in the submandibular gland and can be observed at almost any age. For the diagnosis of sialolith, conventional radiography, ultrasonography and computed-tomography can be used together with clinical examination. CASE REPORT: In the first case, radiopacities were seen under the right mandibular corpus and in the left mandibular angulus region on panoramic radiographs of a 66-year-old female patient. Ultrasonographic evaluation showed these radiopacities to be sialoliths. The patient had no other symptom and was, therefore, followed periodically. The second case was a 61-year-old male patient; in the intraoral examination, hard masses were detected in the left submandibular gland region and no salivary flow was observed in the left Wharton duct. Radiopacities were seen on panoramic and mandibular occlusal radiographs. On ultrasonography, these appeared to be sialoliths and were removed intraorally by excision. The third case was a 55-year-old female patient applied to our clinic with pain on the right cheek and ear while eating. In the intraoral examination, inflammation was detected in the right Stenon duct. On ultrasonography, sialolith and infected parotid gland with heterogeneous echogenicity were noticed. The sialolith was removed surgically under general anesthesia. CONCLUSION: Application of appropriate imaging techniques is important for the diagnosis of sialolith. The diagnosis and treatment of sialolith requires multidisciplinary clinical approach.

Stenon Kanalında Büyük Tükürük Bezi Taşı

Siyalolitiyaz, tükürük bezinin veya boşaltıcı kanalının taş ile tıkanmasıdır. Etkilenen bezde şişlik, ağrı ve enfeksiyon, bazen de trismus görülmektedir. Siyalolitler; en sık submandibuler bezde (%80-90) ortaya çıkmakta, parotis bezinde ise daha az sıklıkla görülmektedir. Siyalolitiyaz olguları genellikle 30-60 yaşları arasındadır. İlk tanısal tetkikler genellikle direkt radyografi ve ultrasonografidir. Siyalolitler genellikle radyoopaktır ve direkt radyografide görülebilmektedir. Altmış yaşındaki erkek olgu bir aydır devam eden, yüzünün sol yanak bölgesinde gıda alımı sırasında artan ağrı ve şişlik şikâyetleriyle başvurdu. Panoramik röntgende sol parotis bezi kanalında siyalolit gözlemlendi. Bu çalışmada, Stenon kanal ağzında lokalize, panoramik radyografide radyoopak yuvarlak alan şeklinde görülen siyalolitin minimal invaziv olarak çıkartılması sunuluştur.

Parotidite induite par la clozapine : à propos d’un cas

Clozapine is the drug of choice for patients with an unsatisfactory response to routine antipsychotic treatment. Side effects such as sedation, weight gain, hypotension and hypersialorrhea are frequently reported whereas clozapine-induced parotitis is a less known complication.We report the case of a 32-year-old woman with a refractory schizoaffective disorder, bipolar type. The failure to respond to at least two well-conducted antipsychotic trials with flupentixol and risperidone, led clinicians to prescribe clozapine, which was started three years earlier. Since its introduction, clozapine induced sialorrhea, which has been managed until now with anticholinergic medication. Recently, Mrs B. was hospitalized for a new relapse. Once treatment compliance checked (good level of plasmatic dosage), we decided to increase the dose of clozapine from 350 mg/d to 500 mg/d. Twenty days later, Mrs B. exhibited improvement of symptoms but complained of acute bilateral auricular pain and odynophagia. The bilateral and comparative clinical exam displayed a bilateral filling of the retromandibular depression, the painful swelling of the parotid gland, along with ptyalism and a slight inflammatory oedema of the Stenon duct orifice. Mrs B. was apyretic, with physiological constants within the limits of normal values. The biological analyses displayed a discrete inflammatory syndrome (mild hyperleucocytosis and anemia), a negative mumps IgM test and positive mumps IgG test, and a 1050 ng/mL clozapine blood level. Once viral parotitis was ruled out, the involvement of clozapine was evoked. Symptomatic medication was prescribed with per os analgesic (paracetamol) and antiseptic mouthwash (Éludril). Clozapine dosage was lowered to 400 mg/d. A week later, clinical examination confirmed improvement of the medical and psychiatric conditions.We report the case of a patient who developed a parotitis following clozapine dose adjustment. Clozapine induced parotitis was retained once the infectious and other organic etiologies had been ruled out. Previous cases of clozapine-induced parotitis have already been reported and we have some arguments to suspect this etiology in our case. First, Mrs B. experienced more hypersialorrhea with the increase in clozapine dosage. Second, the anticholinergic medication was interrupted 3 days before the episode of parotitis. Two main pathophysiological hypotheses, immune and inflammatory, have already been proposed to explain clozapine-induced parotitis. In the former, the immunomodulating properties of clozapine may sensitize the mononuclear blood cells, leading to the sialadenitis. The latter hypothesis is the more documented and proposes that clozapine-induced hypersialorrhea may be responsible for a chronic inflammatory state that can lead to the formation of a parotid lithiasis and consequently parotitis. This case report illustrates clozapine induced-parotitis, a poorly known complication of this compound. Clinicians should be aware of its hypersialorrhea and inflammatory consequences in order to better prevent the occurrence of this complication.

