Sialolithiasis is the formation of calcified masses within salivary glands, primarily affecting the submandibular gland. The condition is associated with factors that promote saliva retention and alterations in saliva composition, leading to symptoms such as pain, swelling, and potential complications like infection or gland atrophy. Diagnosis may involve imaging techniques such as radiographs and CT scans, while treatment can include supportive care, sialoendoscopy, or surgical options in advanced cases.

1. Sialolithiasis
Presented by:- Ayam Chhatkuli
Guided by:- Dr. Manish sir

2. Description
• Sialolith are typically calcified organic
masses that form within the secretory
system of the major salivary gland
• These are one of the most common
salivary gland condition

3. Etiology
• Believed to develop from deposition of the
calcium salts around a focus of material
within the duct lumen
• Initiating focus may consist of:-
 Desquamated epithelial cells
 Bacteria
 Foreign bodies or mucus

4. The etiological factors favouring salivary
stone formation may be classified into two
groups:-
i. Factors favouring saliva retention and
ii. Saliva composition

5. i. Factors favouring saliva retention
 Irregularities in the duct system
 Local inflammation
 Dehydration
 Medications such as anticholinergics and
diuretics

6. ii. Saliva composition
 calcium saturation and deficit of
crystallization inhibitors such as phytate
 bacterial infection increases salivary pH
favouring calcium phosphate supersaturation
promoting sialolith formation
 smoking affect the cytotoxic activity of partial
duct obstruction

7. Clinical features
Age:- wide age range, has been reported in
children also
Sex:- more common in males
Site:- most common in submandibular
gland(80-90%), followed by parotid (5-
15%) and sublingual (2%-5%)
Very rarely occurs in minor salivary gland

8. Presentation
 Pain
 acute, colicky, periprandial
 intermittent swelling of the affected gland
 Swelling will be evident upon eating
 If only partially obstructed, swelling will
subside when salivary stimulation ceases

9.  stasis of saliva may lead to infection, fibrosis
and gland atrophy
 gland is often enlarged and tender to
palpation
 fistula, a sinus tract or ulceration may occur
in the tissue covering the stone in chronic
cases
Other complications include acute
sialadenitis, ductal stricture and ductal
dilation

10. Diagnosis

11. ₴. Plain film radiographs
• inexpensive, readily available, and result
in minimal radiation exposure

12. ₴. AP view of face
• Useful incase of stones in the parotid
gland
• An occusal film placed intraorally adjacent
to the duct may also be useful

13. £. Conventional sialography
using panoramic occlusal, and panoramic
radiography is useful in cases where there
is a strong clinical suspicion of
inflammation or salivary stone disease

14. contrast sialography using iodinated
contrast media may be used to visualize
the parotid and submandibular ductal
system

16. Limitation
o use of ionizing radiation
o dependence on successful ductal
cannulation
o pain during and after the procedure
o potential allergy to the contrast media
Contra indicated in presence of acute
sialadenitis.

17. ₴.Ultrasound
Non invasive, less costly and maybe able to
visualize radiolucent calculi
Limitation
o May not be able for correct assessment of
the number of calculi
o Calculi less than 2mm may not produce an
acoustic shadow

19. £.Non contrast CT
• Has a 10 fold greater sensitivity than plain
film radiography for detecting calcification
• Technique of choice for detecting small
calculi

22. £. CBCT
• Advantage of reduced superimposition
and distortion of anatomical structure
• Reduced radiation exposure over medical
CT

23. £. MRI sialography
It is contraindicated in individuals with
pacemakers or claustrophobia

24. £. Sialendoscopy
• Access to deeper segment of duct
• Simultaneous visualization and removal of
sialolith

26. Treatment
• During acute phase of sialolithiasis,
therapy is primarily supportive
• Use of analgesics, hydration, antibiotics
and antipyretics as necessary
• Sialogogues, massage and heat applied to
the affected area may also be useful

27. Stones at or near the orifice
 Can be removed transorally by milking the
gland
Deeper stones
 Conventional surgery or sialoendoscopy

28. Interventional sialoendoscopy
 effective even in cases of multiple stones
upto 4-5 mm in diameter

29. Extracorporeal shock wave
lithotripsy(ESWL)
 allows for fragmantation of large sialolith
of any size or location
Contraindicated in cases of
 complete duct stenosis
 Pregnancy
 Patient with cardiac pacemaker

30. Sialoadenectomy
Incase of fixed intraparenchymal stones and
failing gland-sparing techniques

31. Why is there
greater chance of
sialolith formation
in submandibular
gland?

32. 1. The torturous course of whatsons duct
2. The higher calcium and phosphate levels
of secretion contained within
3. The dependent position of the
submandibular glands that leaves them
prone to stasis
4. The increased mucoid nature of secretion

33. In radiograph
Once the radiopacity is established it must be
distinguished from several entities
A calcified lymph node
An embedded tooth
A foreign body
A phlebolith
Calcification in the facial artery
Myositis osificans
An anatomic stricture( such as hyoid bone)