Search Results (27)

Background/Objectives: The introduction of innovative technologies for the management of oral diseases has revolutionized treatment approaches, offering less invasive options and improved outcomes. Among oral cavity diseases, sialolithiasis is the most common disorder of the salivary glands. It involves the formation of calculi or stones within the salivary ducts, primarily affecting the submandibular gland due to its tortuous duct and the alkaline nature of its saliva. In particular, laser-assisted techniques have shown significant promise in enhancing the precision and safety in the management of sialolith removal. This article aims to present a case report and also explores the scientific evidence supporting these innovative methods, highlighting their benefits and limitations in clinical practice. Methods: This research was conducted using PubMed and Scopus search engines with a combination of relevant keywords, including laser, laser-assisted, laser treatment in combination with sialolith, sialolith removal, and sialoadenectomy. Selected articles were carefully reviewed to identify studies reporting data on the effectiveness of laser-assisted sialolith removal. Results: Results from the literature review indicate a growing interest in the application of diode laser and CO₂, with evidence suggesting improved clinical outcomes and reduced postoperative pain compared to traditional methods. Conclusions: Although lasers offer enhanced safety and reduced morbidity and bleeding, which ensures optimal visibility, certain limitations must be considered, including the need for an adequate training period. Further randomized clinical trials and longer follow-up studies are needed to better evaluate their use in sialolith removal. Full article

Background/Objectives: Obstructive salivary gland disorders—primarily sialolithiasis and ductal stenosis—remain a significant source of morbidity, often requiring surgical intervention. Sialendoscopy has emerged as a minimally invasive, gland-preserving technique for both diagnosis and treatment. This retrospective study aimed to evaluate diagnostic and interventional sialendoscopy outcomes in a Romanian patient cohort and to identify gland-specific considerations in the management of salivary gland obstruction; Methods: A total of 89 patients with confirmed obstructive salivary gland disease (parotid or submandibular) were included. The most common indications included lithiasis, ductal stenosis, sialadenitis, and mixed pathologies; two cases of juvenile recurrent parotitis (JRP) were also managed. All patients underwent clinical evaluation, imaging (ultrasound, CBCT, CT, MR sialography), and sialendoscopic treatment between 2021 and 2025 in two centers. Data on demographics, imaging, calculus size, procedural technique, anesthesia, and complications were collected and analyzed using descriptive and inferential statistics; Results: The submandibular gland was more frequently involved (70.8%), with larger calculi compared to the parotid (mean 7.6 mm vs. 5.1 mm; p = 0.004). Minimally invasive techniques were predominantly used: sialolithotomy and intracorporeal lithotripsy were each performed in 32.6% of cases. Submandibulectomy was required in only 5.6% of patients. Most procedures (93.3%) were conducted under local anesthesia. Complication rates were low and primarily minor and self-limiting; Conclusions: Sialendoscopy is a safe and effective gland-preserving approach in managing obstructive salivary gland disorders. Gland-specific anatomy influences diagnostic pathways and therapeutic choices. These findings support broader adoption of sialendoscopy in routine practice and highlight the need for tailored management protocols based on gland involvement and stone characteristics. However, the study is limited by the absence of standardized post-intervention quality-of-life assessments and structured follow-up data on symptom recurrence. Full article

Background/Objectives: Sialolithiasis is a common disorder of the major salivary glands characterized by the formation of salivary stones, known as sialoliths. It is predominantly observed in patients in their fourth to sixth decades of life. Several potential factors have been associated with the development of sialolithiasis, including obesity, smoking, medication use, and several systemic diseases such as dyslipidemia, hypertension, and diabetes mellitus. Despite extensive research into the pathogenesis of sialolithiasis, it remains elusive. Therefore, this study aims to explore the characteristics of sialolithiasis among patients residing in Saudi Arabia and to detect the possible role of systemic disorders in the development of sialolithiasis. Methods: This study included 375 patients with a confirmed diagnosis of sialolithiasis between 1 January 2016 and 31 December 2024, at the National Guard Health Affairs centers in Saudi Arabia. Demographic information, body mass index (BMI), presence of systemic disorders (hypertension, diabetes mellitus, dyslipidemia, asthma, cancer), and the age at diagnosis of each disease were collected for data analysis. Results: A total of 55.5% of the patients were male, with a mean age of 39.8 and a mean BMI of 28. Dyslipidemia represented the most prevalent systemic condition (32.9%), followed by diabetes mellitus (23.5%) and hypertension (20.3%). Moreover, 74.4% and 74.2% of the patients developed hypertension and diabetes mellitus before sialolithiasis, respectively. Furthermore, dyslipidemia was associated with a higher risk profile compared with diabetes mellitus and other systemic disorders. Conclusions: This exploratory study indicates that the incidence pattern of sialolithiasis among both genders likely depends on lifestyle factors and other underlying systemic conditions. Elevated BMI may be a contributing characteristic, and the development of systemic diseases such as diabetes mellitus could be linked to the formation of salivary stones. Furthermore, these findings support a multifactorial pathophysiology of sialolithiasis. The aforementioned factors may play a role in the formation of salivary stones through hyposalivation, whether disease-related or medication-induced hyposalivation, potentially serving as a common mechanism. Full article

