Sialolithiasis

A brief account of sialolithiasis from Oral medicine point of view.

1. Sharad Pawar Dental College Dept of Oral Medicine and Radiology Sialolithiasis By Ruchi Rathi Final BDS 2011-84

2. Contents

3. Introduction Also known as ‘Salivary gland stone’ or ‘salivary gland calculus’ Most common calcifications found in soft tissues of oro -orbital region Seen in both major and minor salivary glands

4. Definition It is defined as the formation of calcific concentrations within the parenchyma or ductal system of the major or minor salivary glands.

5. Composition Calculus : Organic material covered with concentric shells of calcific material. Crystalline structure : Hydroxyapatite and octacalcium phosphate Chemical composition : Calcium phosphate with carbon and traces of Mg, K, Cl , NH³ ⁺

6. Etiopathogenesis

7. Prevalence

8. Factors :

9. Clinical Features Epidemology : Age- middle age Sex- male predilection Symptoms: More severe symptoms in extraglandular and intraductal cases

10. Pain: Swelling: Intermittent, transient swelling During meals Resolves after meals: demand subsides Systemic symptoms: Fever Malaise Maybe due to acute suppurative process

11. Signs Pus : Exudate from duct orifice Surrounding tissue : severe inflammaatory reaction, redness, tenderness On Palpation : Firmer and larger than usual Size : few mms to several cms

12. Swab test If stone is present in one duct only Saliva secretion will occur from only one duct Swab on the orifice of both ducts The swab near affected duct will remain dry

13. Minor salivary ducts Rare occurrence Buccal mucosa most common Near comissure or near the mandibular mucobuccal fold Age- 39 yrs Firm, freely movable deeply situated into mucosal surface.

14. Investigations

15. Radiographic Investigations

16. Radiographic features Occlusal view

17. Sialography Radiolucent sialoliths Ductal dilatation caused by associated sialoliths

18. Size- upto 5mm Shape- oval or cylindrical with multiple layers of calcification Number- Maybe solitary or multiple Radiodensity - almost radioopaque Borders- smooth with even radiodensity

19. Contrast material present behind the stone Viewed as-White or gray opacity in the region of glandular apparatus

20. CT Dense radiopaque area

21. Sonography Shows calculi

22. 3D Reconstruction

23. Probe specifically designed for duct Indicates existence and location of calculus Differential Diagnosis Metallic duct probe

24. Differential Diagnosis

25. Management

26. Manual manupulation In case of small stone Gentle massage of the gland Moves stone towards the duct orifice Other modalities- Sialogogues Moist heat Inc fluid intake

27. Stone in submandibular duct

28. Stone in submandibular gland Excision of the gland is recommended Antibiotics In case of acute infections Salivary gland endoscopy Newer method Removal of sialolithiasis Lithotripsy Fragmentation of stone in gland

29. Summary It is the formation of calcific concentrations within the parenchyma or ductal system of the major or minor salivary glands. Submandibular gland is most commonly affected

30. References Textbook of Oral Medicine: Ghom ; 3 rd Ed Textbook of Oral Medicine: Burket ; 9 th Ed eJournal of Dentistry Shafer’s textbook of Oral Pathology White and Pharoah : Oral Radiology 6 th Ed

31. Thank you