Sialoliths are salivary gland stones. Sialolithiasis refers to the process of formation of non-cancerous stones in the salivary glands. Sialoliths are usually made of calcium phosphate and carbon. They have tracks of other minerals. Sialoliths are not related to kidney stones.
Sialoliths affect about 1 out of 100 adults. Men are affected twice as often as women.
Most salivary stones are single; however multiple stones may be present. There are three pairs of major salivary glands: (i) the parotid glands, (ii) the sublingual glands, and (iii) the submandibular glands. In addition to these major glands, there are hundreds of minor salivary glands that are scatter through the mouth and throat. Most sialoliths – up to 9 out of 10 – occur in the submandibular salivary gland, where stones can obstruction Wharton's (sub-mandibular gland's) duct. They also can occur in the parotid, sublingual and minor salivary glands. The higher frequency of sialolithiasis in the submandibular gland is associated with several factors: the pH of saliva (alkaline in the submandibular gland, acidic in the parotid gland); the viscosity of saliva (more mucous in the submandibular gland); and the anatomy of the Wharton's duct (the duct of the submandibular salivary gland opening into the mouth at the side of the frenum linguaean is an "uphill course").
The most common symptom is a painful swilling of the salivary gland. But in about 3 out of 10 cases, the swilling is painless. Pain and swelling usually get worse when people eat 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. The pain is caused by a back-up of saliva behind the stone. This can lead to infection. If left untreated for a long time, it may also destroy the gland's tissue.
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. But some stones (at least 2 out of 10 submandibular stones and 5 out of 10 parotid stones) will not show up on an X-ray. Ultrasound and computed tomography (CT) scans are typically used in these cases. The dentist may try to squeeze saliva from the gland to see if it is blocked.
For small stones, hydration, moist heat, NSAIDs incidentally, and having the patient take any food or beverage that is bitter and / or sour. Sucking on citrus fruits, such as lemon or orange, may increase salivation and promote spontaneous expulsion of the stone.Some stones may be massaged out by a specialist. Stones near the end of a salivary gland duct often can be removed by squeezing them out by hand. Deeper ones require surgery. The entire salivary gland may need to be removed. Sometimes stones are smashed with shock waves. This procedure is known as lithotripsy. This is similar to a process used for kidney stones. However, this procedure has side effects, and not everyone is a candidate for it.
Surgical removal of stones is done by making a small incision near the stone to remove it. In some cases when stones continually reoccur the offending salivary duct is removed.
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