Sialolithiasis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Salivary calculus
Overview
Sialolithiasis refers to the formation of stones in the salivary glands. Stones are most commonly found in the submandibular gland and parotid gland, where stones can obstruct Wharton's duct and Stenson's duct respectively. This calculus (sialolith - pronounced SIGH-al-low-lith) is a salivary gland stone consisting of layers of calcified organic matter - calcium phosphate and carbon, with traces of magnesium, chloride and ammonium. Sialoliths are not related to kidney stones.
Causes
It is frequently associated with chronic infection (Staphylococcus aureus, Streptococcus viridans) of the glands, dehydration (phenothiazines), Sjögren's syndrome and/or increased local levels of calcium, but in many cases can arise idiopathically.
Epidemiology and Demography
The majority (perhaps 90%) form in the submandibular gland but the other glands can create them too.
Natural History, Complications and Prognosis
Complications include persistent obstruction of the duct, leading to bacterial invasion, overgrowth and infection (sialoadenitis). This can require IV antibiotics such as nafcillin, and sometimes surgical drainage.
Diagnosis
History and Symptoms
The resulting blockage and inflammation (sialitis) causes immense pain on eating when saliva production increases and infection of the salivary gland may ensue. Pain may be further be intensified when eating sour or tart foods or candies. Other symptoms are dry mouth; bad taste in mouth; and local swelling. Pain, when present, usually originates from the floor of the mouth, although in many cases the stones cause only intermittent swelling.
Physical Examination
Since chewing promotes release of saliva, symptoms tend to increase during meals. A palpable lump or visible swelling in the area of the gland is often noted.
X Ray
Diagnosis is usually made by characteristic history and physical examination. Diagnosis can be confirmed by x-ray (80% of salivary gland calculi are visible on x-ray), or by sialogram or ultrasound.
Treatment
Medical Therapy
Some current treatment options are:
- For small stones, hydration, moist heat, NSAIDs occasionally, and having the patient take any food or beverage that is bitter and/or sour. Sucking on citrus fruits, such as a lemon or orange, may increase salivation and promote spontaneous expulsion of the stone.
- Sialendoscopy
- To prevent infection while the stone is lodged in the duct, sometimes antibiotics are used. In some cases when stones continually reoccur the offending salivary duct is removed.
- Inflammation and infection are treated with prednisone and antibiotics. If the infection destroys the gland, it may have to be removed entirely.
Surgery
- Some stones may be massaged out by a specialist.
- An ENT or maxillofacial surgeon may canulate the duct to remove the stone (sialotomy).
- A surgeon may make a small incision near the stone to remove it.