Saliva aids in digesting complex starches and maintains healthy teeth. It is produced by thousands of minor salivary glands, and 3 major paired salivary glands, parotid, submandibular, and sublingual glands. Salivary duct stones or sialolithiasis is the formation of stones in the drainage pathways of the major salivary glands causing either a partial or complete blockage of the gland (Fig. 1 Submandibular Gland). The submandibular gland produces the majority of saliva and is also the most common site for the formation of a stone. A partial obstruction may cause swelling and pain that is often aggravated by eating, especially sour or acidic foods. During a complete blockage, the gland becomes tense, sore to the touch, and a fever may be present. This indicates a bacterial infection has occurred in the gland secondary to the blocked duct and back-up of saliva. The pain and swelling occurs adjacent to the affect gland. The parotid gland is located in the cheeks in front of the ears, the submandibular gland is underneath the jaw, and the sublingual gland is behind the chin and underneath the tip if the tongue
Salivary gland stones are formed when the concentration of water in saliva decreases and nutrients in the saliva precipitate to form a stone. This commonly occurs secondary to acute dehydration, but medications (especially diuretics) and autoimmune diseases (Sjogren, Lupus, Sicca Syndrome) predispose patients to forming salivary gland duct stones.
The diagnosis is usually made based on the patients’ history and on physical examination. Many times, stones in the submandibular gland can be felt. Additionally radiological imaging such as MRI, or a saliogram may be used to aid in the diagnosis. A saliogram is injecting the suspected gland with a dye and then using x-rays to identify the stones.
All treatments center on removing the salivary stoneand preventing the reformation of the stone. Small stones may be manually expressed through the duct. Larger stones may be easily removed through a small incision in the mouth. Endoscopic removal of the stone, known as sialendoscopy, is also a very good option. Small scopes can be passed in the openings of the ducts to visualize the stone. If the stone can be visualized through this endoscopic approach, specialized instruments can be used to directly remove the stone. If all method has proved unsuccessful, the entire gland and duct may be surgically excised. After removal the stone, the gland should be massage to expel remnant thickened saliva. To prevent future stones, the patient should drink between 6-8 glasses of water a day and have their medication reviewed to ensure that they do not cause thickening of saliva. Rarely, the stone may cause injury the duct and cause a narrowing or stricture. This predisposed the gland to chronic back-up of saliva and infections. These cases are treated initially with antibiotics, massage, hydration, and salivary stimulants. If these treatments prove unsuccessful, dilation of the duct is undertaken, and if that is unsuccessful the gland may have to be excised.
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