New modalities in the management of human sialolithiasis

Extracorporeal Shock Wave Lithotripsy of Submandibular Stones: Evaluation after 10 Years

The use of extracorporeal shock waves in the treatment of submandibular stones is a minimally invasive approach for the treatment of this disease. Its clinical significance has been determined in a long-term retrospective study, performed as follow-up to the short-term results. From 1989 to 1994, 197 patients (88 female, 109 male; age range, 8 to 83 years) with symptomatic, sonographically detectable concretions of the submandibular gland were treated with extracorporeal shock wave lithotripsy. The review analysis was completed retrospectively in 2002 and included 191 patients with complete data. The period under review ranged from 8 to 13 years, with an average of 10.5 years. Altogether, 67 of the 191 patients (35%) either were free of stones or had no more symptoms from the residual sialoliths. Another 15% had a significant improvement in their symptoms and required no further therapy. The remaining 95 patients (50%) had residual stones; they had no symptoms in the short review period, but have had symptoms since. The therapeutic success was not influenced by the stone size, but rather by the stone location within the gland. After therapy, no severe side effects were identified. Extracorporeal shock wave lithotripsy is a possible treatment for stones in the submandibular gland. In combination with other gland-preserving methods, it now forms part of a multitherapeutic approach that renders submandibulectomy unnecessary in the majority of cases.

CT Scan as an Essential Tool in Diagnosis of Non-radiopaque Sialoliths

Sialolithiasis is the second most common disease of the salivary glands and the main cause of salivary gland obstruction. Diagnosis of calculi/sialoliths can be made by means of an elaborate history, precise clinical examination and radiographic support. But all sialoliths do not present with predictable signs and symptoms and radiographic appearance. Sialoliths have a variety of manifestations and they may or may not be radiopaque. Non-radiopaque sialoliths are difficult to diagnose radiographically. Although newer techniques like CBCT, CT virtual sialandoscopy and established techniques like sialography, xeroradiography can be useful in selected cases. A regular CT scan is an excellent tool in the diagnosis of a non-radiopaque sialolith and associated salivary gland changes. CT scan should be considered as an important tool of imaging for diagnosis, treatment planning and follow-up of all cases of sialoliths and associated pathologies of the salivary gland.

Salivary Fistula with a Calculus!!

Orocutaneous fistula is a pathologic communication between the oral cavity and cutaneous surface. Orocutaneous fistula can occur because of dental infections, salivary gland lesions, neoplasms, or branchial fistula. Overwhelming majority comprises of parotid fistula, submandibular fistula is indeed a rare finding. We report a very unusual case of a large calculus in submandibular gland with a communicating neck fistula.

How to cite this article

Rangappa VB, Soumya MS, Sreenivas V. Salivary Fistula with a Calculus!! Int J Head Neck Surg 2014;5(2):96-98.

Proteomic and scanning electron microscopic analysis of submandibular sialoliths

OBJECTIVES

Several theories have been proposed regarding the genesis of sialoliths, including the organic core theory, which suggests epithelial or bacterial etiology originating in the central core. Our aim was to use novel methodologies to analyze central areas (the core) of calculi from sialolithiasis patients.

MATERIALS AND METHODS

The structures of the halves of six submandibular salivary stones were analyzed by scanning electron microscopy (SEM). After structural analysis, from the other six halves, samples from the central parts of the core and peripheral parts of the core were digested with trypsin and analyzed by matrix-assisted laser desorption ionization-time of flight mass spectrometry. The peptide mass fingerprints were compared with the results of in silico digestion.

RESULTS

SEM analysis of the sialoliths showed that organic structures (collagen/fibrous-like structures, bacterial fragments) were visible only outside of the core in the concentric layers of external areas, but not in the core area. The mass spectrometry (MS)/MS post-source decay experiments were completed from the four, most intense signals observed in the MS spectrum and human defensin was proven to be present in three of the examined samples, originated from the peripheral region of three cores.

CONCLUSIONS

Although proteomic analysis demonstrated defensin protein in the peripheral region of the core in three sialoliths, SEM failed to prove organic structures in the core.

CLINICAL RELEVANCE

New investigation modalities still cannot prove organic structures in the core, henceforward challenging the organic core theory.

Oversized submandibular gland sialolith: a report of two cases

Sialolithiasis is a very common reason in causing obstructive salivary gland disease. Its incidence in males is more than females and children. They usually occur in submandibular ducts or gland and are 1 mm to less than 1 cm and rarely more than 1 cm. If they are more than 15 mm then, are termed as sialoliths of unusual size or giant sialoliths. The literatures have reports of up to 3.5 to 7 cm stones and are rare. The management includes removal of stone and re-channelizing the secretions in a functional gland or excision of gland in atrophied glands along with stone.

Long-term Study of Sialodochoplasty for Preventing Submandibular Sialolithiasis Recurrence

OBJECTIVES

The 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.

METHODS

We 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).

RESULTS

The 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.

CONCLUSION

Sialodochoplasty 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.

