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Obstructive sialadenitis is the most common cause of non-malignant salivary gland disorders, with salivary gland strictures being responsible for approximately 23% of all benign obstructive disease. Significant advances in minimally invasive techniques, including radiologically-guided balloon sialoplasty, offer the potential for successful treatment with reduced complications. At present there is a paucity of follow-up data regarding patient outcomes and repeat interventions in those undergoing the procedure. Patients with parotid or submandibular gland sialadenitis secondary to gland stricture were identified and underwent radiologically-guided balloon sialoplasty at Queen Alexandra Hospital, Portsmouth, UK between 2015 and 2022. Patient outcomes, complications and reintervention rates were recorded prospectively over the seven-year period and analysed retrospectively. A total of 44 patients underwent radiologically-guided balloon sialoplasty. Forty (89%) underwent sialoplasty for parotid gland disease, with a minority (n = 5) receiving an intervention for submandibular gland strictures. A total of 37 (84%) had their obstruction successfully treated (82% of parotid gland obstructions and 100% of submandibular gland obstructions). Five patients (11%) required a repeat intervention. Seventeen successfully treated patients (85%) who attended follow-up clinic appointments described complete resolution of their symptoms, with the remaining three (15%) describing a partial response. Radiologically-guided balloon sialoplasty for the treatment of benign obstructive sialadenitis secondary to a gland stricture is a safe and effective method of eliminating the obstruction and relieving patients' symptoms. Most patients were symptom free at short-term follow up, with a minority requiring a second sialoplastic intervention., (Copyright © 2023 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Transoral removal of a distal salivary stone is common. We have used postoperative sialography to evaluate the results and changes in the salivary ducts after removal of a salivary distal stone without sialodochoplasty. Of 20 patients who had had transoral operations for submandibular stones, 19 recovered normally with no recurrence. One developed partial stenosis and one a spontaneous neo-opening as a result of severe adhesions and inflammation between the salivary stone and the duct. None of the patients had any symptoms of recurrence during the 12-month follow-up. Sialodochoplasty may not be necessary in patients who have had a distal salivary stone removed. Removal without sialodochoplasty resulted in full anatomical recovery of the salivary ducts., (Copyright © 2016. Published by Elsevier Ltd.)

Pneumoparotid is common in patients with lesions of the oral cavity who have diagnostic computed tomography (CT) with the "puffed cheek" technique. Although such observations are often noted, we could find few papers about the incidence in relation to oropharyngeal conditions. We present a retrospective series of 47/300 patients who developed pneumoparotid during multidetector CT examination of the oropharyngeal region to assess the incidence and any possible correlation with regional disease. Patients were followed up for any symptoms and also for complications. In 14 patients the pneumoparotid was right-sided, in 17 left-sided, and in 16 it was bilateral. There was a significant association between the incidence of pneumoparotid and the site of disease, it being stronger (p<0.001) with lesions in the oral cavity than with those in the oropharynx and hypopharynx. Apart from brief discomfort, none of the patients had any symptoms after the procedure. In summary, pneumoparotid developed in 47/300 (16%) of our patients after multidetector CT when the "puffed cheek" technique was used, and was more common in patients with lesions of the oral cavity and anterior tongue than among patients with lesions of the oropharyngeal, nasopharyngeal, and hypopharyngeal regions. Few patients experienced transient fullness immediately after the procedure. None of our patients had lasting or infective symptoms., (Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

