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Tirillini F, Baines SJ, Baines E, Robinson W. Computed tomographic findings in two dogs with chronic unilateral parotid duct ectasia. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Goncalves M, Mantsopoulos K, Schapher M, Iro H, Koch M. Ultrasound in the diagnosis of parotid duct obstruction not caused by sialolithiasis: diagnostic value in reference to direct visualization with sialendoscopy. Dentomaxillofac Radiol 2021; 50:20200261. [PMID: 33002385 PMCID: PMC7923063 DOI: 10.1259/dmfr.20200261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/09/2020] [Accepted: 09/24/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the diagnostic value of ultrasound in the obstructive pathology of the parotic gland not caused by sialolithiasis using sialendoscopy as reference standard. METHODS Retrospective analysis of all patients who presented with suspected diagnosis of obstructive ductal pathology of the parotid gland other than sialolithiasis between January 2011 and December 2017. 538 patients, for a total of 691 parotid glands were included in the study. Ultrasound was performed, followed by sialendoscopy in all cases. Duct diameter and parenchyma echogenicity were assessed. Direct sialendoscopic examination of the parotid duct was regarded as the reference standard. RESULTS Parotid glands with normal sialendoscopic findings (21.6%, n = 149) had a duct diameter of 0.3 mm (0-2.7 mm) and homogeneous hyperechoic parenchyma on ultrasound in 98.7%. Ductal inflammation/sialodochitis (32.9%, n = 227) on sialendoscopy had significantly larger ductal diameter of 0.7 mm (0-4.3 mm, p = 0.001) and hypoechoic parenchyma in 78.0% (p < 0.001). Parotid glands with stenosis (45.6%, n = 315) had hypoechoic parenchyma in 52.6% and a ductal diameter of 4.1 mm (0-19.0 mm; p = 0.001). The ductal diameter was ≥2.7 mm in 95.6% of the stenosis (AUC 0.886, p = 0.001). Using 5.1 mm as benchmark ductal diameter, stenosis with ductal anomaly (68/315) were identifiable with a sensitivity of 92.6% and a specificity of 96.8% (AUC 0.986, p = 0.001). CONCLUSION Ultrasound parameters can be used to distinguish different types of obstructive ductal pathology of the parotid gland, supporting the use of this imaging modality as diagnostic tool of first choice.
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Affiliation(s)
- Miguel Goncalves
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen–Nuremberg, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen–Nuremberg, Erlangen, Germany
| | - Mirco Schapher
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen–Nuremberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen–Nuremberg, Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen–Nuremberg, Erlangen, Germany
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Abstract
A 3yr old spayed female Brittany was referred with a cylindrical mass on the right side of her face. Three months earlier, a small stone embedded in the right parotid duct was noted and removed through a ductal incision by the referring veterinarian. At referral, the dog's general physical condition was normal except for a cylindrical mass on the right cheek. Skull radiographs showed a possibly retained sialolith or dystrophic mineralization within the previous surgical site. Aspiration of the mass yielded a thick, yellow/tan, mucopurulent fluid. Cytology of the fluid demonstrated degenerative neutrophils without bacteria. The cylindrical mass was excised with a carbon dioxide laser. The caudal end of the mass was connected to the parotid salivary gland and the rostral one-third of the mass tapered to a point. The caudal end of the mass was ligated with 3-0 polydioxanone and excised immediately rostral to the ligation. Histopathology revealed that the mass was parotid duct ectasia. The dog completely recovered with some mild temporary facial paresis and had no recurrence of parotid duct ectasia at 4 mo follow-up. The case report describes a dog with an unusual parotid salivary duct ectasia caused by parotid duct sialolith removal.
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Affiliation(s)
- Hyun-Jung Han
- From the Department of Veterinary Surgery, College of Veterinary Medicine (H-Y.Y.), and Department of Veterinary Emergency Medicine, Konkuk Veterinary Medical Teaching Hospital (H-J.H.), Konkuk University, Seoul, South Korea; and Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri (F.A.M.)
| | - F A Mann
- From the Department of Veterinary Surgery, College of Veterinary Medicine (H-Y.Y.), and Department of Veterinary Emergency Medicine, Konkuk Veterinary Medical Teaching Hospital (H-J.H.), Konkuk University, Seoul, South Korea; and Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri (F.A.M.)
| | - Hun-Young Yoon
- From the Department of Veterinary Surgery, College of Veterinary Medicine (H-Y.Y.), and Department of Veterinary Emergency Medicine, Konkuk Veterinary Medical Teaching Hospital (H-J.H.), Konkuk University, Seoul, South Korea; and Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri (F.A.M.)
