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A report on the primary application of the modern technique of plastic removal of stricture of the Stenonic duct. A clinical case of surgical intervention in the localization of stricture and salivary stone is considered. The analysis of the patient's medical history, ultrasound diagnostics, multispiral computed tomography of the maxillofacial region was carried out. Based on the results of the examination, the choice of the surgical intervention technique was made.Сообщение о первичном применении современной методики пластического устранения стриктуры стенонова протока. Рассмотрен клинический случай проведения оперативного вмешательства при локализации стриктуры и слюнного камня. Проведены анализ истории заболевания пациента, ультразвуковая диагностика, мультиспиральная компьютерная томография челюстно-лицевой области. На основании результатов обследования определена методика оперативного вмешательства.

The pathologies of the salivary glands are very diverse. Salivary stone disease occupies a special place among diseases of the salivary glands of a non-neoplastic nature. The incidence of salivary stone disease is extremely extensive and accounts for up to 85% of all pathologies of the salivary glands.Improvement of minimally invasive methods of treatment of salivary stone disease, which does not lead to excision of the gland.On the basis of the Clinics of the Samara State Medical University of the Ministry of Health of Russia, in the period from 2010 to 2020, a clinical group was formed, consisting of 193 patients with salivary stone disease of various localization. The age of the patients ranged from 16 to 84 years. All patients were therapeutically examined at the preoperative stage, voluntary informed consent was signed. Shockwave sialotripsy was performed in 95 patients of the main group (in 64 patients the calculus was located in the submandibular salivary gland, in 31 patients - in the parotid salivary gland). For lithotripsy, we used a lithotripter apparatus «Edap» (France) and «Wolf» (Germany).The analysis of the results obtained as a result of the study made it possible to draw a conclusion about reasonably better results of removal of calculi in the ducts of the salivary glands using the lithotripter «Swiss LithoClast® Master» (Switzerland). At the first visit and the therapeutic effect of the lithotripter, all patients suffering from bouts of salivary colic showed complete cessation.Thus, our study, which was devoted to the study of the results of various methods of treating patients with salivary stone disease, showed that sialolithotripsy using special narrowly targeted devices for crushing and subsequent excretion of salivary calculi allows to achieve the best results at present.Патология слюнных желез весьма разнообразна. Отдельное место среди заболеваний слюнных желез неопухолевой природы занимает слюнокаменная болезнь [1]. Распространенность слюнокаменной болезни чрезвычайно высока и составляет почти 85% от всех патологий слюнных желез.Совершенствование малоинвазивных способов лечения слюнокаменной болезни, не приводящей к иссечению железы.На базе клиник ФГБОУ ВО «Самарский государственный медицинский университет» Минздрава России в период с 2010 по 2020 г. была сформирована клиническая группа, состоящая из 193 пациентов со слюнокаменной болезнью различной локализации. Возраст пациентов варьировал от 16 до 84 лет. Все пациенты были терапевтически обследованы на дооперационном этапе и подписали добровольное информированное согласие. Сиалолитотрипсию ударно-волновым методом провели 95 пациентам основной группы (у 64 пациентов локализация конкремента была в поднижнечелюстной слюнной железе, у 31 пациента — в околоушной слюнной железе). Для литотрипсии применяли аппараты-литотриптеры Edap (Франция) и Wolf (Германия).Анализ полученных результатов позволил сделать заключение об обоснованно лучших результатах удаления конкрементов в протоках слюнных желез с применением литотриптера Swiss LithoClast Master (Швейцария). При первом же посещении и терапевтическом воздействии литотриптером у всех пациентов, страдающих приступами слюнной колики, наблюдалось полное ее прекращение.Исследование показало, что сиалолитотрипсия с использованием специальных узконаправленных аппаратов для дробления и последующего выведения слюнных конкрементов, позволяет достичь в настоящее время лучших результатов.

The endosialoscopy method has opened the possibility of atraumatic removal the stones from large salivary glands. The advantage of endosialoscopic extraction of sialolithes over traditional methods of ductotomy and removal of the gland does not cause doubts, but the indications for its use are not yet clearly defined. This study analyzes the results of 75 surgical endoscopic interventions for salivary stones extraction.Внедрение метода эндосиалоскопии открыло возможность малотравматичного удаления сиалолитов крупных слюнных желез. Преимущество эндосиалоскопической экстракции сиалолитов перед традиционными методами дуктотомии и удаления железы не вызывает сомнений, но показания к ее применению пока четко не определены. В данном исследовании приводится анализ результатов 75 хирургических вмешательств по извлечению сиалолитов с использованием эндосиалоскопии.

The authors conducted an analysis of the efficiency of the method of suandokmai for diagnosis and treatment of diseases of the salivary glands. The use of calendarscope allows to establish the absence of stone in the case of salivary colic. In rare cases it is possible to remove the stone without surgical intervention at small dimensions of the calculus. 'Price of equipment - the efficiency of diagnosis and treatment' does not allow to recommend the method in clinical practice.Авторы провели анализ эффективности использования метода сиалоэндоскопии в целях диагностики и лечения заболеваний слюнных желез. Использование сиалоэндоскопии позволяет установить отсутствие камня при наличии слюнной колики. В редких случаях удается извлечь камень без хирургического вмешательства при малых размерах конкремента. Соотношение 'цена аппаратуры - эффективность диагностики и лечения' не позволяет рекомендовать метод в широкую клиническую практику.

