What causes stones to form in the salivary gland? How does the presence of a stone in the salivary gland manifest: when is surgery needed? How is salivary stone disease treated?
Stones in the excretory ducts of the salivary glands or in the parenchyma of the glands are quite common. In terms of the incidence of salivary stone disease (sialolithiasis), the submandibular gland and its excretory duct take first place. Stones most rarely form in the parotid gland. Very rarely, salivary stones are found in the sublingual salivary gland. Salivary stone disease is observed in males and females approximately equally often, mainly in middle-aged and elderly people.
Salivary stones come in various sizes and weights - from tiny stones weighing a few milligrams to stones weighing 3-5-7 g. Stones are also found in large sizes - up to 20-30 g. The shape of the stones is oval or round, their surface is smooth . Salivary stones located in the parenchyma of the gland are usually round, and in the duct they are mostly oblong, oval in shape. On an x-ray, the stones sometimes resemble the shape of a tooth.
Salivary stone usually has a layered structure, and a foreign body is often enclosed in its center. Most often, there is one stone in the gland or duct, but sometimes you can find several stones at once.
In their chemical composition, salivary stones resemble tartar: they contain about 75% calcium phosphate, about 5-10% calcium carbonate, organic substances (epithelial cells, mucin), traces of potassium, magnesium, sodium, chlorine and iron.
The origin of salivary stones is not entirely clear. Some authors associate the formation of salivary stones with inflammation of the salivary gland (sialoadenitis), while previously, on the contrary, it was believed that inflammatory processes in the salivary glands are caused by the presence of a stone. As a result of sialadenitis, swelling and narrowing of the duct occurs. Around the organic core formed in the duct under the influence of the vital activity of bacteria or a foreign body that has previously penetrated into the duct (toothbrush bristles, fish bone, fruit grain), calcareous salts of saliva accumulate. Some authors consider the process of stone formation not as a result of the deposition of calcareous salts from saliva, but as a consequence of changes in the tissue of the gland or duct by the inflammatory process. It is possible that this point of view is more plausible, since the stone apparently forms in the parenchyma of the gland, from where it is pushed into the duct, where it can remain for a long time, gradually increasing in size.
Recently, an opinion has been expressed that salivary stones arise as a result of a violation of mineral, mainly calcium, metabolism, and local causes are of secondary importance.
Clinically, the presence of salivary stones always causes objective and subjective sensations in the patient. This usually happens when the salivary stone reaches a certain size and closes the lumen of the excretory duct. In these cases, due to saliva retention, acute pain occurs, known as “salivary colic,” and a picture of acute inflammation of the salivary gland develops (acute sialadenitis). Enlargement of the gland and dull pain in it, especially when palpated, sometimes radiating to the tongue, temple, etc., can also occur after each meal due to the accumulation of saliva due to insufficient outflow. Even the sight of food can cause these painful sensations due to increased salivation as a result of a conditioned reflex. Some time after eating, the pain gradually goes away and the swelling disappears. Patients with salivary stone disease may experience a large loss of body weight, since due to the pain and swelling that occurs, they try to eat as little as possible. Often, as a result of the presence of stones in the salivary glands, abscesses and phlegmons of the corresponding area develop. Sometimes, when pressure is applied to the gland, serous-purulent fluid is released from the mouth of the duct. In some cases, the stone is gradually pushed through the flow of saliva and muscle movement through the duct to the mouth and is eventually pushed out.
In other cases, the wall becomes necrotic due to the inflammatory process and the stone ends up lying in the abscess cavity directly under the mucous membrane of the floor of the mouth.
The diagnosis of salivary stone disease is facilitated by a characteristic history and palpation of the stone in the gland or duct using a bimanual (two-handed) examination. Sometimes painful swelling in the area of the salivary gland and the presence of an inflammatory infiltrate around the stone make palpation difficult, especially if its size is small. It is often possible to feel the stone when probing the duct. Usually salivary stones are clearly visible on an x-ray (Fig. 83), but in some cases they cannot be determined in this way (small or soft stone, the projection of the image also matters). X-ray examination of the salivary glands with filling them through the excretory ducts with a contrast mass (sialography) is of great help in diagnosing diseases of the salivary glands.
