This document discusses sialolithiasis, which is the formation of salivary stones in the salivary ducts or glands. Sialoliths are calcified masses that form from the crystallization of salivary minerals. Sialolithiasis most commonly occurs in the submandibular gland due to anatomical factors. Clinically, patients experience pain and swelling during or after eating. Investigations like radiographs and sialography can detect sialoliths. Larger stones may be removed surgically through the duct or gland. Complications include inflammation, duct dilation, and gland atrophy if left untreated.

1. DR DAVIS
NADAKKAVUKARAN
ORAL AND
MAXILLOFACIAL
SURGERY

2. CONTENTS
• INTRODUCTION
• DEFINITION
• ETIOLOGY
• CLINICAL FEATURES
• INVESTIGATIONS
• COMPLICATIONS
• MANAGEMENT

3. INTRODUCTION
• Salivary glands can be classified as major and minor
salivary glands
• major Salivary glands are parotid , submandibular
and sublingual glands.
• Minor salivary glands are widely distributed in oral
cavity.
• Function : produce saliva

4. DEFINITION
• Sialolithiasis is the formation of salivary stone in the
salivary duct or gland resulting in the obstruction of
the salivary flow.
• Sialolith – it is a calcified mass with laminated layers
of inorganic material. it results from crystallization of
salivary solutes.

5. ETIOLOGY
• Inflammation stagnation of saliva
• Irritation
formation of inorganic
• Drugs nidus and its calcification
• Metabolic cause – not established yet

6. CLINICAL FEATURES
• Sialolithiasis mainly occur in submandibular gland due
to :
- long curved wharton’s duct
- positioning of the gland
- tenacity of saliva due to its high
mucin content.
-alkalinity of saliva
• Can occur at any age – in middle aged persons
• Patients complaints of pain and swelling during and after
eating of food.

7. • On examination stone can be palpated, especially if
present in peripheral aspect of duct.
SIALOLITH
 Chemical and physical feature :
- yellowish white in colour ; single or multiple
may be round, ovoid or elongated with a size of 2
cm or more in diameter.
- made up of mainly by calcium phosphate , small
amounts of CaCO3, organic materials and water.

8. • Histologic Features :
- calcified mass exhibiting concentric
laminations around a central nidus of amorphous
debris.
• It is said that sialolith grows at a rate of 1mm
/year.

9. INVESTIGATIONS
• Radiographs :- AnteroPosterior view
- lateral oblique
- occlusal view
• Sialography : specialized radiographic method
involving filling of ducts and parenchyma with a
radiopaque agent and make them visible on a
radiograph.

12. COMPLICATIONS
• Sialolithiasis is both a cause and consequence of
sialadinitis and it is frequently a cause of acute
suppurative sialadinitis.
• Sialoangiectasis : dilatation of the gland and duct
system can happen because of stasis of saliva.
• Retention of saliva – formation of mucoceles.
• Complete obstruction of the duct may result in
atrophy of gland.

13. MANAGEMENT
• A suitable procedure is selected depending upon
number , size, and site of the stone in the duct or
gland .
• milking the gland : Smaller sialolith if located
peripheraly near the ductal opening, may be
removed by manipulation

14. • Surgical removal – larger sialoliths
 transoral sialolithotomy of submandibular duct
• carried out under local anesthesia
• The exact site of stone is located by X-rays
• a suture is placed behind the stone to prevent
its backward movement
• Tongue is lifted and held with the help of a guaze

15. • Insicion is made in the mucosa parallel to the duct
taking care not to injure structures like lingual nerve
and sublingual glands
• After this , a blunt dissection is carried out. The
tissues are displaced to locate the gland.
• Part of the duct lodging the stone is identified, then a
longitudinal incision is made over the stone
• Stone is removed using forceps . If the stone is large,
it is crushed using forceps.

16. • A cannula is passed to aspirate the pieces of stone.
A probe is passed to ensure the patency of duct
anterior to surgical area
• Sutures are placed at the level of mucosa.

18. • Sometimes stones which are not impacted, may
be extracted through intubation of the duct with
fine soft plastic catheter and application of
suction to the tube.
• Modern techniques like piezoelectric shockwave
lithotripsy to fragment the salivary stone can also
be used.the fragments pass through the duct as
salivary flow is stimulated by use of sialogogues.

20. REFERANCE
• TEXT BOOK OF ORAL AND
MAXILLOFACIAL SURGERY – NEELIMA
ANIL MALIK , third edition
• SHAFER’S TEXT BOOK OF ORAL
PATHOLOGY - SHAFER, HINE , LEVY ,
seventh edition

21. THANK YOU