To identify the incidence of different causes of benign obstruction of the salivary glands, we retrospectively analysed 788 anonymised sialography reports of 719 patients referred to the department of dental and maxillofacial radiology between 2006 and 2012. Reports that showed evidence of benign obstruction were included (n=493). Salivary stones were identified in 151 (31%), ductal strictures in 115 (23%), and mucus plugs in 295 (60%). In 67 cases (14%) there was evidence of 2 or 3 causes of obstruction. As previously reported, mucous plugs were the most common finding, possibly because of the use of fluoroscopy or digital subtraction sialography, or both. These methods enable images to be captured during the initial filling of the main duct and are likely to prevent mucus plugs from being obscured by the contrast medium, which is the case in conventional sialography when a single image is produced after the contrast has been injected., (Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Transoral removal of stones for the treatment of submandibular sialolithiasis has been popularised, even for stones in the hilum. Without sialodochoplasty after surgical retrieval, the affected glands seem to recover well functionally, even without sialodochoplasty. However, the anatomical changes of structural recovery have not been fully studied. We investigated the outcomes and the changes to the salivary duct system after transoral removal of hilar stones using postoperative sialography. We enrolled 28 patients (29 sides) who had transoral removal of stones for submandibular hilar sialolithiasis without sialodochoplasty, and prospectively analysed the structural outcomes 3 months and 12 months postoperatively using sialography. We found 23 ducts (79%) recovered with a normal size, while 4 ducts (14%) developed saccular dilatation and one duct (3%) partially stenosed. Saccular dilatation developed after removal of stones larger than 10mm in diameter, but patients had no recurrent symptoms. By the 12 months' follow up, one stone had formed severe adhesions to the salivary duct that caused stenosis, and this patient had recurrent symptoms. Transoral removal of submandibular hilar stones without sialodochoplasty is an effective treatment with good anatomical restoration of the salivary duct and flow., (Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

To evaluate the viability, efficacy, and safety of sialoendoscopy for the diagnosis and management of radioiodine I(131-) related sialoadenitis, we retrospectively reviewed 30 patients referred between September 2007 and July 2013 from the Thyroid Surgery Unit to the Maxillofacial Unit of the Second University of Naples Hospital with persistent sialoadenitis after treatment with I(131). After the affected gland had been isolated, the endoscope was introduced into the duct under local anaesthesia with 2% lignocaine and continuous lavage with isotonic saline, and was advanced until it reached the ductal system. We studied 24 women and 6 men, mean (SD) age 52 (??) years. In 25 patients I(131) was given for papillary (83%), in 3 for medullary (10%), and in 2 for follicular thyroid carcinoma (7%). Stenosis alone was found in 30 glands (40%), mucous plugs alone in 35 (47%), and mucous plugs, stenosis, and kinks in 10 (13%). Of the 75 glands, dilatation of the ducts was successful in 70, and we completely removed all mucous plugs and kinks. We achieved symptomatic improvement in 23 patients (77%) during a follow-up ranging from 2 weeks to 84 months. Sialoendoscopy is a viable technique for the diagnosis of obstructive salivary disease, and is a safe and effective way to treat sialoadenitis, the most common complication of treatment with I(131)., (Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

This study aimed to describe the clinical features and surgical management of fibrous hyperplasia involving the orifice of Stensen's duct. The clinical data of three patients (one male and two females) were collected and analyzed to characterize this lesion. The lesions surrounding the orifice of Stensen's duct were painless and without obvious causes. The patients' clinical features included sensation of a foreign body and an awkward bite during mastication. All patients received surgical management to resect the polyp and reconstruct the orifice of Stensen's duct. The ducts were preserved intact and parotid glands functioned normally after 12-18 months follow-up. In conclusion, the key point for surgical management of fibrous hyperplasia involving Stensen's duct is to keep the duct intact and unobstructed in consideration of its particular location., (Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Our aim was to analyse the nature of a sialendoscopy-based classification and present its use in the treatment of stenoses of Wharton's and Stensen's ducts. The classification of stenoses of Wharton's duct has not been published before. We did 133 sialendoscopies in 114 patients who presented with possible obstruction of the ducts to the tertiary centre for ENT at the University Department in Poznań. Twenty-seven patients had their parotid ducts treated, and 24 their submandibular ducts. Suspicion of stenotic changes of the ductal system was suggested during ultrasound examination. They were examined with semirigid endoscopes that enabled direct visualisation of the stenotic areas. A total of 69 stenoses were diagnosed in 51 patients. Stenoses were divided into three groups according to their site. Patients with stenosis of the salivary ducts were treated by dilatation of the stenotic area, intraductal steroid injections, and insertion of a stent for 14-21 days. Forty of the 51 reported considerable improvement, and 7 partial improvement. Four patients had no improvement. Sialendoscopy is a safe way to treat obstruction of the salivary glands. Short and medium term follow up show that it is extremely successful., (Copyright © 2012. Published by Elsevier Ltd.)