Treatment of salivary stone disease is surgical. Salivary duct stones are usually easy to remove from the oral cavity on an outpatient basis. The walls of the duct are dissected, the stone is removed, after which the surgical wound is drained with iodoform gauze turunda, which is advisable to be fixed with a suture to the oral mucosa. When removing a stone, care should be taken to ensure that the stone does not slip out and enter the respiratory tract. It is much more difficult to remove a stone from the parenchyma of the gland. This intervention is performed in a hospital.
Rice. 83. Stone of the submandibular salivary gland (X-ray). Salivary stone in the peripheral part of the duct of the submandibular salivary gland.
Salivary stone disease (sialolithiasis) is an inflammatory process occurring in the salivary gland. Stones (calculi, salivolitis) can have different shapes and sizes (from 3 to 30 g), and are formed in small glands, submandibular, sublingual or parotid.
Important! The development of this pathology is rare. During the course of the disease, a violation of secretion occurs, which requires timely and high-quality treatment.
The progression of the disease leads to an increase in the stone, which causes discomfort or a feeling of fullness, especially during eating. Within a few minutes, salivary colic goes away, but during the next meal it returns.
Causes of the disease
There are several factors leading to the formation of pathology:
- compression of the ducts as a result of the inflammatory process in the oral cavity;
- mechanical injury to the ducts;
- slow salivary function, leading to stagnation and crystallization of secretions;
- inflammation as a result of foreign particles entering;
- disturbance of metabolic processes, changes in the composition of saliva.
Salivary stone disease in children is usually associated with congenital developmental pathology and is quite rare. The course of the disease in adults and children is the same. In some cases, purulent inflammation joins the development of the disease.
Remember! Lack of timely treatment threatens infection of the canals and, as a result, the development of purulent inflammation.
The stones located in the duct have an oblong shape. The glands formed in the body are round, often with an uneven surface.
Symptoms
At the beginning of pathological changes in the salivary gland, the patient does not feel any symptoms. As the stone grows, the following signs are observed:
- Since less saliva is produced, the mouth feels dry;
- due to the accumulation of fluid, the face and neck area swell;
- saliva is replaced by mucus mixed with pus, which gives an unpleasant taste and smell;
- difficulty opening the mouth, chewing or swallowing;
- the area affected by the stone swells (the earlobe may protrude);
- the skin in the face and neck area takes on a reddish tint.
When the stone reaches a large size, it becomes increasingly difficult for the patient to open his jaws, so he refuses to eat.
Inflammation is accompanied by deterioration of the condition, hyperthermia and loss of strength. The salivary gland becomes firmer and larger to the touch. Loss of appetite, poor sleep and periodic headaches are possible.
Important. If an X-ray examination does not give the required result during diagnosis, the doctor prescribes further studies (CT, ultrasound, MRI, sialography, sialoendoscopy).
After studying the results of the study, the attending physician prescribes treatment for a stone in the salivary gland.
Conservative treatment options
How is a stone removed from the salivary gland? The most commonly used method of disposal is surgery. The chronic form of the disease requires a long therapeutic course, while the acute form requires immediate treatment.
Conservative therapy consists of:
- secretagogues of drugs;
- non-steroidal anti-inflammatory drugs;
- antibacterial medications;
- physiotherapeutic methods.
In each specific case, the drugs are prescribed by the doctor. In addition, conservative therapy includes the use of ground foods and warm drinks (fruit drinks, decoctions). The use of folk remedies is used only as an auxiliary method, in conjunction with traditional medicine.
The administration of salivary drugs together with bougienage of the duct promotes the ejection of the stone by a current of saliva. This method is effective only for small stone sizes.
Important! During the treatment course, you should rinse your mouth every 2 hours and brush your teeth after eating.
Sialolithiasis of the submandibular salivary gland is most common. Small stones can be washed away with saliva, but large stones cannot be removed on their own.
Remember. If the chronic form is accompanied by episodes of exacerbation, surgery to remove salivary gland stones cannot be avoided.
Surgical intervention
If drug therapy does not bring improvement, the doctor removes stones from the salivary gland ducts in several ways:
- bougienage of the salivary ducts (insertion of a probe expands the duct, improving the outflow of saliva);
- sialendoscopy (possible elimination of cicatricial strictures of the ducts);
- extracorporeal lithotripsy (crushing stones with ultrasound);
- intraductal litholysis (dissolution with 3% citric acid solution);
- open surgery (depending on the severity of the disease, either an incision is made and the calculus is removed using a spoon-curette, or the gland itself is removed).
In order to remove stones from the salivary gland, local anesthesia is used in most cases. If surgery is planned to remove a stone from the major salivary gland (parotid), the doctor may use general anesthesia.
