A rare case of parotid duct sialolithiasis with sialo-oral fistula

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A rare case of parotid duct sialolithiasis with sialo-oral fistula

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Calcifications found in the salivary ducts or glands are called sialolithiasis or salivary gland stones. Submandibular gland is most commonly affected followed by parotid. The treatment options are......

Calcifications found in the salivary ducts or glands are called sialolithiasis or salivary gland stones. Submandibular gland is most commonly affected followed by parotid. The treatment options are limited, but include its surgical removal via dissection into the duct or gland. We present a case of 36 years male patient having large parotid duct sialolithiasis with sialo-oral fistula which was treated by intraoral surgical approach.

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  • 1.                                                                                                   A                                      A rare case        e of parot sialo- tid duct s -oral fistu      ialolithia ula sis with
  • 2. Case Report A rare case of parotid duct sialolithiasis with sialo-oral fistula Surya Kanta Pradhan* Department of ENT e Head Neck Surgery, Apollo Hospitals, 251, Sainik School Road, Unit-15, Bhubaneswar 751005, Orissa, India a r t i c l e i n f o Article history: Received 8 July 2014 Accepted 18 July 2014 Available online xxx Keywords: Parotid gland Sialolithiasis Sialo-oral fistula a b s t r a c t Calcifications found in the salivary ducts or glands are called sialolithiasis or salivary gland stones. Submandibular gland is most commonly affected followed by parotid. The treat- ment options are limited, but include its surgical removal via dissection into the duct or gland. We present a case of 36 years male patient having large parotid duct sialolithiasis with sialo-oral fistula which was treated by intraoral surgical approach. Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved. 1. Introduction Sialolithiasis affects 12 out of 1000 of the adults,1 in which males are affected more in comparison to females.2 More than 80% occur in the submandibular gland or duct, 6% in the pa- rotid gland and 2% in the sublingual gland or minor salivary glands. Most common location for parotid gland stones are within the extraglandular portion of Stensen's duct and are usually unilateral. Its size can vary from less than 1 mm to a few centimetres in diameter. Some of the parotid (40%) and submandibular gland (20%) stones are radiolucent and may require sialography for their proper location.2 2. Case report Thirty six years male patient presented with swelling over left side of oral cavity for 3 years with on and off discharge from it. He was also having pain while eating. He was having no his- tory of fever or trauma to face. Intra-oral examination revealed a swelling over left side of buccal mucosa which was reddish white in colour, hard and non-tender on palpation and discharge coming out from that swelling by applying pressure over left parotid. There was no obvious swelling over parotid on extra-oral examination. We have performed intraoral occlusive view of X-ray along with ultrasonograpy and confirmed the diagnosis of parotid duct sialolithiasis and its proper position (Fig. 1). We have chosen intraoral surgical approach as the stone was near the duct's oral opening. A vertical semilunar incision anterior to the orifice was given. The duct was dissected posteriorly and by further blunt dissection, the stone was delivered. The stone was of 1.6 Â 0.7 Â 0.4 cm. Healing was uneventful. Salivary flow returned to normal in one week postoperatively (Fig. 2). When we examined the patient two months later, the left parotid was normal in tone and painless on palpation. There * Tel.: þ918093060163 (mobile). E-mail address: drsuryakanta83@gmail.com. Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/apme a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e2 Please cite this article in press as: Pradhan SK, A rare case of parotid duct sialolithiasis with sialo-oral fistula, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.07.003 http://dx.doi.org/10.1016/j.apme.2014.07.003 0976-0016/Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
