Before proceeding please make sure to subscribe and turn on the bell icon for upcoming videos hello and today's video is about sialolithiasis sial refers to salivary gland and lith refers to stone the suffix iasis means formation so in definition sialolithiasis are calcified structures that forms within the salivary gland or its ducts the exact mechanism of a sialolith is not clear but researchers done up to date suggests that they may arise from a nidus or debris retained within the ductal lumen making its lumen partially blocked this nidus or debris is composed mainly of mucus, bacteria, ductal epithelial cells and foreign bodies the nidus provides a really good environment for the deposition or attachment of salivary minerals which are mostly the calcium salts these salts are laid down in laminations resulting in the formation of a stone or a sialolith the major composition of a sialolith is calcium phosphate which accounts for 75 percent, calcium carbonates for 12 percent soluble salts and organic matter for 5 percent and 3 percent of water coming to some clinical features of sialolithiasis sialolithiasis affects mostly middle aged individuals with a slight male predilection in about 70 to 90 percent of cases the stones most often are formed within the ductal system of the submandibular gland and less often the stones may form within the parotid and sublingual glands the stones could also form within the minor salivary glands most often within the glands of the upper lip and the buccal mucosa the reason why these stones or sialoliths are formed most frequently in the submandibular gland than any of the other glands are followings multiple sharp bends in the submandibular or warthon's duct more viscous nature of saliva of this gland compared to other major glands the higher calcium levels in saliva of this gland and the dependent position of the gland which often increases the chance of stasis of saliva in the submandibular duct in case of symptoms patients experience episodic pain especially during meal times because there is a sudden increase in saliva secretions when taste and smell of a food is experienced the severity of symptoms is directly proportional to the degree of obstruction of the duct and resultant back pressure produced within the gland resulting from the obstruction that is if the duct is completely obstructed by a sialolith the saliva produced within these glands cannot move beyond the obstructed zone hence moves backwards resulting in high back pressure and extreme pain bacterial infection can occur when the gland is filled with stagnant saliva resulting from backflow of saliva with signs of fever foul taste in the mouth and redness over the affected area if the stone is located towards the terminal portion of the duct then a hard mass may be palpated beneath the mucosa just seen in this picture on gross examination the stone may be round, oval or cylindrical in shape. They may be yellow to white to yellow-brown in color the stones may range from tiny particles to stones that are several centimeters in size the stones are usually solitary but there might be multiple stones present in a single region microscopically the stones are acellular and amorphous or shapeless the ductal lining which surrounds the stone often demonstrates metaplastic changes radiographically the stones appear as radioopaque masses but still their radio opacity will be based on their degree of calcification and that's the reason that not all salivary stones are visible on a radiograph the reason behind being the low degree of calcification stones in the terminal portion of the duct or near its orifice are best diagnosed with an occlusal radiograph other known imaging studies are sialography, ultrasound and computed tomography in some complex cases diagnostic sialendoscopy is the gold standard procedure for diagnosis and treatment of salivary gland diseases in this technique a small endoscope is inserted within the ductal orifice allowing visualization of the entire ductal system for any stones strictures or adhesions. coming to the treatment now the treatment options are based on the size of a sialolith small sialoliths can be treated in a conservative way such as a gentle massage of the gland in an effort to milk the stone towards the ductal orifice drugs that induce saliva called sialogouges can also be used moist heat and an increase in fluid intake may also promote passage of the stone in case of larger stones the only option we have is their surgical removal if you think this video was really helpful please do like the video and hit the subscribe button besides if you have got any questions or suggestions regarding this video you may write them down in the comment box thank you for watching