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Nahlieli O. Thirty years of experience and current trends in the management of sialolithiasis: a narrative review. Br J Oral Maxillofac Surg 2025; 63:270-275. [PMID: 40157895 DOI: 10.1016/j.bjoms.2025.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2025] [Accepted: 02/21/2025] [Indexed: 04/01/2025]
Abstract
Current trends in the management of sialolithiasis include a proper diagnosis with the help of a differential diagnosis. Cone beam computed tomography may be a good choice for detecting sialoliths because it is more sensitive than sonography. A practitioner should collect precise information about the stone in question, which includes the exact location of the calculus, its size and volume, and the number of calculi in a given case. For submandibular calculi, the orientation of the stone's location against the gonion and the inferior edge of the mandible creates the system of coordinates almost in a geographical fashion. The next step is management planning, and a proper surgical approach may be selected from a comprehensive list of available techniques. If the sialoendoscopic removal of calculi via ducts is impossible, endoscopy-assisted, ultrasound (US)-guided, or unassisted intraoral surgery, extracorporeal shock-wave lithotripsy (ESWL), a combination of the ESWL with the sialoendoscopy, and endoscopy-assisted ductal stretching procedure are our options. Measures must be taken to avoid or minimise postsurgical complications. The development of our knowledge, skills, diagnostic arsenal, and surgical approaches to sialolithiasis cases over the last hundred years is impressive. However, there is still room for further improvement. Some problems in diagnostics, calculus assessment, and surgical approaches require additional research.
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Affiliation(s)
- Oded Nahlieli
- Endoscopic and Minimal Invasive Oral and Maxillofacial, Department at the Galilee Medical Center Naharia Israel and Department of Oral and Maxillofacial Surgery at the Assuta Ramat Hachial Medical Center Tel Aviv and Eastman Institute for Oral Health University of Rochester, Rochester, NY, USA.
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2
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Özçelik N, Vehbi H, Alaskarov E. Submandibular sialolithiasis treatment: a comparative pilot prospective study of holmium: YAG laser and pneumatic lithotripsy techniques. Eur Arch Otorhinolaryngol 2025:10.1007/s00405-025-09309-9. [PMID: 40087169 DOI: 10.1007/s00405-025-09309-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Accepted: 02/17/2025] [Indexed: 03/17/2025]
Abstract
OBJECTIVE Sialendoscopy is a minimally invasive technique employed to diagnose and treat obstructions in the major salivary glands.Holmium: YAG Laser Lithotripsy (HLL) and Intraductal Pneumatic Lithotripsy (IPL) are increasingly utilized for stone fragmentation; however, comparative studies are still limited. This study aims to prospectively compare the outcomes of HLL and IPL in cases of submandibular sialolithiasis. MATERIALS AND METHODS Fifty patients diagnosed with submandibular sialolithiasis were randomly assigned to two groups for treatment with either HLL or IPL. Demographics, stone size and location, operative times, and complications were meticulously documented. Preoperative imaging with ultrasound and computed tomography identified stone parameters. Follow-up assessments occurred at 1 week, 3 months, and 6 months post-treatment, which included a 3-month ultrasound to evaluate for residual stones and assess ductal evaluation. RESULTS No significant differences between the groups concerning demographics, stone size, or location (p > 0.05). However, the IPL group demonstrated shorter operative times for distal and mid-duct stones (p < 0.05). The stone-free rates were 92% in the HLL group and 96% in the IPL group. The HLL group exhibited higher rates of mucosal laceration and ductal perforation, while the IPL group showed a greater potential for stone migration. Postoperative symptom resolution was achieved in both groups. Additionally, quality of life (QOL) scores, assessed using the SF-36 questionnaire, showed significant improvement at 6 months postoperatively in both groups, with no statistically significant differences between them. CONCLUSION Both HLL and IPL are effective treatments for submandibular sialolithiasis. IPL is associated with shorter operative times, especially for distal and mid-duct stones, while the complication rates for both methods remain within acceptable limits.
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Affiliation(s)
- Necdet Özçelik
- Department of Otorhinolaryngology, İstanbul Medipol University Health Care Practice and Research Center Esenler Hospital, İstanbul, Turkey.
| | - Husam Vehbi
- Department of Radiology, İstanbul Medipol University Health Care Practice and Research Center Esenler Hospital, İstanbul, Turkey
| | - Elvin Alaskarov
- Department of Otorhinolaryngology, İstanbul Medipol University Health Care Practice and Research Center Esenler Hospital, İstanbul, Turkey
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Su LW, Sun H, Zhang HY, Wu Y. Large recurrent sialoliths in a residual Wharton duct after sialoadenectomy: Two case reports and literature review. Medicine (Baltimore) 2025; 104:e41231. [PMID: 39792733 PMCID: PMC11729627 DOI: 10.1097/md.0000000000041231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 12/19/2024] [Indexed: 01/12/2025] Open
Abstract
RATIONALE When gland-preserving treatments are unsuccessful, sialoadenectomy is typically conducted for patients afflicted with submandibular gland diseases. The definitive treatment modality for these individuals is the removal of both the gland and the associated ducts. During surgery, the gland and the majority of the ducts can be excised utilizing the lateral transcervical approach, with residual ducts unlikely to develop pathology. After sialoadenectomy, the recurrence of salivary gland stones is extremely rare. Although there are some relevant speculations, to the best of our knowledge, there are no comprehensive reports of larger recurrent stone-related cases available. PATIENT CONCERNS We present 2 instances of recurrent sialoliths in the residual Wharton duct following sialoadenectomy. In our cases, it was not until several years later that both patients presented with symptoms. The patients, a 51-year-old male and a 28-year-old female, presented with swelling and purulent discharge in the right floor of the mouth. DIAGNOSES Computed tomography scans revealed irregular high-density masses in the floor of the mouth, indicative of sialolithiasis. INTERVENTIONS The intraoral incision exposed the recurrent sialoliths, which were successfully removed along with the residual duct. OUTCOMES There were no complications in both cases. LESSONS This report aims to clarify potential mechanisms behind recurrent sialoliths in residual Wharton ducts after submandibular gland excision, warranting further investigation to improve patient management. New stones may form again in the residual duct even if the glands were removed. With the risk of recurrent sialoliths after resection of the gland, multiway preventive management can optimize outcomes.
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Affiliation(s)
- Li-Wen Su
- Department of Oral and Maxillofacial Surgery
| | - Huan Sun
- Department of General Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | | | - Yang Wu
- Department of Oral and Maxillofacial Surgery
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Chopra V, Singh PP, Arora V. To Evaluate the Success of Sialendoscopy Assisted Intraoral Approach for Removal of Submandibular Hilar Stones. Indian J Otolaryngol Head Neck Surg 2025; 77:135-142. [PMID: 40070995 PMCID: PMC11890793 DOI: 10.1007/s12070-024-05126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 10/05/2024] [Indexed: 03/14/2025] Open
Abstract
To assess the success of sialendoscopy assisted intraoral approach for removal of hilar stone of submandibular gland. To evaluate the ductal system for any concomitant pathology. Conventionally the treatment for submandibular hilar stones has been gland excision. Being an open procedure, sialadenectomy has its own range of complications. After the advent of sialendoscopy there has been a paradigm shift in the management of hilar stones. The current study was done to evaluate the success of sialendoscopy assisted intraoral approach for removal of submandibular hilar stones. The sample size was 30. A diagnostic sialendoscopy was performed followed by intraoral dissection using "the surgical triangle approach" defined by Park et al. The light of sialendoscope was used as a marker of intraoral incision which was given lateral to sublingual gland in the floor of mouth corresponding to the last three teeth. The surgical triangle was exposed which was bounded by the lingual nerve, medial border of mandible and posterior border of mylohyoid muscle. The hilum lies within this triangle and hence incision was given on the duct and stone retrieval was done. 88.8% of palpable submandibular hilar stones and 66.7% of the non palpable stones could be removed. 87.5% of hilar stones and 83.3% of hiloparenchymal stones could be removed. 86.7% of the glands can be preserved by this approach for management of large submandibular hilar and hiloparenchymal stones. Using this approach non palpable stones can also be removed.
