[4] Sialolithiasis Flashcards
What is sialolithiasis more commonly known as?
Salivary stones
What is sialolithiasis?
A condition where calcified mass forms within the salivary gland
How can salivary stones be classified?
By which gland the salivary stone has formed in
Which salivary gland is most commonly affected by salivary stones?
Submandibular gland
What percentage of salivary stones form in the submandibular gland?
85%
What percentage of salivary stones form in the parotid gland?
5-10%
What percentage of salivary stones form in the sublingual or minor salivary glands?
0-5%
What is thought to cause salivary stone formation?
A series of stages that lead to the calculus formation
What is the first stage of salivary stone formation?
Presence of predisposing factors
What are the predisposing factors for salivary stones?
- Abnormalities in calcium metabolism
- Dehydration
- Reduced salivary flow rate
- Altered acidity of saliva due to oropharyngeal infection
- Altered solubility of crystalloids
What is the second stage of salivary stone formation?
Formation of a nidus as a result of predisposing factors
What is the 3rd stage of salivary stone formation?
Successive layering of nidus with organic and inorganic material to form a calcified mass
What is the most common cause of salivary stones?
Idiopathic
What are some less common causes of salivary stones?
- Existing chronic infection of the glands
- Dehydration
- Sjögren’s Syndrome
- Increased local levels of calcium
How can salivary stones present?
- Pain
- Swelling of gland
- Tenderness of involved glands
- Palpable hard lump
- Lack of saliva
When does lack of saliva occur in salivary stones?
In total obstruction
How does salivary stone pain present?
Intermittent and often suddenly worse before meal times and then get better
How does swelling of the gland appear in salivary stones?
Intermittent, often worse before meal times and the goes down again
What symptoms may develop due to secondary infection due to salivary stones?
- Erythema of floor of mouth
- Pus discharging
- Cervical lymphadenitis
- Hallitosis
How are salivary stones diagnosed?
Clinically
What percentage of salivary stones can be seen on x-ray?
80%
How can salivary stones be confirmed?
- X-ray
- Sialogram
- USS
What are the differentials for salivary stones?
- Obstructive sialadentis
- Mumps
- Salivary gland tumours
How can treatment options for salivary stones be divided?
- Non-invasive
- Minimally invasive
- Surgical
- Supportive
What are the non-invasive treatment options for small salivary stones?
- Hydration
- Moist heat therapy
- NSAIDs
- Take bitter/sour food/drink e.g. suck on lemon
What non-invasive treatment methods can be used for larger salivary stones?
- Massaged out by specialist
- Shock-wave therapy
Give one minimally invasive treatment option for salivary stones?
- Sialendoscopy
How can salivary stones be treated surgically?
- Cannulate the duct to remove stone
- Small incision near the stone to remove it
- Removal of salivary duct in recurrent cases
What supportive therapy is sometimes used in salivary stones?
Antibiotics to prevent infection due to lodged stone
What are the potential complications of salivary stones?
- Recurrent stones
- Infection
