Breaking The Block: A deep Dive Into Salivary Gland Stones

 SIALOLITHIASIS /SALIVARY CALCULI /SALIVARY STONE 

  • Calcified structure that develop within salivary ductal system 
  • Arise :deposition of calcium salt around a nidus within the duct 
  • Debris :Bacteria +Epithelial cells + Mucous +foreign body 
  • Not related to any system derangement in calcium, phosphate metabolism 

COMPOSITION:

  • Hydroxyapatite crystal
  • Calcium
  • Phosphorous 
  • Magnesium
  • Potassium chloride
  • Ammonium





ETIOLOGY:

  • Exact -unknown

CLINICAL FETAURE:

  • AGE: No gender predilection
  • Site: Submandibular salivary gland duct ,parotid, minor salivary gland






CLINICAL PRESENTATION:

  • Acute painful ,intermediate swelling of affected gland especially at meal time
  • Pain-size, degree of obstruction ,amount of resultant back pressure produced within the gland 
  • While eating -increased salivary flow -stone blockage causes pooling of saliva within the duct and gland 
  • Salivary gland encapsulated allows only little expansion this enlargement result in pain
  • Size:2mm to submandibular salivary gland 







Why is it seen in submandibular gland more commonly?

  • Submandibular excretory gland duct is wider in diameter ,longer than Stenson duct 
  • Salivary flow in submandibular gland is against gravity 
  • Submandibular gland salivary secretion is more alkaline compared with pH of parotid gland 
  • Submandibular gland saliva contain increased quantity of mucin protein where as parotid saliva is entirely serous 
  • Calcium ,phosphate content in submandibular gland saliva is greater than in other gland 








INVESTIGATION;

  • Occlusal radiograph
  • Radiograph mass (3mm in diameter )
  • If parotid gland involved then puffed cheek view in PA view to be taken 







COMPLICATION:

  • Xerostomia
  • Sialadenitis

TREATMENT:

  • Small-stimulate salivary flow ,milking of gland towards ductal orifices' 
  • Gentle message
  • Pilocarpine 
  • Larger: surgical
  • lithotripsy 
  • Sialoendocsopy 




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