If stones in the salivary gland what to do. Salivary stone disease (sialolithiasis) - causes and methods of treatment of the disease

Salivary stone disease or sialolithiasis - the formation of mineral neoplasms in the structures of the glands.

Their occurrence often causes severe pain, and over time can lead to complete blockage of the ducts and inflammation of the submandibular glands.

At the initial stage of the development of the disease, specialists often resort to conservative treatment, but at an advanced stage, it is impossible to do without surgical intervention.

Causes

The occurrence and growth in the salivary glands of stones is most often the result of a violation in the body of calcium metabolism, accompanied by a lack of retinol.

This situation is often found in people suffering from the following diseases:

diabetes;
diseases of the genitourinary system;
an excess of vitamin D in the body;
pathology of the functioning of the endocrine system - hyperparathyroidism.

In addition, experts note that there are some prerequisites for the accumulation of mineral or organic formations in the glands.

mechanical damage to the ducts improperly selected dentures or sharp edges of teeth and crowns;
the occurrence of crystallization or stagnation of the secretion of saliva due to the slowdown of its separation;
inflammation in the oral cavity, which causes compression of the salivary ducts and accumulation in pathogenic microflora;
the development of an inflammatory process as a result of the penetration of foreign particles into the ducts around which bacteria accumulate and multiply.

Salivary stone disease affects different age groups of the population, however, most often the disease is diagnosed in men and women aged 25-45 who abused smoking or took certain groups of drugs.

Chemical composition

The formation of the stone begins around the core, which may be an accumulation of pathogenic microorganisms or have a non-microbial structure.

It is often based on epithelial cells and foreign particles - toothbrush villi, small non-decomposing particles of food.

The process often proceeds against the background of a change in the qualitative composition of saliva, a decrease in the rate of its separation, a change in the amount of mineral salts and acidity.

Stones that form in the tissues or ducts of the salivary glands consist of organic and mineral components. The elements of the organic structure include mucoproteins, amino acids.

The composition of the stones contains about 15-25% of these substances. The remaining 75-85% are minerals such as sodium, potassium, calcium, iron, phosphates.

Symptoms

The initial stage is asymptomatic, therefore, it is possible to identify the development of the disease only with an instrumental examination - performing an x-ray.

The occurrence of signs of the development of pathology is often observed when the stone reaches a large size and the lumen of the excretory canal is blocked.

The patient has the following symptoms of sialolithiasis:

increased dryness in the mouth due to the production of insufficient saliva;
replacement of saliva with mucus with purulent admixture;
swelling of the face and neck due to accumulation of fluid
pain when opening mouth, chewing food and swallowing, which can radiate to the ear;
feeling of fullness in the problem area, swelling in the lower jaw and neck;
redness of the skin face, neck in the area of stone formation.

When a mineral formation reaches a large size, a person can determine its location during an external examination or feel it.

At an advanced stage of the development of the disease, a person experiences general signs of intoxication of the body - mild fever, lethargy.

A severe form of the course of the disease can lead to the formation of a through hole in the wall of the salivary gland, through which the stone enters the soft tissue.

Diagnostics

To diagnose salivary stone disease, specialists use a combination of various examination methods:

by external examination and palpation an increase in the size of the gland compared to the norm is detected, an increase in the density of its consistency is detected, pain is determined when pressed;
instrumental diagnostic methods, in particular, radiography, a contrast study of saliva, ultrasound, can confirm the presence of a mineral formation and determine its size and position in the parenchyma of the gland;
sialometry– the best way to determine the secretory function of the salivary glands .

In addition to the above studies, saliva is often taken from a patient in order to determine its acidity and qualitative composition.

Together with other methods of examination, this makes it possible to differentiate sialolithiasis from phlegmon, abscess, and neoplasms of the oral cavity.

Treatment

There are various methods of treating salivary stone disease, depending on the degree of its development.

In the early stages of pathology specialists often prefer minimally invasive techniques that facilitate independent stone passage.

In the advanced stage of the pathology, surgery may be required.

