Submandibular Gland Stones Research Articles

Transoral approach for hilo-parenchymal submandibular stones: outcomes and predictors of success

ObjectiveTo evaluate the efficacy and safety of transoral surgical management for complex submandibular gland (SMG) stones. Study DesignA retrospective cohort study of 240 patients treated for sialolithiasis between 2015 and 2018, focusing on 57 cases of submandibular gland stones that underwent stone removal procedures. Treatment methods, success rates, and complications were analyzed using Kaplan-Meier analysis, Cox proportional hazards regression, and multiple logistic regression. ResultsTransoral surgical release was successful in 72.9% of cases. The overall complication rate was 10%. Stone size (HR = 0.85, p = 0.004) and hilar location (HR = 0.72, p = 0.036) were associated with longer symptom resolution time. Multivariate analysis revealed that stone size (OR = 0.78, p = 0.009) and hilar location (OR = 0.45, p = 0.029) decreased the odds of successful removal. ConclusionTransoral surgical management of hilo-parenchymal SMG stones appears to be a safe and effective approach, potentially reducing the need for sialoadenectomy.

Review on submandibular gland stone surgical techniques and new advances

This review delves into the complexities and advancements in the surgical management of submandibular gland stones, a prevalent condition within sialolithiasis, with a particular focus on the submandibular gland which is most frequently affected. Traditional surgical interventions, such as submandibular sialoadenectomy, though effective, come with significant risks and postoperative complications including gland deficiency, scarring, and digestive issues. The emergence of minimally invasive endoscopic techniques marks a significant advancement, offering a less traumatic alternative for stone removal without sacrificing gland functionality. Despite these advances, challenges remain with endoscopic techniques, particularly in the complete removal of calcified stones and in cases involving large stones, leading to extended surgery times and increased costs. The review highlights a novel transoral endoscopic technique aimed at improving the removal of deep lobe stones, showing promising results in terms of efficacy, reduced trauma, and lower complication rates. This study underscores the ongoing evolution in the management of submandibular gland stones, emphasizing the importance of innovation and the adoption of new technologies to enhance patient outcomes and reduce healthcare burdens.

Distribution of Misdiagnostic Maxillofacial Nonmalignant Lesions and Conditions in Salah Alden Government

Diagnosis is the corner stone & entry to the treatment of lesions or conditions. Because misdiagnosis leads to incorrect treatment. It is very important to understand the distribution between the most common misdiagnosis nonmalignant lesions& conditions in the maxillofacial region as apart of whole misdiagnosis. Decrease patient complaining. Evaluate the most common misdiagnosis lesions& conditions in maxillofacial region. Decrease load to hospitals& clinics& decrease infections. The data collected by standardized formula for all patients& different patient clinical, radiological examination & methods used to confirm the diagnosis. Total no. are 30 patients, misdiagnosis lesions& conditions 13% (Sinusitis or dental pain), 20% (submandibular Lymphadenitis. or Sialadenitis), 20% (Otalgia). 10%(Psychopath),10%(Trigeminal neuralgia) ,7%(migraine) ,7%( maxillary sinusitis),13%(submandibular saialidinitis). the true diagnosis was 13%,( Oroantral fistula),20%(oro-Cutaneous fistula),20%(Tmj pain),10%(Tmj dislocation),10%(dental pain),7%(dental pain),7%(Maxillary sinus cyst),13%(submandibular Salivary gland stone). The more unorganized medical &or surgical branches interference within region may lead to these misdiagnosis results. Poor educated patients, doctor’s decision with inadequate examination& investigation participate in increase patients complaining

Recovery of gland function after endoscopy-assisted removal of impacted hilo-parenchymal stones in the Wharton’s duct

The aim of this study was to evaluate the gland function of patients following endoscopy-assisted removal of impacted hilo-parenchymal stones in the Wharton’s duct. The study cohort comprised 115 patients who had undergone successful endoscopy-assisted lithotomy for hilo-parenchymal stones (mean diameter 7.7 mm). Gland function was evaluated at a mean 12 months after surgery using ultrasonography, sialography, and/or sialometry. Postoperative ultrasonography of 51 affected glands revealed a regular gland size in 58.8%, normal parenchyma density in 51.0%, and ductal ectasia in 80.4%. Postoperative sialograms of 109 affected glands were scored as type I (approximately normal) in 13 cases, type II (saccular ectasia of the hilo-parenchymal duct with/without stenosis, and no contrast retention) in 64, type III (saccular ectasia of the hilo-parenchymal duct with/without stenosis, and mild contrast retention) in 23, and type IV (poor shape of the main duct with evident contrast retention) in nine cases. The existence of ductal ectasia corresponded well to larger stone cases (P = 0.002). In the postoperative sialometry of 35 patients with unilateral stones, differences between the two sides were insignificant (P > 0.05). For patients with hilo-parenchymal submandibular gland stones, endoscopy-assisted surgery and extended postoperative follow-up help preserve the gland with good function.

