Salivary duct strictures: nature and incidence in benign salivary obstruction

OBJECTIVES

The aim of this study was to establish the incidence and character of salivary duct strictures by carrying out a 10 year retrospective review. Salivary gland obstruction is most commonly caused either by salivary calculi or duct strictures. These strictures or stenoses develop secondarily to inflammation in the duct wall and may be single or multiple.

METHODS

All reports of sialographic examinations performed on patients referred to the Dental Radiology Department in a London Dental Hospital between 1995 and 2004 were reviewed and those patients with symptoms of salivary obstruction identified. In total, 1362 sialograms using the conventional hand injection technique with water-soluble contrast media were performed on 1349 patients with obstructive symptoms during the 10-year period.

RESULTS

Of the 1362 sialograms performed, the reports revealed that 877 (64.4%) showed evidence of benign intraductal obstruction. The remaining 485 (35.6%) were normal. 642 of the cases (73.2%) revealing obstruction were reported to be due to salivary calculi, 198 due to duct strictures (22.6%) and the remaining 37 (4.2%) were considered to be due to mucous plugs. Detailed analysis of the patients with strictures showed they were more common in women with a mean age of 52 years. Single strictures were evident in 66.7% of cases while 33.3% showed multiple stenoses. Strictures were more common in the parotid duct (75.3%). 7% of patients presented with bilateral stenoses.

CONCLUSION

This is the largest review of duct strictures to be reported. It has shown that ductal stricture formation accounts for almost 25% of cases of benign salivary obstruction and appears to have been an under-recognized condition. Strictures more commonly affect parotid ducts and are typically found in the fourth, fifth or sixth decades, particularly in women.

Intra-oral removal of stones from the hilum of the submandibular gland: report of technique and morbidity

There is increasing evidence to show that the submandibular gland regains function after stone removal and sialoadenectomy may not be the treatment of choice for proximal calculi. A technique of hilar stone removal is described with results and morbidity reported in a series of 55 patients. Stones were retrieved in 54 patients (98%) but four glands (8%) were subsequently removed due to recurrent obstruction. There were no complications related to the procedure (nerve injury, bleeding, infection or scarring) and the morbidity was less than reported for sialoadenectomy.

Glandular function after intraoral removal of salivary calculi from the hilum of the submandibular gland

We studied 43 patients (25 women and 18 men) who had salivary calculi removed from the hilum of the submandibular gland. Preoperatively they had clinical and radiographic examinations, and glandular function was measured scintigraphically in 38 patients. Postoperative follow-up was based on history, clinical examination, structured questionnaire, and scintigraphy. Stone(s) were removed successfully in 42 patients (97%). During the follow-up of a mean of 24 months (range 4-47), 37 patients were symptom-free and 2 patients had mild obstructive symptoms that did not require intervention. The other 4 patients had repeated infections that necessitated removal of the gland under general anaesthesia. Preoperative and postoperative scintigraphic assessments were made in 37 patients (88%). There was a significant increase in the functional fraction and the excretion rate in the gland after removal of the calculus. We conclude that glandular function improves to varying degrees in most patients after the removal of a salivary calculus.

Multiple idiopathic external apical root resorption: report of four cases

Multiple idiopathic external root resorption is an unusual condition that may present in a cervical or an apical form. In this article, we review the published literature relating to multiple idiopathic external apical root resorption and present four clinical cases. We consider the aetiology of this condition and discuss the various treatment options.

Incidental findings on MRI of the temporomandibular joint

OBJECTIVES

The aim of this study was to determine the prevalence of incidental findings in MRI of the temporomandibular joint (TMJ).

METHODS

MRI reports of 730 patients were assessed. The reports were analysed by one consultant and one clinical lecturer in dental and maxillofacial radiology. The prevalence of intracranial and extracranial incidental findings was recorded and categorized.

RESULTS

There were 53 (7.3%) incidental findings, of which 11 (1.5%) were intracranial and 42 (5.7%) were extracranial (divided into paranasal sinuses, mastoid air cells, muscle hypertrophy, lymphadenopathy and salivary glands). A total number of eight intracranial findings needed further dedicated imaging and/or specialist clinical opinion. Only one tumour (a meningioma) was found and required surgical intervention.

CONCLUSIONS

Incidental findings on TMJ MRI are rare but not unheard of. The clinical relevance of incidental findings can be significant, and it is therefore important to ensure that the full data set of images is inspected, including any scout slices. A close working relationship between the areas of dental and maxillofacial radiology and neuroradiology is essential in expediting a second opinion relating to intracranial findings. All incidental findings should be communicated to referring clinicians in a timely manner, based on their urgency and clinical significance.

Ultrasound guided removal of an airgun pellet from a patient's right cheek

This case report describes the use of real-time intraoperative ultrasonography to guide the removal of an airgun pellet embedded in the right cheek of a 20-year-old man. This patient had previously undergone two unsuccessful surgical attempts to have this pellet removed via blind exploration. Through the use of ultrasonography, the pellet's positional relationship throughout the procedure was accurately defined with respect to important soft and hard anatomical structures, as well as to the surgical instruments used, enabling its very efficient removal. This technique is safe, easy, cost effective and accurate, and thus minimizes post-operative morbidity and the risk of surgical complications.