A stone in the salivary gland or salivary stone disease is the formation of the so-called salivolitis in the ducts or (less often) in the parenchyma of these glands. Blockage of the duct causes acute pain, an increase in the size of the gland, 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. Thus, patients suffering from:
- Urolithiasis;
- gout, hyperparathyroidism;
- hypervitaminosis D;
- diabetes.
The risk of stone formation is increased in people who smoke.
And local causes include narrowing and defect of the walls of the ducts, as well as a violation of their secretory function. A salivary gland stone is always accompanied by sialadenitis.
Chemical composition of salivary stone
The formation of the stone occurs around the core, which can be microbial or non-microbial in nature. In the first case, the coreis 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 grains, toothbrush bristles.
The stone contains components of various origins - both organic and mineral. The former accounts for about 10-30%, it consists of amino acids, duct epithelium, mucin. There are much more minerals (70-90%), they mainly include phosphates, calcium carbonate, sodium, potassium, magnesium, chlorine, iron. In general, the chemical composition of the stone in the salivary gland is similar to tartar.
Most likely, the etiopathogenesis of this disease is accompanied by the occurrence of endogenous and exogenous factors that lead to certain pathologies. These include:
- change in composition and secretion of saliva;
- decreased salivary flow rate;
- shift of pH towards alkali and leaching of mineral s alts from saliva.
Stones in the salivary gland: symptoms
Localization of a stone in the parenchyma, as a rule, may not bother a person for a long time. 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 themselves swell while chewing food. However, the most characteristic symptom is the so-called salivary colic. This is a sharp pain due to retention of saliva and an increase in the diameter of the duct.
If the stone blocks the duct of the submandibular salivary gland, then there is pain whenswallowing that radiates to the ear or temple. In case of exacerbation of sialadenitis, subfebrile body temperature, malaise, and headache may occur.
Diagnosis
Diagnosis of the disease is carried out by palpation, in addition, ultrasound examination of the salivary glands, sialography, CT, sialoscintigraphy.
This disease is experienced mainly by people aged 20-45 years. Approximately 1% of the population suffers from this disease. According to statistics, among the dental diseases of the salivary glands, sialolithiasis accounts for about 60%.
Most often, stones are formed in the submandibular regions, and less often - in the sublingual. If the stone is small, then it can be washed out with saliva without interference. However, a large calculus clogs the duct, and then treatment is indispensable. If we talk about the mass of formations, then it varies between 3-20 grams, and in size they can range from one millimeter to several centimeters.
If the location is the 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 may vary.
Removal of a stone from the salivary gland is carried out when medical treatment fails. In such cases, carry out:
- bougienage of salivary ducts;
- lithotripsy;
- sialendoscopy;
- open transaction;
- extirpation of the salivary gland.
Salivary gland stone: treatment
As already mentioned, if the stones are small, they can be excreted with saliva on their own. Sometimes, to facilitate their discharge, conservative therapy is prescribed: a salivary diet, gland massage, thermal procedures. Prevention and relief of the phenomena of acute sialadenitis is carried out with the help of antibiotics.
If the stone in the duct of the salivary gland is located near the mouth, then the dentist can remove it with tweezers or extrusion.
Surgical intervention to remove the stone can be carried out by various methods. The most advanced of these is interventional sialendoscopy, which allows the removal of salivary stones endoscopically, makes it possible to eliminate cicatricial strictures of the ducts.
Modern minimally invasive method is the so-called extracorporeal lithotripsy. Its essence is to crush the stone using ultrasound. Quite often, the method of chemical dissolution of stones is also used, 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. Abscessing of the gland is carried out at the opening of the abscess by diluting the edges of the wound, which ensures unimpeded outflow of pus and discharge of the calculus. In case of recurrent stones or irreversible changesin the structure of the salivary gland, radical measures are resorted to - extirpation of the salivary gland.
Forecast and prevention
When resorting to a 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 patient's quality of life. That is why, if you experience the above symptoms, you should immediately seek medical help.
Early diagnosis avoids removal of the gland, getting rid of the problem by stone extraction.
The main condition for prevention is the exclusion of factors that contribute to stone formation:
- violations of mineral and vitamin metabolism;
- anomalies of ducts;
- bad habits.