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Goncalves M, Mantsopoulos K, Schapher M, Iro H, Koch M. Ultrasound in the Assessment of Parotid Duct Stenosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2935-2943. [PMID: 30907015 DOI: 10.1002/jum.14999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/03/2019] [Accepted: 02/24/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Parotid duct stenosis may occur with or without accompanying ductal anomalies, with associated differences in their pathogenesis and management. By identifying the characteristics of a stenosis, ultrasound (US) can assist in tailored management of parotid duct stenosis. The objective of this study was therefore to describe the US characteristics of parotid duct stenoses and to evaluate criteria for whether and in what ways these can be distinguished from each other by using US. METHODS A total of 108 patients who presented with parotid duct stenoses (130 parotid glands) were examined with high-resolution US between 2014 and 2017. The stenoses were assessed for duct dilatation, location, signs of ductal anomalies (circular encroachments/webs, duct bending/kinking, and presence of a megaduct) and the echogenicity of the gland parenchyma. RESULTS Ultrasound was able to distinguish between stenoses associated with ductal anomalies and those without anomalies. Webs (82.5% versus 7.8%; P < .001), kinking (75.0% versus 3.3%; P < .001), and a megaduct (87.50% versus 15.63%; P < .001) and a tendency toward normal echogenicity in the gland parenchyma (77.5% versus 25.6%; P < .001) were significantly associated with ductal anomalies. Stenoses associated with ductal anomalies also had significantly larger duct diameters in comparison with those without anomalies (mean ± SD, 9.19 ± 3.65 versus 3.27 ± 2.17 mm; P < .001). CONCLUSIONS This study describes US parameters that allow more detailed characterization of parotid stenoses with or without accompanying ductal anomalies. Differentiating between these at an early stage may be helpful for decision making on the further management in these patients.
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Affiliation(s)
- Miguel Goncalves
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Mirco Schapher
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Koch M, Iro H. Salivary duct stenosis: diagnosis and treatment. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:132-141. [PMID: 28516976 PMCID: PMC5463521 DOI: 10.14639/0392-100x-1603] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
Abstract
The management of stenoses of the major salivary glands had undergone a significant change during the last 15-20 years. Accurate diagnosis forms the basis of adapted minimal invasive therapy. Conventional sialography and MR-sialography are useful examination tools, and ultrasound seems to be a first-line investigational tool if salivary duct stenosis is suspected as cause of gland obstruction. Sialendoscopy is the best choice to establish final diagnosis and characterise the stenosis in order to plan accurate treatment. In all major salivary glands, inflammatory stenosis can be distinguished from fibrotic stenosis. In the parotid duct system, an additional stenosis associated with various abnormalities of the duct system has been reported. Conservative therapy is not sufficient in the majority of cases. The development of a minimally invasive treatment regime, in which sialendoscopy plays a major role, has made the preservation of the gland and its function possible in over 90% of cases. Ductal incision procedures are the most important measure in submandibular duct stenoses, but sialendoscopy becomes more important in the more centrally located stenoses. Sialendoscopic controlled opening and dilation is the dominating method in parotid duct stenoses. In 10-15% of cases, success can be achieved after a combined treatment regime had been applied. This review article aims to give an overview on the epidemiology, diagnostics and current state of the art of the treatment of salivary duct stenoses.
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Affiliation(s)
- M Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen, Nuremberg, Germany
| | - H Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen, Nuremberg, Germany
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Vatin L, Foletti JM, Collet C, Varoquaux A, Chossegros C. A case of bilateral megaducts: Diagnostic and treatment methods. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:125-128. [PMID: 28345516 DOI: 10.1016/j.jormas.2017.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/20/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The pathology of the saliva glands comprises both tumoral and obstructive disorders. The latter include lithiasis, stenosis and megaduct. In this paper, we describe a clinical case of bilateral megaduct, a rare pathology, using sialo-MRI imaging and a conservative diagnostic-cum-therapeutic technique, sialendoscopy with dilation followed by catheterization. CLINICAL CASE Our female patient presented oversized parotids with an unsightly deformation of the face (parotid ducts visible beneath the skin) and itchy cheeks, from which she had suffered for several years. Sialo-MRI revealed bilateral hypertrophied parotid saliva glands. We opted to perform diagnostic sialendoscopy to explore the branches of the salivary gland system and found ducts shaped like strings of sausages associated with mucous plugs. The treatment procedure was combined with rinsing of both parotid ducts in physiological serum followed by initiation of antibiotic-corticotherapy within the saliva ducts and, lastly, by placement of transpapillary drains, which were left in place for 10 days. Immediately following the procedure, the patient felt a considerable improvement regarding both local discomfort and her cheek deformation. Postoperative control at 10 weeks by sialo-MRI confirmed the reduction of the dilation of the salivary ducts. At 3 months, the patient continued to display a marked clinical improvement despite her saliva retaining a thick consistency. She no longer suffered from pruritis or deformation of the cheeks. DISCUSSION Sialendoscopy could become the reference treatment tool since it is both efficient and conservative. Duration of her postoperative catheterization remains to be defined.
