Sialolithiasis is a condition that is otherwise referred to as salivary stones or salivary calculi [1]. 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 [2].

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 [3] [4] [5]. 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" [6].

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.

• Pain

  Usually, edema and pain arise occasionally and persist for some days, while recurring infections may be further complicated by an abscess. [symptoma.com]

  It frequently is associated with swelling, pain, and infection of the affected gland. Clinically, sialolithiasis manifests as an increase in the size of the affected gland and increased salivary secretion that results in pain during eating. [ncbi.nlm.nih.gov]

  Ramesh age 26 yrs complained of swelling in floor of the mouth and severe pain during eating and swallowing food. [indiamart.com]

  Since then, her pain had become constant and had progressively worsened. In addition to the jaw pain, she described a burning sensation under her tongue. Her only significant past medical history was cholelithiasis. [consultant360.com]

  Pain and swelling of the concerned gland at mealtimes and in response to other salivary stimuli are especially important. [nature.com]

• Malaise

  Individuals with viral infection such as mumps will present acutely with pain and swelling of both salivary glands, associated with the viral prodrome fever, malaise, headache, and myalgia. [teachmesurgery.com]

  Children typically present with recurrent episodes of acute or subacute parotid gland swelling with fever, malaise, and pain ( Figure 3 ). The disorder is usually unilateral, but can affect both sides. [aafp.org]

• Fatigue

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 30, 2019 [patientslikeme.com]

  […] opening the mouth difficulty swallowing a painful lump under the tongue gritty or strange tasting saliva dry mouth pain and swelling usually around the ear or under the jaw Severe infections of a salivary gland may cause profound symptoms including fever, fatigue [ent.about.com]

• Collapse

  She has a limited mouth opening and her tongue was collapsed with mouth floor. The first choice of treatment was the lithotripsy, once this procedure is less invasive and a surgical remove could worse the collapsed tongue. [ncbi.nlm.nih.gov]

• Parotid Mass

  Parotid masses: MR imaging. Radiology 1987 ; 163 : 405 -409 Mandelblatt SM, Braun IF, Davis PC, Fry SM, Jacobs LH, Hoffman Jr JC. Parotid masses: MR imaging. Radiology 1987 ; 153 : 411 -414 Izumi M, Eguchi K, Ohki M, et al. [ajnr.org]

  Neoplasms BENIGN Benign neoplasms of the salivary glands typically present as painless, asymptomatic, slow-growing neck or parotid masses ( Figure 6 ). [aafp.org]

• Difficulty Opening the Mouth

  Symptoms of sialolithiasis may include: swelling of the affected saliva glands which normally occurs with meals difficulty opening the mouth difficulty swallowing a painful lump under the tongue gritty or strange tasting saliva dry mouth pain and swelling [ent.about.com]

• Facial Swelling

  METHODS: A 48 year-old woman presented to our office with 9 months of intermittent left facial swelling. On bimanual examination, multiple small firm nodules were palpated in the left cheek. [ncbi.nlm.nih.gov]

  Whilst most cases are asymptomatic, some can present with facial swelling and / or facial pain. [teachmesurgery.com]

  Physical examination Usual findings on physical examination are: Facial swelling which may extend from neck to eye. [ehealthhall.com]

  swelling over one or two days. [journals.lww.com]

• Neck Swelling

  A 60 year old female presents with painful right neck swelling. She has a past medical history of alcoholic hepatic cirrhosis. Her vitals signs are within normal limits. On examination she has a mass in the right submandibular area. [ultrasoundoftheweek.com]

  A neck lump is any lump, bump, or swelling in the neck. There are many causes of lumps in the neck. The most common lumps or swellings are enlarged lymph nodes. [nlm.nih.gov]

• Confusion

  In general, there is little confusion as the clinical presentation is relatively specific. [radiopaedia.org]

• Irritability

  Other lesions include mucus cyst, irritation fibroma and mucocele 21 - 22, which may present with similar characteristics to sialolithiasis of the minor salivary gland. [scielo.br]

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 [7] [8] [9] [10].

• Amylase Increased

  Blood testing While blood cell count – increased levels suggestive of infection C-Reactive protein increased – sign of infection Serum amylase increased – another sign of infection X-ray – used for the confirmation of the diagnosis (the salivary stones [mddk.com]

• Amylase Increased

  Blood testing While blood cell count – increased levels suggestive of infection C-Reactive protein increased – sign of infection Serum amylase increased – another sign of infection X-ray – used for the confirmation of the diagnosis (the salivary stones [mddk.com]

[…] shock wave lithotripsy for the treatment of sialolithiasis Sialodochoplasty for the treatment of submandibular sialolithiasis. [aetna.com]

30731479 ) Goncalves M...Koch M 2019 4 Sialendoscopy plus laser lithotripsy in sialolithiasis of the submandibular gland in 64 patients: A simple and safe procedure. ( 30765274 ) Guenzel T...Wiegand S 2019 5 One-Year symptom outcomes after sialolithiasis treatment [malacards.org]

The major axis showed no correlation with the treatment outcomes of sialendoscopy alone. [ncbi.nlm.nih.gov]

Conservative treatment may be of benefit in the treatment of sialolithiasis. Lithotripsy is emerging as a valuable alternative to salivary glands removal in persistent cases of sialadenitis related to sialolithiasis. [nature.com]

