PDF(Pubmed)
Abstract：
The exact mechanism of sialolith formation has yet to be determined. Recurrence of sialolithiasis is rare, affecting only 1%-10% of patients. The current study presents a case of recurrent stones that occurred twice on the right submandibular gland 6 months postoperative and 7 months after reoperation in a 48-year-old female patient. The stones were analyzed using histology, scanning electron microscopy, energy dispersive spectroscopy, and transmission electron microscopy (TEM). The first stone showed a three-layered structure with a poorly mineralized peripheral multilayered zone, highly mineralized middle layer, and the central nidus. The stones were composed of Ca, C, O, Cu, F, N, P, Si, Zn, and Zr. In TEM, compact bi-layered bacterial cell membrane was found on the peripheral layer and the central nidus of the stone as well as exosomes in the central nidus. The results demonstrated the essential components of sialolith formation, including bacteria, inflammatory exosomes, and exfoliated salivary epithelial cells that cooperatively underwent the pathogenetic progresses of central nidus formation, induction of compact zone calcification of the middle layer, and repeated subsequent deposition in the peripheral multilayer zone. The rapid recurrence could have resulted from residual pieces of a sialolith acting as the nidus of bacterial infection.
摘要：
唾液石形成的确切机制尚未确定。唾液酸结石的复发是罕见的，仅影响1%-10%的患者。当前的研究提供了一例复发性结石的病例，该结石在48岁的女性患者术后6个月和再次手术后7个月在右下颌下腺发生了两次。结石用组织学分析,扫描电子显微镜，能量色散光谱，和透射电子显微镜（TEM）。第一块石头表现为三层结构，矿化外围多层带较差，高度矿化的中间层，和中央Nidus。这些石头是由Ca组成的,C,O,Cu,F,N,P,Si,Zn,和Zr。在TEM中,在结石的外围层和中央病灶以及中央病灶的外泌体上发现了致密的双层细菌细胞膜。结果表明了唾液石形成的基本成分，包括细菌,炎性外泌体，和脱落的唾液上皮细胞共同经历了中央乳头形成的发病过程，中间层致密区钙化的诱导，并在外围多层区中重复随后的沉积。快速复发可能是由于作为细菌感染的鼻石残留碎片所致。
