Sialolithiasis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mahda Alihashemi M.D. [2]
Overview
Sialolithiasis is presence of stones within the salivary glands or the salivary gland ducts.The exact pathogenesis of sialolithias is not fully understood but relative stagnation of salivary flow and calcium concentration may be important. 75 percent of sialolithiasis cases are single. 3 percent of stones are bilateral and most of them are located in parotid glands. Stone formation is 80 to 90 percent in the submandibular gland, 6 to 20 percent in the parotid glands and 1 to 2 percent in the sublingual or minor salivary glands. Sialoadenitis is inflamamtion of a salivary gland. Acute sialoadenitis may be caused by viral or bacterial infection. Chronic sialoadenitis is caused by repeated episodes of inflammation. On gross pathology, hard yellow -white spherical depositions usually less than 1 cm are seen. On microscopic pathology, dilated ducts with squamous metaplasia or calculi are usullay present.
Pathophysiology
Pathogenesis
Sialolithiasis :
- Presence of stones within the salivary glands or the salivary gland ducts.
- The exact pathogenesis of sialolithias is not fully understood but relative stagnation of salivary flow and calcium concentration may be important.
- Component of salivary stones include: [1]
- Calcium phosphate
- Hydroxyapatite
- Magnesium
- Ammonium
- Potassium
- Parotid, submandibular, sublingual glands and minor salivary glands are prone to the development of stones.[2][3]
- Parotid glands and stensen ducts are located anterior to the external auditory canal.
- Submandibular glands and wharton ducts are located beneath the floor of the mouth.
- Sublingual glands are located beneath the mucous membrane of the floor of the mouth.
- 75 percent of sialadenosis cases are single
- 3 percent of stones are bilateral and most of them are located in parotid glands.
- Submandibular stones are the largest ones and are often located in the wharton ducts.
- Parotid stones are the smaller than submandibular stones, and they are more located within the glands and they are more multiple.
- Stone formation is 80 to 90 percent in the submandibular gland, 6 to 20 percent in the parotid glands, 1 to 2 percent occur in the sublingual or minor salivary glands.[4]
- Stones occur equally on the right and left sides.
Sialoadenitis
- Inflammation of a salivary gland
- Swelling is usually present
- Acute sialoadenitis may be caused by viral or bacterial infection[3]
- Parotid and submandibular glands are more involved in acute sialadenitis.
- Chronic sialoadenitis is caused by repeated episodes of inflammation and finally it progresses to salivary gland dysfucntion.
Associated Conditions
- Sjögrens[5]
- Medications such as anticholinergics[5]
Gross Pathology
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- On gross pathology, hard yellow -white spherical depositions usually less than 1 cm in diameter is characteristic finding of sialolithiasis.[5]
Microscopic Pathology
- On microscopic histopathological analysis,
- Dilated ducts with squamous metaplasia or calculi
- Chronic inflammation
- Destruction of acini
- Fibrosis in sialadenitis
References
- ↑ Williams MF (1999). "Sialolithiasis". Otolaryngol. Clin. North Am. 32 (5): 819–34. PMID 10477789.
- ↑ Mandel L (2014). "Salivary gland disorders". Med. Clin. North Am. 98 (6): 1407–49. doi:10.1016/j.mcna.2014.08.008. PMID 25443682.
- ↑ 3.0 3.1 McKenna JP, Bostock DJ, McMenamin PG (1987). "Sialolithiasis". Am Fam Physician. 36 (5): 119–25. PMID 3318353.
- ↑ Capaccio P, Torretta S, Ottavian F, Sambataro G, Pignataro L (2007). "Modern management of obstructive salivary diseases". Acta Otorhinolaryngol Ital. 27 (4): 161–72. PMC 2640028. PMID 17957846.
- ↑ 5.0 5.1 5.2 Moghe S, Pillai A, Thomas S, Nair PP (2012). "Parotid sialolithiasis". BMJ Case Rep. 2012. doi:10.1136/bcr-2012-007480. PMC 4543829. PMID 23242089.
- ↑ <"http://www.gnu.org/copyleft/fdl.html">GFDL, <"http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0 or <"https://creativecommons.org/licenses/by-sa/2.5-2.0-1.0">CC BY-SA 2.5-2.0-1.0], <"https://commons.wikimedia.org/wiki/File%3ASialolithiasis.jpg">
