Developmental Obstructive Inflammatory Cystic Neoplastic

Aplasia (agenesis), atresia. atresia. Aberrancy. (Latent bone cyst)

Mucositis. Congenital absence of major salivary glands  Cl.1 ml/min (unstimulated) < 0. Glossitis. Presentation (Xerostomia.5 ml/min (stimulated) Scintigraphy .Caries) Diagnostic Approaches : Sialometry (flow rate) < 0.Caries Glossitis.

mandible.A part of the submand. SG lies submand. It is an aberrant SG Site Recognition of the defect should preclude any treatment or surgical exploration. . within a well-defined welldepression on the lingual posterior surface of the mandible.

Mucous retention/extravasation retention/extravasation .Causes of obstruction include Salivary calculi (Sialolithiasis) Sialolithiasis) Strictures or kinks of the duct wall Oedema or fibrosis of the papilla Pressure on the duct due to an adjacent mass Invasion of the duct by a malignant neoplasm.

The main cause of obstructive salivary diseases Sialolith are calcified and organic matter that form within the duct system of the major salivary glands. . glands.

ductal epith cells. .‡ The exact etiology and pathogenesis of salivary calculi is unknown. ‡ The calculi are believed to arise from the deposition of ca ++ salt around a nidus of debris within the duct lumen. or foreign bodies. these debris include bacteria.

firm .30% of salivary diseases sublingual 7% parotid 10% submandibular 83% Most of SMG calculi are radio-opaque & solitary radioMost of parotid calculi are radiolucent & multiple Minor salivary glands (buccal mucosa or upper lip) (buccal nodule.

90% of sialoliths 90% occur in this gland.‡ The submandibular gland is the most common site of involvement. ‡ Higher concentration of calcium and phosphate ‡ Torturous course of the Wharton¶s duct ‡ The dependent position of the submandibular glands. Why? gland. and 80 . (Anti-gravity flow) (Anti- . which leave them prone to stasis. «..

The degree of symptoms is dependent on the extent of salivary duct obstruction and the presence of secondary infection. . Complete obstruction causes constant pain and swelling An examination of the soft tissue surrounding the duct may show a severe inflammatory reaction. reaction. infection.May be asymptomatic for a long time. time History of pain and/or swelling of the concerned gland during eating followed by gradual reduction between meals. meals.

The involved gland is usually enlarged and tender. ductal stricture. and ductal dilatation fibrosis.Palpation along the pathway of the duct may confirm the presence of a stone. present. and gland atrophy. Stasis of the saliva may lead tender. A uniformly firm gland suggests a hypohypoor non-functional gland nonNo salivary flow or purulent discharge. stone. to infection. discharge. atrophy. . Signs of systemic infection may be present.

. significant because such sialoliths are not radiographically detectable. Calcified phleboliths and lymph nodes can be easily mistaken radiographically for sialoliths. This is clinically calcified. detectable. Sialography can aid in differentiating these lesions. The recommended view for radiography of sialoliths 50% 50% of parotid gland sialoliths and 20% 20% of submandibular gland sialoliths are poorly calcified.Radiographic examination is often necessary since the stone may not be accessible to bimanual palpation.

 Type. ultrasound . MRI. . site & size of stones  Associated inflammatory disorders  Assess the gland function longstanding recurrent swelling Plain films.sialography. CT.sialography. sialoscopy .

   Stones in the Anterior Duct Stones in the Posterior Duct Stones in the Hilum or Gland .Effective treatment of the sialolith depends on the location of the stone and on its effect on gland function.

Removal of the stone: stone: Conservative management by: Milking the gland ShockShock-wave Lithotripsy (external and intraductal) intraductal) Interventional sialendoscopy Surgical removal (Sialolithotomy) Gland excision (Sialadenectomy) .

Indication:  Small. mobile stone at or just behinde the duct orifice  Stone causing partial obstruction Procedures ydration pplication of moist arm heat land massage The use of sialogogues Infection antibiotic .Stone ay be re oved by spontaneous exfoliation on sti ulation of salivation to flush the stone out of the duct.

The gland is then milked to remove any other debris in the more posterior portion of the duct . milked forward.Stone may be removed by manipulation Indication:  Small. mobile stone at or just behinde the duct orifice Procedures Open the duct with the aid of lacrimal probes and dilators. the stone can be identified. By gentle probing. grasped and removed.

(sialolithotomy).) . gL. submand. intraoral approach. Intraglandular Extraoral Intraoral approach (sublingual gL. submand. gL. sialolithotomy).) gL.Extraglandular removal of the stone removal of the gland approach (Parotid. approach.

Indication Extraglandular stone ‡ Stones in the Anterior Duct located in the distal third of the submandibular duct ¥ ‡ Stones in the Posterior Duct .

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rubber tube o The wound held open o The incised duct is closed over silastic catheter .

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Wharton¶s duct Lingual n guidewire Lingual n Wharton¶s duct .

Indication  Very posterior stones  Intra-glandular stones Intra Irreversible parenchymal damage .

‡ Stones in the Terminal Duct ‡ Stones in the Posterior Duct ‡ Stones in the hilum or gland .

Sialolithotomy when the stone is at or just behind the duct orifice Parotid duct meatotomy Meatotomy: An incision made to enlarge a meatus .

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Par tidect my .

ShockShock-wave Lithotripsy Interventional sialendoscopy .

Minigrasping forceps Sialendoscope Sialostent basket retrieving .It allows removal the stone while preserving the gland.

duct.Laser fragmentation and extraction of debris using a wire basket through a minimal incision of Wharton¶s papilla is followed by a complete clearance of the duct. .

Shock-waves fragmenting salivary stones flushing out from the salivary duct system Types  External lithotripsy. results were poor specifically in patients with large calculi  Interventional sialendoscopy External lithotripter with intraductal laser fragmentation and basket extraction of calculi (success rate 80%) .

Sialendoscope Electrohydraulic lithotripter. . Autolith. and a probe which can be inserted into the working channel of the sialendoscope.

Sialolith at the hilus .

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