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.
Entire Body System
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]
Pain, which is intermittent, and may suddenly get worse before mealtimes, and then slowly get better (partial obstruction). [en.wikipedia.org]
The symptoms of the salivary duct stones include pain in the mouth, jaw and face. The pain increases as you take food. [homeremediesforall.com]
- Soft Tissue Mass
Multiple calcifications, calcifications 1 cm, within a soft tissue mass separate from the substance of the submandibular gland suggest a diagnosis, of phleboliths within a venous malformation as opposed to a sialolith. 2014 The American Laryngological [ncbi.nlm.nih.gov]
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]
Jaw & Teeth
- 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 [verywellhealth.com]
Face, Head & Neck
- 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]
- Unilateral Facial Pain
CASE REPORT: We describe the case of a 37-year-old man who presented with 5 days of worsening unilateral facial pain and swelling. [ncbi.nlm.nih.gov]
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    .
CONCLUSIONS: This study demonstrates an association between sialolithiasis and nephrolithiasis. The results call for more awareness of this association among physicians and patients with nephrolithiasis. [ncbi.nlm.nih.gov]
[…] bacteria, mucous and desquamated epithelial cells on which the calcium salts are precipitated due to supersaturation and deficit of crystallization inhibitors Presents with pain and swelling at meal time No association between sialoliths and either nephrolithiasis [pathologyoutlines.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]
The control group consisted of 96,152 participants without nephrolithiasis who were matched 1:4 by age, sex, income, region of residence, diabetes, hypertension, and dyslipidemia. [ncbi.nlm.nih.gov]
CONCLUSION: The treatment of sialolithiasis usually does not present major challenges, nevertheless if the sialolithiasis is associated with EB, the treatment became an extremely challenge. [ncbi.nlm.nih.gov]
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]
Prognosis In the majority of the patients, the prognosis is positive, as the salivary stones are removed without any complications. [mddk.com]
Treatment is based on surgical excision of the lesion, with a favorable prognosis. [scielo.br]
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]
Charts were reviewed for epidemiologic and clinical data, as well as procedural techniques, findings, and outcomes. [aetna.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]
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]
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]
Author information 1 Department of Pedodontics and Preventive Dentistry, SGT Dental College and Research Institute, Budhera, Tehsil-Gurgaon, Haryana, India. [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]
Prevention Poor oral hygiene is considered a risk factor for the appearance of salivary stones, so maintaining an excellent oral hygiene is a good preventative measure. [mddk.com]
- Neville BW, Damm DD, Allen CA, Bouquot JE. 2002. Oral & maxillofacial pathology (2nd ed.). Philadelphia: W.B. Saunders. pp. 393–395.
- Witt RL. Salivary gland diseases, surgical and medical management. Thieme Medical Pub. (2006) ISBN:1588904148.
- 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.
- 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.
- Kraaij S, Karagozoglu KH, Forouzanfar T, et al. Salivary stones: symptoms, aetiology, biochemical composition and treatment. Br Dent J. 2014;217 (11): E23.
- 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.
- 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.
- Forman WH. Subtraction sialography. Radiology. 1977;122(2):533
- 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
- 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