Submandibular Sialolithiasis Research Articles

Submandibular vascular hamartoma with phleboliths mimicking sialolithiasis

The differential diagnoses of radiopacities in the orofacial region include sialoliths, calcified lymph nodes, tuberculous nodes, and uncommon phleboliths. We report a case of a 37-year-old lady with intermittent unilateral left-sided submandibular swelling caused by a vascular hamartoma with phleboliths, which was initially diagnosed as submandibular sialolithiasis.

Submandibular Triangle Masses

The study aims to analyze the demographic data of a large case series operated on because of submandibular triangle mass for more than 10 years and presents a review of the literature. The charts of patients who underwent surgical intervention for submandibular triangle mass between January 2000 and November 2010 were reviewed. The medical history, age, sex, duration of symptoms, clinical presentation, preoperative investigations, and histopathologic diagnosis were reviewed. The study included 66 subjects; 12 patients (18.2%) with submandibular sialolithiasis, 18 patients (27.2%) with sialadenitis, 10 patients with lymphadenitis (15.1%), and 26 patients (39.3%) with tumors. Of the tumors, 23% was malignant and 77% was benign. Benign tumors of submandibular gland comprised 22.7% and malign tumors of submandibular gland comprised 3% of all submandibular mass. The most common benign tumor was pleomorphic adenoma. The most frequent histopathologic diagnoses of submandibular masses originated from the submandibular gland, and these comprised 71.2% of all submandibular mass pathologies. The main symptom was a painless mass. Ultrasonography was the most common preoperative diagnostic procedure. Fine-needle aspiration biopsy was performed in 26 patients. A clear diagnosis could not be provided in 3 (12%) patients. Infectious conditions and benign tumors are more frequent than malign tumors in the submandibular region. The histopathologic diagnoses mainly consisted of submandibular sialadenitis, sialolithiasis, pleomorphic adenoma, and lymphadenitis. Ultrasonography is the first option of radiologic evaluation. Fine-needle aspiration biopsy is a very useful and usually sufficient diagnostic procedure for histopathologic diagnosis. Excisional biopsy can be performed when the fine-needle aspiration biopsy failed.

Algorithm changes in treatment of submandibular gland sialolithiasis

Our research was conducted to determine the algorithm changes during the treatment of submandibular sialolithiasis. Two time periods were compared between 2004–2008 and 2009–2012. The turning point was December 2008, when sialendoscopy procedure was introduced. In the first period, 48 patients were treated: 31 outpatient duct incisions with stone evacuation and 17 surgical excision of submandibular gland. In the second period, 207 sialendoscopy procedures were performed on 197 patients. Out of this particular group, 158 patients were diagnosed with pathological obstruction of salivary glands and 64 of them were confirmed to have sialolithiasis of submandibular gland. Deposits of calcifications in 40 individuals (62.5 %) affected by sialolithiasis were removed endoscopically; however, in 21 patients, due to the increased circumference of the stone, the intimate association of deposits within the wall of the duct along with its presence inside the deep portions of the gland, double approach (incision of the floor of the mouth in hilar area and sialendoscopy) was performed. Three individuals had their salivary glands totally removed due to the presence of calcified deposits within the glandular parenchyma. Our results allow us to affirm that sialendoscopy is the current treatment of choice for submandibular glands affected by sialoliths. Indication for a complete removal of the gland is becoming uncommon as a first line treatment although still indispensable in chosen cases.

A retrospective case series illustrating a possible association between a widened hilum and sialolith formation in the submandibular gland

ObjectiveThe purpose of this study was to explore any association between anatomical variances in the ductal system and sialolith formation using sialoendoscopy and acrylic resin replication of the ductal system. MethodsA retrospective study of 372 submandibular gland sialoendoscopies was performed to review the findings of the submandibular gland duct anatomy. Using sialoendoscopy and replicated casts, a high rate of hilar widening was noted in patients with submandibular sialolithiasis. ResultsSialolithiasis was detected in 326 of the patients who presented with obstructive symptoms. Around 67% (285/426) of the stones were located in the distal third of the ducts or at the hilum of the submandibular gland. During the sialoendoscopic procedure, the anatomy of the ductal system was examined and 285/326 (87.4%) of the hilums were noted to be widened like a basin. The anatomy of the duct from the replicated casts demonstrated a treelike structure and the basin-like widening of the hilum was found in all the excised submandibular glands. ConclusionUsing sialoendoscopy, a high number of patients presenting with sialolithiasis in the submandibular gland seem to have an anatomical variance in the hilar region. The reproduced ductal system from excised glands also demonstrated this abnormal widening of the hilum. Although further studies need to be performed, we try and explain why there is such a high prevalence of hilar widening in patients with submandibular sialolithiasis.