During a 9-year period from October 2002 to October 2011, 561 patients with swelling in the submandibular gland (n=474) and parotid gland (n=87) were successfully studied using sialendoscopy, and the features and pathological changes of the duct evaluated and recorded. Abnormalities were noted in 552/561 cases (98%), and normal features in 9 (2%). The pathological changes in 467 submandibular glands were identified both endoscopically and radiographically, and endoscopic findings showed 3 types: sialolith (n=423, 91%), mucus plug (n=15, 3%), and stenosis (n=29, 6%). In 12 cases foreign bodies (fish bones) were found fixed in calculi. In 85 parotid glands the main pathological finding in the duct was stenosis (n=64, 75%, mucus plug (n=12, 14%), and sialolith (n=9, 11%). Several microstructures had been found on sialendoscopy, including sublingual opening, a basin-like structure in the hilar region, a sphincter phenomenon, and hyperplasia. Sialendoscopy can give direct information about the salivary duct, and in some cases indicate the possible mechanism of obstruction., (Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Obstructive sialoadenitis is the most common non-neoplastic disorder of the salivary glands. With advances in the use of diagnostic and interventional sialoendoscopy in the major salivary glands, operations can often be less invasive and treatment can spare the gland and restore normal function. By using an expandable balloon catheter to dilate ductal stenosis during sialoendoscopy it is possible to dilate a stenotic duct and remove large stones with or without a basket. However, the use of different angiocatheters or dedicated balloons is still empirical. In this pilot study we assessed the feasibility and safety of balloon dilatation of the submandibular gland (Wharton's duct). We did balloon catheter sialoplasty on four ducts from two fresh adult cadavers. We used a non-compliant dilating balloon catheter 6mm in diameter at a pressure of 12 × 10(5)Pa for a total of three minutes and then examined the ducts histologically. There was no damage to the wall of Wharton's duct. Although this is a small study, we have shown the safety of balloon catheter sialoplasty for the first time as assessed histologically after dilatation of the duct. By virtue of the technique histological assessment is not possible after dilatation in patients. Long-term follow up is clearly required in this rapidly evolving area of surgery., (Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Adenomatoid hyperplasia of minor salivary glands is rare, idiopathic, and benign, and typically presents as a tumour-like mass in the hard or soft palate. Its exact nature is not clear and histological examination usually shows an excess of normal-appearing minor salivary glands. To our knowledge, cytogenetic analysis of it in a minor salivary gland of the palate has not previously been reported. We present the cytogenetic analysis of adenomatoid hyperplasia in the hard palate of a 52-year-old woman., (Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Morphologic characteristics of salivary ducts may contribute to stagnation of saliva. The authors hypothesized that some features might contribute to development of submandibular and parotid sialadenitis. 106 digital subtraction sialograms (DSS) were retrospectively reviewed for: degree of sialadenitis, length of Wharton's and Stensen's ducts (SD), and angle of Wharton's duct (WD) genu. Student's t test was used for independent samples to statistically compare normal and sialadenitis groups. The effect of independent variables (age, gender, side, degree of sialadenitis) on the dependent variable (length or angle) were tested using regression analysis. Submandibular duct sialadenitis was mild (67%), moderate (8%), or severe (25%); parotid duct sialadenitis was mild (57%), moderate (18%), or severe (25%). Mean length of normal WD was 58.2 mm, and 56.3 mm with sialadenitis. Mean length of normal SD was 52 mm, and 53 mm with sialadenitis. The mean angle of WD genu was 115° in normal ducts, and 119° with sialadenitis. None of the independent variables affected variation in length or angle. There were no statistical differences in duct length or measured angle between normal and sialadenitis groups. There is a wide variation in salivary duct morphology but this does not appear to be associated with the cause of sialadenitis., (Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The authors report a case of adenoid cystic carcinoma (ACC) complicated with sialolithiasis of the submandibular gland. The patient was a 43-year-old female with a history of papillotubular carcinoma of the breast almost at the same time. She had noticed a swelling in her sublingual area for 10 years, which was later diagnosed by her dentist to be due to a sialolith in the left submandibular gland. After several years of observation, the patient was referred to have her left submandibular gland, containing the stone, surgically removed with a diagnosis of atrophic sialadenitis. Histopathologically, the submandibular gland was extensively replaced with fibrous granulation tissue, in which there were small but invasive foci of ACC. The present case indicates that ACC could arise in the background of chronic sialadenitis. It is suggested that long-standing sialadenitis cases should be carefully examined to exclude suspicion of malignancy before surgery., (Copyright © 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The removal of the submandibular salivary gland for non-neoplastic disease is a common procedure that has well documented risks and postoperative complications. Persistent symptoms of pain and swelling in the floor of the mouth that can occur after excision of the submandibular gland may require removal of the sublingual gland, but a causative association between the two has not, to our knowledge, been comprehensively established. We prospectively studied 77 patients who had had excision of the submandibular gland for benign disease, six of whom (8%) returned to theatre for ipsilateral sublingual sialadenectomy within a 5-year period after the initial operation (mean 24 months). These findings suggest that the association is under-reported, and may need to be considered during the consent process for excision of the submandibular salivary gland., (Copyright © 2010. Published by Elsevier Ltd.)