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Affiliation(s)
- Vidhi Chopra
- Department of Otolaryngology and Head and Neck Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - P. P. Singh
- Department of Otolaryngology and Head and Neck Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Vipin Arora
- Department of Otolaryngology and Head and Neck Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Capaccio P, Lazzeroni M, Torretta S, Solimeno LS, Cristofaro V, Proh M, Cammaroto G, Meccariello G, Vicini C, Pignataro L. Transoral robotic salivary surgery for hilar\parenchymal submandibular stones. Front Surg 2024; 11:1471207. [PMID: 39583550 PMCID: PMC11582058 DOI: 10.3389/fsurg.2024.1471207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 10/16/2024] [Indexed: 11/26/2024] Open
Abstract
Objectives A prospective interventional study was designed to describe our series of patients with submandibular stones undergoing sialendoscopy-assisted TORSS (trans-oral robotic salivary surgery) by means of Si or Xi Da Vinci robotic system between January 2019 and June 2023, in order to assess safety and effectiveness of the procedure. Methods 54 adult patients with submandibular stones undergoing sialendoscopy-assisted TORSS between January 2019-June 2023. Results The global success rate was 81.5%, with better surgical outcomes in patients with palpable hilar/hilo-parenchymal stones compared to non-palpable pure parenchymal ones (92.7 vs. 46.2%). In addition, the mean stone size in cases failing TORSS was smaller than that documented in successfully treated patients (7.8 ± 1.8 vs. 9.8 ± 2.4 mm). No major untoward effects were observed (transitory lingual nerve dysfunction in 3 patients undergoing Xi Da Vinci surgery). A positive outcome in terms of post-operative surgical pain, patient's satisfaction and recovery time was observed. Conclusions Intrinsic stone features (such as size, location/palpability) seems to be predictor for surgical success; an accurate pre-operative planning is mandatory to better select which patient can benefit most from TORSS procedure.
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Affiliation(s)
- Pasquale Capaccio
- Department of Otolaryngology, Asst Fatebenefratelli Sacco, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Matteo Lazzeroni
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Torretta
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Valentina Cristofaro
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Michele Proh
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Claudio Vicini
- Azienda USL Della Romagna, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Ono K, Nishioka T, Obata K, Takeshita Y, Irani C, Kunisada Y, Yoshioka N, Ibaragi S, Tubbs RS, Iwanaga J. Lingual nerve revisited-A comprehensive review Part II: Surgery and radiology. Clin Anat 2024. [PMID: 39121363 DOI: 10.1002/ca.24211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/20/2024] [Accepted: 07/27/2024] [Indexed: 08/11/2024]
Abstract
The lingual nerve (LN) is a branch of the mandibular division of the fifth cranial nerve, the trigeminal nerve, arising in the infratemporal fossa. It provides sensory fibers to the mucous membranes of the floor of the mouth, the lingual gingiva, and the anterior two-thirds of the tongue. Although the LN should rarely be encountered during routine and basic oral surgical procedures in daily dental practice, its anatomical location occasionally poses the risk of iatrogenic injury. The purpose of this section is to consider this potential LN injury risk and to educate readers about the anatomy of this nerve and how to treat it.
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Affiliation(s)
- Kisho Ono
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA
- Cancer Biology and Immunology Laboratory, Columbia University Irving Medical Center, New York, New York, USA
| | - Takashi Nishioka
- Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan
- Department of Dental Informatics and Radiology, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Kyoichi Obata
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yohei Takeshita
- Department of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Chista Irani
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Yuki Kunisada
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Norie Yoshioka
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, West Indies, Grenada
- University of Queensland, Brisbane, Queensland, Australia
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Fukuoka, Japan
- Dental and Oral Medical Center, Kurume University School of Medicine, Fukuoka, Japan
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Tarazis K, Garefis K, Chatziavramidis A, Konstantinidis I. Recurrent Sialolithiasis following Intraoral Deep Hilar/Intraparenchymal Stone Removal from Wharton's Duct. J Clin Med 2024; 13:909. [PMID: 38337603 PMCID: PMC10856032 DOI: 10.3390/jcm13030909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Submandibular gland (SMG) sialolithiasis treatment has shifted significantly, favouring minimal invasiveness. Nonetheless, transoral stone removal remains viable for distal, deep hilar, and intraparenchymal stones. However, data are limited regarding recurrence and revision surgery; (2) Patients/Methods: This retrospective study included 226 patients with SMG stones treated using Wharton's duct slitting and marsupialisation over nine years; 138 had deep hilar or intraparenchymal stones, while 88 had distal stones. Of the former group, 18 experienced symptom recurrence post-surgery, 12 with stones and 6 with duct stenosis; (3) Results: Of the 126 patients without recurrent stones, 71% were male and 29% were female. Their mean age was 51.02 ± 9.36 years. The stones of the 126 patients without recurrence had a diameter of 8.3 mm ± SD: 4 mm, which was significantly smaller than those of the patients who experienced recurrence (13.8 mm ± SD: 2.4 mm; p < 0.05). The mean estimated stone growth recurrence rate was 8.4 ± SD: 1.8 mm per year. A secondary operation was performed 34 ± SD: 14.7 months after the first. Of the patients with recurrence, 91.7% were treated under general anaesthesia. The preferred treatment for 58.4% of patients was intraoral revision operation; the remainder underwent total gland resection. The mean follow-up period was 43 ± SD: 18 months; (4) Conclusions: The rate of revision surgery was relatively low. In recurrent SMG sialolithiasis, new stones may grow faster than the primary stones, which are already larger than those in patients without recurrence. The slitting and marsupialisation of Wharton's duct can treat recurrent cases.
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Affiliation(s)
| | | | | | - Iordanis Konstantinidis
- 2nd Academic ORL, Head and Neck Surgery Department Aristotle University of Thessaloniki, Papageorgiou Hospital, 56403 Thessaloniki, Greece; (K.T.); (K.G.); (A.C.)
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Mao JS, Lee YC, Chi JCY, Yi WL, Tsou YA, Lin CD, Tai CJ, Shih LC. Long-term rare giant sialolithiasis for 30 years: A case report and review of literature. World J Clin Cases 2023; 11:5376-5384. [DOI: 10.12998/wjcc.v11.i22.5376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/01/2023] [Accepted: 07/06/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Sialolithiasis is one of the most common salivary gland disorders, most commonly affecting the submandibular gland. Submandibular sialolithiasis can be treated using non-invasive conservative measures and invasive treatments. Treatment selection was based on the ductal system anatomy and the size and location of the stones. This study aimed to review the updates on sialolithiasis treatment and compare the different management strategies of the variables.
CASE SUMMARY This report presents a case of a long-term, rare, and giant sialolithiasis within the submandibular gland parenchyma for 30 years in an older adult. Our patient presented with painless right submandibular swelling. Computed tomography revealed a calcified mass measuring 35 mm × 20 mm within the right submandibular gland. In this case, the infection and fibrosis of the affected gland and size of the stone did not provide us with other alternatives except for the excision of the involved gland. Thus, right submandibular sialoadenectomy was performed via the transcervical approach. After the surgery, the patient recovered without any complaints, side effects, or complications.
CONCLUSION Tailored management is important for preserving gland function, maintaining low risk, and reducing patient discomfort.
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Affiliation(s)
- Jit-Swen Mao
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
| | - Yu-Chien Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
| | - Jessie Chao-Yun Chi
- Department of Otorhinolaryngology, Head and Neck Surgery, Taichung Hospital, Ministry of Health and Welfare, Taichung 404, Taiwan
| | - Wan-Ling Yi
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
| | - Yung-An Tsou
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung 404, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
| | - Chia-Der Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
| | - Chih-Jaan Tai
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
| | - Liang-Chun Shih
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung 404, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
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Mao JS, Lee YC, Chi JCY, Yi WL, Tsou YA, Lin CD, Tai CJ, Shih LC. Long-term rare giant sialolithiasis for 30 years: A case report and review of literature. World J Clin Cases 2023; 11:5382-5390. [PMID: 37621584 PMCID: PMC10445064 DOI: 10.12998/wjcc.v11.i22.5382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/01/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Sialolithiasis is one of the most common salivary gland disorders, most commonly affecting the submandibular gland. Submandibular sialolithiasis can be treated using non-invasive conservative measures and invasive treatments. Treatment selection was based on the ductal system anatomy and the size and location of the stones. This study aimed to review the updates on sialolithiasis treatment and compare the different management strategies of the variables. CASE SUMMARY This report presents a case of a long-term, rare, and giant sialolithiasis within the submandibular gland parenchyma for 30 years in an older adult. Our patient presented with painless right submandibular swelling. Computed tomography revealed a calcified mass measuring 35 mm × 20 mm within the right submandibular gland. In this case, the infection and fibrosis of the affected gland and size of the stone did not provide us with other alternatives except for the excision of the involved gland. Thus, right submandibular sialoadenectomy was performed via the transcervical approach. After the surgery, the patient recovered without any complaints, side effects, or complications. CONCLUSION Tailored management is important for preserving gland function, maintaining low risk, and reducing patient discomfort.
