Category Archives: Oral Surgery

Patients who present sialadenitis incidents from obstruction caused by stone (formed by saliva’s salts) or from narrowing of the glands’ pores, are treated using a technique that consists of inserting a very small endoscope (optical fiber) into the pore that drains saliva, which is connected to a camera.

The procedure is simple and is executed using local anesthesia; it can solve the problem either during the acute phase or after such frequent infections, and can determine the diagnosis.

The classic methods of displaying obstructive phenomena of salivary glands are: Sielography, ultrasound, x-ray, axial and magnetic tomography. Sielography has remained until now a method of choice for diagnosing obstructive phenomena of major salivary glands.

Ultrasound remains a reliable diagnostic tool for displaying stones within the salivary glands with the limitation that stones less than 3mm cannot be displayed.

Another examination presupposing the use of magnetic resonance is magnetic sielography that gives images of the salivary glands without the use of radiation.

Sialendoscopy system is a new revolutionary technique for endoscopic removal of stones from major salivary glands. (Parotid – submaxillar). Using local anesthesia, we enter the glandular pore and examine its lumen with a 1.3 mm diameter endoscope.

The patient leaves after approximately 40 minutes, having the obstructive phenomenon that has plagued him removed and without needing further hospitalization.

In conclusion, it is possible to remove or decompose the obstructive phenomenon that plagues the patient without requiring surgery or some other surgical operation, and the patient, using only local anesthesia, is relieved of the obstructive phenomenon with the least possible damage to the adjacent tissues and soon recovers immediately.

This operation can be performed by an otorhinolaryngologist, a Maxillofacial surgeon and by a specialized dentist with the help of the previous specialties.

Salivary glands are organs that are distributed around the oral cavity and produce saliva.

They are distinguished in major and minor. The parotid, submaxillar and sublingual salivary glands are considered to be the major ones. Minor salivary glands are around 400-500. Saliva is a liquid essential for digestion, speech, swallowing and for the maintenance of oral health.

The quantity of saliva produced daily is normally about 1-1.5 liters. In the salivary glands, the most common pathological conditions are infections, sialolithiasis, tumors (benign and malignant) and autoimmune diseases.

Salivary Gland Diseases:

Salivary gland inflammations

They are called sialadenitis and may be due to viruses or microbes. The appearance of mumps in childhood caused by the mumps virus is typical. Microbial sialadenitis often occurs in submaxillar glands or parotids, and may be due to obstruction of pores that drain saliva from stenoses, inflammations or stones.

Sialolithiasis

Saliva contains salts that can, in some cases, form stones just like in the kidneys. Then the emissary of the gland is blocked, the drainage of the saliva stops, the gland swells and this is followed by inflammation with pain.

Sometimes sialolithiasis self-heals and sometimes requires the removal of the stone by a cut through the mouth. Endoscopy (sialendoscopy) is a useful diagnostic and therapeutic tool in the sialolithiasis of major salivary glands. In some cases it is necessary to remove the gland itself by surgery under general anesthesia.

Salivary Gland Tumors

These may be malignant or benign. Benign tumors are more common especially in the parotid area. The most common are the manifold gland and the Warthin tumor. Tumors usually grow slowly. But if not treated over the years, a benign tumor can be transformed into malignant.

Therefore, these tumors should always be treated with surgical abscission.

The most common surgical procedures performed for this reason are:

The appropriate surgery considering the parotid is partial or superficial parotidectomy. The surgery includes removal of part of the gland together with the tumor (en block).

It is done with an outer cut around the ear that extends towards the neck. It has the particularity of the presence of the facial nerve within the gland. Damage to the facial nerve leads to a disorder in the movement of the facial muscles.

The gland with the tumor is detached from the nerve branches and gets removed en block. In these procedures, we use a neuro-monitoring system, a system that checks the integrity of the nerve during surgery and warns us when, using our tools, we handle very close to the branches of the personal nerve.

The operation is executed with general anesthesia and usually requires hospitalization for two days. The aesthetic result is very satisfactory. In the submaxillar glands, an operation of choice is the abscission of the gland. This is done with a sub-maxillar cut and the aesthetic result is excellent.

Autoimmune Diseases

Sjogren’s syndrome is an autoimmune disease that causes dry mouth and dry eye due to salivary and lacrimal glands filtration. Sjogren’s syndrome is divided into the primary one when it appears on its own and in the secondary one when it is accompanied by other conditions.

Such diseases are rheumatoid arthritis, lupus erythematosus and scleroderma. Patients with secondary Sjogren syndrome need long-term follow-up due to the risk of developing a non-Hodgkin lymphoma that is 5-10%.

As a side effect, jaw’s osteonecrosis was recorded for the first time in 2003 bibliography.

Bisphosphonates are a group of medicines that, due to their osteolytic effect, are considered the first choice of medicines for patients who suffer from osteoporosis and osteopenia because they reduce the danger of an osteoporotic fracture by 50%.

They are also administered to patients with multiple myeloma, cancer at breast, prostate, kidney, lung and when there are bone metastases.

Also, they are administered for the Paget bone disease treatment and the imperfect osteogenesis. Bisphosphonates, nowadays, are frequently prescribed medicines by doctors of various specialties like rheumatologists, orthopedists, endocrinologists, oncologists, pathologists.

Most commonly administered bisphosphonates include:

• Zoledronate (Zometa)
• Ibandronate (Bonviva)
• Risedronate (Actonel)
• Pamidronate (Aredia)
• Alendronate (Fosamax)

Bisphosphonates are administered either intravenously or from the mouth. The probability for them to cause jaw osteomyelitis or osteonecrosis is increased if they are received from the mouth for more than 3 years or if they are received intravenously for more than 6 months. Generally, the danger of jaw osteonecrosis is much higher when the patient receives the bisphosphonate intravenously.

Osteonecrosis caused by bisphosphonates is more frequent at the lower jaw and usually a dental operation like a tooth extraction has been preceded. During osteonecrosis, there is a decomposition of the mucous membrane and revelation of the necrotic bone which may be asymptomatic or painful. Every patient who receives bisphosphonates in any way must maintain a very high level of oral hygiene.

It is good to avoid executing any intraoral operations (like extractions) to these patients, but if it is necessary, it is considered deliberate to stop receiving the medicine 3 months before and 3 months after the operation. The treatment for osteomyelitis by bisphosphonates is extremely difficult.

The frenulum is a part of soft tissue that starts from the inner part of the lips or the tongue and ends at the gums. In some cases, frenulums can cause receding or divergence between central sectors of the upper jaw.

Apart from dental and periodontological reasons, frenulums are removed from children when they cause difficulties to speech. A short frenulum at the tongue needs to be released as soon as possible before it causes speech problems to the child.

The operation is extremely simple and takes place in the infirmary’s space, using local anesthesia and is usually concluded in 10 minutes. A more conservative technique concerning frenectomy is conducted using a laser.