1) The document discusses sialoendoscopy-assisted sialolithotomy for removing submandibular hilar calculi.
2) It describes the anatomy and diseases of salivary glands, classification of salivary gland stones, and presents several case studies treated with sialoendoscopy.
3) The conclusion is that sialoendoscopy-assisted intraoral removal is a safe and effective gland-preserving technique for patients with large stones located at the hilum of Wharton's duct.
Sialolithiasis / dental implant courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
A brief discription about sialolithiasis and its etiology, investigation, and diagnosis.
I have prepared these slides as a perfect answers to the university questions that can be asked on various topics of sialolithiasis.
Sialolithiasis / dental implant courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
A brief discription about sialolithiasis and its etiology, investigation, and diagnosis.
I have prepared these slides as a perfect answers to the university questions that can be asked on various topics of sialolithiasis.
This a work was done by 2nd year students from menoufia university (faculty of medicine),Egypt, under supervision of some of anatomy and embryology staff
Sialendoscopy is minimal invasive technique of treating obstructive salivary gland disorders that require no incisions, and leaves no scar. This is the endoscopic modality of diagnosing and treating the obstruction of the salivary gland ducts. These can be due to stones, sludge, stenosis or narrowing of salivary gland ducts. The technique is having very less complications with faster recovery time. The patient can go home the very same day in 4 to 5 hours.
To know more visit here:
http://entspecialistindelhi.com/sialendoscopy.php
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This a work was done by 2nd year students from menoufia university (faculty of medicine),Egypt, under supervision of some of anatomy and embryology staff
Sialendoscopy is minimal invasive technique of treating obstructive salivary gland disorders that require no incisions, and leaves no scar. This is the endoscopic modality of diagnosing and treating the obstruction of the salivary gland ducts. These can be due to stones, sludge, stenosis or narrowing of salivary gland ducts. The technique is having very less complications with faster recovery time. The patient can go home the very same day in 4 to 5 hours.
To know more visit here:
http://entspecialistindelhi.com/sialendoscopy.php
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Chamomiletea metroblog com_the_benefits_of_chamomile_teaDeloris Cooper
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Plenty of Asians are fond of this tea and throughout this every day, yet in the east its consequence never gets down. This tea is drastically different from normal tea since it's a mix of herbs and isn't generated out of the leaves of the tea shrub.
CONTENT
INTRODUCTION
DEVELOPMENT
PAROTID CAPSULE
EXTERNAL FEATURES
RELATIONS
STRUCTURE WITHIN THE PAROTID GLAND
PAROTID DUCT
NERVE SUPPLY
LYMPHATIC DRAINAGE AND LYMPH NODES
FUNCTIONS OF PAROTID GLAND
ROLE OF PUBLIC HEALTH DENTIST
CONCLUSION
REFERENCES
“Multiple unilateral submandibular duct calculi: A case report”.navasreni
Sialolithiasis, the formation of calcific concretions in the salivary
duct of a major or minor salivary gland, is a common salivary
gland pathology. These calcifications usually develop in the ductal system of the submandibular salivary gland, but can involve
the parotid gland and, infrequently the ducts of sublingual or minor salivary glands. 1 The size of salivary calculi may vary from
less than 1 mm to a few centimeters in size, with most cases being
less than 10 mm in size.2 Although large and multiple sialoliths
have been reported in the salivary glands, they have been rarely
reported in the salivary duct.2 Here we are reporting a case of
multiple Wharton duct sialolithiasis.
Multiple Submandibular Duct Calculi: A Case Reporteshaasini
Sialolithiasis, the formation of calcific concretions in the salivary
duct of a major or minor salivary gland, is a common salivary
gland pathology. These calcifications usually develop in the ductal system of the submandibular salivary gland, but can involve
the parotid gland and, infrequently the ducts of sublingual or minor salivary glands. 1 The size of salivary calculi may vary from
less than 1 mm to a few centimeters in size, with most cases being
less than 10 mm in size.2 Although large and multiple sialoliths
have been reported in the salivary glands, they have been rarely
reported in the salivary duct.2 Here we are reporting a case of
multiple Wharton duct sialolithiasis
Multiple Submandibular Duct Calculi: A Case Reportkomalicarol
Sialolithiasis, the formation of calcific concretions in the salivary
duct of a major or minor salivary gland, is a common salivary
gland pathology. These calcifications usually develop in the ductal system of the submandibular salivary gland, but can involve
the parotid gland and, infrequently the ducts of sublingual or minor salivary glands. 1 The size of salivary calculi may vary from
less than 1 mm to a few centimeters in size, with most cases being
less than 10 mm in size.2 Although large and multiple sialoliths
have been reported in the salivary glands, they have been rarely
reported in the salivary duct.2 Here we are reporting a case of
multiple Wharton duct sialolithiasis.