Surgical intervention

To date, there are four methods for removing stones from the salivary glands:

Interventional sialendoscopy. The essence of the intervention is that with the help of a thin flexible instrument with a camera at the end - an endoscope.
When introduced into the salivary ducts, the specialist gets the opportunity to examine them and remove the stones. The procedure is minimally invasive and is performed under local anesthesia.
Extracorporeal lithotripsy is an ultrasonic effect on stones from the outside, as a result of which they are crushed.
It creates the possibility of further endoscopic extraction and washing of the ducts with a special solution, which prevents the development of the inflammatory process.
Dissection of the duct it is used when the stone reaches a large size and it is impossible to extract it with a minimally invasive method.
Access to mineral formation in this case can be through the skin or mucous membrane of the oral cavity.

Stone extraction is performed using a surgical spoon or tweezers. Most often, suture and drainage of the duct wound is not required.
Extirpation of the salivary gland or the procedure for its removal is the most radical method of treating salivary stone disease.
The operation is used only if it is impossible to eliminate the pathology in another way - with repeated formation of stones or irreversible changes in the parenchyma of the gland. The procedure is carried out in a hospital under general anesthesia.

Medications, physiotherapy

A non-invasive technique for removing stones from the salivary glands is based on the release of a clogged duct and the activation of the process of self-excretion of mineral formation.

This treatment option is only suitable if the disease is detected at an early stage. Conservative treatment of sialolithiasis is based on the following activities:

Taking medications prescribed by the attending physician. Most often, the basis of treatment is anti-inflammatory drugs, drugs that enhance the secretion of saliva, antibacterial drugs.
physiotherapy procedures, in particular, electrophoresis, fluctuorization, UHF, contribute to the expansion of the salivary ducts and the unhindered passage of stones through them.
special diet with the content of acidic foods and drinks, it activates the production of saliva, which also helps to remove stones through the ducts.

Professional massage performed by a specialist is another way to remove small mineral formations from the salivary glands. However, the decision on the need for it is made only by the attending physician.

ethnoscience

Non-traditional methods of treatment can only be used in conjunction with conservative therapy to remove small mineral formations. According to people's reviews, the following folk recipes are most effective:

Dry sage leaves pour boiling water in the proportion of 400 ml of liquid per 2 tablespoons of the plant, and insist for 1.5-2 hours. Rinse the mouth with a filtered solution every 2-3 hours.
Fresh cranberries grind to a mushy state, after which they dissolve in a teaspoon before each meal for 10 minutes. The tool helps to increase salivation and remove stones.
Not canned birch sap take one glass daily. The liquid helps dissolve calcium-based compounds present in mineral formations.

Remember! The use of alternative methods of treatment is permissible only after consultation with a specialist, in parallel with the implementation of his recommendations.

Relapse and exacerbation

Re-formation of stones in the salivary glands after their removal occurs in 8-10% of cases. As a rule, the situation indicates the persistence of problems with the functioning of the endocrine system and metabolic disorders in the body.

The patient may need to consult with specialized specialists who can identify an existing disease that leads to the growth of stones.

Often, the recurrence of sialolithiasis entails irreversible changes in the structure of the glands, which sooner or later require their removal.

Forecast

The experience of specialists shows that in 90% of cases of timely seeking professional help, the prognosis for the treatment of salivary stone disease is favorable, regardless of the chosen method of therapy.

However, an important factor in a successful outcome and the absence of re-formation of stones is the identification of the cause of the pathology and its elimination.

An appeal to a specialist at an advanced stage of sialolithiasis most often ends with an operation to remove the salivary gland. In the future, this is fraught with a violation of the microflora of the oral cavity, the occurrence of problems with teeth and gums.

Prevention

It is much easier to prevent the development of pathology than to eliminate its consequences, so dentists recommend adhering to the following rules:

eat nutritious and balanced;
use purified drinking water;
monitor oral hygiene;
with a high amount of calcium in the body, avoid excessive consumption of foods rich in this element;
give up bad habits such as drinking alcohol and smoking;
get regular dental checkups.

The video contains additional information on the topic of the article.

The formation of stones in the salivary gland is called salivary stone disease. It is accompanied by the presence of inflammatory processes in the parenchyma or ducts of the salivary glands.

