2. INTRODUCTION
Sialoliths are calcified structures that develop within the
salivary gland or the ductal system.
Men > women
Rare in children
75% - single
3% - bilateral
1.2% -autopsy
3. GLAND WISE DISTRIBUTION
80-92% - submandibular gland.
6-20% - parotid.
1-2% - sublingual and the minor salivary
glands.
Submanibular – larger & intraductal
Parotid – multiple, within the gland
7. CHEMICAL COMPOSITION
Chemical composition
Microcrystalline apatite (Ca5[PO4]3OH) or
Whitlockite (Ca3[PO4])
Brushite and weddellite
BRUSHITE
WEDDELLITE
8. RECENT DISCOVERIES
Scanning electron microscopy has demonstrated oval,
elongated shapes,
suggesting the presence of bacilli in sialoliths.
A recent polymerase chain reaction study found bacterial
DNA, mainly belonging to the Streptococcus genus
ARCH OTOLARYNGOL HEAD NECK SURG/VOL 129, SEP 2003
9. PATHOGENESIS
Multifactorial event
Secretory disturbances & precipitation – inflammatory
process
Specific changes in structure of organic molecules –
supportive frame formation
Metabolic disturbances – alkalinity & precipitation
10. MICROLITHS
Concrements detectable only microscopically
Contain – calcium and phosphorus
hydroxyl apatite
organic secretory material
necrotic cellular residues
Generated - autophagocytosis of organelles that are
rich in calcium.
11. Dyschylia - Disturbed salivary secretion & change in the
composition
Accumulation of organic substances & mineralisation of
organic matrix
Accumulation of calcium
Increase in pH
Decreases the solubility of calcium phosphates
12. PROGRESSION
Secretory disturbances viscous secretions
Microlith formation ductal obstruction
Coaction of factors + participation of bacteria
sialoliths
Dyschylia & increasing microlith formation ascent of
bacteria lead to a focal obstructive atrophy of the
acinar cells secretory disturbances
Journal of Oral Science, Vol. 45, No. 4, , 2003
14. SYMPTOMS
Pain, swelling & discomfort
Pain - meal time – severe with sour or acidic food
Unusual taste
Associated with infection – fever , purulent discharge &
lymphadenopathy
15. CHARACTERISTICS
The annual growth rate - 1 mm per year
Shape - round or irregular
Size - 2 mm to 2 cm
16. GIANT SIALOLITH
72 mm in length and weighing 45.8 g
The ability of a calculus to grow and become a giant sialolith
depends mainly on the reaction of the affected duct.
Rai and Burman. Giant Submandibular Sialolith. J Oral Maxillofac Surg 2009.
17. TREATMENT MODALITIES
Newer treatment modalities - extracorporeal short-wave
lithotripsy and sialoendoscopy are effective alternatives
to conventional surgical excision for smaller sialoliths.
However, for giant sialoliths, transoral sialolithotomy with
sialodochoplasty or sialadenectomy remains the mainstay
of management.
18. HISTOLOGIC FEATURES
Stratified & mineralized with metaplastic excretory duct
cells
Concentric laminated structures
Acini infiltrated by lymphocytes
Dialatation of duct
Epithelium exfoliation
22. Conventional radiography
Intra oral radiographs
IOPA , Occlusal radiographs
Extra oral radiographs
Panaromic , PA skull projection
Intraglandular and small stones can be missed.
20% of sialoliths are radiolucent
23. Sialography
"Gold Standard”
Retrograde infusion of oil or water based contrast & the
architecture of the salivary duct system is visualized radio
graphically .
25. Ultrasonography
Non invasive, alternative method
Stones > 2mm detected as echo-dense spots with a
characteristic acoustic shadow.
26. MR Sialography
Non invasive
Acute infections
Canulation not possible
27. COMPUTED TOMOGRAPHY
Posterior of the duct
Hilum of the gland
Substance of the gland
Radiation exposure
Non invasive & do not require contrast media
28. SIALOENDOSCOPY
Minimally invasive
Diagnostic & therapeutic
Small endoscope – light at end of flexible cannula
29. Differential diagnosis
Phleboliths – radiolucent center
Dystrophic calcification of lymph nodes – Cauliflower
shaped
Palatine tonsiliths- multiple & punctate
Haemangiomas with calcifications
38. Complications
-Inability to remove
fragment
-Postoperative
infections
-Neural damage
-Intraductal
adhesion
-Subglossal scar
band formation
-Sialocele & Ranula
formation
39. paediatric patients
Relatively small and distal
Bimanual careful palpation is mandatory to diagnostic
approach for children suspicious of sialolithiasis.
These findings also suggest that intra-oral approach is
effective treatment procedure for most of sialolithiasis in
children.
Int J Pediatr Otorhinolaryngol 2007 May;71(5)
44. Conclusion
Sialolithiasis is the main cause of unilateral diffuse parotid or
submandibular gland swelling.
Mechanical obstruction of the salivary duct, causing repetitive
swelling during meals, & often complicated by bacterial
infections.
Common in submandibular gland , 10 – 20% are radiolucent
Newer minimally invasive diagnostic & therapeutic modalities
45. References
Contemporary OMFS – Perterson
Oral Radiology – principles & interpretation – White & Pharoah
Sialoendoscopy & salivary gland sparing surgery - Oral Maxillofaccial Surg
Clin N Am 21 (2009)
Pathogenesis & diverse histologic findings of sialolithiasis – J Oral Maxillofac
Surg 68: 2010
Imaging the major salivary glands – British Journal of Oral & Maxillofacial
Surgery 49 (2011)
Oral & maxillofacial pathology – Neville
Text book of OMFS – Neelima Mallik
Editor's Notes
cannot
Do not fully explain the genesis of sialoliths.