Note. Exacerbation of sialolithiasis leads to purulent inflammation. To enhance the outflow of exudate, an incision is made at the site of abscess formation.
Salivary gland stones are calculi (salivolitis) formed in the excretory ducts or parenchyma of the salivary glands. Most often, the formation of stones occurs in the submandibular gland, in rare cases - in the parotid and sublingual glands. The occurrence of stones located in the submandibular gland is directly related to the concentration and viscosity of the saliva secreted by it.
Mostly, salivary gland stones are located in the duct; in rare cases, stones are located in the gland itself. The formation of stones can be either single or multiple, the size of the stones is small. Depending on the location of the stone, you can see a groove that directs saliva into the oral cavity. The chemical composition of the formations is carbon dioxide and phosphate of lime, organic substances contribute to the formation of salivolites. In the process, when a violation of the outflow of saliva develops, the stone stagnates, its constant growth occurs, which leads to swelling and pain during meals. With normal functioning of the salivary glands, stones are removed naturally.
Disease of the salivary glands is quite common and is diagnosed in one person out of 15 thousand. The disease is detected during a general diagnosis of the body; the initial course of the disease is not accompanied by any noticeable discomfort.
Causes of formation of salivary gland stones
When calculi form, the ducts of the salivary gland are blocked, as a result of which saliva does not enter the oral cavity and returns back to the gland. Impaired salivary exchange is characterized by intermittent pain and progressive swelling. In addition, impaired salivary flow may be accompanied by infections.
One of the causes of salivary stone disease is inflammation of the gland. Due to bacterial infections, the parotid gland is damaged, and an inflammatory process begins, blocking the salivary ducts. The disease manifests itself in the form of swelling of the gland, often with purulent discharge that has a specific taste. Most often, the disease occurs in older people who have salivary gland stones. If medical assistance in treating the disease is not provided in a timely manner, there is a possibility of an abscess forming. The inflammatory process of the salivary glands is caused by microorganisms living in the oral cavity - staphylococci. Bacterial infections can result in malnutrition and dehydration.
The progression of viral diseases in humans, such as influenza or mumps, can also cause swelling of the salivary glands. Symptoms of the disease include large swollen cheeks. The appearance of this symptom is provoked by blockage of the parotid salivary glands.
Another reason for the formation of stones in the salivary glands are cysts that form in the oral cavity as a result of injury. Also, the neoplasm may have a congenital pathological nature.
Benign and malignant tumors provoke the occurrence of salivary gland calculi. And in addition to concomitant diseases, the causes of the appearance of salivary gland stones are:
- congenital pathologies of the salivary glands;
- endocrine system disorders;
- smoking;
- hypovitaminosis A;
- impaired metabolism of calcium and phosphorus in the body.
Symptoms of salivary gland stones
A stone in the salivary gland is a pathology that occurs for a long time without visible symptoms. Often, stones are discovered in a patient by accident during a routine examination in the dental office or simply by touching with your own tongue. A stone in the salivary gland is revealed by its compaction; it causes a delay in the secretion of saliva during meals. The swelling in the area of the gland is painful, the unpleasant sensation goes away after saliva enters the oral cavity. Quite often, the formed stone causes an inflammatory process of the salivary gland, which has characteristic symptoms:
- feeling of dryness in the mouth;
- the presence of a specific taste in the mouth;
- pain in the neck and mouth;
- change in the position of the earlobe and the formation of swelling in its area;
- increase in body temperature.
If a stone in the salivary gland provokes an inflammatory process, then the patient begins to feel fatigue and general fatigue, along with this, the body temperature rises. Dry mouth causes problems with eating and even facial expressions. If you ignore a visit to the doctor for a long time, an abscess may form, characterized by a large accumulation of pus in the area of the salivary gland, which can lead to its breakthrough into the oral cavity.
Diagnosis of salivary gland stones
Suspected salivary gland stones are characterized by certain symptoms, but various tests are used to assess the shape and number of stones, as well as their location. The density of the mineralized stone is quite high, so it is quite clearly visible on x-rays. In some situations, an x-ray is not an effective diagnostic method due to the fact that a shadow may fall on the stone or the stone is not sufficiently mineralized. For clearer X-ray results, before starting the procedure, a special substance is injected into the duct, which makes it possible to view the structure and shape of the ducts; the places of ruptures are stones in the salivary gland.