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Affiliation(s)
- Jit-Swen Mao
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
| | - Yu-Chien Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
| | - Jessie Chao-Yun Chi
- Department of Otorhinolaryngology, Head and Neck Surgery, Taichung Hospital, Ministry of Health and Welfare, Taichung 404, Taiwan
| | - Wan-Ling Yi
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
| | - Yung-An Tsou
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung 404, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
| | - Chia-Der Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
| | - Chih-Jaan Tai
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
| | - Liang-Chun Shih
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung 400, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung 404, Taiwan
- School of Medicine, China Medical University, Taichung 404, Taiwan
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Nomura T, Ohki M, Kikuchi S. New Modified Transoral Approach to Remove a Hilar Stone of the Submandibular Gland: A Case Report. Indian J Otolaryngol Head Neck Surg 2022; 74:6391-6393. [PMID: 36742560 PMCID: PMC9895177 DOI: 10.1007/s12070-022-03122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 07/10/2022] [Indexed: 02/07/2023] Open
Abstract
Nerve damage and intraoperative bleeding for the removal of the hilar stones are possible. We used the new modified lateral oral floor approach with a 2-3 cm longitudinal mucosal incision outside of the Wharton's. There were no complications and our technique seemed to be effective.
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Affiliation(s)
- Tsutomu Nomura
- Department of Otolaryngology, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama 350-0283 Japan
| | - Masafumi Ohki
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama 380-8550 Japan
| | - Shigeru Kikuchi
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama 380-8550 Japan
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11
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Saga-Gutierrez C, Chiesa-Estomba CM, Larruscain E, Calvo-Henriquez C, San Jose C, Altuna X. “Omepralith”: A novel simulation model for training in sialoendoscopy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:137-140. [DOI: 10.1016/j.otoeng.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/13/2020] [Indexed: 12/01/2022]
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Quiz J, Gillespie MB. Transoral Sialolithotomy Without Endoscopes: An Alternative Approach to Salivary Stones. Otolaryngol Clin North Am 2021; 54:553-565. [PMID: 34024483 DOI: 10.1016/j.otc.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sialoendoscopy is a valuable technique for a variety of obstructive and nonobstructive disorders of the major salivary glands. However, the utility of sialoscopes is limited for salivary stones, which frequently required open removal. Transoral sialolithotomy without scopes is an efficient, low-cost alternative with excellent outcomes available for most of the submandibular stones.
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Affiliation(s)
- Janyn Quiz
- Department of Otolaryngology-Head & Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 408, Memphis, TN 38163, USA
| | - M Boyd Gillespie
- Department of Otolaryngology-Head & Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 408, Memphis, TN 38163, USA.
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Saga-Gutierrez C, Chiesa-Estomba CM, Larruscain E, Calvo-Henriquez C, San Jose C, Altuna X. "Omepralith": A novel simulation model for training in sialoendoscopy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(20)30200-4. [PMID: 33814119 DOI: 10.1016/j.otorri.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION There are no previously described training models for learning or teaching how to remove lithiasis from the salivary ducts. Therefore, we present a new simulation model to enable us to faithfully represent the process of endoscopic lithiasis extraction by sialoendoscopy. MATERIALS AND METHODS A simulation model was developed using a pig's head, omeprazole spheres were used to simulate lithiasis in the various ducts of each salivary gland and a Dormia basket was used to train in extraction of the lithiasis model. RESULTS Twenty-seven residents in training and/or young specialists were successfully trained in this technique using this model. Twenty-six (96.3%) considered the model useful for training in the use of baskets; all of them were able to capture the omeprazole sphere in the salivary duct. A satisfaction rate of 92.25 out of 100 points was obtained through an anonymous survey. CONCLUSION We describe a novel simulation model using omeprazole spheres, which allows the surgeon to practice how to diagnose and treat obstructive pathology of the salivary glands in a risk-free environment guaranteeing the reproducibility of the technique in conditions similar to those of normal practice.
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Affiliation(s)
- Carlos Saga-Gutierrez
- Servicio de Otorrinolaringología-Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, Donostia, Gipuzkoa, España
| | - Carlos Miguel Chiesa-Estomba
- Servicio de Otorrinolaringología-Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, Donostia, Gipuzkoa, España.
| | - Ehkiñe Larruscain
- Servicio de Otorrinolaringología-Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, Donostia, Gipuzkoa, España
| | - Christian Calvo-Henriquez
- Servicio de Otorrinolaringología-Cirugía de Cabeza y Cuello, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - Carlos San Jose
- Instituto de Investigación Sanitaria Biodonostia, Donostia, Gipuzkoa, España
| | - Xabier Altuna
- Servicio de Otorrinolaringología-Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, Donostia, Gipuzkoa, España
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Li J, Xu XY, Lu ZW, Guan QB, Chen JF. Sialendoscopy-assisted intraoral incision approach for the treatment of posterior Wharton's duct stones: our experience and outcomes. Wideochir Inne Tech Maloinwazyjne 2021; 16:249-255. [PMID: 33786141 PMCID: PMC7991944 DOI: 10.5114/wiitm.2020.94430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/22/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sialoliths can be removed by sialendoscopy in some cases. But sometimes it fails if the stone is located in the proximal or hilum of Wharton's duct. AIM To evaluate the clinical efficacy of the sialendoscopy-assisted intraoral incision approach to remove large stones located in the proximal or hilum of Wharton's duct, when sialendoscopy alone fails. MATERIAL AND METHODS Twenty patients with large stones located in the proximal or hilum of Wharton's duct were included in our study. We used a sialendoscopy-assisted intraoral incision approach to remove large stones located in the proximal or hilum of Wharton's duct when endoscopy failed. The complications and treatment effect were observed. RESULTS The stones were removed successfully in this way in all patients. Two cases had tongue numbness after the operation, and recovered 3 months later without additional intervention. No swelling or pain appeared during the 3-month to 1-year follow-up. Saliva could be observed from the orifice in 15 patients, with little or none in 5 patients. CONCLUSIONS The sialendoscopy-assisted intraoral incision approach to remove large stones located in the proximal or hilum of Wharton's duct is effective and safe.
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Affiliation(s)
- Jin Li
- Department of Oral and Maxillofacial Surgery, The People’s Hospital of Luoding and Affiliated Luoding Hospital of Guangdong Medical University, Luoding, China
- Department of Oral and Maxillofacial Surgery, Affiliated Foshan Hospital of Sun Yat-Sen University, Foshan, China
| | - Xiang Yang Xu
- Department of Oral and Maxillofacial Surgery, The People’s Hospital of Luoding and Affiliated Luoding Hospital of Guangdong Medical University, Luoding, China
| | - Zhi Wen Lu
- Department of Oral and Maxillofacial Surgery, The People’s Hospital of Luoding and Affiliated Luoding Hospital of Guangdong Medical University, Luoding, China
| | - Qing Bin Guan
- Department of Oral and Maxillofacial Surgery, The People’s Hospital of Luoding and Affiliated Luoding Hospital of Guangdong Medical University, Luoding, China
| | - Ju Feng Chen
- Department of Oral and Maxillofacial Surgery, The People’s Hospital of Luoding and Affiliated Luoding Hospital of Guangdong Medical University, Luoding, China
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15
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Brooks JK, Macauley MR, Price JB. Concurrent giant sialoliths within the submandibular gland parenchyma and distal segment of Wharton's duct: Novel case report. Gerodontology 2021; 38:437-440. [PMID: 33586807 DOI: 10.1111/ger.12544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This article discusses the clinical significance of an unusual case of the simultaneous occurrence of 2 giant sialoliths within the ipsilateral submandibular gland and distal aspect of Wharton's duct in a 63-year-old patient. BACKGROUND The majority of submandibular gland sialoliths are found in Wharton's duct, with fewer within the gland parenchyma. Giant sialoliths (exceeding 15 mm in size) are rare. MATERIALS AND METHODS An asymptomatic, otherwise healthy older patient sought dental care and underwent a comprehensive oral and radiographic examination. RESULTS A panoramic radiograph revealed 2 incidental radiopaque structures, representing giant sialoliths within the submandibular gland and along the distal segment of Wharton's duct. This synchronous finding apparently represents the first case reported in the geriatric literature. CONCLUSIONS The detection of 1 salivary stone should heighten the scrutiny for additional stones. Practitioners should carefully weigh the risk of sialolith removal versus deferment of treatment in older medically compromised patients.
