A stone in the salivary gland or salivary stone disease is the formation of the so-called salivolitis in the ducts or (less commonly) in the parenchyma of these glands. Blockage of the duct causes acute pain, enlargement of the gland in size, and in severe cases, an abscess or phlegmon.
Causes of Stone Formation
The formation of stones is a consequence of a combination of general and local factors. Common factors are a violation of calcium metabolism and vitamin A deficiency. So, patients suffering from salivary stone disease are susceptible to:
- urolithiasis;
- gout, hyperparathyroidism;
- hypervitaminosis D;
- diabetes mellitus.
The risk of stone formation is increased in smokers.
And to local causes include a narrowing and a defect in the walls of the ducts, as well as a violation of their secretory function. A stone in the salivary gland is always accompanied by sialadenitis.
The chemical composition of salivary stone
Stone formation occurs around a nucleus, which may have a microbial or non-microbial nature. In the first case, the nucleus is a conglomerate of microorganisms, and in the second, an accumulation of desquamated epithelium and foreign bodies that have fallen into the duct of the gland, such as fish bones, fruit kernels, and toothbrush bristles.
The stone contains components of various origins - both organic and mineral. The first accounts for about 10-30%, it consists of amino acids, ductal epithelium, mucin. Minerals are much more (70-90%), they mainly include phosphates, calcium carbonate, sodium, potassium, magnesium, chlorine, iron. In general, the chemical composition of a stone in the salivary gland is similar to tartar.
Most likely, the etiopathogenesis of this disease is accompanied by the emergence of endogenous and exogenous factors that lead to certain pathologies. These include:
- changes in the composition and secretion of saliva;
- decreased salivary flow rate;
- pH shift towards alkali and leaching of mineral salts from saliva.
Stones in the salivary gland: symptoms
Localization of the stone in the parenchyma, as a rule, for a long time may not bother a person. Only by blocking the lumen of the excretory canal, with an increase in size, the formation causes pain and unpleasant bursting sensations. An unpleasant aftertaste appears in the mouth, and the salivary glands swell during chewing food. However, the most characteristic symptom is the so-called salivary colic. This is an acute pain resulting from retention of saliva and an increase in duct diameter.
If the stone blocks the duct of the submandibular salivary gland, then pain occurs when swallowing, which radiates to the ear or temple. In the case of exacerbation of sialadenitis, subfebrile body temperature, malaise, headache can be observed.
Diagnostics
Diagnosis of the disease is carried out by palpation, in addition, an ultrasound examination of the salivary glands, sialography, CT, sialoscintigraphy is performed.
This disease is mainly encountered by people aged 20-45 years. About 1% of the population suffers from this disease. According to statistics, among dental diseases of the salivary glands, sialolithiasis accounts for about 60%.
Most often, stones form in the submandibular sections, and less often in the sublingual. If the stone is small, then it can be washed out without interference by saliva. However, a large calculus clogs the duct, and then you can not do without treatment. If we talk about the mass of formations, then it varies within 3-20 grams, and in size they can range from one millimeter to several centimeters.
If the location is parenchyma, then the stone in the salivary gland, as a rule, has a rounded shape. And when the calculus is formed in the ducts, then it is more elongated in shape. The color of the stones is usually yellow, the surface is uneven, and the density can be different.
Removal of the stone from the salivary gland is carried out when drug treatment does not give results. In such cases, carry out:
- bougieurage of the salivary ducts;
- lithotripsy;
- sialandoscopy;
- open surgery;
- extirpation of the salivary gland.
Stone in the salivary gland: treatment
As already mentioned, if the stones are small, then they can independently be excreted with saliva. Sometimes, to facilitate their departure, conservative therapy is prescribed: salivary diet, gland massage, thermal procedures. Prevention and relief of the phenomena of acute sialadenitis is carried out using antibiotics.
If the stone in the duct of the salivary gland is located near the mouth, the dentist can remove it with tweezers or squeezing.
Surgical intervention to remove the stone can be carried out by various methods. The most advanced of them is interventional sialendoscopy, which allows you to remove salivary stones endoscopically, makes it possible to eliminate cicatricial strictures of the ducts.
The modern minimally invasive method is the so-called extracorporeal lithotripsy. Its essence is crushing stone using ultrasound. Quite often they use the method of chemical dissolution of stones, for which a 3% solution of citric acid is introduced into the ducts.
Dissection of the excretory duct through the inner surface of the oral cavity is the most common method of surgical removal of the stone. Gland abscess is performed at the opening of the abscess by diluting the edges of the wound, which ensures unhindered outflow of pus and the passage of calculus. In the event of recurring stones or irreversible changes in the structure of the salivary gland, resort to radical measures - extirpation of the salivary gland.
Forecast and Prevention
When resorting to radical removal of the salivary glands, xerostomia often occurs, the microflora of the oral cavity is disturbed, accelerated tooth decay is observed, which, of course, leads to a decrease in the quality of life of the patient. That is why, if the above symptoms occur, you should immediately seek medical help.
Early diagnosis avoids removal of the gland, eliminating the problem of stone extraction.
The main condition for prevention is the exclusion of factors that contribute to stone formation:
- mineral and vitamin metabolism disorders;
- duct anomalies;
- bad habits.