In modern medicine, a diagnostic method in the form of computed tomography is used. With such an examination, stones of the salivary glands are determined, the size of which is less than one millimeter; it is also obvious how many stones are and where they are located. The disadvantage of the method is the inability to determine the condition of the soft tissues.
A clearer diagnostic method is magnetic resonance imaging (MRI). It is used to determine the condition of soft tissues, but it is not able to show the number and location of stones.
Ultrasound examination is also used as diagnostics, but this method requires a highly qualified doctor.
The most accurate and clear method that gives a complete picture of the disease is sialoscopy. It involves inserting microscopic endoscopes into the salivary ducts, allowing doctors to see a real picture of the processes occurring inside the body.
Treatment of salivary gland stones
Treatment for salivary stone disease involves removing the stone. Removing stones from the salivary gland occurs in two ways, depending on their location. When the stone is localized at the mouth of the duct, it is dissected and removed into the oral cavity. The effectiveness of the method is high, but various risks are associated with it:
- impaired taste and tactile sensitivity of the tongue due to nerve damage;
- formation of hematitis and bleeding as a result of damage to large vessels;
- worsening of the disease as a result of displacement of the stone deeper into the duct;
- partial removal of stones.
In some situations, stones are located deep in the ducts or in the thickness of the gland. This position of the stones forces them to be removed along with the gland, which leads to serious consequences. The operation requires hospitalization of the patient and the use of anesthesia. As a result of surgery, there is a risk of the following complications:
- tongue nerve damage;
- vascular trauma leading to life-threatening bleeding;
- trauma to the facial nerve, leading to impaired facial expressions;
- scar formation.
Modern medicine offers another method of treating salivary stone disease - sialoscopy. With this method, salivary gland stones are detected and removed from the ducts using endoscopes. This treatment takes place with virtually no damage to soft tissues. The manipulation is performed under local anesthesia and does not require the patient to be in the hospital. After 30 minutes after the operation, the patient can be discharged from the hospital. During the operation, the doctor inserts small endoscopes into the ducts of the salivary glands, with the help of which the location and number of stones are determined, then they are removed from the ducts using special instruments. Sialoscopy has a number of advantages over other methods for a number of reasons, namely:
- low level of injuries;
- removing stones from different locations;
- use of local anesthesia;
- no risks associated with nerve injuries;
- complete preservation of the salivary gland.
Prognosis and prevention of salivary gland stones
Depending on the treatment method, prognosis will vary. With modern methods of removing stones that preserve the salivary gland, the prognosis for recovery is favorable. With the radical removal of stones, the microflora of the oral cavity is disrupted, tooth decay is possible and the patient’s quality of life decreases.
To prevent salivary stone disease, it is necessary to eliminate factors that contribute to the formation of stones, as well as normalize metabolic processes in the body, get rid of bad habits and adjust drug treatment.
Salivary gland stones or salivolitis are the most common pathology of the human salivary glands. Inflammation of the salivary gland as a result of impaired flow of saliva, infection and inflammation of the gland tissue during salivary stone disease or sialolithiasis is called calculous sialadenitis. This disease is treated by dentists, and in severe cases, when surgical treatment is required, by maxillofacial surgeons. But the primary diagnosis of sialolithiasis is usually made by general practitioners.
Salivolites are salivary gland stones.
Sialolithiasis is a salivary stone disease.
Calculous sialadenitis is inflammation of the salivary gland due to salivary stone disease.
The ducts of three pairs of large salivary glands open into the oral cavity: parotid, submandibular and sublingual. In addition, saliva is produced by minor salivary glands: labial, buccal, lingual, palatine, glands of the floor of the mouth. Their sizes are only up to a few millimeters, and their location does not have an exact anatomical reference.
The most famous of the salivary glands is the parotid gland. glandula parotidea, an acute viral disease of which in children is called mumps or mumps. There are almost never stones in the parotid or sublingual gland. But the submandibular gland is the main stone-forming factory in sialolithiasis. This is probably due to the ascending location of the duct of the submandibular salivary gland.
Salivary gland stones. Causes.
In children and young people, sialolithiasis almost never occurs, and in terms of the chemical composition, salivary gland stones are more than 90% calcium salts - phosphates and carbonates. This indicates the leading role of metabolic disorders in the development of salivary stone disease. Of no small importance are chronic infectious diseases of the oral cavity and ENT organs: caries, chronic diseases of the gums, mouth, chronic diseases of the oral mucosa, etc. Hypovitaminosis, and in some cases structural anomalies of the salivary glands and their ducts, contribute to stone formation.