Parotidite bactérienne aiguë chez les nourrissons de moins de 3 mois : étude rétrospective dans un centre hospitalier universitaire

Acute bacterial parotitis is a rare infectious disease in infants under 3 months of age.To describe the clinical characteristics and the course of acute bacterial parotitis in infants less than 3 months old.Infants under 3 months of age, hospitalized at Robert Debré university hospital, Paris, France, between January 2005 and December 2009 for acute bacterial parotitis, were included in a retrospective study.Five infants less than 3 months of age were included in this study, for a frequency of 2.5/1000 hospitalizations in this age group. All were born at term, 4 of 5 were male. Three of the 5 patients had specific clinical signs of parotitis on admission. One patient had septic shock on admission. The ultrasound confirmed the parotitis in all cases. No parotid abscess was demonstrated on imaging. All patients had at least one abnormal inflammatory biological test (WBC, CRP, PCT). Bacteria were identified in 4 of 5 cases: Staphylococcus aureus was isolated in the pus culture of the Stenon duct in 2 patients and a group B Streptococcus was isolated from blood culture of 2 other patients. The duration of intravenous antibiotic therapy varied from 4 to 13 days, and the total duration of antibiotic therapy was between 10 and 16 days. No surgical procedures were needed.Acute bacterial parotitis in infants under 3 months of age might be associated with localized infections due to S. aureus, but also with a more severe clinical presentation due to group B streptococcus infection. Early diagnosis and appropriate antibiotic therapy might prevent the progression to serious complications.

Greffe de muqueuse jugale pour le traitement d’une sténose urétrale

The indication of the buccal mucosal graft for urethroplasty has evolved over recent years. The ease of its harvesting, availability, and immunohistological properties, as well as its satisfactory results, has made the buccal mucosal graft the current procedure of choice. We report a case of use of a buccal mucosal graft to treat an urethral stricture correction. A 48-year-old man underwent a buccal mucosal graft for post-infectious urethral stricture correction. An inner right cheek graft of 50 × 30 mm was harvested and inserted into place after complete excision of the stricture. Postoperative evolution was satisfactory with no pain at the 5th day, resumption of normal diet at the 12th day, a significant improvement of peak flow rate at the 21st day. Follow-up examination at the 7th week revealed a mouth opening to 40 mm with complete healing. Buccal mucosal graft has currently the highest success rate compared to other surgical techniques as full thickness skin graft from hair or graft of bladder mucosa. Its harvesting can be single or multiple, however care must be taken as regards Stenon's duct and to the labial commissure. The complications of the donor site are infrequent and can be characterized by numbness and limited mouth opening. Tissues that contain immunohistological properties, which are similar to those of the urothelium, buccal mucosal graft, have become the gold standard for this type of correction.

Pneumoparotitis or pneumoparotid: a differential diagnosis to consider

Childhood parotid swelling has a number of differential diagnosis mostly of inflammatory origin. Pneumoparotitis is an uncommon cause of parotid inflammation. It is caused by an excessive increase of intraoral pressure and secondary passage of air into the Stensen or Stenon duct and its glandular branches. Diagnostic clues can usually be obtained by a directed anamnesis. Ultrasonography (US) and computed tomography are essential diagnostic tools for this condition that has a benign course with spontaneous resolution in most cases. We present four cases of pneumoparotitis diagnosed by US in children 5 to 13 years of age. One of the cases occurred after the child chewed gum and made bubbles for a prolonged time-period and the other three after inflating baloons, making bubbles inside a pool and after playing the flute. All cases resolved spontaneously after two days. We suggest to consider pneumoparotitis in the differential diagnosis of parotid swelling in children.