Salivary glands Disorders and management.Manish Shetty
Short, brief description of the salivary gland disorders.
it explain the basic anatomy, physiology of the salivary glands.
all the 3 salivary gland are individually explained with appropriate management of it disorders.
Multiple Submandibular Duct Calculi: A Case Reportclinicsoncology
Salivary gland calculi account for the most common disease of the salivary glands. The majority of sialoliths occur in the submandibular gland or its duct and are a common cause of acute and chronic infections. Sialolith can be unilateral, bilateral, single or multiple.
Multiple Submandibular Duct Calculi: A Case Reportpateldrona
Salivary gland calculi account for the most common disease of the salivary glands. The majority of sialoliths occur in the submandibular gland or its duct and are a common cause of acute and chronic infections. Sialolith can be unilateral, bilateral, single or multiple.
Multiple Submandibular Duct Calculi: A Case ReportSarkarRenon
Salivary gland calculi account for the most common disease of the salivary glands. The majority of sialoliths occur in the submandibular gland or its duct and are a common cause of acute and chronic infections. Sialolith can be unilateral, bilateral, single or multiple.
Salivary gland calculi account for the most common disease of the salivary glands. The majority of sialoliths occur in the submandibular gland or its duct and are a common cause of acute and chronic infections.
Multiple Submandibular Duct Calculi: A Case ReportAnonIshanvi
Salivary gland calculi account for the most common disease of the salivary glands. The majority of sialoliths occur in the submandibular gland or its duct and are a common cause of acute and chronic infections. Sialolith can be unilateral, bilateral, single or multiple. Depending on the gland affected and stone...
Multiple Submandibular Duct Calculi: A Case Reportgeorgemarini
Salivary gland calculi account for the most common disease of the salivary glands. The majority of sialoliths occur in the submandibular gland or its duct and are a common cause of acute and chronic infections. Sialolith can be unilateral, bilateral, single or multiple.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
3. CLASSIFICATION
MAJOR
They are paired
glands
OF SALIVARYGLANDS
MINOR
parotid
sub
mandibular
sublingual
They are numerous
widely distributed in the
oral cavity.
600 to 1000 in no. mostly
located at junction of soft
and hard palate
5. SALIVA
1500 ML per day
PH VALUE:
RESTING GLAND -7
ACTIVE SECRETIONS
IS ABOUT 8
FUNCTIONS
Lubrication for
speech
Helps in
swallowing and
mastication
Digestive
properties
Antibacterial
Immunological
properties
7. EMBROYOLOGY
All salivary glands develop from embryonic oral
cavity as buds of epithelium that extends into
underlying mesenchymal tissues
These epithelial ingrowths or anlages ,are
apparent at 8 weeks gestation and then branch
to form a primitive ductal system and eventually
become canalized to provide structural salivary
gland unit for drainage of salivary secretions.
This unit consists of a myoepithelial cell ,
intercalated duct , striated duct ,excretory duct.
8.
9. Around 7 th or 8 th month in utero secretary
cells called acini begin to develop around
ductal system.
Acinar cells are classified as
serous cells –produce thin watery serous
secretions.
mucous cells-produce thicker mucous
secretions.
10. Anatomy of submandibular
salivary gland
Divided into Superficial and deep part
Location-digastric triangle(formed by
anterior and posterior belly of digastric
muscles and inferior border of the mandible)
Surfacesmedial surface rests
anteriorly-mylohyoid muscle
middle part-hyoglossus
posteriorly-wall of pharynx
12. surfaces
Inferior surface-is superficial, seen in digastric
triangle, directed downwards and laterally.
Lateral surface-is hidden from view of
mandible, divided into anterior and posterior
part.
Anterior part –lies in contact with medial
surface of body of mandible below the
attachment of mylohyoid muscle.
Posterior part-separated from body of mandible
by medial pterygoid muscle.
13. PICTURE SHOWING
SUBMANDIBULAR SALIVARY
GLAND ,WHARTONS DUCT AND
ITS CORELATION WITH
ADJOINING STRUCTURES
Stylohyoid ligament
Inferior alveolar nerve, vessels
Nerve to mylohyoid
Submandibular salivary gland
Sublingual salivary gland
Medial pterygoid
Mylohyoid
genioglossus
Lingual nerve
Anterior belly of digastric
14. Deep part - passes in interval between the
mylohyoid ( laterally ) hyoglossus (medially)
NERVE SUPPLY -Submandibular gland is
innervated by the facial nerve through
submandibular ganglion via chorda tymphani
nerve.
