Sialoliths, or salivary stones, most commonly form in the submandibular gland. They develop due to a combination of anatomic factors, secretory disturbances, and precipitation of calcium and other inorganic minerals within the salivary ducts or glands. Common symptoms include pain or swelling of the affected gland, especially when eating. Diagnosis involves imaging tests like sialography, CT scans, or ultrasound. Treatment depends on the size and location of the stone, ranging from minimally invasive techniques like sialendoscopy to open surgical removal of larger stones.
Sialoliths, or salivary stones, most commonly form in the submandibular gland. They develop due to a combination of anatomic factors, secretory disturbances, and precipitation of calcium and other inorganic minerals within the salivary ducts or glands. Common symptoms include pain or swelling of the affected gland, especially when eating. Diagnosis involves imaging tests like sialography, CT scans, or ultrasound. Treatment depends on the size and location of the stone, ranging from minimally invasive techniques like sialendoscopy to open surgical removal of larger stones.
Sialoliths, or salivary stones, most commonly form in the submandibular gland. They develop due to a combination of anatomic factors, secretory disturbances, and precipitation of calcium and other inorganic minerals within the salivary ducts or glands. Common symptoms include pain or swelling of the affected gland, especially when eating. Diagnosis involves imaging tests like sialography, CT scans, or ultrasound. Treatment depends on the size and location of the stone, ranging from minimally invasive techniques like sialendoscopy to open surgical removal of larger stones.
Sialoliths, or salivary stones, most commonly form in the submandibular gland. They develop due to a combination of anatomic factors, secretory disturbances, and precipitation of calcium and other inorganic minerals within the salivary ducts or glands. Common symptoms include pain or swelling of the affected gland, especially when eating. Diagnosis involves imaging tests like sialography, CT scans, or ultrasound. Treatment depends on the size and location of the stone, ranging from minimally invasive techniques like sialendoscopy to open surgical removal of larger stones.
Specific changes in structure of organic molecules
supportive frame formation
Metabolic disturbances alkalinity & precipitation
MICROLITHS
Concrements detectable only microscopically
Contain
calcium and phosphorus
hydroxyl apatite organic secretory material necrotic cellular residues
Generated - autophagocytosis of organelles that are
rich in calcium.
Dyschylia - Disturbed salivary secretion &
change in the composition
Accumulation of organic substances &
mineralisation of organic matrix Accumulation of calcium Increase in pH
Decreases the solubility of calcium phosphates
PROGRESSION
Secretory disturbances Microlith formation
viscous secretions ductal obstruction
Coaction of factors + participation of bacteria
sialoliths
Dyschylia & increasing microlith formation
ascent of bacteria lead to a focal obstructive atrophy of the acinar cells secretory disturbances Journal of Oral Science, Vol. 45, No. 4, , 2003
OTHER FACTORS
Infection
Salivary dysfunction
Ductal anamolies
Foreign bodies
Ductal epithelium metaplasia
SYMPTOMS
Pain, swelling & discomfort
Pain - meal time severe with sour or acidic
food
Unusual taste
Associated with infection fever , purulent
discharge & lymphadenopathy
S&S : When
saliva cannot exit a blocked
duct, it backs up into the gland, causing : 1. swelling 2. pain * particularly after eating. (1-2 hours)
S&S Dull
pain from time to time over the
affected gland. Infection of the gland may occur. Dry mouth.
S&S Tenderness
in the affected salivary gland.
Difficulty
opening the mouth or
swallowing.
If
there is only partial obstruction
of the affected salivary duct, then symptoms may be minimal or absent (asymptomatic).
CHARACTERISTICS
The annual growth rate - 1 mm peryear
Shape - round or irregular
Size - 2 mm to 2 cm
GIANT SIALOLITH
72 mm in length and weighing 45.8 g
The ability of a calculus to grow and become a giant
sialolith depends mainly on the reaction of the affected duct.
Rai and Burman. Giant Submandibular Sialolith. J Oral
Maxillofac Surg 2009.
TREATMENT MODALITIES
Newer treatment modalities - extracorporeal shortwave lithotripsy and sialoendoscopy are effective alternatives to conventional surgical excision for smaller sialoliths.
However, for giant sialoliths, transoral sialolithotomy
with sialodochoplasty or sialadenectomy remains the mainstay of management.
HISTOLOGIC FEATURES
Stratified & mineralized with metaplastic excretory
duct cells
Concentric laminated structures
Acini infiltrated by lymphocytes
Dialatation of duct
Epithelium exfoliation
DIAGNOSIS
History
Clinical examination Bi-manual palpation
Imaging
BIMANUAL
IMAGING
Imagin g
Conventional radiography
Intra oral radiographs
IOPA , Occlusal radiographs
Extra oral radiographs
Panaromic , PA skull projection
Intraglandular and small stones can be missed.
20% of sialolithsare radiolucent
Sialography
"Gold Standard
Retrograde infusion of oil or water based contrast
& the architecture of the salivary duct system is visualized radio graphically .
LIMITATIONS
Ultrasonography
Non invasive, alternative method
Stones > 2mm detected as echo-dense
spots with a characteristic acoustic shadow.
MR Sialography
Non invasive
Acute infections
Canulation not possible
COMPUTED TOMOGRAPHY
Posterior of the duct
Hilum of the gland
Substance of the gland
Radiation exposure
Non invasive & do not require contrast media
SIALOENDOSCOPY
Minimally invasive
Diagnostic & therapeutic
Small endoscope light at end of flexible cannula
Differential diagnosis
Phleboliths radiolucent center
Dystrophic calcification of lymph nodes
Cauliflower shaped
Palatine tonsiliths- multiple & punctate
Haemangiomas with calcifications
TREATMENT
ARCH OTOLARYNGOL HEAD NECK SURG/VOL
129, SEP 2003
paediatric patients
Relatively small and distal
Bimanual careful palpation is mandatory to diagnostic approach for
children suspicious of sialolithiasis.
These findings also suggest that intra-oral approach is effective
treatment procedure for most of sialolithiasis in children.
May;71(5)
Int J Pediatr Otorhinolaryngol 2007
Conclusion
Sialolithiasis is the main cause of unilateral diffuse parotid
or submandibular gland swelling.
Mechanical obstruction of the salivary duct, causing
repetitive swelling during meals, & often complicated by bacterial infections.
ODONTOGENIC DISEASE of The MAXILLARY SINUS - Dental Ebook & Lecture Notes PDF Download (Studynama - Com - India's Biggest Website For BDS Study Material Downloads)
ODONTOGENIC DISEASE of The MAXILLARY SINUS - Dental Ebook & Lecture Notes PDF Download (Studynama - Com - India's Biggest Website For BDS Study Material Downloads)
