The \"double tongue sign\" is a characteristic finding in patients with Ludwig\'s angina, a potentially life-threatening infection due to airway compromise. Management primarily focuses on early airway protection and antibiotic administration. Submandibular sialolithiasis, on the other hand, could present with the double tongue sign without symptoms suggestive of airway involvement. Unlike Ludwig\'s angina, conservative treatment is usually the first-line approach for sialolithiasis. The importance of rapidly recognizing and distinguishing between the 2 conditions is emphasized through effective triage and risk stratification, particularly in rural areas where physicians are not readily available.

BACKGROUND: We investigated complications and recurrence rates after surgical techniques for sialolith removal with intact and resected Wharton\'s duct of the submandibular gland.
METHODS: The retrospective case-control analysis of a series analysed 271 surgical operations (2003-2022) for sialolithiasis performed at a hospital department of Otolaryngology-Head and Neck Surgery. The study compared two approaches: (1) pure endoscopic technique or pinpoint stone removal with Wharton\'s duct left intact and (2) transoral duct dissection or pinpoint stone removal technique, after which the duct was shortened. While choosing the surgical option, the size of the stone, the location of the stone, and the presence of multiple stones were taken into account. The rates of complications (lingual nerve paraesthesia, duct stenosis, drooling, and sialoadenitis), the incidence of foreign bodies, and the rate of recurrence during follow-up of ≥18 months were compared.
RESULTS: 323 sialoliths were removed from 271 patients. Of these 323 calculi, 150 were removed by the first approach and 173 by the second approach. The calculi varied in diameter from 2 to 38 mm with an average diameter of 8.2 mm. For all 271 patients, the rate of recurrence was 4.8%, but 11 recurrent cases (8.7%) appeared after the first approach surgeries and 2 cases (1.4%) after the second approach surgeries (p = .03). Other variables did not show statistically significant differences.
CONCLUSIONS: Surgical removal of the submandibular calculi, ending with shortening of Wharton\'s duct, reduces the recurrence rate for sialolithiasis but does not affect the rate of postsurgical complications.

BACKGROUND: Facial paralysis due to parotid sialolithiasis-induced parotitis is a unusual clinical phenomenon that has not been reported in prior literature. This scenario can present a diagnostic challenge due to its rarity and complex symptomatology, particularly if a patient has other potential contributing factors such as facial trauma or bilateral forehead botox injections as in this patient. This case report elucidates such a complex presentation, aiming to increase awareness and promote timely recognition among clinicians.
METHODS: A 56-year-old male, with a medical history significant for hyperlipidemia, recurrent parotitis secondary to parotid sialolithiasis, and recent bilateral forehead cosmetic Botox injections presented to the emergency department with right lower facial drooping. This onset was about an hour after waking up and was of 4 h duration. The patient also had a history of a recent ground level fall four days prior that resulted in facial trauma to his right eyebrow without any evident neurological deficits in the region of the injury. A thorough neurological exam revealed sensory and motor deficits across the entirety of the right face, indicating a potential lesion affecting the buccal and marginal mandibular branches of the facial nerve (CN VII). Several differential diagnoses were considered for the lower motor neuron lesion, including soft tissue trauma or swelling from the recent fall, compression due to the known parotid stone, stroke, and complex migraines. An MRI of the brain was conducted to rule out a stroke, with no significant findings. A subsequent CT scan of the neck revealed an obstructed and dilated right Stensen\'s duct with a noticeably larger and anteriorly displaced sialolith and evidence of parotid gland inflammation. A final diagnosis of facial palsy due to parotitis secondary to sialolithiasis was made. The patient was discharged and later scheduled for a procedure to remove the sialolith which resolved his facial paralysis.
CONCLUSIONS: This case emphasizes the need for a comprehensive approach to the differential diagnosis in presentations of facial palsy. It underscores the potential involvement of parotid sialolithiasis, particularly in patients with a history of recurrent parotitis or facial trauma. Prompt recognition of such uncommon presentations can prevent undue interventions, aid in timely appropriate management, and significantly contribute to the patient\'s recovery and prevention of long-term complications.