BLOOD SUPPLY -Branches of facial and lingual
artery
LYMPHATICS – drains into submandibular lymph
nodes ,through them into deep cervical
lymphnodes ,particularly jugulo-omohyoid node.
18. Additional relationships
Gland is covered by 2 layers of fascia formed
by splitting of investing layer of deep cervical
fascia.
Superficial layer covers the inferior surface of
the gland and attaches to the lower border of
the mandible.
Deeper layer covers the medial surface and is
attached to the mylohyoid line of the
mandible.
19. WHARTONS DUCT•2-4mm in diameter & about 5cm in length.
•It opens into the floor of the mouth thru a
punctum.
•The punctum is a constricted portion of the
duct to limit retrograde flow of bacteria-laden
oral fluids.
•Duct arises in the deep lobe and runs antero
medially ,Lingual nerve crosses the duct
inferiorly, after immediately arising from deep
lobe.
20.
21. Some terminologies
Sialolith-salivary calculi.
Sialolithiasis-process of formation of salivary calculi.
Sialography or sialogram-repeated radiographic
examination of salivary glands after injection of contrast
medium into the salivary duct.
Sialochemistry-examination of electrolyte composition of
saliva
Sialoendoscopy-specialized procedure that uses a small
video camera with a light at the end of the flexible
canula, which is introduced into the ductal orifice.
Sialometry-is a measure of salivary flow
22. SCINTIGRAPHY-the production
of,
2 – dimensional images of
distribution of radio activity in the tissues
after internal administration of a
radiopharmaceutical imaging agent ,the
images are obtained by a scintillation
camera,(gamma camera).
LITHOTRIPSY-procedure involving the usage
of high energy shock waves to fragment and
disintegrate or destruct the calculi.
23. sialolith
They are calcified structure develop with in
ductal system of major and minor salivary
glands.
Major cause of both-chronic recurring
sialadenitis ,acute suppurative sialadenitis.
Stones composed of inorganic calcium and
sodium phosphate salts.
They are believed to arise from deposition of
these salts around nides of debris with in duct
lumen.
24. Sialoliths continue ……
These debris may include inspissated mucus
, bacteria , ductal epithelial cells or foreign
bodies (coagulated).
Prevalent in men than women ratio. 2:1.
Peak incidence age = 30-40 years.
Submandibular gland involvement is 80 %.
PH value of these secretion is 6.8-7 %.
Increased concentration of calcium and
phosphate ratio.
Mucous Secretions are more viscous.
25. Pathophysiology
Dehydration
Concentration of saliva
Fasting or Anorexia
Stasis of saliva
Drugs- Anti-histamines, Anti-cholinergics.
Decrease production of saliva
Stone can cause stasis of saliva and subsequent
bacterial ascent into the gland.
Infection most commonly from S. aureus or Strep
Viridans.
26. ETIOLOGY OF SIALOLITHS
EXACT CAUSE OF SIALOLITH FORMATION IS
NOT KNOWN,
But 3 prerequisites stand out as primary etiology
1) NEUROHUMORAL CONDITION> leading to
salivary stagnation .
2) A nidus or matrix for stone formation.
3)some metabolic mechanism may favors
precipitation of salivary salts into the matrix in the
presence of coexisting inflammation.
4) long tortuous duct and situated lower level than
its orifice ,so increased salivary stagnation, so
increased calculus formation.
27. Signs and symptoms
Pain and swelling are exacerbated during
mealtimes
Check for flow of whartons duct
Check for tenderness of submandibular
salivarygland
Palpate for stone in floor of the mouth
Check mandibular occlusal radiograph
30. PURPOSE
TO ACESS THE CLINICAL EFFECTS OF
ENDOSCOPY ASSISTED SIALOLITHECTOMY
FOR SUBMANDIBULAR HILAR CALCULI
31. MATERIALS AND METHODS
STUDY WAS TAKEN IN 70 PATIENTS WITH
SYMPTOMATIC STONES IN HILUM OF
SUBMANDIBULAR SALIVARY GLANDS.
FROM : DECEMBER 2005 THROUGH MARCH
2011.
OPERATIVE DATA WERE ANALYZED
RETROSPECTIVELY AND FOLLOWED
PERIODICALLY POSTOPERATIVELY.