Sialolithiasis: mineralogical composition, crystalline structure, calculus site, and epidemiological features

The purpose of this paper was to describe the characteristics of salivary calculi and their relationship to epidemiological factors, through a cross-sectional study. We analysed 100 calculi obtained in 2017–2021. Patient data including age, time since onset of symptoms, gland involved, and site of location in the salivary system were studied. The calculi were studied to determine their morphological features using scanning electron microscopy and energy dispersive plain radiographic analysis. Most of the calculi had formed in the submandibular gland (SG) (82%). The mean age of patients at onset was 45.83 years; patients presenting parotid gland (PG) stones were somewhat older (p = 0.031). The mean time since the onset of symptoms was longer in PG calculi (p = 0.038). The most common lithiasis site was the main duct (74%), followed by the hilum (22%). Hilar stones were the largest (p < 0.05) and heaviest (p = 0.028). Octacalcium phosphate (OCP) was the most common crystalline phase (Cp) founded, followed by hydroxyapatite (HA) and whitlockite (WH). Specifically, OCP had a higher presence in PG calculi (p = 0.029) and WH was the most common phase in SG calculi (p = 0.017). The most prevalent site of lithiasis was the main duct, and the largest and heaviest calculi were found in the SG. PG stones were associated with a longer history of symptoms and older age. OCP was the most frequent Cp of the calculi studied, and the main Cp in PG stones. WH was the predominant Cp in SG stones. The Cp of the calculi was not influenced by location, patient age, or time of symptoms.

Utility of Ultrasonography for Diagnosis of Salivary Gland Sialolithiasis: A Meta‐Analysis

We hypothesized that ultrasonography for salivary gland stone detection would have a diagnostic accuracy similar to that confirmed by sialendoscopy, sialography, or surgery. Therefore, we evaluated the diagnostic characteristics of ultrasonography in terms of submandibular and parotid stone detection compared to confirmatory methods. We searched PubMed, Embase, the Web of Science, SCOPUS, and the Cochrane database to October 31, 2021. The risk of bias was evaluated using the QADAS-2 tool. Ten studies involving 1393 patients were included in the analysis. The diagnostic odds ratio of ultrasonography was 162.6013 (95% confidence interval [CI] [53.9883; 489.7208] and I2 value 81.0%). The area under the summary receiver operating characteristic curve was 0.963. The sensitivity, specificity, negative predictive value, and positive predictive value were 0.8992 (95% CI [0.8534; 0.9318]; I2 =79.9%), 0.9664 (95% CI [0.9290; 0.9844], I2 =65.6%), 0.8076 (95% CI [0.7256; 0.8694]; I2 =80.4%), and 0.9853 (95% CI [0.9629; 0.9943]; I2 =77.4%), respectively. However, high-level among-study heterogeneity (I2 ≥ 50%) was evident, attributable to the inclusion of different glands. On subgroup analysis, significant differences in the negative predictive values (parotid gland only [0.9392], submandibular gland only [0.6718], and parotid and submandibular glands [0.8105]) were apparent. We found no significant among-study difference in the sensitivity, specificity, positive predictive value, or diagnostic odds ratio (P > .05). Ultrasonography usefully detects submandibular and parotid gland stones. Ultrasonography of the parotid gland was associated with the highest diagnostic accuracy, but further clinical studies are needed. NA Laryngoscope, 132:1785-1791, 2022.

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.

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.

Nuances and Management of Hilar Submandibular Sialoliths With Combined Transoral Robotic Surgery–Assisted Sialolithotomy and Sialendoscopy