Ultrasound Assessment after Submandibular Sialolithotomy

Objective: 1) To demonstrate the utility of ultrasound in the assessment of residual submandibular stones after endoscopic-assisted or purely open sialolithotomy. 2) To discuss limitations of using ultrasound for detection of sialolithiasis of the submandibular glands. Method: From August 2009 to January 2012, 22 adult patients with symptomatic submandibular sialolithiasis underwent endoscopic-assisted or purely open sialolithotomy in a tertiary-level clinic setting. Pre- and immediate postoperative ultrasound was performed. Outcomes included presence of residual stones/fragments and proximal ductal dilatation. Results: Twenty-two patients with symptomatic submandibular sialolithiasis refractory to sialendoscopic extraction underwent either endoscopic-assisted sialolithotomy or pure open sialolithotomy for proximally located stones. Three of 22 (13%) demonstrated residual stones on ultrasound immediately after sialolithotomy. Those patients underwent mandatory exploration at the time of the procedure, and 3 of 3 (100%) were demonstrated to have residual sialoliths/ fragments, which were successfully removed. Thirteen of 22 (59%) demonstrated proximal ductal dilatation after stone removal. There were no instances of infection, ductal stenosis, loss of glandular function, or permanent lingual nerve paralysis with follow-up ranging from 6 months to 1 year. Conclusion: After cases of endoscopic-assisted or open submandibular sialolithotomy, there is no widely used method to assess for residual stones. As a first, we propose that ultrasound is reliable not only for the presence of stones prior to treatment but also for the assessment of residual stones after submandibular sialolithotomy.

Ultrasound Localization during Submandibular Sialolithotomy

Objective: 1) To describe a novel office-based operative technique that has been demonstrated to be successful in stone localization and retrieval of proximally located submandibular sialoliths. 2) To demonstrate the feasibility of the technique and discuss its indications. Method: From August 2009 to January 2012, patients with symptomatic submandibular sialolithiasis underwent ultrasound needle localization and open sialolithotomy in a tertiary-level clinic setting. Outcomes included success of delivery, presence of infection, ductal stenosis, loss of glandular function, or lingual nerve paralysis. Independent variables included size and location of sialoliths. Results: Sixteen in-office cases of ultrasound-guided needle localization and open sialolithotomy were performed for patients who had failed sialendoscopy and stone extraction. Follow-up ranged from 6 months to 1 year. Sixteen of 16 (100%) were successful. The average size of sialoliths was 6.7 mm (range, 5-11 mm). Mean procedure time was 24 minutes (range, 18-42 minutes) from needle localization. There were no complications of infection, ductal stenosis, loss of glandular function, presence of additional sialoliths, or permanent lingual nerve paralysis. No patients had salvage submandibular sialadenectomy. Conclusion: After failing a purely endoscopic approach, proximally located sialoliths of the submandibular gland pose a problem for precise localization and treatment. Ultrasound has been demonstrated to be reliable for identifying sialoliths. We propose a novel technique and assert that ultrasound-guided needle localization is a reliable aid to effective transoral sialolithotomy.

