salivary gland in the field of Oral & Maxillofacial surgery. Obstruction of salivary secretion by a sialolith can result in swelling and pain, as well as infection of the gland. The swelling is usually correlated to meals, when salivary secretion is enhanced. Sialolithiasis occurs mainly in the submandibular gland(92%) and to a lesser degree in the parotid gland(6%). The sublingual gland and the minor salivary gland are rarely affected(2%). This is a report of rare case, the authors have experienced, within the left sublingual gland and the minor salivary glands. It is multiple sialolithiasis(about 22 silaoliths) in the sublingual and the minor salivary glands which has very low incidence of sialolithiasis. The pathosis were removed using transoral sialolithotomy with sublingual sialadenectomy.]]>
Incidence ; Meals ; Salivary Gland Calculi ; Salivary Glands ; Salivary Glands, Minor ; Sublingual Gland ; Surgery, Oral

The submandibular gland is the second largest major salivary gland, which secretes 40% of the total daily saliva. Owing to its anatomic characteristics as well as the high viscosity and basicity of the saliva, sialolithiasis is found most commonly in the submandibular gland. Sialolithiasis that cannot be treated by conservative treatment is conventionally removed by an excision of the submandibular gland. Generally, an excision of the submandibular gland is performed via an extra-oral approach but the disadvantages of this treatment include a risk of injuring the facial nerve and scar formation. Case reports have revealed an even less invasive intraoral surgical technique for the removal of sialolith that does not affect the submandibular gland function. The functional recovery of the gland, complications and recurrence rates after surgery with this conservative intraoral procedure were all successful. We report 5 patients from the department of Oral and Maxillofacial Surgery at Dental Hospital, Yonsei University, who had undergone a resection of the sialolith though the intraoral approach with successful results.
Cicatrix ; Facial Nerve ; Humans ; Recurrence ; Saliva ; Salivary Gland Calculi ; Salivary Glands ; Submandibular Gland ; Surgery, Oral ; Viscosity

Sialolithiasis occurs in approximately 0.45% to 1.20% of the general population. The typical clinical symptom manifests as a painful swelling of the affected glands after a meal or upon salivary stimulation, which extremely affects the life quality of the patients. With the development of sialendoscopy and lithotripsy, most sialoliths can be successfully removed with preservation of the gland. However, sialoliths in the deep hilar-parenchymal submandibular ducts and impacted parotid stones located in the proximal ducts continue to pose great challenges. Our research center for salivary gland diseases (in Peking University School and Hospital of Stomatology) has used sialendoscopy for 17 years and treated >2 000 patients with salivary gland calculi. The success rate was approximately 92% for submandibular gland calculi and 95% for parotid calculi. A variety of minimally invasive surgical techniques have been applied and developed, which add substantial improvements in the treatment of refractory sialolithiasis. Further, the radiographic positioning criteria and treatment strategy are proposed for these intractable stones. Most of the hilar-parenchymal submandibular stones are successfully removed by a transoral approach, including transoral duct slitting and intraductal basket grasping, while a small portion of superficial stones can be removed by a mini-incision in submandibular area. Impacted stones located in the distal third of parotid gland ducts are removed via "peri-ostium incision", which is applied to avoid a cicatricial stenosis from a direct ostium incision. Impacted parotid stones located in the middle and proximal third of the Stensen's duct are removed via a direct mini-incision or a peri-auricular flap. A direct transcutaneous mini-incision is commonly performed under local anesthesia with an imperceptible scar, and is indicated for most of impacted stones located in the middle third, hilum and intraglandular ducts. By contrast, a peri-auricular flap is performed under general anesthesia with relatively larger operational injury of the gland parenchyma, and should be best reserved for deeper intraglandular stones. Laser lithotripsy has been applied in the treatment of sialolithiasis in the past decade, and holmium ∶YAG laser is reported to have the best therapeutic effects. During the past 3 years, our research group has performed laser lithotripsy for a few cases with intractable salivary stones. From our experiences, withdrawal of the endoscopic tip 0.5-1.0 cm away from the extremity of the laser fiber, consistent saline irrigation, and careful monitoring of gland swelling are of vital importance for avoidance of injuries of the ductal wall and the vulnerable endoscope lens during lithotripsy. Larger calculi require multiple treatment procedures. The risk of ductal stenosis can be alleviated by endoscopic dilation. In summary, appropriate use of various endoscopy-assisted lithotomy helps preserve the gland function in most of the patients with refractory sialolithiasis. Further studies are needed in the following aspects: Transcervical removal of intraglandular submandibular stones, intraductal laser lithotripsy of impacted parotid stones and deep submandibular stones, evaluation of long-term postoperative function of the affected gland, et al.
Humans ; Salivary Gland Calculi/surgery* ; Constriction, Pathologic ; Endoscopy ; Salivary Ducts/surgery* ; Lithotripsy ; Treatment Outcome

