View revision history Report problem with Article. Citation, DOI and article data. Gaillard, F. Submandibular duct. Reference article, Radiopaedia. URL of Article. Quiz questions. Sialolithiasis: MR sialography of the submandibular duct--an alternative to conventional sialography and US? Radiology full text - Pubmed citation. A preincision insertion of a lacrimal probe into the duct or careful blunt dissection of the tissues with a curved mosquito hemostat will be successful. Carry the dissection with only slight deviations medially or laterally.
Retraction sutures can be placed through the lateral aspect of the incised mucosal tissues and tied to the adjacent teeth. For posteriorly located stones the mucosal incision is extended posteriorly and the duct exposed until a bulge is observed. Placing a curved hemostat inferior to it isolates the stone.
A longitudinal incision through the superior duct wall overlying the sialolith will result in its evacuation. The patency of the duct is checked by inserting a good sized lacrimal probe, which is then followed with saline intraductal irrigation and milking of the involved gland to remove any small residual stone fragments or mucus plugs.
The completion of the procedure can be done by either a primary closure or sialodochoplasty. If primary closure is done, do not suture the incised duct wall, because this will increase the risk of stenosis. To reduce the extent of oral floor swelling from the salivary leakage and postsurgical edema, a tight mucosal closure is contraindicated and surgical drains are mandatory.
A definitive risk for this procedure is increasing the severity of precondition of salivary stasis and also the risk of recurrence. This can be avoided by a dochoplasty. A new fabricated ductal opening is recommended at any location in the horizontal portion of the duct as long as it is posterior to the removed sialolith. The longitudinal superior ductal incision is lengthened posteriorly. The margins are spread laterally, and each side is sutured to their adjacent mucosa with two absorbable fine sutures.
If possible a single suture is then placed through the superior wall of the duct at the proximal end of the longitudinal ductal incision to engage the overlying mucosa. Ligation of the duct anterior to the dochoplasty to force salivary flow through the new opening is optional.
Periodic duct dilation and sialagogues will ensure a new ductal opening. Electrocorporeal shock wave lithotripsy is an old technique used as a noninvasive technique. Marmary first reported fragmentation of sialolith using shock waves in Large machines with very broad focus posed a problem at that time, but the development of smaller machines led to finely focused waves, which improved the efficacy of this technique. Iro et al. Study by Yoshizaki et al. With the need of advanced armamentarium and poor result this technique does not seem to be effective as a viable routine method of management.
Instead of using it as a solo technique adjuvant interventional endoscopy or surgical intervention proved to be effective in the treatment of sialoliths. Azaz et al. But there is no added advantage over the conventional surgical management. Being a blind procedure, with the extent of tissue destruction being unknown and the need for specialized equipment with the absence of clear benefit and with the possibility of deleterious effects, this procedure also does not seem to be a feasible technique for removal of sialoliths.
The endoscopic system includes diagnostic and interventional sialoendoscopy, a papillary dilator, forceps, grasping wire basket 3—6 wires , and an electrohydraulic lithotripter.
The endoscope is rinsed intermittently with a solution of 0. This slightly dilates the duct, cleans the view of the endoscopist, and removes pus, debris, and occasional blood. The first procedure is diagnostic and can explore the ductal system thoroughly. When the stone is located interventional endoscopy is required. Small round stones can be removed by wires or forceps. Larger stones should be fragmented and then be removed by wires or forceps.
When there is only stenosis balloon dilatation of the duct can be done and if mucin plugs are present they can be removed by forceps or washed out by continuous lavage through the endoscope.
Interventional sialoendoscopy and operation can be used jointly to treat multiple stones. Initial treatment results are found to be satisfactory but long-term results are yet to be explored. Gland removal is indicated only when small stones are present in the vertical portion of the duct from the comma area to the hilus or within the gland itself that are not surgically accessible intraorally and produce obstructive symptoms [ 8 ].
With the availability of interventional endoscope even this can be avoided. The authors declare that there is no conflict of interests regarding the publication of this paper. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview. Academic Editor: Constantino Ledesma-Montes. J Biol Buccale ; 8 : — Scanning electron microscopic and X-ray microdiffractometeric studies on sialolith-crystals in human submandibular glands. Acta Pathol Jpn ; 34 : 47— Scanning electron microscopy and energy-dispersive X-ray microanalysis studies of several human calculi containing calcium phosphate crystals.
