Sialolithiasis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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 Demographics
The majority (perhaps 90%) form in the submandibular gland but the other glands can create them too.
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, when present, usually originates from the floor of the mouth, although in many cases the stones cause only intermittent swelling. 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.
Physical Examination
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.