Salivary glands, major and minor, are susceptible to a wide variety of pathologic conditions. Excision of the submandibular gland is a surgical procedure often undertaken. The procedure is the treatment of choice for patients with neoplasm of the submandibular gland and those with non-neoplastic submandibular disorders which are not controlled with conservative medical measures. Extirpation of the submandibular gland may also be undertaken for diagnostic purposes. We evaluated 84 patients who had been admitted to the Dept. of oral and maxillofacial surgery of Pusan National University Hospital from January, 1989 to December, 2002 and had been performed submandibular gland excision. The results are as follows : 1. The patients undertaken the excision of the submandibular gland showed an age range of 16 to 71 years. The average was 49.1. 2. They consisted of 60 males(71.4%) and 24 females(28.6%), having 2.5 : 1 of genda ratio. 3. The most common symptom was swelling in 41 cases(48.8%), followed by the pain in 23 cases(27.4%). Other symptoms included mass, dysphagia, facial abnormaly and neck dyscinesia. 4. 42 cases(50.0%) showed sialadenitis and sialodochitis associated with salivary calculus. 5. According to the histopathologic study, all cases consisted of 17 neoplasmatic conditions(20.3%) and 67 non-neoplasmatic(79.7%). The neoplasmatic cases included 13 benign tumors and 4 primary malignant tumors. Sialadenitis and sialodochitis associated with or without salivary calculus were most marked, found in 50 cases(59.3%), in the non-neoplasmatic conditions. Pleoomorphic adenoma showed the highest frequency of the benign tumor.
Adenoma ; Busan ; Deglutition Disorders ; Humans ; Neck ; Salivary Calculi ; Salivary Glands ; Sialadenitis ; Submandibular Gland* ; Surgery, Oral

OBJECTIVEA study was conducted to evaluate the clinical application of sialendoscopy combined with conven tional laparoscopy in a 30 degree angle in depth salivary calculus of submandibular glands.

METHODSA total of seventeen patients were presented with repeated swelling in the unilateral submandibular area from June 2013 to August 2015. All patients underwent CT examinations of the mandible and salivary gland function imaging preoperatively. Sialoendoscopy and conventional endoscopy were applied to do intraoral lithotomy. Among the study group, thirteen cases were males and four cases were females. A total of twelve were left cases and five were right cases. Results Seventeen patients had deep positive calculus in the submandibular glands under CT. Photo technetium function was basically normal, whereas secretion of ipsilateral decreased significantly in salivary function tests. Double endoscope assisted surgeries were performed successfully through the mouth to remove the stones. The operation time was (42+21) min. There were no obvious complications in perioperative periods.

CONCLUSIONIntraoral lithotomy assisted by sialoendoscopy and conventional laparoscopy for deep stones in the submandibular glands is a new technique. This technique will possibly lead to complete avoidance of gland resection because of early deep sialolithiasis.

Endoscopy ; methods ; Face ; Female ; Humans ; Male ; Mandible ; Minimally Invasive Surgical Procedures ; Neck ; Perioperative Period ; Salivary Gland Calculi ; surgery ; Submandibular Gland ; surgery

OBJECTIVETo investigate the clinical effects of sialoendoscopically-assisted sialolithectomy for the sialolithiasis in the hilum of the submandibular glands.

METHODSBetween December 2005 and March 2011, treated 80 cases of radiography-verified sialiolithiasis in the hilum of the submandibular glands, The patients included 42 males and 38 females aged from 13 to 68 years. All these patients underwent sialoendoscopic observation and sialoendoscopically-assisted sialolithectomy and were followed up periodically for 3 - 6 months after operation. The success rate of stone removal, postoperative complications and clinical effects were analysed.

RESULTSThe stones were completely removed in 71 cases, and almost completely removed in 5 cases, with a successful rate of 95% (76/80). Among 76 successful cases, 8 were treated by basket entrapment, 59 by intraoral open surgery and 9 by both of these two techniques. Within 3 - 6 months' follow-up, 1 case suffered temporary lingual nerve parenthesis and two suffered ranula formation.

CONCLUSIONSSialoendoscopically-assisted sialolithectomy is a safe and effective gland-preservation technique for the patients with the hilum of the submandibular glands.

Adolescent ; Adult ; Aged ; Endoscopy ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Natural Orifice Endoscopic Surgery ; adverse effects ; Ranula ; etiology ; Salivary Duct Calculi ; surgery ; Salivary Ducts ; pathology ; Submandibular Gland ; surgery ; Young Adult