Symptoms of salivary gland inflammation
First, signs of impaired saliva flow appear. During meals, when salivation is at its maximum and the stone completely or partially blocks the salivary duct, a painful feeling of fullness appears with an increase in the size of the submandibular gland, which can be confused with inflammation of the lymph node. This is the so-called “salivary colic” - an acute attack of pain associated with retention of saliva and mechanical irritation of the duct with a stone. Subsequently, pain occurs when swallowing, radiating to the ear or throat, intensifying while eating. If the stone is large, it can be felt or even seen in the area where the salivary gland duct exits.
Exacerbation of sialadenitis is accompanied by general intoxication, increased body temperature, and headache. Appetite decreases sharply, and even thoughts about food increase pain. There is often an unpleasant taste in the mouth, and when there is suppuration, clots of pus appear in the mouth.
Diagnosis of salivary stone disease
In the differential diagnosis, salivary gland cyst, salivary gland tumor - adenoma and salivary gland cancer, as well as diseases of the ear, throat and teeth should be excluded. Symptoms of inflammation in salivary stone disease are characteristic; you can often feel the stone through the skin or see it. But the final confirmation of the diagnosis is provided by x-ray or ultrasound of the salivary glands.
Treatment of sialolithiasis
With early diagnosis and uncomplicated course, the stone is removed from the duct on an outpatient basis using tweezers. Sometimes dissection of the mouth of the salivary duct is required to remove the stone. Conservative methods include nonsteroidal anti-inflammatory drugs, antibiotics, and dry heat.
If the stone is large in size and located in the salivary gland itself or in the depths of the duct, as well as in the case of the development of purulent complications - an abscess or phlegmon - surgical treatment with removal of the stone, and in some cases complete removal of the salivary gland, is indicated.
The main pathogenetic link is the formation of stones in the ducts of the salivary glands. Most often, the submandibular gland, and more specifically, its ducts, is involved in the pathological process. The ducts of the sublingual and parotid salivary glands are affected less frequently.
The disease is more common in children aged 7–12 years.
Mechanism of disease development
The formation of stones in the salivary glands occurs in the presence of chronic sialadenitis. Inflamed gland tissue creates conditions for disruption of metabolic processes, as a result of which the density of saliva and the rate of its outflow change. Acute forms of the disease are rarely complicated by stone formation.
The photo shows stones extracted from the salivary gland
The formation of a stone or seal in the gland duct leads to disruption of the outflow of saliva. The compensatory mechanism is the expansion of the duct, but this mechanism acts only for a short time, and then closes the pathogenesis ring.
Due to prolonged stagnation of saliva in the dilated duct, all conditions are created for its infection and the formation of an inflammatory infiltrate.
Causes and risk factors
The main reason for the formation of stones in the ducts of the salivary glands is prolonged stagnation of saliva. This condition occurs due to:
- ductal dyskinesia;
- inflammatory changes – sialadenitis;
- disturbance of metabolic processes in the body (metabolism of phosphorus and calcium);
- decreased protective properties of saliva;
- entry of a foreign body into the duct.
A predisposing factor to the development of salivary stone disease is the presence of chronic diseases in the patient caused by metabolic disorders in the body.
Features of the clinical picture
With the development of calculous sialadenitis, the patient experiences a number of symptoms that force him to see a doctor:
- pain in the mouth while eating;
- dry mouth;
- difficulty opening the mouth;
- saliva becomes viscous and difficult to swallow;
- pain in the ear area
Symptoms of the disease develop gradually and are found in various combinations depending on the stage of the disease. At the initial stage, called asymptomatic, the patient only notices the occurrence of unpleasant sensations while eating.
20 minutes after the mechanical impact, the discomfort completely disappears and nothing bothers the person. Do not delude yourself and not pay attention to what is happening. This stage is the first news of the formation of a pathological process. If left untreated, it goes into the acute phase.
Acute VS chronic
Acute sialadenitis develops suddenly, sometimes within several hours, and is manifested by acute pain, fever, general weakness and headache.
This process in most cases accompanies the development of an abscess or phlegmon. Swelling, redness and soreness increase at the site where the salivary gland duct exits.
Eating is difficult due to increased pain with any mechanical impact. On examination, in addition to subjective complaints, a gaping of the mouth of the salivary gland duct, dry mucous membrane, lack of outflow of saliva, and a small amount of pus discharge from the opening are noted.
