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Submandibular Stone Not Seen on CT, Ultrasound or Sialogram

Submitted by hoffmanh on Tue, 12/10/2024 - 10:45
stone not seen on CT US or sialogram
stone not seen on CT US or sialogram
stone not seen on CT US or sialogram
stone not seen on CT US or sialogram
stone not seen on CT US or sialogram
stone not seen on CT US or sialogram
stone not seen on CT US or sialogram
stone not seen on CT US or sialogram
stone not seen on CT US or sialogram

See also: Instructions to patients - submandibular salivary stones; Sialograms and Sialography

Click on images above and advance for full story

 

stone not seen on CT US or sialogram

click for video: 

 

 

 

Op Note

Preop Dx: Right submandibular sialadenitis with ductal stricture

Postop Dx: Same - additionally: sialolithiasis

Procedure: Right submandibular sialodochoplasty with

                        Duct cannulation and dilation over 0.015 inch guidewire -  24 then 22 gauge angicath then 4Fr COOK salivary access dilator followed by 7 Fr COOK salivary access dilater

                        Removal of 2 mm stone with removal of 7 Fr COOK salivary access dilator (and guidewire)

                        Sialendoscopy (1.3 mm Marchal sialendoscope) to 6 cm (tertiary ducts) with slight debris irrigated free, no stone

                        Kenalog 10 infused into duct initially with 22 gauge then increased to 18 gauge angiocath (5 cc delivered 2.5 cc retained)

Anesthesia: General OETT

Findings as above and photos

Decision to avoid placement of stent based on clearly identified stone as likely source of obstruction with readily and maximally dilated duct (7 Fr COOK dilator) permitting passage of stone

 

References

Kondo N, Yoshihara T, Yamamura Y, Kusama K, Sakitani E, Seo Y, Tachikawa M, Kujirai K, Ono E, Maeda Y, Nojima T, Tamiya A, Sato E, Nonaka M. Diagnostic and treatment effects of sialendoscopy for patients with swelling of the parotid gland when sialoliths are undetected with computed tomography. Auris Nasus Larynx. 2018 Aug;45(4):880-884. doi: 10.1016/j.anl.2017.11.004. Epub 2017 Dec 6. PMID: 29217121.