The formation of salivary stones is known as sialolithiasis. It is one of the most common diseases of the salivary glands in Central Europe.
What is sialolithiasis?
Sialolithiasis is one of the most common causes of inflammation of the large salivary glands. Salivary stone disease requiring treatment develops in 25 to 50 people per million inhabitants. The number of new cases in Germany each year is between 2200 and 5000. Salivary stones occur most frequently in the large paired salivary glands. For atelosteogenesis definitions, please visit definitionexplorer.com.
These include the submandibular salivary glands ( Glandulae submandibularis ), the sublingual salivary glands ( Glandulae sublingualis ), and the parotid glands ( Glandulae parotis ). The small non-paired salivary glands such as the lingual, buccal and palatine glands are only affected in very rare cases. Most commonly, salivary stones develop in the submandibular gland.
Causes
The cause of sialolithiasis is still unclear. Presumably, metabolic disorders associated with an increased calcium concentration in the blood serum promote the formation of salivary stones. Inflammatory changes and obstructions to the drainage of secretions can also promote the development of sialolithiasis.
In the case of the submandibular gland, the most commonly affected salivary gland, the long and sometimes tortuous duct seems to play a role in its development. In addition, this salivary gland produces a very viscous secretion. This is probably why most of the salivary stones are found here. The individual stones consist of an organic central matrix with deposits of calcium phosphate.
The calculus can be several millimeters in size. Most people develop salivary stones between the ages of 30 and 50. However, sialolithiasis can also be observed in childhood.
Symptoms, Ailments & Signs
Because the excretory ducts of the affected salivary glands are completely or partially blocked by the stones, symptoms occur after the stimulation of salivary secretion. Since the saliva secretion is particularly stimulated shortly before or during eating, this is where most of the complaints arise. The combination of pain and swelling is characteristic of sialolithiasis.
These two symptoms appear together in 50 percent of patients. In 46 percent of the patients only swelling develops. Pain is non-existent. When pain and swelling occur together, it is also known as salivary stone colic (colica salivaria). In addition, other signs of inflammation such as redness or overheating can occur. After the salivation stops, the symptoms usually slowly subside.
If the disease progresses for a longer period of time, however, the swelling can persist. This is an indication of a permanent displacement of the duct. If the salivary glands are massaged or if there is an acute inflammation, purulent secretions can drain from the duct into the oral cavity. This leads to a bad taste sensation. Abscesses, phlegmonous inflammations or fistulas can develop as complications.
Diagnosis & course of disease
Any unclear swelling of a salivary gland and any purulent inflammation of the salivary glands (sialadenitis) should lead to salivary stone disease. In most cases, stones can be found on palpation of the floor of the mouth and the submandibular salivary gland. For this, however, the stones must be at least four millimeters in size.
Parotid stones cannot be felt due to the anatomical position of the salivary duct system. Imaging procedures are required to accurately diagnose the size and localization of the stones. The examination method of choice is the ultrasound examination in the B-mode. Stones as small as 1.5 millimeters can be detected with high-resolution transducers. In addition, the exact localization and the number of stones can be precisely determined.
Due to their composition, only 60 to 90 percent of all stones are visible in X-rays. In radiographs, phlebolites, calcified lymph nodes and calcified intravascular thrombi must also be clarified in the differential diagnosis. Sialography is usually not required. In sialography, a contrast medium is injected into the ducts of the salivary glands.
Obstructions caused by stones become visible in the X-ray image. In the case of unclear swelling of the head salivary glands, a salivary duct endoscopy can also be performed. It serves to differentiate stones, inflammatory changes and duct strictures.
Complications
In most cases, sialolithiasis causes symptoms when the secretion of saliva is stimulated. For example, it can cause severe discomfort and complications when eating or drinking, resulting in weight loss or dehydration. Pain can also occur when eating and have a very negative effect on the patient’s quality of life.
Furthermore, most patients also suffer from swelling or inflammation, so that the affected areas turn red or may be itchy. Taste disturbances can also occur as a result of sialolithiasis. Furthermore, fistulas or abscesses form in the oral cavity and the pain increases. In some cases, the symptoms of sialolithiasis can also disappear on their own, so that self-healing occurs.
