Volume: 2014 | Number: 1
ISSN (print): 1855-9913 | ISSN (web): 1855-9921
CASE REPORT: Laser-Assisted Treatment of Sialolithiasis
V Maljkovic, B Gaspirc
Sialolithiasis is the most common disease of the salivary glands. Many cases are asymptomatic, and therefore it is difficult to determine the true prevalence of sialolithiasis. Sialoliths are calcareous deposits in the ducts or the parenchyma of salivary glands. The most common sialoliths are of the submandibular gland (about 80%), followed by the parotid gland (19%), sublingual glands and minor salivary glands (1%). The higher rate of sialolith formation in the submandibular gland is due to the torturous course of Warthon's duct and the position of the glands, which leave them prone to stasis.
The etiology of sialolith formation is still unknown. However, there are several factors that contribute to stone formation. Inflammation, irregularities in the duct system, local irritants, and anticholienergic medications may cause pooling of saliva within the duct, which is thought to promote stone formation.
Clinically, it presents like an acute, painful, and intermittent swelling of the gland, especially during a meal, when the saliva flow is increased. The degree of symptoms is dependent on the extent of salivary duct obstruction and the presence of a secondary infection. The stone may totally or partially block the flow of saliva, causing salivary pooling within the duct and gland body. The enlargement of the gland consequently causes pain. The involved gland is usually enlarged and tender, pus may be seen draining from the duct and signs of systemic infection may be present. Stasis of the saliva may lead to infection, fibrosis and gland atrophy. Possible complications that may arise from sialoliths are acute sialdadenitis, ductal stricture, ductal dilatation, and bacterial infections. If the calculus is large, it can be palpated and sometimes even seen at the duct orifice.