The case of a hydatid cyst located in the duct of Wharton of a 56-year-old farmer is reported not only because of the unusual location of the disease, but also because the clinical manifestations and surgical findings of the hydatid cyst strongly resembled those of a salivary calculus in the duct of Wharton. The patient presented with a non-painful swelling of the right submandibular region. The mass, which appeared 5 years before seeking medical advice, augmented progressively during the first year after its onset and remained stable during the next 4 years. The subsequent surgical excision of the mass was uneventful and a round mass, which was palpated intraoperatively in the duct of Wharton was assumed to be a sialolith. The diagnosis for a hydatid cyst of the duct of Wharton was made by histological examination. Although salivary calculus is the most common finding in cases of obliteration of the duct of Wharton, histological examination of the surgically excised submandibular gland may reveal benign tumours. In extremely rare cases where hydatid cysts are located in the cervicofacial area, a detailed further diagnostic procedure is required in order to diagnose possible involvement of other organs.

Sclerosing polycystic adenosis of the major salivary glands is rare and can simulate a slow growing tumour. It is pseudoencapsulated and includes tubuloacinar adenosis with dilated ducts, apocrine metaplasia, epithelial hyperplasia, and cystic changes associated with fibrosis. The histological appearance of the lesion is similar to that of fibrocystic disease of the breast. The multifocal nature of the lesion makes its management difficult. We report a case of sclerosing polycystic adenosis in a 45-year-old white woman.

During a 6-year period we did a total of 72 videoendoscopies of the salivary glands and their associated ductal systems. This minimally invasive procedure is associated with little morbidity and discomfort. The main indication was sialolithiasis of the submandibular and parotid glands. Sialoendoscopy was used not only for diagnosis of radiolucent calculi but also for simultaneous removal of calculi. Sialoendoscopy was also of benefit in the diagnosis and treatment of other diseases of the salivary glands. Even patients with chronic sialadenitis could be helped with endoscopic dilatation of the causative sialostenosis, thereby enabling us to conserve the gland.

