Obstructed salivary gland disease

Management of sailoliths or salivary gland stones

1. Obstructed salivary Gland disease Dr. Naveed Iqbal

2. Causes of salivary gland obstruction Intraductal causes are stones, mucus plugs and strictures. Extraductal causes are Trauma and pressure from adjacent neoplasm.

3. Sialolithiasis ( salivary stones) 85 % of stones occur in submandibular gland. 10 % in parotid gland 5 % in sublingual gland Rare in minor salivary glands. 80 % of submandibular stones are Radiopaque . 40 % of parotid stones are radiopaque .

4. Why stones are more common in submandibular gland? Increased Concentration of calcium in submandibular secretion. Alkaline PH Warthon’s duct has long course with 2 sharp curves. One at posterior border of mylohyoid and 2 nd at duct opening. Small size punctum . These factors causes stasis and precipitated material, mucus and cellular debris are easily trapped as compared to parotid gland.

5. Clinical features of sailolithiasis Meal time pain and swelling Infection of the gland Swelling in floor of the mouth Pus discharge from duct Absent salivary flow

6. Diagnosis Diagnosis is made on the basis of 1. clinical features 2. plain radiogrphs for radiopaque stones initial investigation.. 3. ultrasound.. initial investigation stone appears white with dilation of proximal duct. 4. saliography uses radiopaque contrast medium injected into duct and radiographs are to examine the gland. It is used to exclude other causes of obstruction. It shows stone, atrophy of gland and dilation and costriction of duct. ‘’Sausage Link appearance’’ 5. sailoendoscopy uses small video camera inserted into duct for examination.

7. Treatment of submandibular stones Treatment depends on location of stone Submandibular stones are classified anterior or posterior in relation to the line between first molars. Anterior stones can be visualized on occlusal view and are removed with intraoral incision opening of duct is called sailodochotomy , removal of stone is called sailolethectomy , and Sailodochoplasty suturing of duct to floor of the mouth. Posterior stones are not visualized on occlusal film and OPG or CT scan is required. Posterior stones are located at hilum or with in the substance of gland. These stones and gland are removed with extraoral approach.

8. Other approaches of treatment Extracorporeal lithotripsy: This technique uses electromegnatic waves to break the small stones which are removed by normal flow of saliva. Endoscopic removal with balloon catheter or basket or lithotripsy.

9. Treatment of Parotid stones Anterior or distal stones close to orifice can be removed with dilatation of duct orifice. Posterior stones at hilum of gland require extraoral approach to remove superficial lobe and stone.