Drugs are usually used to treat this condition. Special complications do not occur and the course of the disease is positive. The patient’s life expectancy is also not reduced by the disease if it is treated in time.
When should you go to the doctor?
In the case of sialolithiasis, the affected patient is dependent on treatment by a doctor in any case. Self-healing cannot occur and the symptoms usually continue to worsen if the sialolithiasis is not treated. In general, early diagnosis of the disease has a very positive effect on its further course. A doctor should be consulted if the person concerned suffers from severe pain and swelling in the mouth. In most cases, these symptoms occur when eating and have a negative effect on the quality of life of those affected.
In many cases, those affected lose weight or suffer more from deficiency symptoms. Redness also indicates sialolithiasis and should also be examined by a doctor if it occurs over a longer period of time. Many patients also suffer from a disturbed sense of taste and also from inflammation in the mouth. Sialolithiasis can be treated by a general practitioner or by an ENT specialist. As a rule, there is also a positive course of the disease. The patient’s life expectancy is also not reduced if the treatment is successful.
Treatment & Therapy
Various invasive and minimally invasive procedures are available for the treatment of sialolithiasis. The therapy is chosen depending on the stone location and the stone size. The primary goal of treatment is stone freedom. If there are large stones and the symptoms are very pronounced, freedom from symptoms can also be considered a success.
Non-purulent salivary stone diseases diagnosed for the first time can initially be treated with secretion-stimulating measures and gland massages. As a result, the symptoms usually improve quite quickly and smaller stones pass spontaneously. Smaller stones can also be easily removed with special catch baskets.
Acute and purulent sialolithiasis must always be treated with antibiotics effective against staphylococci and streptococci. Decongestant medication and painkillers are also used. An abscessing inflammation is always an indication for immediate surgical intervention.
A so-called aisle slotting is often carried out. The procedure can almost always be performed with local anesthesia. Alternatively, intracorporeal lithotripsy can also be used. The method is based on the local generation of shock waves. These induce mechanical destruction of the salivary stones.
The procedure must not be used in patients with coagulation disorders or in patients with acute inflammation. In rare cases, gland extirpation, i.e. surgical removal of the mandibular salivary gland, may be necessary. Because surgery can injure the lingual nerve, hypoglossal nerve, and marginal ramus, gland extirpation should only be performed when there are no gland-preserving treatment options.
Prevention
Sialolithiasis can only be prevented to a limited extent. Care should be taken to ensure thorough dental care and oral hygiene.
Aftercare
In most cases, those affected with sialolithiasis have only very few and often limited direct follow-up measures available. Therefore, the affected person should ideally consult a doctor early on and thus initiate treatment in order to prevent the occurrence of other complications and symptoms.
The sooner a doctor is consulted, the better the further course of this disease. Sialolithiasis cannot heal itself, so early diagnosis of the disease is paramount. In most cases, the symptoms of the disease are treated by taking various medications. The person concerned should ensure that the dosage is correct and that the medication is taken regularly in order to limit the symptoms properly and permanently.
All doctor’s instructions must be followed. When taking antibiotics, alcohol should not be drunk while taking them, so as not to reduce the effect of the medication. Regular checks and examinations by a doctor are also very important for sialolithiasis in order to identify other symptoms and damage at an early stage. The disease usually does not reduce the life expectancy of the patient.
You can do that yourself
In everyday life, sialolithiasis can cause uncomfortable feelings and inflammation. This affects the sense of taste and often leads to severe symptoms in the patient. With the help of self-help measures or on their own, the swelling only goes down in a few cases.
Therefore, those affected should consult a doctor to have the appropriate medication prescribed. In this way, the disease progresses positively and the symptoms can be resolved without complications. However, patients should not wait too long, because the sooner you see the doctor, the better he can treat the disease.
Only limited measures are available for everyday prevention of the disease. Above all, good dental care plays an important role. Thorough oral hygiene does not completely prevent problems in the oral cavity, but the risk is significantly reduced. Many patients eat less to reduce pain. However, this does not affect the course of the disease, but rather impairs the immune system. Depending on the severity of the disease, it can still make sense to be a bit careful when choosing food.