When the disease becomes chronic, the inflammatory phenomena disappear. A slight swelling remains, asymmetry of the glands develops, and a slight increase in the size of the glandular tissue is formed.
When massaging the duct, a small amount of viscous transparent content is released from it. Careful palpation reveals one or more dense formations in the duct.
Diagnosis of the disease
When identifying the first clinical signs of salivary stone disease, you should immediately consult a doctor.
Modern medicine has made great strides in diagnosing the disease. The patient can be examined by either a dentist or a therapist (in the absence of the former).
Upon examination, the doctor can identify the main clinical sign - an increase in the size of the salivary gland, swelling in the area of the opening of the excretory duct. In some cases, stones are detected in the salivary gland by palpation (by feeling the tumor site with a finger).
To confirm and clarify the diagnosis, the doctor may prescribe the following studies:
- radiography of the upper or lower jaw in a given projection;
- CT scan;
- ultrasonography.
After a detailed study of the research results, the doctor can not only make an accurate diagnosis, but also prescribe the only correct and effective treatment.
Complex of therapeutic measures
Salivary stone disease most often requires surgical treatment. An invasive treatment method is used only after a course of conservative therapy has failed.
In the acute phase of the disease, treatment must be started immediately. When the disease becomes chronic, the course of therapy lasts for a long time, at least two weeks.
Conservative treatment of salivary stone disease includes:
- prescribing medications that enhance the secretion of the salivary glands;
- a course of non-steroidal anti-inflammatory drugs: reduces temperature, reduces tissue swelling, suppresses the inflammatory response;
- antibacterial therapy (if the cause of the disease is a bacterial infection);
- physiotherapeutic treatment.
Methods of conservative treatment include nutrition consisting of crushed and grated foods. Increasing the amount of warm drinks (rosehip decoction, fruit drinks) in order to increase saliva production.
During the treatment period, it is necessary to increase the frequency of hygiene procedures: brush your teeth after every meal, rinse your mouth every 2 hours.
Treatment of the disease with folk remedies is of auxiliary value and should be used only in combination with traditional medicine. The most famous folk recipes are rinsing the mouth with a soda-salt solution and sucking on a slice of lemon.
If the disease becomes chronic with episodes of exacerbation, surgical treatment becomes necessary.
As a first step, doctors resort to galvanization of the salivary glands. This procedure involves applying a low-power electric current to the gland.
In some cases, this is enough to destroy the stones at the formation stage. If the process cannot be stopped, there is a need to perform surgical intervention.
Surgery
In clinical practice, there are clear indications for surgery:
- melting of gland tissue due to a purulent process;
- complete blockage of the gland duct with the development of persistent pain.
Surgical treatment consists of opening the duct and installing drainage. Operating access – oral.
The operation is performed under local anesthesia. The drug is injected in several places, starting from a place 1 - 2 cm behind the stone.
On both sides, parallel to the course of the duct, 2 ligatures are applied, which act as “holds” for the surgeon’s assistant. Only after this a transverse incision of the mucous membrane is performed,
The next stage is opening the duct and removing the stone. The wound is not sutured, but a drainage tape or tube is inserted. Over the course of 3-5 days, antibacterial drugs are injected into the area of the postoperative wound to prevent inflammation.
Prevention of calculous sialadenitis
There is no specific prevention of salivary stone disease. The main preventive measures are aimed at maintaining oral hygiene and eliminating mechanical blockage of the salivary gland duct.
Complications and prognosis
A complication of the acute form of the disorder is its transition to a chronic form. Chronic salivary stone disease leads to dysfunction of the gland.
The long course of the disease provokes the transformation of glandular tissue into fibrous or connective tissue. As a result, the gland acquires a lumpy shape and loses its ability to perform basic functions. This transformation can take place according to the type of tumor transformation.
The prognosis of the disease is doubtful. In 50% of cases, regardless of treatment, relapses occur. Secondary prevention is aimed at preventing the development of severe forms and complications.
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Salivary gland stones
Salivary stone disease or sialolithiasis is a pathology of the salivary glands in which stones form in them. As a result, the normal secretion of saliva is disrupted. Most often, stones develop in the submandibular salivary glands, but they can also affect other major salivary glands. At present, the exact reasons that lead to the development of the disease have not been established.
