Introduction

Sialolithiasis is the visibility of calculi in the salivary glands or ducts. Stones will form in the salient gland or ducts complying with the stagnation the saliva; lock are frequently composed that calcium phosphate and also hydroxyapatite, together the saliva is well-off in calcium

They have actually an incidence of roughly 27-59 situations per million populace per year. Whilst most instances are asymptomatic, part can present with facial ede and / or facial pain.

You are watching: Presence of stone(s) in a salivary gland

Salivary Gland Anatomy

The three major salivary glands (Fig. 1) are:

Parotid gland – situated superior come the angle of the mandible, the gland is superficial come the masseter muscle and also drains (via Stensen’s duct) opposite to the upper second molarSubmandibular gland – lying in ~ the floor of the mouth in the submandibular triangle, the drains (via Wharton’s duct) right into the floor that the mouth, beside the frenulum that the tongueSublingual gland – located below the mucous membrane the the floor that the mouth, they space drained through multiple small ducts that empty either into Wharton’s duct or directly into the floor of the mouth
*

figure 1 – The three significant salivary glands, the parotid, submandibular, and sublingual glands


Sialolithiasis most typically occur in the submandibular gland, because of the anatomy of this duct being long and also its flow of saliva against gravity. The kind of salivary secretions native the submandibular gland are likewise more mucoid in nature together opposed to the an ext serous secretions from the parotid gland.


Risk Factors

Medication, frequently diuretics or anti-cholinergicsDehydrationGoutSmokingChronic periodontal diseaseHyperparathyroidism

Clinical Features


By James Heilman, MD (Own work) , via Wikimedia Commons
*

figure 2 – A rock seen located in the submandibular outstanding duct


Individuals through sialolithiasis have tendency to be asymptomatic, yet a little proportion deserve to have an intermittent facial swelling linked with eating, which have the right to be pains or painless. Symptoms are usually unilateral in nature.

When the gland is palpated, saliva deserve to be viewed at the duct orifice (Fig. 2), along with the presence of tiny stones. Top top palpation, a stone may be palpable in the duct and the gland may feel tender in the existence of infection.


Differential Diagnosis

The key differential to think about for such a presentation is infection. Individuals with viral epidemic such as mumps will present acutely through pain and swelling of both salient glands, connected with the viral prodrome fever, malaise, headache, and myalgia.

Other causes the swollen salivary glands include Sjögren’s syndrome, sarcoidosis, or salient gland tumour (unilateral swelling).


Investigations

Most situations of suspected sialolithiasis are investigated* with either ultrasound or radiographs.

Ultrasound scans space a cheap and also minimally invasive technique that is very good at analysing the entirety gland and periglandular structures. As most salivary gland stones room radio-opaque (80% submandibular gland, 60% parotid gland), a plain film radiograph is a straightforward investigation which deserve to be performed to confirm presence of a stone.

*Sialography is not on regular basis performed because of its invasive nature. The duct is cannulated and also radiopaque dye is injected with plain movies are taken.

Management

Most patients room managed conservatively with oral hydration, analgesia, and also sialologues, such as lemon juice, which encourage saliva production. Milking / massaging the gland can help as well.

If the gland becomes infected and the patient develops sialedenitis, climate antibiotics are typically indicated.

Definitive Management

Patients through recurrent or persistent symptoms should be referred because that specialist treatment. Interventional radiology measures are most generally trialled, i beg your pardon involve fluoroscopic control such the the stones are visualised in the duct and also then extracted through a basket.

A surgical approach can be used to eliminate some more an overwhelming stones; a transoral approach can be provided if the stones space distal or a transcervical method for proximal stones (or wherein the transoral approach has been unsuccessful). Operation intervention yet comes with threats of damage to the hypoglossal, facial, or lingual nerves.

Other feasible interventions encompass sialoendoscopy (whereby the stones are straight visualised via endoscopic imaging and extracted v a basket) or extracorporeal shockwave lithotripsy (for part stones in the proximal ducts, whereby transoral retrieval the the rock is no possible).

Gland removal is critical resort. Excision of the parotid or submandibular gland are just performed because that patients through chronically persisting symptoms.

See more: What Does Cc Mean In French To English, Translate Cc From French To English


Complications

Most patients with salivary calculi will live with them for number of years, many occurring recurrent infections and also in some patients chronic sialedenitis leading to a chronically soft salivary gland. Severe situations of infection deserve to also result in abscess formation.


Key Points

Sialolithiasis is the presence of calculi in the salivary glands or ductsMost cases are asymptomatic yet part may existing with unilateral face swelling, generally worse v eatingMost situations of doubt sialolithiasis are investigated with either ultrasound or radiographsConservative monitoring is all that is required for most cases, yet surgical and radiological interventions may be compelled in a minority