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Affiliation(s)
- John K Brooks
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | | | - Jeffery B Price
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
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16
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Wen CZ, Douglas JE, Elrakhawy M, Paul EA, Rassekh CH. Nuances and Management of Hilar Submandibular Sialoliths With Combined Transoral Robotic Surgery-Assisted Sialolithotomy and Sialendoscopy. Otolaryngol Head Neck Surg 2020; 165:76-82. [PMID: 33371823 DOI: 10.1177/0194599820973231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the management, technical nuances, and success rates of transoral robotic surgery (TORS)-assisted sialolithotomy. STUDY DESIGN Retrospective database review. SETTING Quaternary academic medical center. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Christopher Z Wen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Mohamed Elrakhawy
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Ellen A Paul
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Christopher H Rassekh
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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17
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Araújo RV, Milani BA, Martins IS, Vilela Dias EM, Bernaola-Paredes WE. An Extraoral Surgical Approach to Treat Chronic Submandibular Sialolithiasis - A Case Series. Ann Maxillofac Surg 2020; 10:537-542. [PMID: 33708613 PMCID: PMC7944014 DOI: 10.4103/ams.ams_102_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/25/2020] [Accepted: 06/28/2020] [Indexed: 11/04/2022] Open
Abstract
Sialolithiasis is the most common cause of sialadenitis in the submandibular gland, in which the highest incidence of this condition occurs, among the major salivary glands. This could be explained by the anatomy of Wharton's duct, and the chemical composition of the saliva produced by this gland. There are several alternatives and techniques for the treatment of sialolithiasis, including lithotripsy, sialoendoscopy, and conservative removal of the sialoliths or complete removal of the submandibular gland, through the transoral and extraoral routes for access to the gland. To determine the form of treatment, characteristics such as topography, diameter, and location of the sialolith in the duct are observed. The aim of this case series was to show our experience gained in two clinical cases of submandibular gland excision through an extraoral approach, using the submandibular access technique. In addition, we discussed the cause of sialolithiasis in these patients and after follow-up, compared the clinical results we obtained with this technique with those reported in the current literature. The submandibular approach or Risdon access continues to be a safe approach to removing the submandibular gland, as it is a commonly used technique and obtained satisfactory results, as shown in these cases. However, the major disadvantages were the less favorable esthetic results and paralysis of the marginal mandibular branch of the facial nerve.
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Affiliation(s)
- Renan Veiga Araújo
- Department of Oral and Maxillofacial Surgery, Campo Limpo Medical Center, Sao Paulo, Brazil
| | - Basílio Almeida Milani
- Department of Oral and Maxillofacial Surgery, Campo Limpo Medical Center, Sao Paulo, Brazil
| | - Ivan Solani Martins
- Department of Oral and Maxillofacial Surgery, Hospital Sirio-Libanes, Sao Paulo, Brazil
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18
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Abstract
There are numerous salivary gland pathologies for which robotic surgery can provide benefit. This article reviews the primary indications for use of transoral robotic surgery for salivary gland neoplasms. It also discusses transoral and retroauricular robotic approaches for pathology of the submandibular gland and prestyloid parapharyngeal space. These approaches have the advantage of avoiding a visible scar and are additionally minimally invasive in other ways as well. Robotic surgery offers advantages in several different modules of salivary gland surgery, similar to those it offers for oropharyngeal cancer, including improved optics, manual dexterity, and teamwork.
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19
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Mulcahy CF, Fassas S, Lloyd A, Strum D, Badger C, Joshi A. Modified Marionette Technique for Unassisted In-Office Access to the Submandibular Duct. Laryngoscope 2020; 131:1016-1018. [PMID: 32880965 DOI: 10.1002/lary.29054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/08/2020] [Accepted: 08/06/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Collin F Mulcahy
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, District of Columbia, U.S.A
| | - Scott Fassas
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, District of Columbia, U.S.A
| | - Ashley Lloyd
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, District of Columbia, U.S.A
| | - David Strum
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, District of Columbia, U.S.A
| | - Christopher Badger
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, District of Columbia, U.S.A
| | - Arjun Joshi
- Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, District of Columbia, U.S.A
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20
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Avishai G, Ben-Zvi Y, Ghanaiem O, Chaushu G, Gilat H. Sialolithiasis-Do Early Diagnosis and Removal Minimize Post-Operative Morbidity? ACTA ACUST UNITED AC 2020; 56:medicina56070332. [PMID: 32630773 PMCID: PMC7404452 DOI: 10.3390/medicina56070332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 01/09/2023]
Abstract
Background and objectives: Sialolithiasis is an inflammation of a salivary gland due to obstruction of salivary flow by a sialolith. We aim to assess potential factors that may predict lower morbidity following endoscopically assisted per-oral sialolith removal. Materials and Methods: Retrospective cohort study. Retrospective review of 100 records of patients with sialolithiasis, following surgical sialolith removal. A single medical center (Department of oral and maxillofacial surgery-Rabin Medical Center, Beilinson & Hasharon-Israel) survey. Data were gleaned from the patient files based on a structured questionnaire. Factors that may predict morbidity were evaluated using linear regression equation. Results: 59 of the subjects were men and 41 were women. The mean age of the patients in the study was 50 ± 17.5 years. Sialolith volume and past antibiotic treatment were positively associated while age was negatively associated with hospitalization duration. Conclusion: Early sialolith diagnosis and removal may lower postoperative morbidity.
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Affiliation(s)
- Gal Avishai
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, 49414 Petach-Tikva, Israel; (Y.B.-Z.); (G.C.)
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, 69978 Tel Aviv, Israel;
- Correspondence: ; Tel.: +97-254-4336-464
| | - Yehonatan Ben-Zvi
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, 49414 Petach-Tikva, Israel; (Y.B.-Z.); (G.C.)
| | - Omar Ghanaiem
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, 69978 Tel Aviv, Israel;
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, 49414 Petach-Tikva, Israel; (Y.B.-Z.); (G.C.)
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, 69978 Tel Aviv, Israel;
| | - Hanna Gilat
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, 69978 Petach Tikva, Israel;
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21
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Capaccio P, Montevecchi F, Meccariello G, D’Agostino G, Cammaroto G, Pelucchi S, Vicini C. Transoral robotic surgery for hilo-parenchymal submandibular stones: step-by-step description and reasoned approach. Int J Oral Maxillofac Surg 2019; 48:1520-1524. [DOI: 10.1016/j.ijom.2019.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/20/2019] [Accepted: 07/02/2019] [Indexed: 11/29/2022]
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22
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Zhao YN, Zhang YQ, Zhang LQ, Xie XY, Liu DG, Yu GY. Treatment strategy of hilar and intraglandular stones in wharton's duct: A 12-year experience. Laryngoscope 2019; 130:2360-2365. [PMID: 31691983 DOI: 10.1002/lary.28361] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/31/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS To suggest a strategy for transoral removal of hilar and intraparenchymal submandibular stones. STUDY DESIGN Retrospective case series. METHODS Retrospective evaluation was performed for 514 consecutive patients with hilar and intraparenchymal submandibular stones treated via endoscopy-assisted surgery from January 2006 to June 2018. Three patients had bilateral stones. The stones were classified as: hilar (type I), posthilar (type II), intraparenchymal (type III), and multiple stones (type IV). RESULTS The affected glands included 311 with type I, 84 with type II, 65 with type III, and 57 with type IV stones. Stones were successfully removed in 478 glands (92.5%, 478/517). Main treatment techniques included hilum ductotomy in 311 glands, intraparenchymal ductotomy in 68, submandibulotomy in 14, intraductal retrieval in 74, and hilum ductotomy accompanied by intraductal retrieval in 11. At a mean 40-months follow-up of 478 successful cases, clinical outcomes were good in 425, fair in 27, and poor in 26 glands. Postoperative sialograms in 75 stone-free patients were categorized as: type I, normal (n = 6); type II, ectasia or stenosis in the main duct and no persistent contrast on functional films (n = 44); type III, ectasia or stenosis in the main duct and mild contrast retention (n = 15); and type IV, poor shape of the main duct and evident contrast retention (n = 10). Postoperative sialometry of 32 patients revealed no significant differences of the gland function between the two sides. CONCLUSIONS Appropriate use of various endoscopy-assisted approaches helps preserve the gland and facilitates recovery of gland function in patients with different depths of hilo-parenchymal submandibular stones. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2360-2365, 2020.