Formations that interfere with the outflow of saliva consist mainly of calcium and other mineral deposits. Small stones are often excreted with saliva, but their retention in the salivary canals can cause abscess and inflammation, pain, swelling of the jaw and deformation of facial features. How to remove a stone in the salivary gland: treatment, causes and symptoms of salivary stone disease further in the material.

Causes

Salivary stone disease is a fairly rare disease that occurs in only 1% of the population. Subject to this pathology are people aged 20 to 45 years, regardless of gender. The formation of stones with a probability of 80% can be observed in the submandibular gland, in the parotid gland, salivary stone disease occurs less frequently and almost never appears in the sublingual glands.

Specialists distinguish the following features of stones in the salivary glands:

yellow tint;
weight from 3 to 30 grams;
formations of an oblong shape in the excretory ducts;
round - in the parenchyma;
uneven surface.

The most common causes of salivary stones are:

Vitamin A deficiency, calcium absorption disorders, vitamin D intoxication.
Endocrine disorders, thyroid diseases.
Lack of parathyroid hormone in the body.
The presence of stones in the urinary tract, and diseases such as diabetes and gout.
Smoking.
Long-term use of certain medications.
Congenital pathologies of the salivary ducts and disorders of their excretory function.
Infection and inflammation in the cavities of the salivary glands.
Mechanical damage and injuries received during chewing, blows.
The presence of foreign particles in the cavity of the gland: seeds, grains, bones, toothbrush pile, which create a favorable environment for the formation of salivary stone around them.

The occurrence of stones can also be influenced by a change in the composition of saliva caused by any external or internal factors.

Read about the anatomy of the salivary glands on this.

Symptoms of pathology

With small stones, the disease can pass without any symptomatic manifestations. Manifestations of pathology depend on the location, weight, size and shape of the stones, as well as the state of health and immunity of the patient.

The main symptoms that allow diagnosing the presence of the disease are:

Swelling of tissues in the area of localization of the calculus during meals, as well as with increased salivation due to a reaction to the sight and smell of food.
Pain and discomfort.
Dysfunction of salivary secretion, provoking a feeling of dryness.
Salty taste in the mouth and bad smell from the mouth.
Enlargement and hardening of the salivary gland affected by a stone.
Inflammation of the mucous membranes of the oral cavity, as well as redness of the tissues of the neck and face.
Difficulty in the act of chewing food, as well as a violation of diction and facial expressions.

If the tissues around the stone become inflamed and infected, the disease can also be accompanied by suppuration, fever, deterioration in general condition, and headaches. In the presence of such symptoms, it is recommended to immediately visit a dentist.

Diagnosis of the disease

The exact diagnosis and cause of the disease can only be determined by a qualified specialist using the following methods:

Inspection and palpation allow you to determine the approximate size and location of the calculus, as well as the density, degree of tissue swelling and the presence of pain.
Radiography - taking an x-ray of the jaw, in which the doctor can isolate salivary stones.
Sialography is a study of the salivary glands by introducing a contrast solution.
Sialometry of the salivary glands, which allows you to determine the amount of saliva secreted per unit of time, which helps to establish the dysfunction of the organ.
Analysis of the composition of saliva using biochemical research and determination of the degree of acidity.

According to the symptoms, salivary stone disease is somewhat similar to some other diseases of the oral cavity: phlegmon, lymphadenitis, phleboliths, abscess.

For this reason, it is important not to diagnose the pathology on your own, but to trust specialists who accurately differentiate the disease and make the correct diagnosis.

Salivary stone disease: treatment

With a good combination of circumstances, stones can independently exit the salivary gland, but in most cases, medical and even surgical assistance is required. After establishing the diagnosis, it is necessary not only to treat the disease symptomatically, but also to eliminate its cause: drink a complex of vitamins, conduct an endocrinological examination, or eliminate the lack of nutrients in the body. For the treatment of salivary stone disease, specialists can prescribe both conservative and surgical treatment.

Medical therapy may include the following drugs:

antibiotic;
anti-inflammatory;
antifungal;
painkillers;
immunomodulators;
vitamin complexes.