Neumoparotiditis o neumoparótida en el niño: Un diagnóstico diferencial a considerar

Childhood parotid swelling has a number of differential diagnosis mostly of inflammatory origin. Pneumoparotitis is an uncommon cause of parotid inflammation. It is caused by an excessive increase of intraoral pressure and secondary passage of air into the Stensen or Stenon duct and its glandular branches. Diagnostic clues can usually be obtained by a directed anamnesis. Ultrasonography (US) and computed tomography are essential diagnostic tools for this condition that has a benign course with spontaneous resolution in most cases. We present four cases of pneumoparotitis diagnosed by US in children 5 to 13 years of age. One of the cases occurred after the child chewed gum and made bubbles for a prolonged time-period and the other three after inflating baloons, making bubbles inside a pool and after playing the flute. All cases resolved spontaneously after two days. We suggest to consider pneumoparotitis in the differential diagnosis of parotid swelling in children.

Botulinum toxin to treat parotid saliva retention after transient postoperative Stenon's duct occlusion

Botulinum toxin (BT) can effectively and safely reduce saliva production when injected into saliva glands. We are reporting its use to treat a saliva retention cyst after transient postoperative Stenon's duct occlusion. A 59-year-old female was operated on a right premaxillary benign myofibroplastic tumour. Intraoperatively the Stenon's duct could not be displayed and identified. After 5 days later the Redon drain was removed and a massive subcutaneous cyst occurred in front of the parotid gland. 330 ml of saliva, as identified by a positive amylase test, was punctured on 6 occasions during the next 10 days without any tendency for normalisation. BT (Xeomin®, Merz Pharmaceuticals, 100 MU/5 ml 0.9% NaCl/H2O) was then injected into 5 sites equally distributed over the right parotid gland under ultrasound guidance. Subsequent punctures 2, 7 and 12 days later produced 12, 8 and 3 ml of saliva. On day 13 the saliva retention cyst could no longer be identified. After 12 months there was still no cyst re-occurrence despite a normalised saliva production. Adverse effects could not be identified. BT can safely and effectively reduce saliva retention when the Stenon's duct is occluded in the course of an operation and thus may allow for spontaneous re-canalisation of the duct before complicated reconstruction operations are performed.

Parotid Pneumocele in Down's Syndrome

Pneumoparotiditis is related to the cause of an infrequent increase in the size of the parotid gland due to the entrance of air through the Stenon duct following an increase in the pressure in the oral cavity. It is observed in musicians who play wind instruments, glass blowers, patients undergoing diagnostic or therapeutic techniques, in adolescents that provoke it intentionally, and in mentally handicapped people as found in the clinical case reported here. The symptoms are usually non-specific and the diagnosis is confirmed with an axial tomography. The interest in this clinical case lies in the peculiar form of presentation and its diagnostic confirmation through the use of CT imaging.

Ultrastukturelle Analysen zum Sekrettransport im Ductus parotideus

Mechanisms of secretion transport through the parotid duct (stenon's duct) and their influence on diseases of the parotid gland have not been investigated sufficiently until today. According to this background we performed histologic and scanning electron microscopical investigations of 23 parotid ducts in order to investigate the arrangement of fibrillar structures of the duct as well as get deeper insights into the physiology of secretion transport mechanisms. The subepithelial soft tissue of the parotid duct could be divided into two layers. The inner layer measured about 100-200 microm and consisted of collagen and elastic fibres running in a spiral arrangement. The outer layer varied in its thickness and was composed of collageous fibres, which were mostly arranged longitudinally. The arrangement of collagen fibrils in the wall of the parotid duct seems to influence secretion transport. Due to the spiral organization of collagen fibrils, distension of the duct is likely to be associated with a "wring-out" mechanism leading to unidirectional transport of saliva into the oral cavity. A muscular sphincter at the outlet of the parotid duct did not exist. The duct pierced the buccinatory muscle. Here, it was surrounded by sceletal muscle fibres that lead to a functional closure during contraction. Our results indicate that an active transport of saliva through the parotid duct--as so far assumed--is unlikely.