Background/Objectives: The failure rate of minimally invasive surgical approaches to parotid stones is about 10%, primarily due to the presence of large, impacted, or unpalpable deep stones. When stones are palpable and exceed 7 mm in size, a combined transfacial and sialendoscopic approach offers a safe and effective surgical option, while unpalpable and impacted stones located in the parenchyma, not visible or accessible through sialendoscopy, can be treated with a CT-guided transfacial approach. Methods: Twenty-two patients (three females, mean age 53 years, range 32–73 years) underwent CT navigation-assisted transfacial removal of unpalpable and impacted parotid stones at the Department of Otolaryngology and Head and Neck Surgery of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan between 2017 and 2024. Results: The mean size of the stones was 7.4 mm (range 4–14 mm), while the mean depth of stones, calculated as the distance from the skin surface, was 8.7 mm (range 4–14 mm). Stones were removed successfully in all but five patients (77% success rate). Failure of the procedure was significantly associated (p < 0.05) with the depth of the stone (>12 mm); in all these cases, patients were treated immediately by means of traditional parotidectomy. Conclusions: The CT-navigation-assisted transfacial approach can be considered a safe, reliable, and efficacious option for the treatment of difficult unpalpable parotid stones, impacted and deeply located in the gland parenchyma. Stones deeper than 10 mm can be more effectively treated by means of traditional parotidectomy if extracorporeal lithotripsy is not available. Full article

Objectives: Since the peri- and intraoperative management of patients with inflammatory and obstructive sialadenitis (IOS) differs significantly between treating centers worldwide, we investigated whether these patients can be treated successfully, resource-savingly and with high patient satisfaction using minimally invasive procedures under local anesthesia (LA). Methods: We developed a comprehensive, stratified routine anesthesia and pain management protocol based on our proposed classification of invasiveness (grade 1–4), for almost all available IOS treatment procedures. We included 377 patients with 470 LA-conducted interventions in our study and evaluated their perceptions during and after the treatment. Results: The protocol was applied to all 377 study participants for all 470 interventions. The mean grade of invasiveness was 2.49 ± 1.31, with a mean procedure duration of 30 ± 20 min. We found a significant positive association between invasiveness levels and procedure duration (p = 0.001) or pain directly after surgery (p = 0.004). Patients rated the procedures as ”well acceptable” or better in a large majority (88.1–97%) regarding the administration and potency of LA, procedure duration, and pain during and directly after surgery. In total, 96.4% of patients would have the treatment repeated under the same conditions. Conclusions: The proposed anesthesia and pain management regimen, respecting invasiveness levels, enables IOS patients to undergo treatment under LA with high success rates, serving as a potential guide for performing physicians. Full article

The process of stone formation in the human body remains incompletely understood, which requires clinical and laboratory studies and the formulation of a new endogenous, nanotechnological concept of the mechanism of origin and formation of crystallization centers. Previously, the mechanism of sialolithiasis was considered a congenital disease associated with the pathology of the ducts in the structure of the glands themselves. To date, such morphological changes of congenital nature can be considered from the position of the intrauterine formation of endogenous bacterial infections complicated by the migration of antigenic structures initiating the formation of crystallization centers. The present work is devoted to the study of the morphology and composition of stones obtained as a result of surgical interventions for sialolithiasis. Presumably, nanoparticles of metals and other chemical compounds can be structural components of crystallization centers or incorporated into the conditions of chronic endogenous inflammation and the composition of antigenic structures, in complexes with protein and bacterial components. X-ray microtomography, X-ray fluorescence analysis, scanning transmission electron microscopy and microanalysis, mass spectrometry, and Raman spectroscopy were used to study the pathogenesis of stone formation. Immunoglobulins (Igs) of classes A and G, as well as nanoparticles of metals Pb, Fe, Cr, and Mo, were found in the internal structure of the stones. The complex of antigenic structures was an ovoid calcified layered matrix of polyvid microbial biofilms, with the inclusion of metal nanoparticles and chemical elements, as well as immunoglobulins. The obtained results of clinical and laboratory studies allow us to broaden the view on the pathogenesis of stone formation and suggest that the occurrence of the calcification of antigenic structures may be associated with the formation of IgG4-associated disease. Full article