If within the indicated time the stones do not leave the salivary gland, the doctor needs to carry out mechanical or surgical removal of the stone from the salivary gland using the following methods:

The surgical method consists in inserting a probe into the duct of the salivary gland and determining the localization of the mineral formation. After that, the surgeon makes an incision along the duct and removes the stone using a special device. With such an operation, suturing is not required, the tissues of the oral cavity gradually heal naturally, forming a new mouth.
Removal of a stone from the duct of the salivary gland by extrusion or with tweezers when the stones are localized close to the mouth of the duct.
In advanced cases, the above methods do not guarantee a cure for the disease, so the doctor may prescribe extirpation, that is, the complete removal of the salivary gland. This operation often leads to a decrease in the standard of living of patients: the microflora of the oral cavity is disturbed, the teeth become more susceptible to erosion, and there is also constant dry mouth and insufficient salivation, which causes discomfort during meals.

It is important to remember that the removal of the salivary gland is a radical method that can be avoided in 90% of cases with timely contact with a medical institution.

Stones in the salivary gland: treatment with folk remedies and a therapeutic diet

Also, with stones in the salivary gland, a salivary diet is indicated.

It includes the use of the following products:

Sour fruits and berries, sauerkraut, lemons and citrus fruits. Before eating, you need to eat a small amount of sour-tasting foods that stimulate increased salivation. It is recommended to use crackers in combination to remove dead cells.
Squash. This plant is a kind of zucchini, but contains much more vitamins and nutrients, including ascorbic acid. This vegetable has a beneficial effect on the alkaline environment of the oral cavity, which is useful for salivary stone disease.
Beet. This product improves digestion and metabolism, and is also useful for stimulating bowel function.
Drinking fluids in large quantities will help to avoid intoxication of the body.

With salivary stone disease, it is necessary to limit the use of foods high in calcium - these are cottage cheese, milk, cheeses, sesame seeds, fish.

Stones in the salivary gland: operation - video

Discussion.

Photo 10: Extracted stone

Conclusion

The main number of cases of salivary stone disease (80%) occurs in the submandibular salivary gland and its duct. In 10%, the parotid salivary gland is affected, and in the remaining 10%, the sublingual salivary gland and the minor salivary glands are affected.

Bilateral involvement or involvement of multiple glands occurs in less than 3% of cases.

In patients with several salivary stones, the formations may be located in various places along the duct or in the body of the gland. Stones in the submandibular salivary gland that are close to the orifice tend to become very enlarged before they become symptomatic. The incidence of sialolithiasis on the right and left is approximately the same.

Typically, salivary stones range in size from 1 mm to 1 cm. Giant salivary stones are formations larger than 1.5 cm, which are rarely reported in the medical literature. Giant stones larger than 3 cm are an extremely rare case, described only a few times.

Description of the clinical case.

In 2010, a 53-year-old man came to the Department of Oral and Maxillofacial Surgery with complaints of a voluminous, solid formation on the floor of the mouth under the tongue on the left. From the anamnesis, it was found that the patient had swelling associated with meals. Medical history without features.

On examination and bimanual palpation, the swelling was found to be related to the left submandibular salivary gland and was firm and mobile (Figure 1). The floor of the mouth is swollen. A large calcified mass was found at the OPG (Photo 2). CT scan shows obstruction of the submandibular salivary gland duct by a 3.32 x 1.14 cm calculus (Figures 3, 4 and 5). In the biochemical analysis of blood, the indicators are normal.

Photo 1: Education in the hyoid region on the left

Photo 2: OPG with a massive radiopaque lesion

Photo 3a 3b 3c, 4 and 5: CT showing the size and location of the stone

Under local anesthesia, the stone was removed through an incision in the floor of the mouth (Photo 6.7). The calculus was yellowish in color, oval in shape with a rough and uneven surface (Photo 8). A polyethylene tube was inserted into the incision site. The edges of the wound are sutured (Photo 9). Sutures and drainage were removed after 2 weeks.