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Affiliation(s)
- L Vatin
- Oral and Maxillofacial Department, pôle PROMO, Hospital de La Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - J M Foletti
- Oral, Maxillo-Facial & Plastic Surgery Department, Hospital Nord, chemin des Bourrelys, 13015 Marseille, France; Radiology department, Hospital de La Conception, 147, Boulevard Baille, 13005 Marseille, France
| | - C Collet
- Oral and Maxillofacial Department, pôle PROMO, Hospital de La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix-Marseille University, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille cedex 07, France
| | - A Varoquaux
- Radiology department, Hospital de La Conception, 147, Boulevard Baille, 13005 Marseille, France; Aix-Marseille University, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille cedex 07, France
| | - C Chossegros
- Oral and Maxillofacial Department, pôle PROMO, Hospital de La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix-Marseille University, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille cedex 07, France; Parole et Langage Laboratory (LPL), UMR 6057, Pr N.N'Guyen, 13100 Aix-en-Provence, France
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Gardhouse S, Guzman DSM, Petritz OA, Mok MY, Mohr FC, Tong N, Sadar M, Salinger ED, Steffey MA. Diagnosis and Treatment of Sialectasis in a Domestic Rabbit (Oryctolagus cuniculus). J Exot Pet Med 2016. [DOI: 10.1053/j.jepm.2015.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lee DH, Yoon TM, Lee JK, Lim SC. Congenital dilatation of Stensen's duct in siblings. Int J Pediatr Otorhinolaryngol 2015; 79:1952-4. [PMID: 26347191 DOI: 10.1016/j.ijporl.2015.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/19/2015] [Accepted: 08/21/2015] [Indexed: 11/28/2022]
Abstract
Congenital dilatation of the Stensen's duct is an extremely rare disease, which may have a hereditary background. However, there are no reports about the familial occurrence of congenital Stensen's duct dilatation. Herein, we present the first case of congenital dilatation of Stensen's duct in siblings. Therefore, we suggest that congenital dilatation of the Stensen's duct is an extremely rare hereditary disorder.
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Affiliation(s)
- Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Tae Mi Yoon
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Joon Kyoo Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, South Korea.
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Hwasun, South Korea
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Lohia S, Joshi AS. Idiopathic sialectasis of the Stensen's duct treated with marsupialisation. BMJ Case Rep 2013; 2013:bcr2013201548. [PMID: 24234433 PMCID: PMC3830397 DOI: 10.1136/bcr-2013-201548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Sialectasis is an uncommon medical condition of the salivary glands. Conservative treatments of sialectasis include repeated aspiration, compression, dilation of the papilla and stent placement. This is the first reported case that we know of, using marsupialisation for distal sialectasis. Our case highlights the diagnostic and therapeutic challenges posed by sialectasis and demonstrates the efficacy of marsupialisation for distally based sialectasis when conservative treatments fail.
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Yoruk O, Kılıc K, Kantarcı M. "Mustache sign" due to Stensen duct dilation. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e514-6. [PMID: 24209996 DOI: 10.1016/j.oooo.2013.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 07/31/2013] [Accepted: 08/05/2013] [Indexed: 11/15/2022]
Abstract
An 80-year-old woman presented with a 5-year history of painless swellings of the left and right cheeks. The degree of swelling did not change with mastication. On palpation, the cheeks were soft, well defined, and movable. Compression and massage of the swollen areas caused increased salivary discharge from the orifices of the Stensen ducts. Three-dimensional computed tomography showed well-bordered, 15- to 20-mm wide, bilateral, tube-like dilatations of the ducts. The ductal origin of the swellings was explained to the patient, but she refused invasive procedures, thus no sialogram or surgical procedure was performed. We describe the clinical and radiographic features of a case of bilateral, congenital Stensen duct dilatation with bilateral swelling of the cheeks.
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Affiliation(s)
- O Yoruk
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
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