Análise da aplicabilidade da ultrassonografia no diagnóstico de sialolitíase nas glândulas salivares maiores

Abstract

Sialolithiasis is characterized by the formation of calcified structures (sialoliths or stones) in the parenchyma or ducts of the major salivary glands (GSM). Radiographic or computed tomography (CT) examinations can be used to detect these structures, although they present limitations for the detection of poorly mineralized sialoliths, as well as for the differentiation of soft tissues. Magnetic resonance imaging (MRI) has good accuracy for diagnosing alterations in GSM or mineralized or non-mineralized salivary stones, however, its use in clinical practice is limited due to its high financial cost and low availability. Ultrasonography (US) has been described as an excellent imaging alternative for the evaluation of GSM, due to its reduced cost, real-time image acquisition, good image resolution and the non-use of ionizing radiation. The objective of this work is to analyze the applicability of ultrasound in detecting sialolithiasis in GSM. A literature review was carried out on the use of US in the evaluation of sialolithiasis. In this review, data were collected about the authors, year of publication, type of study carried out, which GSM was evaluated, the diagnostic value of US (accuracy, sensitivity, specificity, positive predictive value, negative predictive value), main ultrasound characteristics of sialolithiasis, relevant clinical data and other additional information. Salivary stones, single or multiple, larger than 2 mm in size, were well detected by US, as well as non-mineralized mucous plugs. Stones smaller than 1 mm were more difficult to visualize in the US, with the sonopalpation technique, associated with the use of lemon juice or intraoral ascorbic acid, being important in these cases. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value were satisfactory. Any parenchymal alterations were clearly visualized using US. Clinical and ultrasound data were important in establishing differential diagnoses. Ultrasonography, therefore, can be considered as a suitable imaging method for the initial assessment of sialolithiasis in GSM, both in adults and children.