Photos 6 and 7: Dissection of the floor of the mouth and removal of the stone

Photo 8: The extracted stone was yellow, oval in shape, had a rough and uneven surface

Photo 9: Short polyethylene tube

Discussion.

Anti-gravity saliva is more alkaline and contains more Ca and mucin ions, which may explain the predominant formation of stones in the submandibular gland.

The exact etiology and pathogenesis is still unknown. Somewhat more often, the pathology affects men aged 40 years. Patients complain of pain, discomfort and swelling before and during meals. In such cases, a bimanual massage of the affected gland should be performed with an examination of the secreted saliva. The stone is often located in the excretory duct anteriorly. Such characteristics cause a pronounced pain syndrome. The calculus in the submandibular salivary gland in 80-94.7% of cases is radiopaque. In addition to X-ray examination methods, it is also recommended to use ultrasound, which can detect 90% of all formations larger than 2 mm. When small stones are detected, CT is the most informative way. The implementation of the organized crime group can also be very useful. For small radiopaque lesions, contrast sialography is the test of choice, although stone movement toward the gland is sometimes unavoidable.

Photo 10: Extracted stone

Despite the fact that sialolithiasis can be both in the gland itself and in the duct, the detection of large stones larger than 3 cm is rare. In the above situation, the stone completely occupied the duct. Literature analysis found only 16 clinical cases with stones larger than 3.5 cm.

Stones are usually oval or round in shape, yellowish in color with a smooth or rough surface. The composition contains calcium phosphate with small amounts of hydroxyapatite, magnesium, potassium and nitrogen compounds. Submandibular salivary gland stones are usually removed surgically through an intraoral or extraoral approach. Surgical extraction is indicated only when the stone is located in the excretory duct. In the case of localization of the formation in the body of the gland, fragmentation of the gland or endoscopic laser lithotripsy is performed. This treatment is taken several times. After removing the stone, a scintigraphic examination shows the functional restoration of the gland. In some cases, complete removal of the gland is indicated.

New developments in the treatment of pathology are promising. Gradually, non-invasive techniques such as ultrasonic lithotripsy, the use of a stone basket, and endoscopic laser technologies are being introduced.

In a review of 4,691 cases, successful use of microforceps and baskets for the extraction of stones less than 5 mm and extracorporeal lithotripsy for fixed parotid stones less than 7 mm in diameter are reported.

Conclusion

This article describes a rare clinical case of the formation of a large salivary gland stone, which could have been avoided with early diagnosis and appropriate treatment. Once the diagnosis is made, steps should be taken to extract the mass with the least possible invasiveness of the procedure.

A disease known in medicine as calculous sialadenitis, and the inhabitants call it salivary stone disease is quite common.

The main pathogenetic link is the formation of stones in the ducts. Most often, the submandibular gland, and more specifically, its ducts, is involved in the pathological process. The ducts are affected less frequently.

The disease is more common in children aged 7 to 12 years.

The mechanism of the development of the disease

The formation of stones in the salivary glands occurs in the presence of chronic sialadenitis. Inflamed tissues of the gland create conditions for metabolic disturbances, as a result of which the density of saliva and the rate of its outflow change. Acute forms of the disease are rarely complicated by stone formation.

In the photo, stones extracted from the salivary gland

The formation of a stone or seal in the duct of the gland leads to a violation of the outflow of saliva. The compensatory mechanism is the expansion of the duct, but this mechanism acts only for a short time, and then closes the ring of pathogenesis.

Due to the prolonged stagnation of saliva in the dilated duct, all conditions are created for its infection and the formation of an inflammatory infiltrate.

Causes and risk factors

The main reason for the formation of stones in the ducts of the salivary glands is prolonged stagnation of saliva. This condition occurs due to:

duct dyskinesia;
- sialadenitis;
violation of metabolic processes in the body (metabolism of phosphorus and calcium);
decrease in the protective properties of saliva;
entry into the duct of a foreign body.

A predisposing factor to the development of salivary stone disease is the presence of a patient with chronic diseases caused by metabolic disorders in the body.