Speckle noise in ultrasound images (UIs) significantly reduces the accuracy of disease diagnosis. The aim of this study was to quantitatively evaluate its feasibility in salivary gland ultrasound imaging by modeling the adaptive non-local means (NLM) algorithm. UIs were obtained using an open-source device provided by SonoSkills and FUJIFILM Healthcare Europe. The adaptive NLM algorithm automates optimization by modeling the isotropic search window, eliminating the need for manual configuration in conventional NLM methods. The coefficient of variation (COV), contrast-to-noise ratio (CNR), and edge rise distance (ERD) were used as quantitative evaluation parameters. UIs of the salivary glands revealed evident visualization of the internal echo shape of the malignant tumor and calcification line using the adaptive NLM algorithm. Improved COV and CNR results (approximately 4.62 and 2.15 times, respectively) compared with noisy images were achieved. Additionally, when the adaptive NLM algorithm was applied to the UIs of patients with salivary gland sialolithiasis, the noisy images and ERD values were calculated almost similarly. In conclusion, this study demonstrated the applicability of the adaptive NLM algorithm in optimizing search window parameters for salivary gland UIs. Full article

(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. Full article

Primary lymphomas of the salivary gland are rare. The most common subtype is MALT lymphoma. MALT lymphoma has an indolent clinical course, and patients often present with a prolonged history. Evaluations of parotid masses begin initially with radiological imaging, but pathological and histological examination remains the mainstay of definitive diagnosis. This case describes a primary non-Hodgkin’s lymphoma of the parotid gland in a healthy 32-year-old male. This case report will evaluate the prevalence of primary MALT lymphoma and discuss the possible presentation. Full article

Introduction: Juvenile recurrent parotitis (JRP) is characterized by intermittent swelling of one or both parotid glands, accompanied by pain and associated with non-obstructive sialectasia. Sialoendoscopy is considered a significant treatment for JRP, being a safe and minimally invasive treatment method with good clinical outcomes. The purpose of this study was to assess the procedure of sialoendoscopy as a treatment modality for JRP and discuss the relevant literature on this topic. Methods: This study retrospectively reviewed clinical records of children diagnosed with JRP who were treated in the Maxillofacial Department of the Tzafon Medical Center, Poriya, Israel, with sialoendoscopy between May 2016 and March 2023. Data on demographics, the site of symptoms, follow-up duration, treatment outcome, and complications were collected for each patient. The inclusion criteria were patients not older than 16 years of age, with at least two episodes of swelling of the parotid gland unilaterally or bilaterally during a time period of 6 months. The exclusion criteria were patients older than 16 years of age, and patients who were diagnosed with sialolithiasis or Sjogren’s syndrome. Results: The study included 17 children, of whom 12 (70%) were boys and 5 (30%) were girls. The mean age of the children at the time of the procedure was 6.7 years and ranged from 3 to 16. The affected parotid gland was the left in 7 children (41%), right in 9 children (53%), and bilateral in 1 child (6%). The average follow-up time was 45.17 months and ranged from 5 to 81 months. A total of 15 children (88%) were deemed to have a successful treatment result regarding the frequency of episodes after therapy and subjective improvement. Full resolution was seen in 10 children (59%). The sialoendoscopy findings were avascularity in the walls of the parotid duct, strictures, and mucous plugs. Pathological findings in sialoendoscopy were found in 11 out of 12 asymptomatic contralateral glands (p-value > 0.001). Conclusions: Sialoendoscopy under general anesthesia is a worthwhile and practicable treatment method for treating JRP. Satisfactory results were seen in the vast majority of patients. It is recommended to perform bilateral sialoendoscopy also in cases of a unilateral symptomatic gland. This treatment method is effective, safe, and potentially repeatable. Full article

Submandibular gland sialolithiasis can be addressed by gland removal or by stone removal. Intraoral stone removal has now become the go-to technique to minimize aesthetic and functional sequelae (e.g., marginalis mandibulae injury, visible surgery scar) and, although traditional techniques were first experimented with (intraoral ducotomy), newer techniques drew the interest of the scientific community: sialoendoscopy, TORS-S (TransOral Robotic Surgery Assisted–Sialolithotomy) and VITOM-guided sialolithotomy. In this article, we compare the two newest transoral techniques for transoral sialolithotomy, TORS-S and 3D-4K VITOM-guided sialolithotomy, used to treat bilateral hilar submandibular gland sialolithiasis in the same patient, one technique for each side. Using these techniques, a faster recovery is achievable with almost no anatomical and/or functional sequelae, since they both allow better visualization and manipulation of soft tissues and noble structures (e.g., lingual nerve and Wharton’s duct) and make surgery easier and safer. Moreover, OR staff can better perceive surgical steps and be involved in the procedure, thus showing the high educational and training potential of these technologies. Full article