It is believed that sialolithiasis develops against the background of a violation of mineral, in particular calcium, metabolism. In the first stages of stone formation, symptoms of the pathological process may be absent. As the stone grows, pain and discomfort occurs. If the stone blocks the duct of the salivary gland, the patient will develop swelling and severe pain. To treat the disease, folk remedies are used to normalize metabolism and strengthen the immune system. External rinses help prevent bacterial infection.
Salivary glands
The salivary glands are located in the oral cavity under the mucous membrane. This structure is of epithelial origin, whose main function is the production of saliva. Saliva performs an important function in the digestion process. It contains digestive enzymes, in particular amylase, which begins the process of breaking down carbohydrates. In addition, saliva moistens food and forms a bolus, which then easily passes through the esophagus into the stomach, where the digestion process continues.
There are two types of salivary glands:
- Large glands. There are three known pairs of large salivary glands: parotid, submandibular and sublingual. These glands produce the bulk of saliva.
- Small glands. A large number of single glands that are located throughout the oral cavity. The function of these glands is more related to hydration and protection of the mucous membrane.
Salivary stone disease affects large glands, mainly submandibular. Rarely, stones form in the parotid glands.
Development of the disease
Calcifications form in the salivary glands. Stones can form in the glands themselves or in their ducts. Concrements can have different shapes and sizes. In the body of the gland itself, large round stones are formed; their size can reach several centimeters. More elongated stones of smaller size are formed in the ducts of the gland. Such neoplasms have a layered structure. Sometimes a foreign body can be found in the center of the stone, which triggered the onset of the salt formation process.
The formation of stones leads to partial or complete blockage of the salivary gland duct, which prevents the normal outflow of saliva. In this case, the patient develops swelling, which can be permanent or temporary.
Causes of the disease
At present, the exact causes of salivary gland stones have not been precisely established. This disease is probably caused by metabolic diseases, in particular, calcium metabolism disorders, since in patients, calcifications form in the salivary gland.
The following causes of salivary stone disease are distinguished:
- disturbance of mineral, in particular calcium, metabolism;
- prolonged dehydration;
- lack of vitamins;
- unbalanced, poor quality nutrition;
- hard drinking water with a high content of calcium salts;
- drug therapy with certain drugs: antiallergic,
- antihistamines, diuretics and blood pressure-normalizing drugs;
- mechanical damage to the glands;
- foreign body in the gland.
Symptoms of stones in the salivary gland
At the initial stage, there may be no symptoms of stone formation in the salivary glands. The pathological process does not cause any concern. In this case, the disease can be detected only by chance during an X-ray examination of the jaw.
Clinical manifestations occur when the size of the stone has increased so much that difficulties arise with the outflow of saliva. As the disease progresses, the size of the gland itself increases, which causes discomfort in the patient. Pain also soon appears - a key sign of the formation of salivary gland stones. Painful sensations can last from several minutes to several hours. Most often, discomfort and pain occur during eating.
The stones continue to increase in size, and at a certain point, partial or complete blockage of the gland duct occurs, which leads to disruption of the outflow of saliva. This leads to the formation of edema. The patient experiences sharp pain. If measures are not taken in a timely manner, a person may develop inflammation of the affected salivary glands.
The patient may develop acute and chronic forms of the disease.
The acute form occurs abruptly with severe pain and increased body temperature. In some cases, this condition leads to the formation of an abscess or cellulitis. The patient may develop an infectious process with subsequent discharge of pus. Eating becomes impossible, since the pain intensifies with any impact on the area where the gland is located.
If it is not possible to remove the stone, the disease may become chronic. Inflammation decreases, the person’s condition improves. The patient may still have slight swelling and asymmetry of the glands. When palpated, compactions can be detected.
Diagnosis of pathology
Salivary stone disease is diagnosed using X-ray examination. The x-ray clearly shows stones in the ducts or glands. X-ray examination is carried out in different projections to accurately determine the number, location and size of stones.
For a more accurate diagnosis, you may additionally need:
- X-ray with contrast agent;
- computer topography;
- ultrasonography.
Treatment of salivary stones
Salivary gland stones must be removed. A small tumor can be removed independently, causing increased salivation. Lemon is perfect for this. The patient needs to dissolve a slice of lemon in his mouth until he feels that the blockage has passed and the stone has come out into the oral cavity. A special massage can also contribute to this.
