Background
Sialoendoscopy is the standard treatment for sialolithiasis; however, some patients may be unlikely to benefit from an endoscopic approach. This study assesses predictors of failure in the endoscopic management of sialoliths.
Methods
Patients treated for sialolithiasis from 2012 to 2017 at two centers were stratified into 3 groups: successful interventional sialendoscopy, incisional sialolithotomy, and gland excision. Patient, disease, and surgical factors were compared.
Results
Interventional sialendoscopy was attempted in 156 of 206 cases and successful for 42 (27%). Endoscopically retrieved calculi were smaller (4.96 mm) compared to incisional sialolithotomy (7.90 mm). Nonendoscopic approaches were required more often in submandibular cases 87% (P ≤ .005). Palpable stones were present in 74% of incisional sialolithotomies (P < .001). Submandibular location (OR 3.50, 1.53‐7.98), palpability (OR 2.74, 1.21‐6.18), CT localization (OR 3.05, 1.32‐7.10, P = .010), and increased diameter (OR 1.25, 1.09‐1.44) were predictive of incisional management.
Conclusion
Stone size/location, CT‐localization, and palpability were predictive of calculi that require an incisional approach. If these factors are recognized, the surgeon can consider proceeding directly to incisional sialolithotomy.
Level of evidence
III
Airway obstruction in children has a wide differential diagnosis that includes laryngomalacia, infectious processes, paralysis, extrinsic compression, and other rare anatomic anomalies. Isolated laryngeal lymphatic malformations are rare developments that can manifest with clinically significant airway obstruction. To the best of our knowledge, there have been fewer than 20 reported cases. These laryngeal mucosal lesions are best managed with radiofrequency ablation or laser ablation. We present a case of a 2-year-old child who presented with airway obstruction, initially diagnosed with laryngomalacia, who was subsequently diagnosed and treated for an isolated epiglottic lymphatic malformation.
A woman in her 30s with a history of bruxism and long-term use of a bite guard presented with pain centering on left submandibular area for 2 years. She was initially prescribed a muscle relaxant without notable improvement. Physical examination revealed a mild firmness in the left submandibular area. The mucosa of the oral cavity and floor of mouth was normal. Cranial nerve function, including tongue mobility and sensation, was also normal. Contrast-enhanced computed tomography (CT) demonstrated a 1.7 × 1.5 × 1.4-cm mass, adjacent to the left submandibular gland. Scattered, nonenlarged lymph nodes were observed (Figure , A). An ultrasonography-guided fine needle aspiration biopsy was nondiagnostic owing to an inability to obtain sufficient tissue. The patient underwent surgical exploration with left submandibular gland excision and resection of the left submandibular mass (Figure , B). Histopathologic findings showed spindle cell neoplasm with morphologic features and no malignant neoplasm identified (Figure , C). Results from immunohistochemical analysis were positive for S100 (Figure , D) and negative for smooth muscle actin, CD34, and pankeratin.
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