Treatment and prognosis In many instances, conservative medical management suffices. Hydration and moist heat are helpful. NSAIDS may be beneficial. [radiopaedia.org]

The prognosis is often good, and generally there is no recurrence. [ncbi.nlm.nih.gov]

Additional information may be obtained by sonography such as number, size, and location of stones to determine prognosis of stone passage and may guide initial management of the symptomatic patient in the emergency setting 3. [em.emory.edu]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Etiologic factors in sialolithiasis. Otolaryngol Head Neck Surg. 2011; 145(6): 935–9. Williams MF. Sialolithiasis. Otolaryngol Clin North Am. 1999; 32(5): 819–34. [nzma.org.nz]

OBJECTIVES: The purpose of this study was to investigate etiologic factors for sialolithiasis in a population of patients from the United States. STUDY DESIGN: Retrospective, cohort study. SETTING: Tertiary university. [ncbi.nlm.nih.gov]

DESIGN: An epidemiological study based on patient data extracted from the National Patient Registry and drinking water data from the Geological Survey of Denmark and Greenland retrieved as weighted data on all major drinking water constituents for each [ncbi.nlm.nih.gov]

The project is composed of an epidemiologic and a clinical part. [isrctn.com]

The epidemiological data (gender, age), duration of complaints, the treatment method and its effectiveness were analyzed and compared in both groups. In preoperative diagnosis, routine real-time B-mode ultrasonography was applied in all patients. [link.springer.com]

In a recent epidemiological study examining the nutritional habits and other behaviors of patients with sialolithiasis, tobacco smoking was found to be the only positive correlation with the disease (M. Oedman, MD, unpublished data, 2002). [jamanetwork.com]

CAUSES: There are thought to be aseries of stage that lead to be formation of Calculi (lithogenesis) Abnormality in calcium metabolism Dehydration Reduced salivary flow rate Altered acidity (pH) of saliva caused Oropharyngeal infections SIALOLITHIASIS PATHOPHYSIOLOGY [medifitbiologicals.com]

Pathophysiology saliva. Salivary glands serve many functions, including lubrication, enzymatic degradation of food, production of hormones, antibodies and other blood-reactive substances, media taste and antimicrobial protection. [medicaldb.blogspot.com]

Harrison JD: Modern management and pathophysiology of ranula: literature review. Head Neck 2010;32:1310-1320. Chi AC, Lambert PR 3rd, Richardson MS, Neville BW: Oral mucoceles: a clinicopathologic review of 1,824 cases, including unusual variants. [karger.com]

Approximately 15% of salivary stones occur within the parotid gland, and less than 5% occur within the sublingual and minor salivary glands.[2][6] Pathophysiology The exact pathogenesis of sialolithiasis is not well understood, but two dominant theories [ncbi.nlm.nih.gov]

Prevention & Expectations What can be done to prevent the condition? Prevention of salivary duct stones focuses on increasing the water content of the saliva. [medicineonline.com]

Has there been any research on steps to prevent stone formation? asked Nov 17 '15 at 5:16 Hi and welcome. Very interesting question! I'm looking forward to the answer. – anongoodnurse Nov 17 '15 at 5:58 [health.stackexchange.com]

Author information 1 Department of Pedodontics and Preventive Dentistry, SGT Dental College and Research Institute, Budhera, Tehsil-Gurgaon, Haryana, India. [ncbi.nlm.nih.gov]

Definition Salivary stones represent grit blocking salivary ducts, thus preventing saliva drainage and causing gland enlargement. Incidence/Age Usually occurs in middle-aged adults, with a slight male preponderance. [surgerydoor.co.uk]

1. Neville BW, Damm DD, Allen CA, Bouquot JE. 2002. Oral & maxillofacial pathology (2nd ed.). Philadelphia: W.B. Saunders. pp. 393–395.
2. Witt RL. Salivary gland diseases, surgical and medical management. Thieme Medical Pub. (2006) ISBN:1588904148.
3. Sumi M, Izumi M, Yonetsu K, et al. The MR imaging assessment of submandibular gland sialoadenitis secondary to sialolithiasis: correlation with CT and histopathologic findings. AJNR Am J Neuroradiol. 1999;20 (9): 1737-43.
4. Jäger L, Menauer F, Holzknecht N, et al. Sialolithiasis: MR sialography of the submandibular duct--an alternative to conventional sialography and US? Radiology. 2000;216 (3): 665-71.
5. Kraaij S, Karagozoglu KH, Forouzanfar T, et al. Salivary stones: symptoms, aetiology, biochemical composition and treatment. Br Dent J. 2014;217 (11): E23.
6. Capaccio P, Torretta S, Ottavian F, Sambataro G, Pignataro L. Modern management of obstructive salivary diseases. Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale. 2007; 27 (4): 161–72.
7. Yu C, Zheng L, Yang C, et al. Causes of chronic obstructive parotitis and management by sialoendoscopy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(3):365–70.
8. Forman WH. Subtraction sialography. Radiology. 1977;122(2):533
9. Kalk WW, Vissink A, Fred KL, et al. Morbidity from parotid sialography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(5):572–75
10. Szolar DH, Groell R, Braun H, et al. Ultrafast Computed Tomography and three-dimensional image processing of CT sialography in patients with parotid masses poorly defined by magnetic resonance imaging. Acta Otolaryngol. 1996;116(1):112–18