A case of salivary duct carcinoma arising in the submandibular region of an 83-year-old man is presented. Histologically, the tumour consisted of solid cell nests with ductal structures. Tumour cell nests showed central comedonecrosis. Immunohistochemically, the tumour cells were positive for keratin and epithelial membrane antigen but negative for S-100 protein and calponin. Clinical features as well as pathological examinations based on haematoxylin-eosin and immunohistochemical stainings were important in the diagnosis of this case.

Drug administration and numerous systemic diseases may cause morphological changes of the parotid gland. The aim of this study was to investigate the possible relationship between experimental adjuvant arthritis following ibuprofen treatment and morphological alterations of the parotid glands in rats. Freud's adjuvant was injected intradermally into the plantar surface of the hind paw of the animals to induce experimental arthritis. Ibuprofen was administrated per os (17 mg/kg/day). Both adrenals and parotid glands were isolated and their absolute and relative weights were evaluated. A full histological examination of parotid glands took place. The diameter of the foot as well as the serum levels of rheumatoid factor was measured. In conclusion, both experimental adjuvant arthritis and ibuprofen treatment induce morphological changes of the parotid tissues, which are related to macro- and micro-structure of the gland.

We present a retrospective series of 23 consecutive parotidectomies, over a 10-year period (1989-1999) for 22 patients with chronic sialadenitis unresponsive to conservative measures. There were 10 male and 12 female patients. Mean age was 52 years (range 12-72), and mean duration of symptoms 4.5 years (range 8 months-30 years). All patients had preoperative sialography and 2 had computed tomography to exclude a neoplasm. A complete superficial parotidectomy with preservation of the main duct was done in all cases. Fifteen patients developed temporary facial nerve weakness postoperatively and 7 developed Frey's syndrome. There were no cases of permanent facial nerve palsy. Nineteen patients reported complete resolution of their symptoms and 3 patients had mild persisting symptoms that did not necessitate any further treatment. Histologically there was evidence of sialadenosis in one case and benign lymphoepithelial lesion in another; the others showed evidence of chronic sialadenitis of varying degrees of severity. Fifteen patients had postoperative sialograms, of which 11 showed evidence of some filling of residual parotid gland parenchyma and in 8 patients there was filling of a normal-looking accessory lobe. In this series, superficial parotidectomy with preservation of the main duct was safe and effective, with minimal long-term complications, for most patients with chronic parotid sialadenitis that was unresponsive to conservative measures and, in some patients, it allowed some preservation of function. The potential damage to the facial nerve and the cosmetic problems associated with a total or near-total parotidectomy were avoided., (Copyright 2001 The British Association of Oral and Maxillofacial Surgeons.)

Salivary duct carcinoma is rare. We describe a 56-year-old man who developed salivary duct carcinoma in the mandible 10 years after removal of the right second and third molars. The tumour originated in the retromolar gland or the ectopic minor salivary gland in the mandible. The panoramic radiograph showed a radiolucent, poorly circumscribed area about 40 x 30 mm in size and distal to the lower right first molar. This tooth, together with all neoplastic tissue, was removed, and histopathological examination showed it to be a salivary duct carcinoma in the mandible. On immunohistochemical staining, keratin antibodies stained the ductal structure, 1A4 antibody stained myoepithelial cells, but S-100 protein and vimentin were not seen. The patient was well and with no sign with recurrence 6 years postoperatively.

Two cases are presented in which non-operative removal of a submandibular duct stone and dilatation of a duct stricture were performed using a 3 mm balloon. Both cases were performed as an outpatient procedure. At follow-up after 1 year and 6 months respectively, both patients are completely asymptomatic.

The effect of local anesthetic injections in the palate of rats was studied by light microscopy and immunohistochemistry with antibody to proliferating cell nuclear antigen (PCNA). The results of this study suggest that local anesthetic injections could be one of the causes of necrotizing sialometaplasia.