  • 3. were no symptoms of parotid swelling or pain associated with meals and salivary flow was normal. 3. Discussion Parotid gland stones are relatively rare with only a few re- ported cases. Messerly (1969) removed a 51 mm long calculus that occupied the entire length of Stenson's duct in a 66-year- old man.3 Iqbal et al (1992) reported a parotid calculus measuring 3 Â 2.5 Â 1.5 cm.4 Kesse (1998) also reported a calculus in parotid measuring 5 cm in length and 3 cm in its longest width.5 Mayumi Shimizu et al (2005) reported 3 cases of Sj€ogren's syndrome in which multiple sialolithiasis were observed in the parenchyma of the parotid gland. They found multiple microliths of less than 1 mm in diameter in the panoramic tomography with tangential projection.6 Karavidas et al (2010) in his study of 70 patients with parotid sialoliths, who were treated by minimally invasive surgical techniques found the average size of the stones were 7.2 mm.7 After going through the literature, we found the number of cases of parotid stone were occasionally reported. A parotid stone of size1.6 Â 0.7 Â 0.4 cm with a sialo-oral fistula in our case is extremely rare. Non-surgical methods advocated for removal of a parotid stone includes lithotripsy,8 endoscopic techniques,9 an intra- ductal retrieval basket10 and ductal dilatation with massage.11 However, intraoral surgical removal of a stone is simple and effective if the sialolith is within 1.5 cm of the duct orifice.12 Extraoral procedure with or without parotid's superficial lobe removal is required for stones placed posteriorly or within the gland. Surgical morbidity can be avoided with the confirma- tion of the anterior setting of the stone and consequent intraoral approach. Conflicts of interest The author has none to declare. r e f e r e n c e s 1. Leung AK, Choi MC, Wagner GA. Multiple sialolths and a sialolith of unusual size in the submandibular duct. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87:331e333. 2. Cawson RA, Odell EW. Essentials of Oral Pathology and Oral Medicine. 6th ed. Edinburgh: Churchill Livingstone; 1998:239e240. 3. Messerly CD. Oddities of salivary calculi. Oral Surg Oral Med Oral Pathol. 1969;28:862e865. 4. Iqbal SM, Singh RR, Dewangan G. L: sialocele of Stensen's duct (a case report). J Laryngol Otol. 1986;100:363e365. 5. Kesse WK. A megalith of the parotid salivary gland. J Laryngol Otol. August 1998;112:784e785. 6. Shimizu Mayumi, Yoshiura Kazunori, Nakayama Eiji, Kanda Shigenobu. Multiple sialolithiasis in the parotid gland with Sj€ogren's syndrome and its sonographic findingsdReport of 3 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. January 2005;99(1):85e92. 7. Karavidas K, Nahlieli O, Fritsch M, McGurk M. Minimal surgery for parotid stones: a 7-year endoscopic experience. Yearb Otolaryngol Head Neck Surg. 2010;2010:44. 8. Ottaviani F, Capaccio P, Rivolta R, Cosmacini P, Pignataro L, Castagnone D. Salivary gland stones: US evaluation in shock wave lithotripsy. Radiology. 1997;204(2):437e441. 9. Nahlieli O, Baruchin AM. Sialoendoscopy: three years' experience as a diagnostic and treatment modality. J Oral Maxillofac Surg. 1997;55(9):912e918. 10. Sharma RK, Al-Khalifa S, Paulose KO, Ahmed N. Parotid duct stone: removal by dormia basket. J Laryngol Otol. 1994;108(8):699e701. 11. Iro H, Zenk J, Waldfahrer F, Benzel W, Schneider T, Ell C. Extracorporeal shock wave lithotripsy of parotid stones: results of a prospective clinical trial. Ann Otol Rhinol Laryngol. 1998;107(10 Pt 1):860e864. 12. Baurmash H, Dechiara SC. Extraoral parotid sialolithotomy. J Oral Maxillofac Surg. 1991;49(2):127e132. Fig. 1 e Left parotid gland stone visualised near the duct opening. Fig. 2 e Stone after extraction. a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e22 Please cite this article in press as: Pradhan SK, A rare case of parotid duct sialolithiasis with sialo-oral fistula, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.07.003
  • 4. Apollohospitals:http://www.apollohospitals.com/ Twitter:https://twitter.com/HospitalsApollo Youtube:http://www.youtube.com/apollohospitalsindia Facebook:http://www.facebook.com/TheApolloHospitals Slideshare:http://www.slideshare.net/Apollo_Hospitals Linkedin:http://www.linkedin.com/company/apollo-hospitals Blog:Blog:http://www.letstalkhealth.in/