GLAND FUNCTION WAS INVESTIGATED BY
POST OPERATIVE SYMPTOMS,CLINICAL
EXAMINATIONS,SIALOGRAPHY,AND
SCINTIGRAPHY.
32. DIAGNOSIS
BY, ONE OR A COMBINATION OF
RADIOGRAPHIC INDICATORS
CROSS SECTIONAL MANDIBULAR
OCCLUSAL FILMS
LATERAL PROJECTIONS OF GLAND
CONE BEAM COMPUTED TOMOGRAPHY
33. CASE SELECTION
INCLUSION CRITERION WAS THAT ,THE STONES
WERE SITUATED AT OR PROXIMES TO THIRD
MANDIBULAR MOLAR REGIONS
STONES WERE VERIFIED TO BE IMPACTED
AFTER HILIUM OF THE WHARTONS DUCT
UNDER ENDOSCOPIC VIEW
AMNEABLE TO BASKET RETRIVAL WERE
EXCLUDED
34. SIALOENDOSCOPY
LADUSCOPE T FLEX PD-HS-0250
ENDOSCOPE
HIGLY FLEXIBLE ,SEMIRIGID ENDOSCOPE
WITH NITINOL SHEATH
80 MM LONG
1.1mm OUTER DIAMETER
0.4 mm WORKING LENGTH CHANNEL
SEPARATE CHANNEL FOR IRRIGATION
35. PROCEDURE
Main duct of the gland is explored and induction
of endoscope done by persistent irrigation.
Small and mobile stones at distal or middle part
of the duct were removed by basket entrapment.
Impacted hilar stones were then removed by as
endoscopy assisted sialolithectomy technique.
After the stone was verified ,a 2-3 cm incision
was made in the floor mucosa according to the
light transmitted through endoscope.
36. As the assistant raised the floor of the mouth with
digital pressure in submandibular triangle.
The duct was isolated from the surrounding tissues
with particular care to avoid damage to lingual nerve.
Then the hilum was incised at the precise location of
the stone and the stone was removed.
Thereafter the entire duct was re-explored for
remnant stones or mucous plugs
Hilum then sutured after 4Fr angio catheter
had been inserted as a stent, Stent left in situ for
1-2 weeks after surgery.
37. TREATMENT
Amoxicillin or cefaclor was administrated for 7
days.
Hydration was achieved by the patient
drinking more than 2 liters of water a day , and
patient advised to avoid sialogogues and spicy
foods.
After stent and sutures were removed
,frequent self massaging and sialogogues were
recommended.
38. FOLLOW UP
post operative Clinical assessment was done,
to diagnose, any recurrence and
changes in size of the gland .
Consistency of the affected gland.
Appearance of the ostium ,and the amount
and the nature(clear or milky) of salivary flow
on massage.
39. Siolography
Sialography of submandibular salivarygland
was performed with water soluble contrast
agent , diatrizoate meglumine, using a closed
intravenous catheter (22 gauge),.
After catheter was introduced ,1.5 to 2ml of
contrast solution was injected carefully.
Lateral views and 5-min emptying film were
taken , and appearance of main ducts, branch
ducts and parenchyma were analyzed.
40. A-Lateral view x-ray showing
large stone
B-Stone was removed
through an incision at the
genu of whartons duct
C-Extracted stone fragments
D-Six month follow up
sialogram shows proximal
duct dilation (filling film)
E-No persistent contrast
opacified on functional film
43. CONCLUSION
SIALOENDOSCOPY ASSISTED INTRA ORAL
REMOVAL IS SAFE AND EFFECTIVE GLANDPRESERVATION TECHNIQUE FOR PATIENTS
WITH LARGE CALCULI AT HILUM OF THE
WHARTONS DUCT .
44. A short movie…by use of
endoscopy assisted
lithotripsy with a
lithotripter
Editor's Notes
serous
Deep part- passes in interval between the mylohyoid ( laterally ) hyoglossus (medially)
INTER RELATIONSHIP BETWEEN DUCTAL SYSTEMS
STONES WERE VERIFIED TO BE IMPACTED AFTER HILIUM OF THE WHARTONS DUCT UNDER ENDOSCOPIC VIEWAMNEABLE TO BASKET RETRIVAL WERE EXCLUDED
Thereafter the entire duct was re-explored for remnant stones or mucous plugs Hilum then sutured after 4Fr angio catheter had been inserted as a stent, Stent left in situ for 1-2 weeks after surgery.