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Affiliation(s)
- Ya-Ning Zhao
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Ya-Qiong Zhang
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Li-Qi Zhang
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Xiao-Yan Xie
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Deng-Gao Liu
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, China
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23
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Saga-Gutierrez C, Chiesa-Estomba CM, Larruscain E, Ángel González-García J, Sistiaga JA, Altuna X. Transoral Sialolitectomy Combined With Sialoendoscopy Versus Open Submaxilectomy for the Management of Hilar Lithiasis of the Submandibular Gland. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Costan VV, Ciocan-Pendefunda CC, Sulea D, Popescu E, Boisteanu O. Use of Cone-Beam Computed Tomography in Performing Submandibular Sialolithotomy. J Oral Maxillofac Surg 2019; 77:1656.e1-1656.e8. [DOI: 10.1016/j.joms.2019.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 11/27/2022]
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25
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Capaccio P, Di Pasquale D, Bresciani L, Torretta S, Pignataro L. 3D video-assisted trans-oral removal of deep hilo-parenchymal sub-mandibular stones. ACTA ACUST UNITED AC 2019; 39:367-373. [PMID: 31388194 PMCID: PMC6966778 DOI: 10.14639/0392-100x-2282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/25/2018] [Indexed: 12/21/2022]
Abstract
The aim of this paper is to describe the intra-operative findings and surgical results of the first application of 3D high-definition (HD) endoscopic support to the trans-oral surgical treatment of five patients with deep hilo-parenchymal sub-mandibular stones who underwent clinical and ultrasonographic (US) follow-up examinations at one month after the procedure. Five patients undergoing 2D-HD video-assisted transoral surgery for the same condition were used as controls. The results were classified as successful (US - demonstrated complete clearance) or unsuccessful (US - demonstrated total or partial persistence). Visual analogue scales (VAS) were used post-surgically to evaluate the sharpness and brightness of the 2D and 3D images on the screen and stereoscopic depth perception (SDP) of the 3D-HD endoscope. Successful stone removal and significant subjective improvement (lack of obstructive symptoms) was obtained in all but one of the patients in the 3D group, in whom the one-month US evaluation revealed a residual 3 mm asymptomatic hilo-parenchymal stone that was successfully treated by sialendoscopy-assisted intra-corporeal laser lithotripsy. Wharton’s duct and the lingual nerve were identified and preserved in all cases. The mean 3D-HD VAS results were brightness 7 (range 6-8), sharpness 7.8 (range 7-9) and SDP 8.2 (range 8-9); the mean 2D-HD results were brightness 7.8 (range 7-9) and sharpness 7 (range 7-8). Our findings confirm the safety and efficacy of conservative transoral surgical treatment of hilo-parenchymal sub-mandibular stones. From a surgeon’s perspective, 3D-HD guided exploration of the oral floor seems to provide a better view of Wharton’s duct and the lingual nerve, especially near the sub-mandibular parenchyma. The 3D-HD video-assisted transoral removal of deep hilo-parenchymal sub-mandibular stones can therefore be considered a useful new means of preserving the function of an obstructed salivary gland.
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Affiliation(s)
- P Capaccio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Italy
| | - D Di Pasquale
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - L Bresciani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - S Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
| | - L Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
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Holden A, Man CB, Samani M, Hills A, McGurk M. Audit of minimally-invasive surgery for submandibular sialolithiasis. Br J Oral Maxillofac Surg 2019; 57:582-586. [DOI: 10.1016/j.bjoms.2019.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 05/14/2019] [Indexed: 11/24/2022]
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27
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Saga-Gutierrez C, Chiesa-Estomba CM, Larruscain E, González-García JÁ, Sistiaga JA, Altuna X. Transoral Sialolitectomy as an Alternative to Submaxilectomy in the Treatment of Submaxillary Sialolithiasis. EAR, NOSE & THROAT JOURNAL 2019; 98:287-290. [PMID: 30961382 DOI: 10.1177/0145561319841268] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sialolithiasis is the most common pathology in the submaxillary gland. The introduction of minimally invasive techniques isolated or associated with sialoendoscopy is replacing glandular resection as a treatment. The conservation of the gland is justified by the recovery of function and a low recurrence rate. The rate of complications is lower in conservative techniques than in submandibular gland resection. PATIENTS AND METHODS Thirty-three patients with fixed stones in the hilum of the submaxillary gland were treated by transoral sialolitectomy between July 2015 and July 2018, demographic data of the patients such as the number of stones, size, time of hospital stay, complications, pre- and postoperative lingual nerve function, and lithiasis recurrence were collected. RESULTS The average volume of the stones was 1.02 cm. Complete removal of the stone was possible in 32 patients. All the patients were operated in the outpatient clinic. Seven (21%) patients reported some degree of alteration of the lingual nerve function, of which the only one presented a persistence of more than 4 weeks due to an inadvertent injury that required a microsurgical anastomosis. CONCLUSIONS Transoral sialolitectomy is a reproducible technique with good results and lower complication rates than submandibular gland resection. Our results in the first 33 cases encourage us to maintain the combined techniques as standard in the treatment of submaxillary sialolithiasis. Current experience guides the definitive substitution of submandibular gland resection by conservative techniques in obstructive pathology.
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Affiliation(s)
- Carlos Saga-Gutierrez
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian-Donosti, Guipuzkoa-Basque, Spain
| | - Carlos Miguel Chiesa-Estomba
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian-Donosti, Guipuzkoa-Basque, Spain
| | - Ekhiñe Larruscain
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian-Donosti, Guipuzkoa-Basque, Spain
| | - José Ángel González-García
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian-Donosti, Guipuzkoa-Basque, Spain
| | - Jon Alexander Sistiaga
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian-Donosti, Guipuzkoa-Basque, Spain
| | - Xabier Altuna
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian-Donosti, Guipuzkoa-Basque, Spain
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Pachisia S, Mandal G, Sahu S, Ghosh S. Submandibular sialolithiasis: A series of three case reports with review of literature. Clin Pract 2019; 9:1119. [PMID: 30996853 PMCID: PMC6444375 DOI: 10.4081/cp.2019.1119] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/20/2019] [Indexed: 11/22/2022] Open
Abstract
One of the most common disorders of the salivary glands is sialolithiasis. A history of pain or/and swelling in the salivary glands, especially during meal suggests this diagnosis. For small and accessible stones conservative therapies like milking of ducts with palliative therapy can produce satisfactory results. Surgical management should be considered when the stone/stones are inaccessible or large in size as conservative therapies turned out to be unsatisfactory. In this paper, we present three cases of sialolithiasis in the submandibular gland along with a review of existing literature. The purpose of this paper is to add three more cases to the literature and review the theories of etiology, clinical features, available diagnostic and treatment procedures.
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Affiliation(s)
- Sandeep Pachisia
- Department of Oral and Maxillofacial Surgery, Haldia Institute of Dental Sciences and Research, West Bengal University of Health Sciences, Haldia, West Bengal, India
| | - Gaurav Mandal
- Department of Oral and Maxillofacial Surgery, Haldia Institute of Dental Sciences and Research, West Bengal University of Health Sciences, Haldia, West Bengal, India
| | - Sudipto Sahu
- Department of Oral and Maxillofacial Surgery, Haldia Institute of Dental Sciences and Research, West Bengal University of Health Sciences, Haldia, West Bengal, India
| | - Sucharu Ghosh
- Department of Oral and Maxillofacial Surgery, Haldia Institute of Dental Sciences and Research, West Bengal University of Health Sciences, Haldia, West Bengal, India
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Duong LT, Kakiche T, Ferré F, Nawrocki L, Bouattour A. Management of anterior submandibular sialolithiasis. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2019. [DOI: 10.1051/mbcb/2018039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Sialolithiasis is defined by the presence of a calculus within the salivary gland or its excretory system. It primarily affects the submandibular gland at a frequency of 80%. Involving many factors, the exact aetiology and pathogenesis of salivary calculi remain to be discussed. Body: The purpose of this article is to expose the different aspects of the pathology. Aetiological factors, the diagnostic approach which requires the use of imaging tests as well as the medical and surgical management of anterior submandibular sialolithiasis, will be described. A decision tree regarding the type of management and a table summarizing the main differential diagnoses will be proposed. Conclusion: Submandibular sialolithiases are a common salivary gland disorder. The treatment of sialolithiasis must be early and remains mainly surgical. The level of cooperation as well as the patient's medical and surgical history should guide the management of this type of disorder of the salivary system.
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Saga-Gutierrez C, Chiesa-Estomba CM, Larruscain E, González-García JÁ, Sistiaga JA, Altuna X. Transoral sialolitectomy combined with sialoendoscopy versus open submaxilectomy for the management of hilar lithiasis of the submandibular gland. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 70:342-347. [PMID: 30579511 DOI: 10.1016/j.otorri.2018.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/02/2018] [Accepted: 09/07/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The treatment of salivary obstructive pathology by minimally invasive techniques has been an object of assessment by different studies for decades. Lithiasis at the level of the salivary duct will be the most frequent cause of obstruction, representing more than 50% of the pathology of the major salivary glands and almost 80% of these affecting the Wharton duct. MATERIAL AND METHODS A prospective study comparing the results of combined transoral sialolitectomy (CTS) and open submaxillectomy techniques by cervicotomy in 2 groups of patients treated by lithiasis at the level of the hilum of the submaxillary gland. RESULTS 22 patients were included in the study 16 (72.7%) were men and 6 (27.3%) were women, the average age was 54.41 years ± 12.75 (Min: 30/Max: 77). Regarding the variables associated with the disease: average lithiasis, size of the stone, hospital stay, lingual nerve alteration or complications for both techniques, differences were not found between both groups. There were only statistically significant differences in the average stay in favor of the CTS (P=.001). CONCLUSION The minimally invasive approaches to the salivary ductal system, associated or not with sialoendoscopy, can be efficacy and can be associated with lower number of complications. The natural tendency should be aimed to gradually replacing open sialoadenectomy techniques, reserving its indication for the treatment of tumor pathology.
