F. Salles

Transoral approach for Stensen's duct lithiasis

Extracorporeal lithotripsy (ECL) and interventional sialendoscopy are the classical treatments for Stensens duct salivary stones, but some cases cannot be treated using these techniques. Another technique is now available, transoral Stensens duct approach.

Exérèse endobuccale des lithiases submandibulaires postérieures : 36 cas

INTRODUCTION Proximal submandibular calculi are usually removed by transcervical submandibular sialadenectomy. The aim of this study was to show that intraoral removal of hilar submandibular calculi gives the same results with fewer complications than submandibulectomy. PATIENTS AND METHODS The surgical indication is assessed by palpability of the stone and confirmed by simple CT scan. The surgical procedure is performed under local or general anaesthesia. At the end of the procedure, the duct is controlled with a sialendoscope to remove remaining concretions. We prospectively followed 36 patients with a mean follow-up of six months (one to 36 months). RESULTS The transoral removal of calculi was performed in 34 patients without any definitive neurological complication. The procedure failed in two patients with nonpalpable calculi. Two patients had a recurrence of symptoms due to small intraglandular calculi, which were evacuated later. DISCUSSION The transoral removal of submandibular hilar calculi is a safe and reproducible procedure with less morbidity than submandibulectomy. It should be recommended for posterior palpable submandibular calculi.

Exérèse des lithiases postérieures de la glande submandibulaire par abord endobuccal

INTRODUCTION Sialolithiasis is the most common non-neoplastic salivary gland disease, accounting for 1.2% of the autoptic population. More than 80% of salivary calculi are located in the submandibular ductal system. Hilar calculi are usually removed by transcervical submandibular sialadenectomy. However, intra-oral removal of hilum submandibular calculi is an interesting alternative. INDICATIONS The main criterion for intra-oral removal is the calculi palpability, knowing that calculi under 8mm of diameter are often treated by other techniques (sialendoscopy and lithotripsy). OPERATIVE PROCEDURE We describe a conservative and gland-preserving transoral surgical technique for hilar submandibular calculi with postoperative sialendoscopic control. The different surgical steps are illustrated. DISCUSSION Preservation of the submandibular gland has been attempted in the treatment of sialotithiasis by transoral resection of calculi from the hilum of the gland. This technique features a low morbidity and leads to a complete recovery of glandular function.

Sialographie 3D en cone beam: étude préliminaire

INTRODUCTION Stones, stenosis and inflammatory lesions are the main causes of mealtime syndrome. The aim of paraclinical exam is to find the cause of these obstructive symptoms. Ultrasound is often sufficient to confirm the lithiasic origin of salivary gland swelling. Non-lithiasic salivary obstructions are more difficult to diagnose. We studied the feasibility and quality of a new medical imaging device: three-dimensional (3D) sialography using the technique of cone beam with flat panel (CPCT). PATIENTS AND METHODS Five patients were included, referred for diagnostic management of non-lithiasic salivary gland parotid colic. It was performed for each patient in the angiography room, conventional sialography and 3D CPCT. Images were compared to conventional sialography. RESULTS None of catheterization failure or side effects were observed in five patients. 3D CPCT sialography enabled to view gland ducts until their fifth or sixth division. Compared to conventional sialography, 3D CPCT improves signal and contrast to noise ratio. DISCUSSION This technique allows an anatomic resolution and signal/noise ratio unmatched. It also allows to reduce metallics artefacts. Its main drawback is those associated with ductal catheterization, exposure to ionizing radiation and potential allergy to iodinated contrast agents.

Lettre à l’éditeur, lettre aux auteurs. Faut-il allumer le MeSH ?

L e MeSH qu’est-ce-que c’est ? Il s’agit de l’abréviation de medical subject headings, littéralement les « mots-clés et rubriques médicaux ». En pratique, il s’agit d’une liste de mots-clés définie par la National Library of Medecine, pour classer mais aussi retrouver les articles de la banque Medline. En effet, Medline vient d’enregistrer sa 20 millionième référence, ce qui pose des problèmes de classement et surtout des problèmes pour rechercher l’article souhaité. Cette liste de mots-clés du MeSH est donc devenue indispensable pour classer les articles. Elle comprend actuellement 25 588 mots-clés et 83 qualificatifs ! Ainsi, pour une maladie comme la maladie parodontale ou parodontal diseases (motclé) on pourra avoir plusieurs qualificatifs : diagnostic, épidémiologie, complications, traitement. . . C’est pour cette raison qu’il est demandé à tous les auteurs de donner des mots clés pour leur article, et de choisir ces mots clés au sein des 25 588 du MeSH ! Pour accéder à cette liste de mots-clés, il suffit d’aller sur le site de la National Library of Medecine (http://www. ncbi.nlm.nih.gov/pubmed), plus connu sous le nom de PubMed. Dans l’onglet du haut (fig. 1) on va choisir la ligne correspondante au MeSH (on peut également accéder directement au MeSH en tapant dans son navigateur l’adresse suivante : http://www.ncbi.nlm.nih.gov/mesh.