Ultrasound Findings after Submandibular Sialolithotomy

Objective: 1) To demonstrate the utility of ultrasound in the assessment of the submandibular gland after endoscopic-assisted or purely open sialolithotomy. 2) To discuss limitations of using ultrasound for assessment after submandibular sialolithotomy. Method: From August 2009 to January 2012, 22 adult patients with symptomatic submandibular sialolithiasis underwent endoscopic-assisted or purely open sialolithotomy in a tertiary-level clinic setting. Pre- and immediate postprocedure ultrasound was performed. Examinations were analyzed for evidence of persistent obstruction. Results: Twenty patients with symptomatic submandibular sialolithiasis underwent either endoscopic-assisted sialolithotomy or pure open sialolithotomy for proximally located stones. Three of 22 (13%) demonstrated residual stones on ultrasound characterized by acoustic shadowing immediately after sialolithotomy and were retreated in the same setting with success. Fifteen of 22 (68%) demonstrated proximal ductal dilatation after stone removal. Eighteen of 22 (81%) demonstrated trace hyperechogenic foci without shadowing indicating air bubbles or blood. At 2 weeks, all findings had resolved. There were no instances of infection, ductal stenosis, loss of glandular function, or permanent lingual nerve paralysis with follow-up ranging from 6 months to 1 year. Conclusion: Ultrasound can be used to assess for residual obstruction immediately after submandibular sialolithotomy. Only the presence of posterior shadowing reliably predicted pathology. The presence of proximal ductal dilatation and hyperechogenic foci without shadowing take longer to resolve after sialolithotomy, and should not be used to influence treatment decisions during procedures.

Ağız İçine Spontan Açılan Büyük Submandibular Sialolitiazis: Olgu Sunumu

Introduction: Sialolithiasis is one of the most common disease of salivary glands. The incidence of the disease in adult population is 12/1000. However, most of the salivary gland stones occur on the submandibular gland and or its duct. Clinically, recurrent and painful swellings that affects the salivary gland or its duct can be seen. Material and Method: In this case report, a giant submandibular sialolithiasis that opened to the floor of the mouth spontaneously was presented. Conclusion: The treatment of sialolithiasis can varies according to the localization of the stone, duration of the symptoms and the size of the stone. In this case, the stone that erupted to the mouth spontaneously was removed surgically. Key words: Sialolithiasis; Submandibular Gland; Treatment.

Long-term Study of Sialodochoplasty for Preventing Submandibular Sialolithiasis Recurrence

ObjectivesThe transoral removal of stones by sialodochoplasty has been popularized in the treatment of submandibular sialolithiasis. However, the effectiveness of sialodochoplasty is controversial, and there are no reports on the long-term outcomes of this procedure. The purpose of this study was to assess the effectiveness and long-term outcomes of sialodochoplasty in patients with submandibular sialolithiasis.MethodsWe conducted a cross-sectional study that included retrospective chart reviews and prospective telephone or interview surveys of 150 patients treated for submandibular sialolithiasis from March 2001 to January 2008. The patients were treated with two different procedures by two different surgeons. One surgeon performed a transoral sialolithectomy without sialodochoplasty in 107 patients (SS group), and the other surgeon performed a transoral sialolithectomy with sialodochoplasty in 43 patients (SP group).ResultsThe success rate of transoral sialolithectomy was 98.1% in the SS group and 93% in the SP group. The recurrence rates of symptoms or stones were 1.9% and 4.7% in the SS and SP groups, respectively. The incidence of postoperative transient hypoesthesia was 13.1% in the SS group and 34.9% in the SP group. The mean operating times were 29.79 and 47.44 minutes in the SS and SP groups, respectively. The mean percentage of general anesthesia was 42.1% in the SS group and 83.7% in the SP group.ConclusionSialodochoplasty in addition to transoral sialolithectomy for submandibular sialolithiasis did not affect the rate of symptom or stone recurrence, but did increase the postoperative hypoesthesia incidence and general anesthesia percentage.

Unusual Cause of Orocutaneous Fistula in the Neck

A case of orocutaneous fistula secondary to submandibular sialolithiasis, which was masquerading clinically as branchial fistula is presented. This case highlights the importance of conducting fistulogram in the evaluation of discharging lesions in the neck.

Retrograde Sialendoscopy: A New Technique for Avoiding Retained Ductal Stones

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

ORGAN-PRESERVING MICROSURGERY IN THE TREATMENT OF PATIENTS SUFFERING FROM SIALOLITHIASIS

Sialolithiasis is one of the most frequent causes of salivary gland disorders. The main method of the management is surgical. The surgical operations can be performed externally and endorally at the extent of a complete or partial removal of the gland. The efficiency of the operation is defined by the absence of recurrent sialolithiasis and evidence of a surgical trauma. The article presents the characteristics of the traditional and newly developed methods of the surgical management of submandibular sialolithiasis.