To describe the management, technical nuances, and success rates of transoral robotic surgery (TORS)-assisted sialolithotomy. Retrospective database review. Quaternary academic medical center. Between the months of January 2015 and May 2019, patients with hilar submandibular gland stones underwent 2 main variations of TORS-assisted sialolithotomy and sialendoscopy: (1) TORS followed by sialendoscopy for patients with palpable predominantly single stones and (2) either sialendoscopy followed by TORS and sialendoscopy or sialendoscopy followed by TORS only for patients with nonpalpable or multiple stones. Clinical charts were reviewed to collect data, including stone size (imaging review, intraoperative measurement), palpability, duration of operation, TORS variation, operative challenges, symptom improvement, gland preservation rate, and complications. Thirty-seven patients were identified. Patients were 26 to 80 years old (mean, 57.2 years), and 40.5% were female. Twenty-four patients (64.9%) underwent TORS followed by sialendoscopy; 10 (27.0%), sialendoscopy followed by TORS and sialendoscopy; and 3 (8.1%), sialendoscopy followed by TORS only. The mean stone size was 12.4 mm (range, 4-28 mm). Eleven patients had multiple stones with a mean 4 stones per patient (range, 2-9). Procedural success was 91.9% (34/37) at a mean follow-up of 34.2 weeks (range, 1.4-262.1), and the gland preservation rate was 97.3% (36/37). No patients reported symptoms of lingual nerve injury at 3-month follow-up. TORS combined with sialendoscopy for hilar submandibular gland sialolithiasis allows for improved visualization of critical anatomy, tissue manipulation, and operative flexibility. In our experience, the operative success rate is high, and duration of surgery compares favorably with conventional combined hilar approaches.

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.

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.

Giant submandibular gland stone largest in India: Management and review of literature: A rare case report

Sialoliths are calcerous concretions seen in the salivary gland parenchyma or its duct, accounting more than 50% of salivary gland diseases. Giant sialoliths measuring 35 mm are rare, with only 19 cases published in literature. Ninety‑five percent of the giant sialoliths reported were in the submandibular gland, all occurring in male patients. Preoperative imaging help in defining the size,location of lesion and helps in planning approach. We are reporting a rare case of giant submandibular gland sialolith in a 52 year male patient measuring 40 mm (probably largest in india), which was removed through transcervical approach under general anesthesia.

Advantages of submandibular gland preservation surgery over submandibular gland resection for proximal submandibular stones

This study sought to compare surgical outcomes after the removal of submandibular gland (SMG) stones via 2 different surgical methods. From June 2015 to July 2016, a total of 40 patients with SMG stones were selected from the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University (Shenyang, China), and were randomly assigned to 2 groups. Twenty patients underwent sialendoscopy-assisted stone removal via extraoral incision with preservation of the SMG, and 20 patients underwent traditional SMG resection. The outcomes of the 2 surgical procedures were assessed. The operation time and hospital stay were shorter in the SMG preservation group than the SMG resection group. There were no significant differences in stone size or location between the groups. The mean visual analog scale (VAS) score was lower in the SMG preservation group than the SMG resection group. All patients in the SMG resection group exhibited varying degrees of scarring and concave deformity on the face and neck, whereas all patients in the SMG preservation group retained intact facial morphology. Sialendoscopy-assisted stone removal with preservation of the SMG exhibited many advantages relative to traditional SMG resection.

Microcalcifications in stone-obstructed human submandibular gland are associated with apoptosis and cell proliferation

ObjectiveHuman submandibular gland (SMG) stones are associated with inflammation, fibrosis and microcalcifications in the surrounding tissues. However, there is little information about the accompanying cell injury-repair process, apoptosis, and cell proliferation. The purpose of this study was to investigate such an association and its clinical significance. Design of studyMid-gland paraffin sections of human SMGs (“stone glands”) and normal SMGs (“non-stone glands”) were subjected to stains for general histology (hematoxylin and eosin), fibrosis (Masson’s trichrome), and calcification (alizarin red) and to immunohistochemistry for proliferative activity (Ki-67), and apoptosis (Caspase-3). Tissues were assessed for areas of inflammation, calcium deposition, and fibrosis, and for cycling and apoptotic cells. ResultsAcini were atrophic and proportionately fewer in lobules with fibrosis in stone glands. Additionally, stone glands had intraluminal calcifications (microliths) in scattered excretory and striated ducts and blood vessel walls. Areas of inflammation and fibrosis were small and uncommon, and calcifications were not seen in non-stone glands. Proliferating and apoptotic cells were common in the main duct of stone glands where ciliated and mucous cell hyperplasia and stratified squamous metaplasia had occurred, uncommon in the main duct of non-stone glands, and uncommon in all other parenchymal elements of both stone and non-stone glands. ConclusionStone obstruction in the main excretory ducts of SMG resulted in progressive depletion of acini from proximal to distal lobules via calcification, inflammation, fibrosis, and parenchymal cell atrophy, apoptosis and proliferation. Interlobular duct microliths contributed to this depletion by further provoking intralobular inflammation, fibrosis, and acinar atrophy.