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Affiliation(s)
- Carlos Saga-Gutierrez
- Servicio de Otorrinolaringología, Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Carlos Miguel Chiesa-Estomba
- Servicio de Otorrinolaringología, Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España.
| | - Ekhiñe Larruscain
- Servicio de Otorrinolaringología, Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - José Ángel González-García
- Servicio de Otorrinolaringología, Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Jon Alexander Sistiaga
- Servicio de Otorrinolaringología, Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Xabier Altuna
- Servicio de Otorrinolaringología, Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
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Jeffery DT, Jeffery CC, Kelly HR. Chew on This: Emergency Imaging of the Oral Cavity and Salivary Glands-What the Clinician Really Needs to Know. Semin Ultrasound CT MR 2018; 40:104-115. [PMID: 31030734 DOI: 10.1053/j.sult.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nontraumatic emergencies of the oral cavity, sublingual and submandibular spaces, and salivary glands are common and those requiring imaging will most often be infectious in nature.1,2 However, noninfectious pathologies such as sialolithiasis, autoimmune sialoadenitis, and soft tissue swelling due to angioedema or hemorrhage are also important conditions that radiologists must be familiar with in order to inform the clinician of critical imaging findings that can have a profound impact on patient outcomes. To understand these pathologies, familiarity with the anatomy of these spaces is essential.
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Affiliation(s)
- Dean T Jeffery
- Department of Radiology and Diagnostic Imaging, University of Alberta, Canada
| | - Caroline C Jeffery
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, Edmonton, Canada
| | - Hillary R Kelly
- Department of Radiology, Massachusetts Eye and Ear Infirmary & Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital & Harvard Medical School, Boston, MA.
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Koch M, Schapher M, Mantsopoulos K, Goncalves M, Iro H. Intraductal Pneumatic Lithotripsy after Extended Transoral Duct Surgery in Submandibular Sialolithiasis. Otolaryngol Head Neck Surg 2018; 160:63-69. [DOI: 10.1177/0194599818802224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Persistent, residual, or recurrent stones after transoral duct surgery are always associated with hilar to intraparenchymal and/or multiple sialolithiasis, causing difficulties in the treatment. This study was performed to assess the value of intraductal lithotripsy in the treatment of persistent, residual, or recurrent sialolithiasis after extended duct surgery in the submandibular gland. Study Design Retrospective study covering February 2015 to June 2018. Study Setting Tertiary referral center for salivary gland diseases. Subjects and Methods After extended ductal surgery, 39 patients presenting with persistent, residual, or recurrent stones were treated. Four patients had persistent stones; 16 had residual stones; and 19 presented with recurrent stones. Among these patients, 50 stones were treated with intraductal pneumatic lithotripsy. Fragmentation rate, stone-free rate, and symptom-free rate after treatment with intraductal lithotripsy were outcome measures. Results Of the 39 patients, 97.4% became stone-free, and all were symptom-free. Ninety-eight percent of the stones were completely fragmented. For 23.1% of the patients, >1 stone was treated with intraductal lithotripsy. All patients with persistent stones, 93.7% of those with residual stones, and all with recurrent stones became stone-free and symptom-free. No severe complications developed. Conclusions This study shows that patients presenting with difficult and/or multiple sialolithiasis after extended transoral submandibular duct surgery can be treated with success rates >97%. For multiple sialolithiasis in particular, a multimodal treatment approach with interventional sialendoscopy and intraductal lithotripsy as a central element is a prerequisite for success, as this enables the most difficult part to be performed with high success rates.
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Affiliation(s)
- Michael Koch
- 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
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Erlangen–Nuremberg, Erlangen, Germany
| | - Miguel Goncalves
- 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
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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: 40] [Impact Index Per Article: 5.7] [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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Gallo A, Capaccio P, Benazzo M, De Campora L, De Vincentiis M, Farneti P, Fusconi M, Gaffuri M, Lo Russo F, Martellucci S, Ottaviani F, Pagliuca G, Paludetti G, Pasquini E, Pignataro L, Puxeddu R, Rigante M, Scarano E, Sionis S, Speciale R, Canzi P. Outcomes of interventional sialendoscopy for obstructive salivary gland disorders: an Italian multicentre study. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 36:479-485. [PMID: 28177330 PMCID: PMC5317126 DOI: 10.14639/0392-100x-1221] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/19/2016] [Indexed: 12/18/2022]
Abstract
Interventional sialendoscopy has become the predominant therapeutic procedure for the management of obstructive salivary disorders, but only a few multicentre studies of large series of patients with a long-term follow-up have been published. This Italian multicentre study involved 1152 patients (553 females; mean age 50 years) who, after at least a clinical and ultrasonographic evaluation, underwent a total of 1342 diagnostic and interventional sialendoscopies, 44.6% of which involved the parotid gland. 12% (n = 138) of patients underwent multiple treatments. The procedure was successful in 1309 cases. In 33 cases (2.4%) the procedure could not be concluded mainly because of complete duct stenosis (21 cases). Salivary stones were the main cause of obstruction (55%), followed by ductal stenosis and anomalies (16%), mucous plugs (14.5%) and sialodochitis (4.7%). Complete therapeutic success was obtained in 92.5% of patients after one or more procedures, and was ineffective in < 8%. Untoward effects (peri and postoperative complications) were observed in 5.4% of cases. Sialendoscopy proved to be an effective, valid and safe procedure in the diagnostic and therapeutic management of non-neoplastic obstructive salivary gland diseases.
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Affiliation(s)
- A Gallo
- Department of Medico-surgical sciences and biotechnologies, ENT Section, Sapienza University of Rome, Italy
| | - P Capaccio
- Department of Biomedical, Surgical and Dental Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - M Benazzo
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico "S. Matteo" Foundation, Pavia, Italy
| | - L De Campora
- Department of Otorhinolaryngology, "Fatebenefratelli" Hospital, Roma, Italy
| | - M De Vincentiis
- Department of Sense Organs, ENT Section, Policlinico "Umberto I", Sapienza University of Rome, Italy
| | - P Farneti
- Department of Experimental, Diagnostic and Specialty Medicine, Dimes, Bologna University Medical School, Ear, Nose and Throat Unit of "Sant'Orsola-Malpighi" Hospital, Bologna, Italy
| | - M Fusconi
- Department of Sense Organs, ENT Section, Policlinico "Umberto I", Sapienza University of Rome, Italy
| | - M Gaffuri
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - F Lo Russo
- Department Experimental biomedicine and clinical neurosciences, Otorhinolaryngology Unit, University of Palermo; Italy
| | - S Martellucci
- Department of Medico-surgical sciences and biotechnologies, ENT Section, Sapienza University of Rome, Italy
| | - F Ottaviani
- Department of Clinical Sciences and Community Health, San Giuseppe Hospital, Università degli Studi di Milano, Milan, Italy
| | - G Pagliuca
- Department of Medico-surgical sciences and biotechnologies, ENT Section, Sapienza University of Rome, Italy
| | - G Paludetti
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Italy
| | - E Pasquini
- Ear, Nose and Throat Metropolitan Unit, Surgical Department, AUSL Bologna, Italy
| | - L Pignataro
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - R Puxeddu
- Department of Otorhinolaryngology, AOU, PO "S. Giovanni di Dio", University of Cagliari, Italy
| | - M Rigante
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Italy
| | - E Scarano
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Italy
| | - S Sionis
- Department of Otorhinolaryngology, AOU, PO "S. Giovanni di Dio", University of Cagliari, Italy
| | - R Speciale
- Department Experimental biomedicine and clinical neurosciences, Otorhinolaryngology Unit, University of Palermo; Italy
| | - P Canzi
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico "S. Matteo" Foundation, Pavia, Italy
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Xiao JQ, Sun HJ, Qiao QH, Bao X, Wu CB, Zhou Q. Advantages of submandibular gland preservation surgery over submandibular gland resection for proximal submandibular stones. Oral Surg Oral Med Oral Pathol Oral Radiol 2017. [PMID: 29530607 DOI: 10.1016/j.oooo.2017.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to compare surgical outcomes after the removal of submandibular gland (SMG) stones via 2 different surgical methods. MATERIALS AND 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. RESULTS 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. CONCLUSIONS Sialendoscopy-assisted stone removal with preservation of the SMG exhibited many advantages relative to traditional SMG resection.
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Affiliation(s)
- Jin-Qing Xiao
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning Province, China
| | - Hai-Jiang Sun
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning Province, China
| | - Qi-Hui Qiao
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning Province, China
| | - Xin Bao
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning Province, China
| | - Chuan-Bin Wu
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning Province, China
| | - Qing Zhou
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning Province, China.
