May 31, 2019
J Diagn Treat Oral Maxillofac Pathol 2019;3:144−53.
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HOW TO CITE THIS ARTICLE
Cherniak OS, Fesenko II. Effectiveness of ultrasound in verification of the mucus plugs and sialoliths of the Wharton`s duct. J Diagn Treat Oral Maxillofac Pathol 2019;3(5):144−53.
The pathological changes in 467 submandibular glands were identified both endoscopically and radiographically, and endoscopic findings showed three types: calculus (91 percent), mucus plug (3 percent), and stenosis (6 percent).1
—Yu Chuangqi et al, 2013
Mucus plugs1, 2 (synonyms: mucous plugs3, mucin plugs4, fibromucinous plugs5, 6 and mucosal plugs7) and sialoliths (synonyms: salivary stones, salivary calculi1, and concrements8, 9) belong to the one of the common causes of the obstructive salivary gland disease (synonyms: obstructive sialadenitis10 and obstructive sialadenopathy8). Among other etiologies of obstructive sialadenitis are: foreign bodies, inflammation, kinks, strictures, anatomic malformations, polyps or even tumors.11 Those causes are found in different percentages. The radiographic investigation e.g. X-ray and computed tomography (CT) are very useful in detection of the salivary stones. Nevertheless, as approximately 80-90 percent of the sialoliths are opaque on a standard review X-ray and CT, and in 10-20% radiolucent.12, 13 But these methods are not useful in the detection of mucus plugs due to the non-contrast features of the last. There are a lot of studies which described ultrasound features of the sialoliths.14, 15 Also, there are some studies that demonstrate endoscopic view of the mucosal plugs in a ductal system1, 7, 16 and in some cases the authors during sialendoscopy noted the floating mucous plugs.17 But we cannot find articles in PubMed which demonstrate ultrasound and clinical appearance of the obstructive salivary gland disease caused by sialoliths with mucus plugs simultaneously.
The purpose of our article is to describe a first and precise description of ultrasound pattern of the mucus plugs comparing with sialolith and their clinical presentation after removal. We report the consecutive gray scale and color Doppler sonograms with a supplemental video.
A 32-year-old woman was seen in Maxillofacial Surgery Center of the Kyiv Regional Clinical Hospital because of swelling in right submandibular and sublingual area during last days. The salivary colic (synonyms: postprandial salivary colic18, spasmodic pain during eating19 and meal time syndrome6) began to disturb the patient at the same time as the appearance of edema. An intraoral examination
showed severe swelling of the mucosa in the right sublingual area with its significant erythema and a local necrosis (Fig 1). During massage of the right submandibular gland no milking exudate or saliva was present from the duct`s orifice. Bimanual palpation of the right submandibular gland was painful to the patient and also indicated us the enlargement of the gland.
FIGURE 1. Intraoral view before ultrasound and treatment. Note an erythema and swelling (arrowhead) in the right sublingual area. Necrosis of the mucosa is indicated by arrow.
Ultrasound (US) investigation was performed with 12-3 MHz linear transducer (synonym: linear probe14) (model HD11 XE, Philips). US in the right submandibular position showed the two-times enlarged right submandibular gland comparing with a contralateral organ (Fig 2).
FIGURE 2A. Comparison of the longitudinal gray scale sonograms of a right obstructed and inflamed submandibular gland with a left nonsymptomatic gland (image B). At image A, the gland is indicated by "+" and "×" calipers. The gland is enlarged in size almost twice and has a rounded form. Note a dilatation of the intraglandular duct (arrow).
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