Sialolithiasis is a condition characterized by the formation of stones within the salivary gland and most often in the submandibular gland. Otherwise known as salivary calculi or stones, the condition may lead to the formation of stones in other glands, such as the parotid or sublingual, and is usually treated with the removal of the calcified mass.
Sialolithiasis is a condition that is otherwise referred to as salivary stones or salivary calculi . The disease represents up to half of the cases that involve salivary gland abnormalities and features a calcified mass (stone) that develops in the duct of a salivary gland .
In the staggering majority of the cases, the calculi develop in the submandibular gland, with the second largest percent being stones of the parotid gland   . The affected gland produces saliva that is required to pass through the corresponding duct in order to be released into the oral cavity. Calcified masses may obstruct the flow of the saliva from the duct, leading to pain in the glandular region. This condition usually arises suddenly during the ingestion of food and edema develops as well. It usually resolves within 1 or 2 hours after the patient has finished their meal. Due to the fact that the pain is elicited when saliva is overproduced, such as upon viewing or smelling food; the condition is therefore also referred to as "mealtime syndrome" .
In the case where calculi do not completely obstruct the duct, symptoms vary. Usually, edema and pain arise occasionally and persist for some days, while recurring infections may be further complicated by an abscess. Frequently patients with sialolithiasis are asymptomatic and the calculi are discovered through a radiograph conducted for different reasons.
The first step towards a successful diagnosis of sialolithiasis includes an accurate medical history and a physical examination. Patients typically present with painful edema of the gland where the calculus has formed, which are usually caused when the gland is stimulated to produce saliva. Sialolithiasis can be further complicated by the infection of the affected salivary gland.
Palpation is pivotal for the diagnosis of sialolithiasis; the floor of the mouth should be palpated from the posterior to the anterior direction, and this can help to detect stones that have formed in the submandibular gland. Parotid calculi can also be felt by palpation of the intraoral region adjacent to the Stenson's duct orifice if they are superficial.
Various imaging modalities can also be employed in order to diagnose salivary stones. Plain x-rays can illustrate calculi that are opaque to various types of radiation. The majority of calculi are radiopaque, whereas calculi that have developed in the parotid glands tend to be radiolucent, which leads to the inability of a simple x-ray to depict them. In cases where the stones cannot be viewed, sialography is employed in order to illustrate stones that cannot be pictured through a conventional radiograph and further contributes to the identification of stenoses and fistulas    .