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Capaccio P, Gaffuri M, Rossi V, Pignataro L. Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 37:122-127. [PMID: 28516974 PMCID: PMC5463519 DOI: 10.14639/0392-100x-1601] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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
It has been suggested that a conservative trans-oral approach to proximal and hilo-parenchymal submandibular stones (HPSMS) is a valid alternative to the more frequently used sialadenectomy. The aim of this study was to evaluate the surgical, ultrasonographic and patients' subjective outcomes of results of the trans-oral removal of HPSMS. Between January 2003 and September 2015, sialendoscope-assisted trans-oral surgery was used to remove symptomatic, large (> 7 mm), fixed and palpable HPSMS from 479 patients under general anaesthesia. All patients were followed clinically and ultrasonographically to investigate symptom relief and recurrence of stones, and were telephonically interviewed to assess saliva-related subjective outcomes with a questionnaire. Stones were successfully removed from 472 patients (98.5%); the seven failures (1.5%) concerned pure parenchymal stones. One year after the procedure, 408 patients (85.1%) were symptom free, 59 (12.3%) had recurrent obstructive symptoms and 12 (2.6%) had recurrent infections. Of the 54 patients who developed a recurrent stone (11.2%), 52 underwent a second procedure: 29 interventional sialendoscopies, two sialendoscope-assisted intra-corporeal pneumatic lithotripsy, eight secondary transoral surgery to remove residual stones, six a cycle of extra-corporeal lithotripsy and seven submandibular sialadenectomy. Most patients (75.2%) reported mild surgery-related pain. The symptoms of 454 patients (94.8%) improved after adjunctive treatment and, at the end of follow-up, the affected gland was preserved in 98.5% of patients. A sialendoscope-assisted trans-oral removal of large HPSMS is a safe, effective, conservative surgical procedure, and functional preservation of the main duct and parenchyma of the obstructed gland allows sialendoscopic access through the natural ostium in case of recurrence. Combining a trans-oral approach with other minimally invasive, conservative procedures ensures symptomatic relief and salivary duct system clearance in the majority of patients.
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Affiliation(s)
- P Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical, Dental Sciences
| | - M Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Rossi
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical, Dental Sciences
| | - L Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Italy
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Bignet C, Carvalho J, Lemaire E, Charpiot A. Acute submaxillitis: Etiological data and etiological management. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:315-319. [PMID: 28359731 DOI: 10.1016/j.anorl.2017.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objective of the present study was to test the hypothesis that acute submaxillitis involves salivary duct obstruction. Obstacle characteristics and treatment were analyzed. MATERIAL AND METHODS Patients presenting with an episode of acute submaxillitis between 2009 and 2015 were retrospectively included. All underwent salivary duct imaging and/or sialendoscopy, with pathologic examination if the salivary gland was removed for etiologic diagnosis. For etiological treatment, if the causal lesion could not be treated by isolated sialendoscopy, surgery used a direct approach assisted by sialendoscope. In case of failure of these procedures, submaxillectomy was indicated. RESULTS Twenty-nine patients were included, 28 of whom showed salivary duct abnormality. At least 1 calculus was found in 27 patients; calculi were usually single (n=20), situated in the mid-third (n=21), and large (mean 7.7mm). Ten patients showed stenosis, associated with salivary calculus in 9 cases. Twenty-five patients with salivary duct obstruction underwent sialendoscopy. Isolated sialendoscopy was used in 5 cases, and a combined approach in 13 cases. CONCLUSION An episode of submaxillitis requires salivary duct exploration by sialendoscopy, to enable early treatment given the prevalence of associated calculi and high success rate of conservative management by sialendoscopy.
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Affiliation(s)
- C Bignet
- Service d'ORL et de chirurgie cervico-faciale, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - J Carvalho
- Service d'ORL et de chirurgie cervico-faciale, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - E Lemaire
- Service d'ORL et de chirurgie cervico-faciale, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - A Charpiot
- Service d'ORL et de chirurgie cervico-faciale, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
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Hartmann A, Seeberger R, Bittner M, Rolke R, Welte-Jzyk C, Daubländer M. Profiling intraoral neuropathic disturbances following lingual nerve injury and in burning mouth syndrome. BMC Oral Health 2017; 17:68. [PMID: 28330489 PMCID: PMC5363027 DOI: 10.1186/s12903-017-0360-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 03/08/2017] [Indexed: 01/03/2023] Open
Abstract
Background The aim of the study was to analyse intraoral neurophysiological changes in patients with unilateral lingual nerve lesions as well as patients with Burning Mouth Syndrome (BMS) by applying a standardized Quantitative Sensory Testing (QST) protocol. Methods The study included patients suffering from a peripheral lesion of the lingual nerve (n = 4), from BMS (n = 5) and healthy controls (n = 8). Neurophysiological tests were performed in the innervation areas of the tongue bilaterally. For BMS patients the dorsal foot area was used as reference. Results For patients with peripheral lesion of the lingual nerve the affected side of the tongue showed increased thresholds for thermal (p < 0.05–0.001) and mechanical (p < 0.01–0.001) QST parameters, indicating a hypoesthesia and thermal hypofunction. In BMS patients, a pinprick hypoalgesia (p < 0.001), a cold hyperalgesia (p < 0.01) and cold/warmth hypoesthesia (p < 0.01) could be detected. Conclusions The results of this study verified the lingual nerve lesion in our patients as a peripheral dysfunction. The profile showed a loss of sensory function for small and large fibre mediated stimuli. A more differentiated classification of the lingual nerve injury was possible with QST, regarding profile, type and severity of the neurologic lesion. BMS could be seen as neuropathy with variable central and peripheral contributions among individuals resulting in chronic pain.
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Affiliation(s)
- Amely Hartmann
- Private Practice Dr. Seiler und Kollegen, Echterdinger Str. 7, 70794, Filderstadt, Germany.
| | | | - Malte Bittner
- Private Practice Dr. Meschenmoser und Dr. Bittner, Stuttgart, Germany
| | - Roman Rolke
- Department of Palliative Medicine, University of Aachen, Aachen, Germany
| | - Claudia Welte-Jzyk
- Department of Oral Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Monika Daubländer
- Department of Oral Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
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Xiao JQ, Sun HJ, Qiao QH, Bao X, Wu CB, Zhou Q. Evaluation of Sialendoscopy-Assisted Treatment of Submandibular Gland Stones. J Oral Maxillofac Surg 2017; 75:309-316. [DOI: 10.1016/j.joms.2016.08.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/10/2016] [Accepted: 08/14/2016] [Indexed: 11/16/2022]
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Schapher M, Mantsopoulos K, Messbacher ME, Iro H, Koch M. Transoral submandibulotomy for deep hilar submandibular gland sialolithiasis. Laryngoscope 2017; 127:2038-2044. [PMID: 28052363 DOI: 10.1002/lary.26459] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 10/30/2016] [Accepted: 11/14/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the long-term results after transoral submandibulotomy for stones located in the deep hilar and intraparenchymal submandibular region. STUDY DESIGN Retrospective cohort analysis. METHODS Retrospective evaluation including all patients treated with transoral submandibulotomy for sialolithiasis at a tertiary referral center. RESULTS Complete stone removal at the first transoral surgical treatment was achieved in 185 of 234 patients (79.1%). One hundred seventy-five of the 234 patients were followed up for a mean of 31.2 ( ± 20.5) months. During the follow-up period, 140 of the 175 patients (80.0%) became symptom free after one operation. In patients with residual symptoms, no further treatment was needed in 12 patients (6.9%) due to the mildness of the symptoms; 23 patients (13.1%) received further therapy, which was successful in 15 cases. Submandibulectomy only had to be performed in 3.4% of the patients with follow-up (6/175). In a questionnaire survey, 91.4% of the patients stated that they would be prepared to have the same operation again. CONCLUSIONS These findings show that transoral removal of submandibular sialoliths located in the deep hilum or adjacent intraglandular parenchyma is an effective treatment that can be assisted by additional measures. The techniques described show high success rates, good long-term results, low complication rates, and they avoided the need for submandibulectomy in >95% of cases. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2038-2044, 2017.
