Oral and maxillofacial surgery (OMS) and its training systems continue to evolve around the globe.1 Review of Kumar emphasized that a wide diversity of dental/stomatology/medical background requirements and training pathways exist across the states that lead to a degree in OMS.1 Nevertheless, to our knowledge the issue of OMS education in Ukraine is not highlighted in the English-language literature. Moreover, the relevance of coverage of this issue has increased this month. As on April 23, 2021 a more than a historical order for the whole oral and maxillofacial community in Ukraine was approved.2 Order #799 of the Ministry of Healthcare of Ukraine “On Approval of Amendments to the Handbook of Qualification Characteristics of Workers' Professions.2 Issue 78 “Healthcare”.” This much-needed ministerial document orders to add a new “Maxillofacial Surgeon Doctor” (MFSD) position to the Section “Professionals in the Field of Stomatology.”2

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The pathological changes in 467 submandibular glands were identified both endoscopically and radiographically, and endoscopic findings showed three types: calculus (91 percent), mucus plug (3 percent), and stenosis (6 percent). —Yu Chuangqi et al, 2013 China Mucus plugs (synonyms: mucous plugs, mucin plugs, fibromucinous plugs and mucosal plugs) and sialoliths (synonyms: salivary stones, salivary calculi, and concrements) belong to the one of the common causes of the obstructive salivary gland disease (synonyms: obstructive sialadenitis and obstructive sialadenopathy). Among other etiologies of obstructive sialadenitis are: foreign bodies, inflammation, kinks, strictures, anatomic malformations, polyps or even tumors. 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. 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. Also, there are some studies that demonstrate endoscopic view of the mucosal plugs in a ductal system and in some cases the authors during sialendoscopy noted the floating mucous plugs. 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.

A 36-year-old man with a 3-year history of recurrent salivary colic was referred to a maxillofacial surgery department. Gray scale ultrasound (US) showed enlarged right submandibular gland, significantly dilated intraglandular duct with two sialoliths (with an artifact of acoustic shadowing) inside, one – floating (Video-Panel A and B, arrow) and another – nonmovable (arrowhead). Left nonsymptomatic normal in size gland (asterisk) is showed at Panel C. The affected gland was excised under general anesthesia due to the diagnosis of chronic submandibular obstructive sialolithiasis. Intraglandular duct contained two yellowish stones, first was an oval form with a pellet surface (Panel D, arrow), second – a round shaped with a smooth surface (Panel D, asterisk) and it was presented at US as a floating sialolith; both are easily crumbled on palpation. As the specimen and intraglandular duct were dissected longitudinally, that`s why dissected intraglandular duct (Panel D, arrowheads) is visible in both parts of the gland. Also, a 1 small calculus (Panel D, curved arrow) was found in the parenchymal ducts. Postoperative period was smooth, and 1-year follow-up after surgery, the patient has no complaints.

A 26-year-old female patient presented with a painless soft tissue mass at the lower third of the right neck. The mass appearance and growth was noted during last several years. Longitudinal gray-scale ultrasound (US) showed that long-to-short diameter of this cystic lesion measured 3.51 × 2.12 cm (distances are indicated by even calipers ‘+’ and ‘×’) (Panel A: arrow, position of the probe’s side which corresponds to the probe bump and symbolizes the probe side [arrow] at Panel C; arrowhead, septa; C, cystic component; S, solid component). Lesion is visualized as a multicystic mass (hypoechoic with multiple anechoic areas) with septations and a prominent mixed structure (combination of macro- and microcystic cavities). A honeycomb US pattern and no vascular fill of the anechoic areas (Panel B: arrow, position of the probe’s side; asterisk, neck vessel; arrowhead, weak intratumoral blood flow), most likely represented a lymphangioma. Typically, the strong flow signal is noted from 9.30 to 59.37 percent of hemangioma cases. The artifact of acoustic enhancement―common for the fluid-containing structure―was noted posteriorly to the lesion. The fact that the tumor cannot be compressed using probe indicates that the cystic structure differs from the cystic structure of reported US features of cavernous lymphangiomas (sponge-like neoplasms). The capsulated lesion (Panel D: He, hemolymphangioma) was surgically removed under general anesthesia applying the incision along the anterior margin of the right sternocleidomastoid muscle. During tumor removal, light-gray fluid content was partially evacuated due to the rupture of cystic wall. Panel E shows a specimen―the decreased in volume mass―after the evacuation of its cystic content. The spaces of the intratumoral macrocysts are indicated by arrowheads. Histopathological examination established the diagnosis of a ‘hemolymphangioma’ (also known as ‘hemangiolymphangioma’). The patient showed no signs of recurrence at the end of the 36-month follow-up period. Li et al (2017) emphasized that it’s crucial to perform such preoperative imaging, which can help to avoid biopsy upon differential diagnostics between lymphangiomas and vascular malformations with numerous vessels (which can lead to intensive bleeding).8 In summary, hemolymphangioma is a very rare mixed malformation of both blood and lymphatic vessels. Ohsawa et al (2018) concluded that complete excision of hemolymphangiomas provides the best results with a lower recurrence rate. Diagnostic ultrasound and its Doppler option proved efficacy in case of such malformations.