Scanning Microsc ; 8 : — Spectroscopic and thermal analysis of a submandibular sialolith of Wharton's duct resected using Nd: YAG laser. Lasers Med Sci ; 23 : — Lipid composition of the matrix of human submandibular salivary gland stones. Arch Oral Biol ; 27 : — Studies on the organic composition of dental calculus and related calculi. Calcif Tissue Res ; 16 : — Lipid composition of human parotid salivary gland stones. J Dent Res ; 62 : — Protein composition of submandibular stones.
Mandel I D, Eisenstein A. Lipids in human salivary secretions and salivary calculus. Arch Oral Biol ; 14 : — Lipids associated with mineralization of human submandibular gland sialoliths. Arch Oral Biol ; 26 : — Ekberg O, Isacsson G. Chemical analysis of the inorganic component of human salivary duct calculi.
Morphological investigations of apatite nucleation in hard tissue and salivary stone formation. Naturwissenschaften ; 55 : The crystal chemistry of submandibular and parotid salivary gland stones.
J Oral Pathol ; 8 : — Structural analysis and protein identification from submandibular salivary stones. J Dent Res ; A Whinery J. Salivary calculi. J Oral Surg ; 12 : 43— Surgical management of nonneoplastic diseases of the submandibular gland.
A follow-up study. Int J Oral Maxillofac Surg ; 25 : — Salivary gland calculi: diagnostic imaging and surgical management.
Comp Contin Educ Dent ; 14 : — Baurmash H D. Submandibular salivary stones: current management modalities. Am Fam Physician ; 36 : — Diagnostic and interventional sialendoscopy: a preliminary experience.
Laryngoscope ; : — Sialendoscopy for the management of obstructive salivary gland disease: a systematic review and meta-analysis. Transoral removal of submandibular stones.
Speichelsteine der Glandula submandibularis. Setinentfernung mit Organerhalt. HNO ; 53 : — Chronic sialadenitis of the submandibular gland. A retrospective study of case. Arch Otorhinolaryngol ; : 91— Salivary gland function after sialolithiasis: scintigraphic examination of submandibular glands with 99mTc-pertechnetate. J Oral Maxillofac Surg ; 47 : — Glandular function after intraoral removal of salivary calculi from the hilum of the submandibular gland. Br J Oral Maxillofac Surg ; 42 : — Der Stellenwert der extrakorporalen Stosswellen-lithotripsie bei der Therapie der Sialolithiasis.
HNO ; 61 : — Nahlieli O, Baruchin A M. Long-term experience with endoscopic diagnosis and treatment of salivary gland inflammatory diseases. Download references. Kraaij, K. Karagozoglu, T. You can also search for this author in PubMed Google Scholar. Correspondence to H. Reprints and Permissions. Kraaij, S. Salivary stones: symptoms, aetiology, biochemical composition and treatment.
Br Dent J , E23 Download citation. Accepted : 02 September Published : 05 December Issue Date : 05 December Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative.
Oral Radiology Clinical Proteomics Advanced search. Skip to main content Thank you for visiting nature. Download PDF. Subjects Oral surgery Pathogenesis Salivary gland diseases. Key Points Salivary stones or sialoliths are calcified concrements in the salivary glands, most frequently located in Wharton's duct of the submandibular gland.
The management of salivary stones depends on the size and location of the stone. Abstract Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. Introduction Salivary stones or sialoliths are calcified structures or concretions located in the parenchyma or ductal system of the salivary glands Fig. Fragmented sialolith, removed from the submandibular gland.
Full size image. Table 1 Frequency of swelling and pain in patients with salivary stones 2 , 3 , 4 Full size table. Table 2 Characteristics of submandibular and parotid sialoliths 2 , 3 , 4 , 5 , 16 , 17 , 20 , 21 , 25 Full size table. Aetiology The exact aetiology of salivary stones is not completely understood, and various hypotheses have been put forward.
We recommend consulting your dental professional if you notice any signs or symptoms of a blocked salivary duct. That way, you can catch the issue at its source before it leads to more severe symptoms! While processing information about Wharton's duct anatomy may seem confusing at first, we think it's helpful to understand your mouth's anatomy. When you become more comfortable with the oral cavity's inner workings, you gain a better understanding of your whole-body health.
And good oral health is imperative for good overall health! When we understand the risks associated with not following a routine of brushing our teeth and gums, cleaning between our teeth with interdental devices, and following with a mouthrinse, we become more likely to adhere to these practices. We believe it all starts with taking the time to understand the body's structure and daily functions.
This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.
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