The authors with the goal of postoperative dynamic control over the results of surgical treatment of patients previously operated for salivary stone disease and various ducts deformations of the parotid salivary glands examined 16 patients with an observation period up to 8 years. It was found that recurrent acute parotitis or recurrence of stone formation was observed in 100% of cases. The authors developed methods of surgical treatment leads to long-term clinical success with no recurrence of the disease.Авторы с целью послеоперационного динамического контроля за результатами хирургического лечения больных, ранее оперированных по поводу слюннокаменной болезни и различных протоковых деформаций околоушных слюнных желез, обследовали 16 пациентов со сроком наблюдения до 8 лет. Было установлено, что повторных обострений паротита или рецидива камнеобразования не наблюдалось в 100% случаев. Использование разработанных авторами методов оперативного лечения приводит к исчезновению клинических проявлений в длительной динамике наблюдений заболевания и отсутствие рецидивирования болезни.

Shockwave lithotripsy was performed by various appliances in sialolithiasis patients. The best results were obtained by means of miniature appliances. Lithotripsy proved to be useful safe alternative for sialolithiasis treatment.

There were examined and treated 181 patients with sialolithiasis in the period of the disease exacerbation. About 30% of the patients were directed to the clinic with mistaken diagnoses. Out of diagnostic techniques in the period of exacerbation there were employed external and bimanual palpation of the inflamed gland region. The most diagnostic value in the period of sialolithiasis exacerbation had X-ray and computer sialotomography (it allowed to diagnose salivary calculi in 98% of the cases). In the period of sialadenitis exacerbation sialotomography is not recommended for use. Ultrasound diagnostics let to reveal concretions of big sizes. Treatment of patients in the acute period of sialolithiasis included salivary gland duct system sanation with antiseptics use and external blockades.

Salivary pools from 16 patients with sialolithiasis were analyzed after sialolithotripsy. Quantitative parameters (total protein, calcium, phosphorus, sodium, potassium, chlorine), pH, and viscosity of the saliva were studied. The patients were divided into 2 groups by the results of lithotripsy: 1) with good and satisfactory results and 2) with poor results. Total protein content in salivary pools and salivary viscosity in patients with sialolithiasis were significantly higher than in the saliva of normal controls, while the concentrations of calcium and potassium were lower than in the controls. Phosphorus content and viscosity of mixed saliva were higher in group 1 than in group 2, in which the results of lithotripsy were unsatisfactory. These data can be used for predicting the outcomes of lithotripsy and for tentative diagnosis of sialolithiasis.

Salivary lithotripsy may be performed with lithotriptors used for crushing urinary concrements. In some cases the method helps escape removal of the salivary gland if the stone is localized inside the gland. Further modifications of the method are needed.

Computer-aided tomography (CAT) was carried out in 68 patients with tumors of the salivary glands and 45 with sialolithiasis. CAT detected the tumors and located them, showed the type of the tumor (benign or malignant) and the tumor invasion. Sensitivity of CAT in tumors of the salivary glands was 97%, specificity 81.8%, accuracy 94.9%. In sialolithiasis CAT not only detected the concrements, but helped assess the status of the gland and the adjacent structures; its sensitively, specificity and accuracy were 95.5, 100 and 98.0%, respectively.

The authors have revealed dilatation of the excretory ducts of salivary glands involved in sialolithiasis and of other salivary glands in a patient. A hypothesis on the primary etiological role of ductal ectasia in the development of sialolithiasis in case some other additional factors are present is put forward. The authors recommend resorting to computer-aided tomography and functional digital subtraction sialography of the salivary glands for the diagnosis of sialolithiasis and discuss the advantages of these methods in comparison with other ones.

Composition and structure of more than 50 sialoliths were examined to optimize the treatment of sialolithiasis. Infrared spectroscopy, x-ray phase analysis, optic and electron microscopy were used in examinations. The concrements consist of organic and mineral substances, the former ones predominating. Mineral phase is represented mainly by carbonate-containing hydroxylapatite. The structure of the concrements is concentrically lamellar, in some of them the mineral phase predominates in the central parts of stones, in others in the peripheral parts; stones with regular distribution of the mineral phase along the stone section are quite frequent. The authors conclude that search for the optimal parameters of hypershock exposure to disintegrate the concrements is going to be rather difficult because of the complexity of their structure. They distinguish two trends of this research: (1) specification of the optimal parameters of hypershock exposure and (2) combination of hypershock wave exposure and litholytic solutions.

A total of 142 patients with sialolithiasis were examined, treated, and followed up. Analysis of clinical manifestations and morphologic changes has revealed a staged pattern of this condition, depending on the sialolith localization, disease standing, and incidence of inflammation exacerbations. The authors consider that a profound study of clinical symptoms with the use of mathematical statistics methods permits a sufficiently accurate identification of the histologic stage of the process and helps define the scope of surgical intervention.