Sialolithiasis

Sialolithiasis is the formation of calcified stones, or sialoliths, within a salivary gland or its duct. It most commonly involves the submandibular gland, followed by the parotid gland, and less often the sublingual or minor salivary glands.

The condition typically occurs in adults and is associated with factors that reduce salivary flow or alter saliva composition, such as dehydration, chronic oral infections, or certain medications. Stones form when mineral salts precipitate around a nidus of organic material, leading to ductal obstruction and resultant dilatation and pain during salivary stimulation.

Clinically, patients often present with intermittent swelling of the affected gland, especially during meals, accompanied by pain or tenderness. A palpable ductal stone or purulent discharge from the duct may be observed. If obstruction becomes infected, signs of sialadenitis can occur, sometimes with fever or purulent drainage.

Diagnosis is based on history and examination, with imaging used to confirm the presence and location of stones. Ultrasound is commonly the initial modality; computed tomography or magnetic resonance imaging can identify nonradiopaque stones and assess surrounding tissue. Sialography and sialendoscopy may be employed for detailed ductal visualization and to guide treatment.

Management ranges from conservative to interventional. Conservative measures include hydration, gland massage, sialogogues to stimulate flow, analgesia, and oral hygiene. Antibiotics are used for infected cases. Small or accessible stones may be removed or fragmented via sialendoscopy; larger or impacted stones may require extracorporeal lithotripsy or surgical removal, with duct repair or gland excision as needed. The prognosis is generally favorable with treatment, though recurrence can occur.