Features of the clinical picture

With the development of calculous sialadenitis, the patient has a number of symptoms that make him see a doctor:

pain in the mouth while eating;
difficulty opening the mouth;
saliva becomes viscous and difficult to swallow;
ear pain

Symptoms of the disease develop gradually and are found in various combinations depending on the stage of the disease. At the initial stage, called asymptomatic, the patient notes only the occurrence of unpleasant sensations while eating.

20 minutes after the mechanical impact, the discomfort completely disappears and nothing bothers the person. Do not flatter yourself and do not pay attention to what is happening. This stage is the first news of the formation of the pathological process. In the absence of treatment, it passes into the acute phase.

Acute VS chronic

Acute sialadenitis develops suddenly, sometimes within a few hours, manifested by acute pain, fever, general weakness and headache.

This process in most cases accompanies development or phlegmon. Swelling, redness and soreness increase at the exit site of the salivary gland duct.

Eating is difficult due to the increase in soreness with any mechanical impact. On examination, in addition to subjective complaints, there is a gaping of the mouth of the salivary gland duct, dryness of the mucous membrane, lack of saliva outflow, and a small amount of pus is released from the hole.

With the transition of the disease to a chronic form, inflammatory phenomena disappear. A slight swelling remains, asymmetry of the glands develops, a slight increase in the size of the glandular tissue is formed.

When massaging the duct, a small amount of viscous transparent content is released from it. Careful palpation reveals one or more solid masses in the duct.

Diagnosis of the disease

When identifying the first clinical signs of salivary stone disease, you should immediately consult a doctor.

Important! Early diagnosis of the disease is the key to the effectiveness of treatment and achievement of complete recovery.

In the diagnosis of the disease, modern medicine has stepped far ahead. Examination of the patient can be performed by both the dentist and therapist (in the absence of the first).

On examination, the doctor can identify the main clinical sign - an increase in the size of the salivary gland, swelling in the area of the opening of the excretory duct. In some cases, palpation (when feeling the site of the tumor with a finger) stones are detected in the salivary gland.

To confirm and clarify the diagnosis, the doctor may prescribe the following studies:

radiography of the upper or lower jaw in a given projection;
ultrasound procedure.

After a detailed study of the research results, the doctor can not only make an accurate diagnosis, but also prescribe the only correct and effective treatment.

Complex of therapeutic measures

Salivary stone disease most often requires surgical treatment. An invasive method of treatment is used only after the ineffectiveness of a course of conservative therapy.

In the acute phase of the disease, treatment should be started immediately. With the transition of the disease into a chronic form, the course of therapy takes a long time, at least two weeks.

Conservative treatment of salivary stone disease includes:

prescribing medications that enhance the secretion of the salivary glands;
course of non-steroidal anti-inflammatory drugs: reduces temperature, reduces tissue swelling, suppresses the inflammatory response;
antibiotic therapy(if the cause of the development of the disease was a bacterial infection);
physiotherapy treatment.

The methods of conservative influence include nutrition, consisting of crushed and grated products. An increase in the amount of warm drink (rosehip broth, fruit drinks) in order to increase the secretion of saliva.

During the treatment period, it is necessary to increase the frequency of hygiene procedures: after each meal, rinse the mouth every 2 hours.

Treatment of the disease with folk remedies is of secondary importance and should be used only in combination with traditional medicine. The most famous folk recipes are mouth rinsing with soda-salt solution, resorption of lemon slices.

In the case of the transition of the disease to a chronic form with episodes of exacerbation, there is a need for surgical treatment.

At the first stage, doctors resort to galvanization of the salivary glands. This procedure consists in exposing the gland to an electric current of low power.

In some cases, this is enough to destroy the stones during the formation stage. If the process could not be stopped, it becomes necessary to perform surgical intervention.

Surgery

In clinical practice, there are clear indications for the operation:

melting of gland tissues due to a purulent process;
complete blockage of the duct of the gland with the development of persistent pain syndrome.

Surgical treatment consists in opening the duct, installing drainage. Operational access - oral.

The operation is performed under local anesthesia. The drug is injected in several places, starting from a place 1-2 cm behind the stone.

