Salivary Gland Anatomic Anomalies and Foreign Bodies AHNS Salivary Endoscopy Course Nicholson Center Orlando, Florida April 9, 2013 Harry Hoffman MD MS.

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Presentation transcript:

Salivary Gland Anatomic Anomalies and Foreign Bodies AHNS Salivary Endoscopy Course Nicholson Center Orlando, Florida April 9, 2013 Harry Hoffman MD MS 3,000 page handout with videos/photos: search for “Iowa Protocols” search: “AHNS Salivary Lectures 2013”

Disclosures None

Anatomic Anomalies Parotid: Normal ductal system Accessory lobe Anomalous drainage acquired and congenital Submandibular Relationship to lingual nerve and sublingual gland Sublingual Ducts of Rivinus Bartholin’s duct

Anatomic Anomalies Parotid: Normal ductal system / Accessory Lobe

Anatomic Anomalies Parotid: Normal ductal system / Accessory Lobe

Anatomic Anomalies Parotid: Accessory Lobe Stone

Anatomic Anomalies Parotid: Accessory Lobe Stone

Anatomic Anomalies Parotid: Anomalous drainage acquired and congenital

Anatomic Anomalies Submandibular Relationship to lingual nerve and sublingual gland Sublingual Ducts of Rivinus Bartholin’s duct

Anatomic Anomalies Submandibular Relationship to lingual nerve and sublingual gland

Anatomic Anomalies Sublingual glands secrete directly through mucosa into FOM via multipel ducts of Rivinus and Bartholin’s duct that empties into the Wharton’s duct

Salivary Foreign Bodies Philosophy: Endogenous v Exogenous Sialolithiasis theories: 1.Intracellular microcalculi excreted in canal as nidus to calcify 2. “Mucus plugs’ as nidus to calcify 3. “aliments, substances, or bacteria in the oral cavity migrate into the salivary ducts for further calcification” Marchal et al: Retrograde Theory in Sialolithiasis Formation arch Otolaryngol 127, Jan 2001 pp Published reports Su et al: Sialoendoscopic management of submandibular gland obstruction Caused by intraglandular foreign body. Vol. 114 No. 5 November 2012 Blade of grassPin needlePiece of broom straw Hair brush thistleVegetable fiberFingernail Fish boneLimb of shrimpFeather ShrapnelPiece of Hair5 Cases of Fish Bones Fish boneVegetable nidusWood-like strands

Salivary Foreign Body Examples: Parotid: percutaneous welding slag Submandibular: migrated stent (20 gauge angiocatheter) “google” or “bing” or otherwise search: “Iowa Protocols” then search in the protocols: “foreign body” or “sialendoscopy”