Acute Sialadenitis Secondary to Submandibular Calculi After Botulinum Neurotoxin Injection for Sialorrhea in a Child with Cerebral Palsy

Children with cerebral palsy and other neurologic diseases often present with sialorrhea. Intraglandular botulinum neurotoxin is being increasingly reported to be clinically effective for the treatment of sialorrhea. This treatment is becoming more popular in recent years because of being less invasive than surgical procedures. In addition, fewer adverse effects have been documented compared with oral or topical anticholinergic medication. We report the first case in a child with cerebral palsy who developed serious acute sialadenitis with submandibular sialolithiasis after intraglandular botulinum neurotoxin injection for sialorrhea.

Etiologic Factors in Sialolithiasis

The purpose of this study was to investigate etiologic factors for sialolithiasis in a population of patients from the United States. Retrospective, cohort study. Tertiary university. Charts for all patients diagnosed with sialolithiasis between January 2001 and February 2010 were retrospectively reviewed. Demographic factors, smoking history, comorbid medical conditions, and medication history were recorded. Statistical analyses were then performed on the collected data. Population prevalences of smoking, diuretic usage, cholelithiasis, and nephrolithiasis were obtained through literature review. A total of 153 patients with sialolithiasis were identified. Of these patients, 125 (82%) had submandibular sialolithiasis, and 28 (18%) had parotid sialolithiasis. Positive smoking histories were present in 67 individuals (44%). Both the current rate of smoking and the rate of a history of smoking were higher in our cohort when compared with the general population, although the differences did not reach statistical significance. Smoking history did not correlate with the size of the primary sialolith. Diuretic usage in the cohort was observed at a rate of 20%, higher than reported population rates of diuretic use of 8.7%. The prevalences of cholelithiasis and nephrolithiasis were not different from observed population rates. Sialolithiasis is an uncommon condition of unclear etiology. This study represents an initial attempt to quantify the prevalence of smoking and diuretic therapy in a population of patients with sialolithiasis.

Mucosal Cyst Developing after Submandibular Sialolithiasis Surgery

Sialolithiasis refers to calculi forming where saliva is produced, with over 90% occuring in the submandibular gland. When saliva stagnates due to sialolithiasis, swelling develops and eating becomes painful. Symptoms are severe in the acute stage, but an asymptomatic state may persist. A 19-year-old woman with right submandibular sialolithiasis detected while she was in primary school developed an abscess that was not ameliorated in conservative treatment. An intraoral attempt to remove calculi released only pus. Despite temporary improvement, Wharton's duct was obstructed 2 months postoperatively, with impaired saliva outflow causing acute submandibular swelling. Computed tomography (CT) showed a huge mucosal cyst in the oral floor. The mandibular gland and cyst were removed by external incision.

Sialoendoscopically Assisted Open Sialolithectomy for Removal of Large Submandibular Hilar Calculi

The management of large hilar calculi is a technically challenging issue during sialoendoscopic surgery. The aim of the present study was to evaluate the clinical efficacy of sialoendoscopically assisted open sialolithectomy for the removal of large submandibular hilar calculi to avoid sialoadenectomy. The present study was undertaken among patients with sialolithiasis scheduled for sialoendoscopic surgery from August 2005 to October 2008. When we failed to remove large submandibular hilar stones intraductally, we performed sialoendoscopically assisted open sialolithectomy. The clinical characteristics, pre- and intraoperative data, and outcomes were documented in a prospective fashion. Of 78 consecutive patients with submandibular sialolithiasis, 18 were treated with sialoendoscopically assisted open sialolithectomy immediately after failure of intraductal removal of calculi by sialoendoscopy. For 17 patients, large hilar sialoliths were successfully removed using this surgical technique. The surgery failed in 1 patient with multiple sialoliths, and the procedure was converted to open sialoadenectomy. Temporary numbness of the tongue for 1 week postoperatively was documented in 3 patients. The patients were followed up for a median period of 18 months without any symptoms or signs of recurrence. Our results suggest that sialoendoscopically assisted open sialolithectomy is an effective and safe surgical technique to remove large submandibular hilar calculi.

