0:01

Here is a case that is pretty classic

0:03

for a submandibular glandular stone.

0:08

And you look at the parotid glands,

0:11

they look pretty nice.

0:12

There's no calcifications within them.

0:14

We look at the ductal region here.

0:18

This is a blood vessel.

0:20

So this is one of the problems with doing post-contrast

0:24

CT scanning when you're looking for stones.

0:28

First off, we get a lot of the dental amalgam artifact,

0:31

which is independent of the contrast.

0:33

But can I say that this is not a stone, a tiny stone.

0:37

And you know,

0:37

even with your dual-phase CT scan,

0:40

this may be a problem because it's such a small abnormality.

0:44

In this case, this was a blood vessel.

0:46

However,

0:46

when we go down here to the left submandibular gland,

0:51

we see that there is this big calcification,

0:54

which is at the junction between the gland and the

0:57

proximal duct.

0:57

We see a little bit of ductal dilatation.

1:00

And we notice that the left submandibular gland is enlarged

1:04

compared to the right submandibular gland.

1:07

So let's put it all together.

1:08

There is sialolithiasis associated with sialodochoectasia,

1:13

as well as sialadenitis on the left side, with internal

1:18

sialectasia within the glandular system itself,

1:21

you see that there are probably some dilated

1:23

ducts here as well.

1:25

And it's inflamed.

1:27

You look at the platysma muscle

1:30

on the left side and compare it to the platysma muscle on

1:34

the right side, and you see that it's thickened

1:37

because of adjacent inflammation.

1:40

So this is actually a nice example.

1:42

This big calcification, unlikely to be able to be removed by

1:48

doing an interventional procedure through the ductal system.

1:52

They usually would try to dilate, dilate,

1:54

dilate the duct and then try to either use secretagogues,

1:59

which is...

2:00

You know,

2:01

give the patient something to cause them to

2:02

salivate profusely to try to move it out.

2:05

But this is a large, large stone.

2:07

I think that this one will require removal

2:10

of the gland and the ductal tissue.