Sialolithiasis mainly affects the oral salivary glands due to the presence of small stones that obstruct the secretion of saliva. The treatment and control of pain and inflammation during the course of this pathology is essential to guarantee the patient’s comfort. For this reason, a ketorolac calcium cross-linked alginate hydrogel was developed, and it was then applied in the area of the buccal cavity. The formulation was characterized (swelling and degradation profile, extrusion, extensibility, surface morphology, viscosity, and drug release). The drug release was studied ex vivo in static Franz cells and with a dynamic ex vivo method under artificial saliva continuous flow. The product exhibits adequate physicochemical properties considering the intended purpose, and the drug concentrations retained in the mucosa were high enough to deliver a therapeutic local concentration able to reduce the pain associated with the patient’s conditions. The results confirmed the suitability of the formulation for application in the mouth. Full article

This study aimed to systematically review the literature to determine the efficacy and safety of transoral robotic surgery (TORS) in the management of submandibular gland (SMG) sialolithiasis. PubMed, Embase, and Cochrane were searched for English-language articles evaluating TORS in the management of SMG stones published up to 12 September 2022. Nine studies with a total of 99 patients were included. Eight patients underwent TORS followed by sialendoscopy (TS); 11 patients underwent sialendoscopy followed by TORS and sialendoscopy (STS); 4 patients underwent sialendoscopy followed by TORS only (ST); and 4 patients underwent TORS without sialendoscopy (T). The mean operative time amounted to 90.97 min. The mean procedure success rate reached 94.97%, with the highest for ST (100%) and T (100%), followed by the TS (95.04%) and STS (90.91%) variants. The mean follow-up time was 6.81 months. Transient lingual nerve injury occurred in 28 patients (28.3%) and was resolved in all of them within the mean of 1.25 months. No permanent lingual nerve injury was reported. TORS is a safe and effective management modality for hilar and intraparenchymal SMG sialoliths, with high procedural success in terms of successful sialolith removal, SMG preservation, and reduced risk of permanent postoperative lingual nerve damage. Full article

Identifying a submandibular (Wharton’s) duct punctum often hinders sialendoscopy; however, there is a paucity of evidence on whether the appearance of Wharton’s duct papilla impacts the sialendoscopic procedure. A classification of Wharton’s duct papillae based on the macroscopic appearance, size of dilatation probes, and sialendoscopic approach was proposed herein. The classification describing four main types of papillae, A, B, C, and D, was prospectively evaluated on 351 Wharton’s duct papillae in 315 patients. For each papillae type, the demographic/clinical data, intraoperative complications, and time required for sialendoscope introduction were analyzed. Estuary-like papilla (type A) was commonly seen after spontaneous stone extrusion, had no intraoperative complications noted, and had the shortest time required for the sialendoscope introduction. Normal papilla (type B) was the most frequently observed papilla (48.1%), reflecting diverse underlying pathology, while difficult papilla (type C) was often associated with unfavorable anatomical variations of the mandible or floor of the mouth. Substantially closed papilla (type D) had the highest rate of intraoperative complications, namely, perforation with a false passage, and required the longest time for the sialendoscope introduction. In seven patients (2.0%), the entrance into the duct was feasible only through the fistula, while the sialendoscope introduction failed in eight patients (2.3%). In conclusion, the appearance of Wharton’s duct papillae may be influenced by the underlying pathology. Based on the proposed classification, papilla typology affects the duration of sialendoscope introduction and may influence the frequency of intraoperative complications. Full article

In India, most snakebite envenomation (SBE) incidents are caused by the “Big Four” snakes which include Russell’s viper, common krait, Indian cobra, and saw-scaled viper. Their common envenomation effects include neurotoxicity, myotoxicity, and coagulopathy. However, they also induce rare complications such as priapism, pseudoaneurysm, and sialolithiasis. Ocular manifestations such as optic neuritis develop rarely following envenomations by non-spitting snakes and they may cause temporary vision changes and blindness if untreated. While optic neuritis following Indian cobra envenomation has been reported previously, this was not encountered in victims of common kraits. Hence, for the first time, we report optic neuritis developed in a victim following envenomation by a common krait and compare its clinical features and diagnostic and therapeutic methods used with another case of optic neuritis in a victim of an Indian cobra bite. Both patients received antivenom treatment and made an initial recovery; however, optic neuritis developed several days later. The condition was diagnosed using ophthalmic examination together with computed tomography and/or magnetic resonance imaging methods. Due to very similar clinical features, both patients received intravenous corticosteroids which restored their vision and successfully treated optic neuritis. This case report suggests that the optic neuritis developed in a common krait envenomation is comparable to the one developed following a cobra bite, and therefore, the same diagnostic and therapeutic approaches can be used. This study also raises awareness of this rare complication and provides guidance for the diagnosis and treatment of SBE-induced optic neuritis. Full article