On both sides, parallel to the course of the duct, 2 ligatures are applied, which act as "holders" for the surgeon's assistant. Only after that, a transverse incision of the mucous membrane is performed,

The next stage is the opening of the duct and the extraction of the calculus. The wound is not sutured, but a drainage tape or tube is inserted. Within 3-5 days, antibacterial drugs are introduced into the area of the postoperative wound in order to prevent inflammation.

Prevention of calculous sialadenitis

There is no specific prevention of salivary stone disease. The main preventive measures are aimed at maintaining oral hygiene and eliminating mechanical blockage of the duct of the salivary glands.

Complications and prognosis

A complication of the acute form of the disorder is its transition to the chronic form. Chronic salivary stone disease leads to dysfunction of the gland.

The long course of the disease provokes the transformation of glandular tissues into fibrous or connective tissue. As a result, the gland acquires a bumpy shape, loses the ability to perform basic functions. Such a transformation can take place according to the type of tumor transformation.

The prognosis of the disease is doubtful. In 50% of cases, regardless of the treatment, relapses occur. Secondary prevention is aimed at preventing the development of severe forms and complications.

- stones (salivoliths) formed in the excretory ducts or parenchyma of the salivary glands (submandibular, parotid, sublingual, small). When the duct is blocked, salivary gland stones cause acute pain (salivary colic), gland enlargement, sialadenitis phenomena; in some cases, the formation of an abscess or phlegmon of the salivary gland may occur. The presence of salivary stones is diagnosed by palpation, ultrasound of the salivary glands, sialography, CT, sialoscintigraphy. To remove salivary gland stones, conservative therapy can be prescribed, salivary duct bougienage, lithotripsy, sialendoscopy, open surgery or salivary gland extirpation.

General information

Salivary gland stones (sialolithiasis, salivary stone disease) are single or multiple mineral formations that clog the ducts of the salivary glands. Salivary gland stones occur in 1% of the population, predominantly between the ages of 20-45 years. In dentistry, among diseases of the salivary glands, sialolithiasis accounts for 20.5-78% of all pathology. In 85-95% of cases, stones form in the submandibular salivary glands and the Wharton duct; in 3-8% - in the parotid glands and Stensen's duct; extremely rarely - in the sublingual and small salivary glands. In about a quarter of cases, multiple salivary gland stones occur.

Small stones of the salivary glands are easily washed out with saliva; however, large calculi are able to clog the lumen of the duct. The mass of salivary gland stones varies from 3-7 to 20-30 g, the size is from several millimeters to several centimeters. In the parenchyma of the salivary glands, stones of a rounded shape are usually formed; in the excretory ducts - oblong. Salivary calculi often have a yellowish color, uneven surface, different density.

Causes of the formation of stones of the salivary glands

The formation of salivary gland stones contributes to a combination of general and local factors. Among the first are calcium metabolism disorders and vitamin A deficiency in the body. Patients with urolithiasis, gout, hyperparathyroidism, hypervitaminosis D, and diabetes mellitus tend to form salivary gland stones. The risk of salivary gland stones increases in smokers, patients taking certain medications (antihistamines, antihypertensives, diuretics, psychotropic, etc.).

Local causes include anomalies of the ducts of the salivary glands (narrowing, ectasia, wall defects, etc.) and changes in their secretory function. The presence of stones is always accompanied by inflammation of the salivary glands (sialadenitis), but the question of what is primary - stone formation or infection of the gland remains controversial.

A salivary stone usually forms around a nucleus that is microbial or non-microbial in nature. In the first case, the core is most often a conglomerate of microorganisms (actinomycetes), in the second - an accumulation of desquamated epithelium and leukocytes, foreign bodies that have fallen into the gland duct (fish bones, fruit grains, toothbrush bristles). Salivary gland stones consist of components of organic and mineral origin. The organic component (10-30%) includes amino acids, duct epithelium, mucin; mineral substances (70-90%) are represented by calcium phosphate and carbonate, sodium, potassium, magnesium, chlorine, iron. In general, the chemical composition of salivary calculus is close to that of tartar.

