Lecture Notes: Sialolithiasis

Introduction

• Definition:
  • Sialolithiasis refers to calcified structures forming within the salivary gland or its ducts.
  • "Sialo" refers to the salivary gland, "lith" means stone, and "iasis" indicates formation.

Formation Mechanism

• Exact mechanism unclear.
• Possible origins:
  • Nidus or debris within the ductal lumen.
  • Composed of mucus, bacteria, ductal epithelial cells, and foreign bodies.
  • Provides environment for mineral deposition, mainly calcium salts.
• Composition:
  • 75% Calcium Phosphate.
  • 12% Calcium Carbonate.
  • 5% Soluble Salts and Organic Matter.
  • 3% Water.

Clinical Features

• Demographics:
  • Affects mostly middle-aged individuals.
  • Slight male predilection.
• Location:
  • 70-90% in submandibular gland.
  • Less frequently in parotid and sublingual glands.
  • Rarely in minor salivary glands (upper lip, buccal mucosa).

Reasons for Submandibular Predilection

• Multiple sharp bends in Wharton's duct.
• More viscous saliva.
• Higher calcium levels.
• Dependent position increasing stasis risk.

Symptoms

• Pain:
  • Episodic pain, especially during meals due to increased saliva secretion.
  • Severity correlates with degree of obstruction and back pressure.
• Infection:
  • Stagnant saliva can lead to bacterial infection.
  • Symptoms include fever, foul taste, redness over the area.
• Palpation:
  • Hard mass might be felt if stone is near the duct's terminal.

Physical and Microscopic Examination

• Appearance:
  • Stones can be round, oval, or cylindrical.
  • Colors range from white to yellow-brown.
  • Size varies from tiny particles to several centimeters.
• Microscopic: Acellular and amorphous nature.

Radiographic Features

• Stones appear as radioopaque masses.
• Visibility depends on calcification degree.
• Preferred Imaging:
  • Occlusal radiograph for terminal stones.
  • Other methods: sialography, ultrasound, CT.
• Advanced Diagnosis:
  • Diagnostic sialendoscopy: Gold standard for complex cases.
  • Involves endoscope insertion to visualize ductal system.

Treatment Options

• Small Sialoliths:
  • Gentle massage.
  • Sialogogues (drugs inducing saliva).
  • Moist heat and increased fluid intake.
• Large Sialoliths:
  • Surgical removal.

Conclusion

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