Ultrasound-guided mechanical intraductal stone fragmentation and removal for sialolithiasis

Not all patients with sialolithiasis can be treated successfully by established minimally invasive techniques. A forceps was used under sonographic control to fragment and retrieve salivary calculi in five cases refractory to established minimal invasive approaches. One patient with a sialolithiasis of the Stenon duct, two patients with a stone in the hilum region of the submandibular gland, and one patient with a sialolith in the sublingual gland were cured by this technique. For another patient, only a part of the stone in the hilum region of the submandibular gland could be removed. No relevant side effects occurred. To the authors' knowledge, this is the first report of a new, simple, and inexpensive minimally invasive technique that proved to be at least partially successful in the treatment of sialolithiasis in cases refractory to other therapies. The technique also seems to be suitable as a primary treatment approach.

内視鏡を用いた耳下腺導管拡張症の観察

We report a 47-year-old male with extreme dilatation of the Stenon's duct resulting from parotid papilla obstruction. He visited our clinic with a painless swelling in his left cheek and oral cavity after eating. The swelling had been present for four months. Physical examination, computed tomography, and magnetic resonance imaging showed that the lesion was due to extreme dilatation of the Stenon's duct. The obstruction was corrected by the surgical creation of a new, larger orifice. The cheek swelling immediately disappeared and has not returned after three months. Endoscopic examination of the Stenon's duct using a dacryoendoscope and nasal endoscope was carried out during surgery. These endoscopes were easily inserted into the Stenon's duct and provided adequate resolution of images of the duct lumen. Inflammatory debris and ductal swelling with hyperemia were observed in the lumen and gradually diminished from the parotid papilla to the parotid gland. In the parotid gland, the lumen was dilated, but did not show debris or ductal swelling. This endoscopic examination was very useful in understanding the etiology of the extreme dilatation of the Stenon's duct.

耳下腺における線維素性唾液管炎例

We report a 25-year-old female with sialodochitis fibrinosa of the bilateral parotid glands. She had a history of nasal allergy. On microscopic examination of the white mucus plug taken from Stenon's duct, many eosinophils were seen.Increased IgE was shown by blood examination and Interleukin 5 in the saliva was increased slightly. A steroid agent was very effective for the symptoms.Sialodochitis fibrinosa was probably caused by an allergic factor.

A traumatic transection of Stenon's duct: A case report

A traumatic transection of Stenon's duct: A case report

A case of extreme dilatation of Stenon's duct

A case of extreme dilatation of Stenon's duct

Diversion of salivary flow to treat drooling in patients with cerebral palsy

The authors performed six sialodochoplasties between 1991 and 1994 to treat drooling in six children who suffered from cerebral palsy. There were three boys and three girls, aged 13 to 22 years (mean, 16 years). All patients underwent parotid duct rerouting. The first four patients (group I) also underwent associated excision of submandibular ducts, and the last two patients (group II) benefited from rerouting of the submandibular ducts. In group I, results were considered good in two cases, fair in one case, and poor in one case. A fistula of the new Stenon duct appeared in one patient, which required excision and ligation followed by progressive involution of the parotid gland. Both group II patients had excellent and rapid results. The requirements leading to surgical decision are determined. The importance of physiotherapy is emphasized. Surgical techniques are described and discussed, as are objective criteria for the assessment of surgical results, namely salivary radioisotopic scanning.

ステノン管断裂の一治験例

An accidental blow with a piece of iron caused a crushing injury of the left cheek of a 52-year-old woman. The patient had emergency surgery at a nearby hospital. Starting the next day there was bulging of the left cheek after eating. Since pressure bandaging for 10 days did not reduce the swelling, she was referred to our hospital. A 70mm wound was present along the midline of the left cheek. No salivary flow was seen from the ostium of Stenon's duct. Facial paralysis was not present. A sialogram and sialo-CT scan demonstrated obstruction of Stenon's duct and a sialocele. Under general anesthesia reoperation was performed. It was found that the distal end of the severed Stenon's duct had been ligated with silk and a sialocele had formed in the superficial part of the parotid gland. A silicone tube was introducted through the duct, and an end-to-end anastomosis of Stenon's duct was accomplished. The ruptured parotid gland was closed with silk sutures. On the 10th day the tube was removed, and salivary flow could be observed. A sialogram on the 14th day demonstrated slight constriction of the anastomosis. 99mTc scintigraphy indicated functional recovery of the left parotid gland 3 months after the operation.