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Affiliation(s)
- Mirco Schapher
- 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
| | - Maria-Elena Messbacher
- 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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Sialendoscopy and Combined Minimally Invasive Treatment for Large Parotid Stones. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1354202. [PMID: 27882318 PMCID: PMC5110870 DOI: 10.1155/2016/1354202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/18/2016] [Accepted: 10/18/2016] [Indexed: 11/25/2022]
Abstract
Sialendoscopy (SE) represents nowadays one of the standard diagnostic and therapeutic procedures in the treatment of major salivary glands lithiasis. We know from experience that it is successful only in small percentage of patients, when used in monotherapy. However, it represents an indispensable part of all of the combined minimally invasive gland-preserving treatment techniques, the success rate of which is around 90%. In this work, we focused on the role of sialendoscopy in the treatment of patients with larger inflamed fixed stones in glandula parotis. We conducted a total of 364 sialendoscopy procedures in 332 patients on our site. We have confirmed lithiasis as a cause of salivary gland obstruction in 246 (74%) patients. In 9 patients there was larger, single, or multiple inflamed fixed lithiasis of glandula parotis. In this subgroup of patients endoscopically assisted sialolithectomy from external mini-incision has become the method of choice. In 9 of the 9 (100%) cases we have achieved complete elimination of stones, and in 8 of the 9 (89%) cases we have achieved complete elimination of complaints. Sialoendoscopically assisted sialolithectomy of glandula parotis from external mini-incision has proved to be highly effective technique to eliminate stones with minimal complications.
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Zenk J, Bozzato A, Winter M, Gottwald F, Iro H. Extracorporeal Shock Wave Lithotripsy of Submandibular Stones: Evaluation after 10 Years. Ann Otol Rhinol Laryngol 2016; 113:378-83. [PMID: 15174765 DOI: 10.1177/000348940411300507] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Johannes Zenk
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Anatomical study of the submandibular gland duct after removal of a distal stone without sialodochoplasty: a sialographic evaluation of a clinical phase II trial. Br J Oral Maxillofac Surg 2016; 54:556-60. [DOI: 10.1016/j.bjoms.2016.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/21/2016] [Indexed: 11/23/2022]
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Park JS, Sohn JH, Kim JK. Factors influencing intraoral removal of submandibular calculi. Otolaryngol Head Neck Surg 2016; 135:704-9. [PMID: 17071298 DOI: 10.1016/j.otohns.2006.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 07/10/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES: To assess the effectiveness of intraoral removal of submandibular calculi based on several factors that may influence the results of surgery. STUDY DESIGN AND SETTING: We retrospectively reviewed 172 patients who underwent intraoral removal of submandibular sialolithiasis. Results of surgery were divided into complete removal, partial removal, and failure. The effect of location, palpability, size, and presence of infection of the calculi on the results was estimated. RESULTS: Univariate analysis showed that palpability and presence of infection were statistically significant factors affecting intraoral removal. Palpability was the only significant factor after multivariate analysis. Twelve of 13 patients with recurrent calculi underwent repeat intraoral removal successfully. CONCLUSIONS: The palpability of submandibular calculi is the most important factor influencing their successful intraoral removal. SIGNIFICANCE: Intraoral removal can be performed successfully regardless of location, size, presence of infection, or recurrence of calculi, if the calculi are palpable.
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Affiliation(s)
- June Sik Park
- Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University School of Medicine, Daegu, South Korea
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Kim J, Shin S, Lee H, Lee S. Factors affecting long-term outcome of transoral surgery for submandibular stones: a follow-up study of 125 patients. Clin Otolaryngol 2016; 41:365-70. [DOI: 10.1111/coa.12523] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J.K. Kim
- Department of Otolaryngology-Head and Neck Surgery; Catholic University of Daegu School of Medicine; Daegu Korea
| | - S.M. Shin
- Department of Otolaryngology-Head and Neck Surgery; Catholic University of Daegu School of Medicine; Daegu Korea
| | - H. Lee
- Department of Otolaryngology-Head and Neck Surgery; Catholic University of Daegu School of Medicine; Daegu Korea
| | - S. Lee
- Department of Otolaryngology-Head and Neck Surgery; Catholic University of Daegu School of Medicine; Daegu Korea
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Kraaij S, Karagozoglu KH, Forouzanfar T, Veerman ECI, Brand HS. Salivary stones: symptoms, aetiology, biochemical composition and treatment. Br Dent J 2014; 217:E23. [DOI: 10.1038/sj.bdj.2014.1054] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2014] [Indexed: 11/09/2022]
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Pace CG, Hwang KG, Papadaki M, Troulis MJ. Interventional Sialoendoscopy for Treatment of Obstructive Sialadenitis. J Oral Maxillofac Surg 2014; 72:2157-66. [DOI: 10.1016/j.joms.2014.06.438] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/12/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
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Woo SH, Kim JP, Kim JS, Jeong HS. Anatomical recovery of the duct of the submandibular gland after transoral removal of a hilar stone without sialodochoplasty: evaluation of a phase II clinical trial. Br J Oral Maxillofac Surg 2014; 52:951-6. [PMID: 25239734 DOI: 10.1016/j.bjoms.2014.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
Abstract
Transoral removal of stones for the treatment of submandibular sialolithiasis has been popularised, even for stones in the hilum. Without sialodochoplasty after surgical retrieval, the affected glands seem to recover well functionally, even without sialodochoplasty. However, the anatomical changes of structural recovery have not been fully studied. We investigated the outcomes and the changes to the salivary duct system after transoral removal of hilar stones using postoperative sialography. We enrolled 28 patients (29 sides) who had transoral removal of stones for submandibular hilar sialolithiasis without sialodochoplasty, and prospectively analysed the structural outcomes 3 months and 12 months postoperatively using sialography. We found 23 ducts (79%) recovered with a normal size, while 4 ducts (14%) developed saccular dilatation and one duct (3%) partially stenosed. Saccular dilatation developed after removal of stones larger than 10mm in diameter, but patients had no recurrent symptoms. By the 12 months' follow up, one stone had formed severe adhesions to the salivary duct that caused stenosis, and this patient had recurrent symptoms. Transoral removal of submandibular hilar stones without sialodochoplasty is an effective treatment with good anatomical restoration of the salivary duct and flow.
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Affiliation(s)
- Seung Hoon Woo
- Department of Otolaryngology, Gyeongsang National University, Jinju, South Korea; Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Jin Pyeong Kim
- Department of Otolaryngology, Gyeongsang National University, Jinju, South Korea
| | - Jong Sei Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Objective and subjective outcome in 42 patients after treatment of sialolithiasis by transoral incision of Warthon's duct: a retrospective middle-term follow-up study. Eur Arch Otorhinolaryngol 2014; 271:3059-66. [PMID: 24493562 DOI: 10.1007/s00405-014-2905-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 01/19/2014] [Indexed: 10/25/2022]
Abstract
In this retrospective follow-up study, we present the middle-term results of transoral removal of submandibular calculi by incision in the floor of the mouth together with a patient satisfaction survey. These results will be compared with those of international studies. This is an individual retrospective cohort follow-up study. Forty-two patients had salivary calculi removed by incision in the mouth in the period from August 2009 to July 2012 at the Ear-nose-throat department of the North Zealand Hospital, Hillerød, Denmark. A retrospective study was carried out, focusing on the effects of the surgery and on patient satisfaction. The patients completed a questionnaire and underwent an objective physical exam. We found a high success rate (93 %), high patient satisfaction (94 %) and a high number of patients with no symptoms (92 %). In 94 % of the patients the gland was preserved, and there were no infections. One patient (3 %) suffered from damage to the lingual nerve, and 6 % (n = 2) claimed to suffer from continuous tingling of the tongue. Based on the present study and previous studies on transoral removal of calculi by incision in the floor of the mouth, we find this procedure effective, brief and safe for removal of large, immobile calculi from the hilum of the submandibular gland to the papilla.
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Joshi AS, Lohia S. Ultrasound indicators of persistent obstruction after submandibular sialolithotomy. Otolaryngol Head Neck Surg 2013; 149:873-7. [PMID: 24145146 DOI: 10.1177/0194599813508271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify and describe the ultrasound indicators of persistent obstruction following transoral submandibular sialolithotomy and discuss the utility of ultrasound in the immediate postoperative period. STUDY DESIGN We performed a prospective case series with planned data collection of patients who underwent treatment for symptomatic submandibular swelling. SETTING A tertiary care center. SUBJECTS Thirty-three patients of either sex with known submandibular gland sialoliths who failed endoscopic retrieval of calculi. METHODS We performed in-office or operating room-based transoral submandibular gland sialolithotomy followed by immediate postprocedure ultrasound examination for the assessment of residual calculi. All patients underwent mandatory reexploration for suspicious findings. RESULTS Only the appearance of hyperechogenic foci with posterior shadowing reliably predicted the presence of residual stones following transoral sialolithotomy (P < .0001). The presence of hyperechogenic foci without posterior shadowing (P = 1.00), ductal dilatation (P = .23), and intraglandular dilatation (P = 1.00) was not indicative of retained calculi. CONCLUSION The presence of hyperechogenic foci with posterior shadowing on immediate postprocedure ultrasound is an accurate indicator of residual stones following transoral submandibular sialolithotomy. Ultrasound examination can be reliably used to identify patients at risk of symptomatic recurrence of sialoliths.
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Affiliation(s)
- Arjun S Joshi
- The George Washington University, Division of Otolaryngology-Head and Neck Surgery, Washington, DC, USA
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