Use of a novel tongue retractor for intraoral removal of proximal/hilar submandibular gland stone

ObjectiveIntraoral removal of proximal/hilar or intraglandular stones is technically difficult, because the surgical field is limited. However, intraoral removal of deep submandibular gland stones has several advantages over submandibular sialoadenectomy, including shorter operation time and better gland function. To overcome the technical difficulties associated with intraoral removal of deep submandibular gland stones, we designed a novel tongue retractor and here describe its use. MethodsThe tongue retractor for the intraoral removal of proximal/hilar submandibular gland stones has a wing on each side for the retraction of soft tissues. After careful dissection along Wharton’s duct to the hilum of the submandibular gland, we used the new tongue retractor. ResultsThe new tongue retractor enables the lingual soft tissues to be retracted easily and it maintains a better surgical field, compared with standard tongue retractors. For hilar/intraglandular stones in the medial portion of the submandibular gland, after dissection of the medial side of the gland, the newly designed tongue retractor provided a good surgical field for easy and reliable stone removal. ConclusionThis novel tongue retractor offers a better surgical field and shorter operation time for intraoral stone removal than standard tongue retractors.

The Role of Fetuin-A and Electrolytes in the Etiology of Sialolithiasis.

Objective The aim of this study was to investigate serum and saliva fetuin-A, protein, and electrolyte levels in patients with sialolithiasis. Study Design Prospective randomized controlled study. Setting Tertiary center. Subjects and Methods Twenty patients with recurrent sialadenitis secondary to submandibular salivary gland stones and 20 asymptomatic healthy volunteers without salivary gland stones were included in the study. Bimanual palpation and ultrasonography were performed in the patient and control groups. The electrolyte, protein, and fetuin-A levels of the serum and saliva were measured. Results The serum calcium, phosphorus, and potassium levels of the patients were significantly lower than those of the control group (respectively, P = .04, P = .01, P = .04). There was no statistically significant difference between the serum fetuin-A levels of the 2 groups ( P = .06). The saliva phosphorus values of the patients were higher than those of the control group ( P = .05), as were their saliva fetuin-A and total protein values ( P = .001, P = .01). A positive correlation was determined between the saliva fetuin-A levels and the saliva phosphorus and potassium levels of the patients ( P = .04, P = .02). The magnesium level, which has been argued to be a factor in the prevention of calcification, showed an increased correlation with the total protein in the patient group ( P = .02). Conclusion It is possible that the high levels of saliva fetuin-A, total protein, and phosphorus with insufficient of saliva magnesium levels may make a contribution to the formation of sialoliths.

小児に生じた両側顎下腺唾石症の1例

小児に生じた両側顎下腺唾石症の1例

Evaluation of Sialendoscopy-Assisted Treatment of Submandibular Gland Stones

The aim of the present study was to evaluate the therapeutic efficiency of sialendoscopy-assisted operations in the treatment of submandibular gland stones. The data from 8 patients with sialolithiasis who underwent sialendoscopy from August 2015 to January 2016 at the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University (Shenyang, China) were retrospectively reviewed. All the patients had undergone preoperative technetium-99m pertechnetate salivary gland scintigraphy. The results revealed that the salivary glands exhibited normal or slightly reduced uptake and excretion dysfunction. Computed tomography examinations revealed stones located in the intraductal area near the glands or in the branches that could not be removed owing to their deep locations within the mouth. Therefore, an endoscope was inserted, the stones were located intraductally using sialendoscopy, and a transcervical incision was made to remove the stones and preserve the submandibular gland. The stones were completely removed, and the submandibular gland was preserved in all cases. The patients recovered well postoperatively, and no complications developed. Our results suggest that sialendoscopy-assisted sialolithectomy is an effective and safe surgical technique for the removal of proximal and intraglandular submandibular gland stones. The patients' quality of life had obviously improved postoperatively.

Submandibular gland resection via subclavian into the road under the endoscope

Objective:To evaluate resection of submandibular gland through a minimal skin incision under the endoscope. Method:A retrospective analysis of the clinical data from 28 cases of submandibular gland resection by endoscope surgery via subclavian approach, 14 cases of preoperative diagnosis of pleomorphic adenoma, submandibular gland of chronic inflammation in 11 cases, 3 cases of the submandibular gland stone,one case of lymphatic cyst,all cases were evaluated by preoperative imaging or 3 d sonography. Result:All patients' submandibular gland and tumors were resected totally under the endoscope, no open surgery, no surgical complications, and postoperative aesthetic outcome was good, patients were satisfied, pleomorphic adenoma patients were postoperative followed up of 4 to 24 months, and no recurrence. Conclusion:Under the cavity mirror via subclavian path submandibular gland resection is safe and feasible, and has a good cosmetic effect.

内視鏡下に摘出した小児顎下腺唾石の1例

Although sailolithiasis generally occurs in the submandibular gland, submandibular stones rarely appear in children as compared with adults. We report a case of a submandibular gland stone in a child.