Effectiveness of Ultrasound in Verification of the Mucus Plugs and Sialoliths of the Wharton’s Duct

Abstract

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.