Sialolithiasis
Thereis presence of one or more round or oval calcified structures in the duct ofthe major or minor salivary glands( salivary stones)
Howthe stone is formed:
Itis assumed that mucin proteins and desquamated ductal epithelial cells form asmall nidus on which the calcium salts are precipitated, this nidus then allowsconcentric lamellar crystallizations to occur and thus sialolith increases insize as a layer by layer gets deposited on it
Clinicalfeatures of sialolithiasis:
About80%of sialolith affects the major salivary glands and there is more predilectionsfor the submandibular gland.
Stonesare rare in children the average age is the 4th decade with no sex preference.
Theyare asymptomatic discovered on dental radiographs.
Ifsymptomatic the chief complains are pain and swelling . Swelling is results asthere is ductal dilatation caused by the ductal blockade.
Thepain is described as pulling drawing or stinging.
SialolithiasisInvestigations:
Panoramicradiograph.
Ultrasound imaging
orsailography
Histopathologyof sialolithiasis:
Stone: On gross examination moststones are yellow or white in colour. they may be round to oval
- some of the stones are nodular
- after decalcification the stone showsconcentric rings as of the annual rings of a tree trunk
-The stone is acellular and amorphous innature and may contain microbial colonies.
Ducts: the ductal lining thatsurrounds sialolith shows variety of reactive changes.
- there is squamous and mucus cell
metaplasia and changes to stratifiedsquamous epithelium with numerous mucous goblet cells
Sialolithiasistreatment:
- Manyof the major salivary gland sialoliths can be removed by manipulation of thestone through major duct orifice
- Whenmanipulation fails then a surgical cut is made into the main duct
- Intriangular, or multiple stones and long standing obstructions removal of thestone and sialadenectomy is done.
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