暂无摘要。

UNASSIGNED: Non-odontogenic osseous lesions of the mandible are relatively uncommon entities compared to odontogenic lesions. Although the posterior mandible is not a usual site, it is not rare either for these osseous lesions, making the diagnosis ambiguous, and if misdiagnosed leading to different treatment protocols.
METHODS: A 43-year-old female presented with a hard tissue lesion of the posterior mandible, misdiagnosed as a sialolith of the submandibular salivary gland in two other centers due to overlapping of symptoms, anatomic complexity, and inadequate investigations. The lesion was later diagnosed to be an osteoma of the posterior mandible with added investigations, and surgically excised. Histopathology confirmed the diagnosis.
UNASSIGNED: A variety of hard tissue lesions are known to occur in the posterior mandible like Submandibular sialolith, Osteomas, Calcified Submandibular lymph nodes, Phlebolith, and Tonsillolith. However, due to the region\'s structural complexity, localization of a hard tissue lesion may not always be forthright, even with radiographs. Moreover, in cases with conflicting symptoms, as was in this case there are more chances of misdiagnosis. The reasons for such diagnostic challenges are deliberated with radiological review of posterior mandibular osseous lesions. Recommendations are also suggested for proper investigations, thereby management of these posterior mandibular osseous lesions.
CONCLUSIONS: Misdiagnosis of these posterior mandibular lesions may lead to the patient undergoing unnecessary surgical procedures as different lesions require different management. Differential diagnosis and adequate protocol for investigations are required.

UNASSIGNED: Sialoliths are calcified organic matter that form within the secretory system of the salivary glands. They rarely measure more than 1.5 cm. Giant sialoliths are rare and defined as a size of 3.5 cm or larger.
UNASSIGNED: Patient complained of the pain and swelling in the right submandibular area for two years with increase in size during meals.
UNASSIGNED: Based on the clinical and radiological investigations.
UNASSIGNED: Sialolith measuring 39 mm and weighing 7.02 g, was removed in a minimally invasive manner through transoral sialolithotomy using diode 810 µm LASER unit under local anaesthesia.
UNASSIGNED: Patient was relieved of the preoperative symptoms and was on follow-up for one year.
UNASSIGNED: Various newer treatment modalities are effective alternatives to conventional surgical treatment of sialoliths. However, transoral sialolithotomy remains the mainstay of management.

The formation of stone in the ductal system of the salivary gland is termed sialolithiasis, with the submandibular gland being the most commonly affected. The precise aetiology is unknown but certain factors peculiar to the submandibular gland accounts for its likelihood of developing a calculous disease. Stones are classified based on their dimension, and may be silent or present with symptoms attributable to the size, location and complications. Here, a 50-year-old female who presented with a painless swelling in the left submandibular region that had grown slowly over the previous year, is reported. Following clinical and radiologic evaluation, left submandibular stone disease was preoperatively diagnosed. The patient underwent sialoadenectomy with transient palsy of the marginal mandibular branch of the facial nerve. Histopathology confirmed sialolith (2.7 cm) with severe squamous metaplasia of the duct. This presentation demonstrates some peculiar features attributable to the size, vertical orientation and location of the stone, in addition to the compression of the gland, thick fibrous capsule and significant squamous metaplasia of the duct. These findings require further evaluation for optimal treatment in view of the emerging trends for managing sialolithiasis.

UNASSIGNED: Salivary glands lithiasis (Sialolithiasis) is defined as calcified concretions in the salivary glands. Most common localization is in submandibular gland. Usually, submandibular stones are mainly located in Wharton\'s duct, whereas parotid stones are more often located in the gland parenchyma. Sialoliths are usually 5-10 mm in size, and stones more than 10 mm are unusual sizes. Exact etiology of sialolith formation is still unknown.
UNASSIGNED: We discuss a case of a 70-year-old patient, presenting painful swelling and a giant submandibular gland sialolith successfully treated with open surgery.
UNASSIGNED: A careful anamnesis and physical examination of the patient are important in the diagnosis of sialolithiasis. In addition, several imaging techniques, such as panoramic X-rays and Ultrasound, can be applied. The management can be both medical and surgical.

暂无摘要。

Sialolithiasis is a disorder of the salivary glands characterized by the presence of mineralized structures. The aim of this article is to contribute to the understanding of the etiopathogenesis of sialolithiasis based on data reported in the literature and the interpretation of scanning electron microscopic (SEM), histopathologic, fluorescence, and energy-dispersive X-ray spectroscopic (EDX) studies. The results of these analyses in a single case are presented. Fluorescence microscopy captured saliva flowing inside a giant sialolith, EDX analysis enabled the quantification of samples of minerals and characterized the chemical composition in the internal areas of the sialolith, and SEM images captured the external communications of the sialolith (ostia). Many theories have been proposed to explain sialolithiasis development, but few consider the role of saliva in its dynamic form. The authors propose that the triple synergism of microbiota, biofilm, and salivary dynamics plays a fundamental role in the development and intrinsic architecture of sialoliths, creating a cyclic sialolithic mineralization. This hypothesis is supported by the results of the laboratory studies in the present case.