Most likely, a number of endogenous and exogenous factors are involved in the etiopathogenesis of salivary stone disease, leading to a change in the composition and secretion of saliva, a decrease in the rate of salivation, a shift in pH to the alkaline side, and precipitation of mineral salts from saliva.

Symptoms of salivary gland stones

With the localization of the stone in the parenchyma of the salivary gland, the course of the disease is asymptomatic. At this stage, calculi are an accidental finding during an x-ray examination of a patient for another odontogenic disease.

Subjective and objective signs of salivary stone disease usually develop when the salivary gland stone reaches a relatively large size and blocks the lumen of the excretory canal. In the clinically pronounced stage, patients notice bursting sensations and swelling of the salivary gland during meals, an unpleasant aftertaste in the mouth. A characteristic sign of salivary gland stones is the so-called "salivary colic" - an acute pain attack associated with retention of saliva and a sharp increase in the size of the gland duct.

When blocking the duct of the submandibular salivary gland with a stone, pain occurs when swallowing with irradiation to the ear or temple. In some cases, stones can be seen or felt at the opening of the salivary gland duct. Exacerbation of sialadenitis is accompanied by symptoms of general intoxication - subfebrile body temperature, malaise, headache.

With a complicated course of salivary stone disease, abscesses and phlegmon can form in the area of the affected salivary gland and its ducts. In some cases, perforation of the gland occurs with the release of the calculus into the soft tissues.

Diagnostics

External examination, as a rule, reveals an increase in the size of the corresponding gland; bimanual palpation reveals its dense texture and pain. Quite often the stone can be felt when probing the duct of the salivary gland. In some cases, the mouth of the duct gapes, a mucous or purulent secret is released from it.

To confirm the presence of stones, a survey radiography and radiopaque examination of the salivary gland (sialography, digital sialoscopy), ultrasound of the salivary glands are performed. In case of difficulties in differential diagnosis, computed sialotomography, sialoscintigraphy is performed. In order to study the secretory function of the salivary glands, sialometry is shown. To study the composition and properties of saliva, biochemical analysis, pH is investigated.

Salivary gland stones must be differentiated from lymphadenitis, tumors of the oral cavity, phleboliths, odontogenic abscess, perimaxillary phlegmon.

Treatment of salivary gland stones

In some cases, salivary gland stones may pass spontaneously; sometimes, in order to facilitate their discharge, conservative therapy is prescribed: a salivary diet, gland massage, thermal procedures, bougienage of the ducts of the salivary glands. Antibiotics are prescribed for the prevention and relief of acute sialadenitis.

Salivary gland stones located near the mouth of the duct can be removed by the dentist with tweezers or by squeezing. Surgical tactics involves the removal of stones from the duct of the salivary gland in various ways. The most advanced treatment for salivary stone disease is interventional sialendoscopy, which makes it possible to remove salivary stones endoscopically and eliminate cicatricial strictures of the ducts. Among the modern minimally invasive methods of treating sialolithiasis is also extracorporeal lithotripsy - crushing salivary gland stones using ultrasound. In some cases, intraductal litholysis is effective - the chemical dissolution of stones by introducing a 3% solution of citric acid into the ducts of the salivary gland.

Surgical removal of salivary gland stones can be carried out in an open way - by dissecting the excretory duct from the oral cavity. At the stage of abscessing of the gland, an abscess is opened, the edges of the wound are bred to ensure unhindered outflow of purulent exudate and discharge of the calculus. With recurrent stones or irreversible changes in the salivary gland, a radical surgical intervention is indicated - extirpation of the salivary gland.

Forecast and prevention

Radical removal of the salivary glands is accompanied by xerostomia, a violation of the microflora of the oral cavity, accelerated tooth decay, which undoubtedly reduces the quality of life of patients. Thanks to the use of modern methods of treatment, in about 80-90% of cases, it is possible to avoid the removal of the salivary gland and limit ourselves to the extraction of the stone of the salivary gland.

Further prognosis and prevention of salivary stone disease largely depend on the elimination of factors contributing to stone formation: violations of mineral and vitamin metabolism, anomalies of the ducts of the salivary glands, bad habits, correction of drug therapy.