Increased calcium and decreased magnesium and citrate concentrations of submandibular/sublingual saliva in sialolithiasis

Objective The purpose of the present study was to investigate the electrolyte alterations of submandibular/sublingual saliva in submandibular sialolithiasis patients compared with saliva from healthy controls. Design Submandibular/sublingual saliva was collected from 10 submandibular sialolithiasis patients and from 10 sex- and age-matched healthy controls. Ion chromatography was performed to determine the concentrations of inorganic cations (potassium, calcium, magnesium, and sodium), inorganic anions (chloride, phosphate, nitrate, and sulphate) and organic anions (thiocyanate, lactate, acetate, and citrate). Results The calcium concentration was significantly higher in sialolithiasis patients than in controls ( P < 0.05). In contrast, the levels of magnesium and citrate in the saliva of sialolithiasis patients were significantly reduced compared to the values obtained in controls ( P < 0.05). No significant differences were detected among other ions. Conclusions Our findings indicate that saliva electrolyte composition of sialolithiasis patients is substantially altered with respect to crystallisation mechanisms. Increased calcium ion as a crystallisation substance and decreased magnesium and citrate ions as crystallisation inhibitors may be involved in the etiopathology of calculi formation.

Acute upper airway obstruction caused by massive oedema of the tongue: unusual complication of sialoendoscopy

To underline the importance of accurate clinical evaluation of major salivary gland obstructions, in order to choose the right surgical approach and to reduce the risk of complications. We report a case of an unusual, previously unreported upper airway obstruction caused by massive swelling of the tongue following a successful sialoendoscopy, performed for treatment of submandibular sialolithiasis under general anaesthesia. Sialoendoscopy has gained popularity and is an accepted method for diagnosis and treatment of most inflammatory conditions of the major salivary glands. It can be performed as an out-patient procedure under local anaesthesia, and is not usually associated with significant complications. However, in the presence of larger stones (>4 mm) of the submandibular gland, we suggest that interventional sialoendoscopy should be performed under general anaesthesia with optimal airway control, in order to manage the major risk of perforations and ductal lesions enabling spread of saline solution into the mouth tissues and causing life-threatening swelling of the floor of the mouth and tongue.

Long‐term outcomes of intraoral submandibular stone removal in children as compared with adults

To investigate the long-term outcomes of intraoral submandibular stone removal in children as compared with those in adult patients. Retrospective clinical review. We retrospectively analyzed the medical records of 17 children and 48 adult patients who had undergone intraoral stone removal for submandibular sialolithiasis and followed up for more than 24 months. The mean durations of follow-up were 43.4 months and 49.4 months for children and adults, respectively. The long-term outcomes were compared between the two age groups. Intraoral submandibular stone removal achieved the status of "symptom-free" in 82.4% of child and 83.3% of adult patients. Recurrence in the affected gland was not found in any children but was found in two adult patients (4.2%). In pediatric patients with calculi around the hilum, a higher incidence (50%) of having long-term complaints was noted as compared with cases with calculi in the proximal and distal duct (P = .029). However, this difference was not evident in adult patients. Intraoral removal of submandibular stones is an effective treatment option with an acceptable long-term outcome for children. Nevertheless, in cases with calculi around the hilum, a careful surgical approach is required.

術前診断に苦慮した顎下腺海綿状血管腫の１例

Cavernous hemangiomas rarely arise in the submandibular gland. We report a case of cavernous hemangioma in the submandibular gland that had atypical clinical symptoms and imaging findings.A 27-year-old man presented with intermittent pain and swelling in the right submandibular region in August 2007. Three years 6 months ago the patient had had colicky pain during a meal and was given a diagnosis of submandibular sialolithiasis at another university hospital. Extraoral examination revealed an elastic soft mass with well-demarcated borders in the right submandibular region. On oral examination, salivation from the right Wharton's duct was normal, and other findings were unremarkable. MRI demonstrated a well-demarcated tumor in the submandibular gland, which showed low-signal intensity on Tl-weighted images and heterogeneous highsignal intensity on T2-weighted images. Enhanced CT showed a poorly-defined intraglandular lesion and enlarged submandibular and upper jugular lymph nodes. On the basis of these preoperative findings, a malignant tumor was included in the differential diagnosis. The submandibular gland was extirpated to remove the tumor with intraoperative frozen section examination in October 2007. The tumor was histopathologically diagnosed as a cavernous hemangioma with chronic sialadenitis.Factors such as the characteristic blood flow of the cavernous hemangioma and the intraglandular location of the tumor may have caused the atypical features of this case.