0:01

We made it.

0:02

We got through all those neoplasms of the salivary glands,

0:06

and now it's time for a nice little

0:08

upper teeth of benign lesions.

0:12

And these are usually inflammatory lesions.

0:14

The most common of these is going to be sialolithiasis,

0:18

and that is stones in the gland or in the ducts.

0:22

If you take all comers,

0:25

possibly mumps might still be the most common

0:28

inflammatory lesion of the parotid gland,

0:30

and that usually causes a bilateral parotitis in children.

0:35

But with the MMR vaccination, that's a lot less common.

0:38

So let's talk about sialolithiasis,

0:42

and first define some terms.

0:44

So, sialolithiasis refers to stones in the gland.

0:48

If you use the term sialodocholithiasis,

0:51

you're referring to calcifications, actually,

0:52

within the duct.

0:54

Sialadenitis means inflammation of the glandular tissue,

0:58

most common, again, being mumps.

1:00

Second most common staph aureus from an adjacent

1:03

skin infection going into the parotid gland.

1:06

If we use the term sialodochitis,

1:09

we suggest that the duct itself is inflamed,

1:12

and that might be because of sialodocholithiasis.

1:16

Sialectasia is ductal dilatation

1:19

or sialodochoectasia ductal dilatation.

1:25

There is another term that is used which is sialosis.

1:28

The synonym is sialadenosis,

1:32

and as you can tell by the term -osis instead of -itis,

1:36

we're suggesting a noninflammatory

1:38

cause of glandular enlargement.

1:41

So these are non-tender,

1:43

noninflamed enlarged glands,

1:45

usually the parotid glands,

1:47

usually bilateral and symmetrical.

1:49

This can occur due to metabolic

1:51

diseases in the body, which include diabetes,

1:54

thyroid and obesity,

1:56

where you have just plump parotid glands.

2:00

And you can also see them in other pathologic conditions

2:04

associated with alcoholism, liver disease, hypertension,

2:08

and some of the medications used to treat, for example,

2:11

diabetes, thyroid, hypothyroidism and hypertension.

2:16

So this is Sialosis, or Sialadenosis.

2:18

What we see on imaging is just bilateral enlarged glands,

2:22

which may show very faint contrast enhancement.

2:26

So those are the terms we're going to be using,

2:28

but we're going to start in on Sialolithiasis.

2:32

So, Sialolithiasis is the ductal...

2:36

is the calcifications in the gland within the gland itself,

2:39

or sialodocholithiasis within the duct itself.

2:43

This is predominantly a disease

2:45

of the submandibular gland.

2:47

But we do see calcifications in the ducts

2:50

also associated with the parotid gland,

2:52

and I've shown you a few examples of that.

2:55

Why is it more common in the submandibular gland?

2:59

Well, as you recall from our anatomic review,

3:01

the secretions that occur from the submandibular gland

3:05

are more mucous mucinous viscous,

3:08

and therefore they are more likely to be

3:11

thick and can lead to a concretion.

3:14

The submandibular gland also has a more basic

3:20

saliva which leads to a higher rate of calcification of

3:26

the calcium oxalate and calcium phosphate

3:29

which are the most common of the

3:31

salivary duct...

3:34

salivary duct stones.

3:36

It also drains uphill from being in the submandibular gland

3:40

below and draining up to the frenulum of the...

3:43

on either side of the frenulum of the floor of the mouth.

3:45

So therefore there's more likely to be stasis,

3:47

whereas the parotid duct, Stensen's duct, tends to be going

3:53

slightly downhill and anteriorly directed.

3:57

The duct itself, as I mentioned, has

4:00

a tight orifice,

4:01

but also is more likely to be traumatized at the floor

4:04

of the mouth by things like food, et cetera.

4:07

And that can narrow the duct and inflame the duct,

4:09

so it gets quite narrow, and therefore

4:11

the flow may be decreased.

4:13

It has a very tight opening for insertion of

4:16

the catheter when you're doing sialography.

4:20

When you have stones in the gland,

4:24

they are multiple in about 25% of cases.

4:28

Here is a patient who has multiple stones in the gland.

4:33

So this is kind of classic, right?

4:35

So we have multiple calcifications in the Wharton's duct,

4:39

Wharton's duct being the duct of the submandibular gland,

4:43

seen here as multiple. So, as I said, 25% multiplicity.

4:50

And you notice that the gland itself is enlarged

4:53

compared to the contralateral gland.

4:55

It's a little bit lower density because it's edematous.

4:58

So, what do we use the term?

5:01

So these are Sialodocholithiasis,

5:04

associated with Sialadenitis,

5:07

post-obstructive inflammation of the submandibular gland.

5:11

There's even a few lymph nodes nearby

5:14

due to that inflammation.

5:16

There also is sialodochoectasia,

5:19

enlarged dilated gland...

5:23

duct.

5:25

sialodocho ectasia,

5:26

sialoectasia, enlarged duct which is obstructed.