A Large Sialolith Perforating the Wharton's Duct: Review of Literature and a Case Report

Sialolithiasis accounts for the most common cause of diseases of salivary glands. The majority of sialoliths occur in the submandibular gland or the Wharton's duct. This article discusses review of literature, predisposing factors, signs and symptoms, diagnostic methods and various modalities available for the management of sialolithiasis. This case report presents a case of sialolith of a large size in the left Wharton's duct, which was explored and removed via an intra-oral approach.

Technology of sialendoscopy

Technical developments have taken place since the first endoscopes suitable for sialendoscopy appeared. Now, a variety of endoscopes are available. Ranging from rigid to flexible, each type has its own properties. Light sources, imaging, recording instrumentation, and other equipment used with the endoscopes facilitate or extend the range of their use. Experiences using different endoscopes in more than 300 endoscopies are discussed.

Spectroscopic and thermal analysis of a submandibular sialolith of Wharton’s duct resected using Nd:YAG laser

A sialolith observed in the Wharton's duct of a male patient was resected using an Nd:YAG laser. This is the first report on the resection of sialolith using laser. The resected sample was analyzed for structural details using Fourier transform infrared (FTIR), FT-Raman, and fluorescence spectroscopic techniques. Other techniques like energy dispersive X-ray analysis, scanning electron microscopy, and thermal analysis were also used for the analysis of structural details. The major peaks of the vibrational spectra are observed to be due to the vibrations of the phosphate and hydroxyl groups of the inorganic part of the sample and the proteinaceous component of the organic part. The major elements in the sample are identified as calcium and phosphorous in the ratio 7:3. The fluorescence spectra recorded at excitation wavelengths 280, 325, and 410 nm showed emission maxima corresponding to the endogenous fluorescence of structural proteins and amino acids. The inorganic part of the sialolith remained stable even at temperatures up to 1,673 K. The spectroscopic studies indicated that the structure of the sialolith is similar to that of the dentine part of the human teeth. In situ disintegration of the sialolith involves very high temperature. High calcium and phosphorous content in the food may be attributed to one of the reasons for the formation of sialoliths.

Sialoscopy—initial experiences with a new endoscope

BACKGROUND

After the introduction of mini-endoscopes for the diagnosis of swelling of the major salivary glands there has been further development of materials and techniques. A new highly flexible semirigid sialoendoscope with high quality imaging (6000 pixels), an outside diameter of 1.1 mm, a working channel of 0.4 mm, and a separate channel for irrigation has been developed and we examined its clinical value.

METHODS

We used the endoscope in 22 patients for diagnosis and treatment.

RESULTS

Sialoendoscopy was achieved after dilatation of the papilla in all cases. The image (both in contrast and resolution) was excellent. We found sialolithiasis in 13, stenosis in 3, and sialodochitis in 3. Through the working channel we were able to insert instruments with success in seven cases with pathological findings. One patient developed a complication.

Sialolithiasis: an unusually large submandibular salivary stone

Salivary gland calculi account for the most common disease of the salivary glands. The majority of sialoliths occur in the submandibular gland or its duct and are a common cause of acute and chronic infections. This case report describes a patient presenting with an unusually large submandibular gland sialolith, the subsequent patient management, the aetiology, diagnosis and various treatment modalities available for management of salivary gland calculi depending on their site and size.

Extracorporeal shock wave lithotripsy of parotid stones. Results of a prospective clinical trial

The extracorporeal shock wave treatment of parotid stones is a rather new therapy. Its usefulness was determined in a prospective study. Seventy-six patients (36 female, 40 male, 2 to 80 years of age) with symptomatic, sonographically detectable solitary sialoliths of the parotid gland were treated with an extracorporeal piezoelectric shock wave therapy after unsuccessful conservative therapy (sialagogues, gland massage, bougienage of the secretory duct). At most, 3 treatments per patient were performed. Altogether, 38 of the 76 patients (50%) were free of stones and no longer suffered from complaints after completion of shock wave treatment and a mean follow-up period of 48 months (range 6 to 71 months). During the follow-up period, in no case could renewed stone formation be observed. Residual stone fragments were detectable in 20 patients (26%), but did not cause further symptoms. Thirteen patients (17%) with residual stone fragments stated a significant improvement of their complaints after therapy. Five patients (7%) did not observe any changes of their pretherapeutic complaints and underwent parotidectomy. The therapeutic success was not influenced by stone size or by stone localization within the gland. During the follow-up period, no side effects of the therapy were identified. With stones of the parotid gland, extracorporeal shock wave lithotripsy is -- after one has used conservative therapies (sialagogues, gland massage) -- the treatment of choice, avoiding in the majority of cases a parotidectomy with its operative risks (paresis of the facial nerve, Frey's syndrome).

Nonlinear absorption: intraocular microsurgery and laser lithotripsy

The paper reviews the principles of nonlinear absorption with reference to the present major clinical applications of plasma-mediated effects: intraocular microsurgery and laser lithotripsy. Emphasis is laid on the analysis of the working mechanisms, sources of collateral damage, and on strategies for both the optimization of efficacy and the minimization of side effects.