Salivary stone disease develops against the background of a violation of mineral metabolism. It is very important to determine the causes of violations and correct this condition. Traditional treatment for salivary stone disease is aimed at normalizing metabolism and preventing the formation of stones. For these purposes, the following recipes are used:
- Walnut. For treatment you need to take a decoction of the leaves of this plant. For 2 cups of boiling water take 2 tbsp. l. chopped leaves, boil over low heat for 5 minutes, cool and filter. Standard dosage: half a glass 4 times a day.
- Kalina. An infusion of viburnum fruits is prepared. They are ground with honey and poured boiling water, left for an hour and drunk. You need to drink 1 glass of this product per day in two doses.
- Field steelhead. The root of this plant is used in therapy. Finely chop 25 g of the root, add 1000 ml of water and cook over low heat until the volume of liquid is reduced by 1/3, then cool and strain. Drink a decoction of the roots, half a glass 3 times a day, half an hour before meals.
- Melissa. Tea is prepared from lemon balm leaves (you need to take 2 teaspoons of leaves per glass of boiling water). Take 1/3 glass of this tea before each meal.
It is also important to drink general strengthening and immunomodulating drugs that will prevent the development of infection:
- Birch juice. This juice is very useful for those with a tendency to form calcifications. To achieve a therapeutic effect, you need to drink one glass of juice daily.
You can also use a decoction of birch buds or young leaves for treatment. Take 1 tbsp per glass of boiling water. l. dried or fresh plant materials. Drink at least two glasses of this product a day.
External oral products are also used for treatment:
- Soda solution. For a glass of warm water you need to take 1 tbsp. l. baking soda, stir and soak a cotton swab in the solution. The oral cavity is thoroughly treated with this swab 2-3 times a day.
- A decoction of spruce or pine needles. The decoction described above can also be used to rinse your mouth 3 times a day.
Prognosis and prevention
The prognosis is favorable in most cases. If measures are taken in a timely manner, there will be no negative consequences for the body. A possible complication of sialolithiasis is an inflammatory process that develops if a stone injures the gland and interferes with the normal outflow of urine.
To prevent the disease, first of all, you need to monitor the general health of the body, since sialolithiasis develops in most cases against the background of metabolic diseases. It is also necessary to drink and use only purified drinking water for cooking.
It is also necessary to monitor oral hygiene: brush your teeth after every meal, use dental floss, and rinse your mouth regularly. This will prevent infection of the affected gland and the development of inflammation.
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Magazine headings
This pathology is quite rare, but it requires timely and high-quality treatment. Salivary stones often form in the submandibular ducts, and can have different parameters (from 3 to 30 g) and different shapes (round, oval).
The disease is more often diagnosed among the male population aged 20 to 45 years.
Causes of salivary stone formation – who is at risk?
In the human body there are three large groups of salivary glands: sublingual, parotid, submandibular. This is where stones often form.
In small glands, stones are found much less frequently.
Salivary stones can form due to several factors, which can be divided into two groups:
Caused by changes in the amount of calcium and some other minerals in the blood. An increase in this substance provokes the formation of stones in certain organs.
Calcium imbalance can occur due to the following phenomena:
- Vitamin D overdose/poisoning.
- Malignant/non-malignant neoplasms.
- Presence of bone metastases.
- Diabetes.
- Taking antiallergic, psychotropic, diuretic drugs.
- Smoking.
Common factors also include a lack of vitamin A in the body. Such a defect negatively affects the acidity of saliva and deforms the membrane of the excretory ducts.
There may be several of them:
- Incorrect structure of the salivary gland ducts. In certain areas they are narrowed, in others they are expanded. This is a congenital anomaly.
- Mechanical effect on the salivary gland. Incorrectly chosen artificial crowns and the cutting part of the teeth (in case of chips) can act as irritants.
- The harmful effects of a foreign body (for example, a bristle from a toothbrush, a small fish bone) that has entered the duct.
- Inflammatory processes inside the duct. Harmful microorganisms multiply in a closed area, which leads to the accumulation of purulent masses. This increases inflammation and contributes to the increase in stone parameters.
Symptoms and diagnosis of stones in the salivary glands - do not miss the pathology!
Depending on the size and location of the stone and the stage of the disease, symptoms will vary.
At the initial stages, the disease in question does not manifest itself. It can be detected randomly during an X-ray examination (as prescribed by the orthodontist).
Surgically removed salivary gland and duct stones
- Tingling, discomfort in the sublingual area when eating food. This is especially true for salty foods. After finishing the meal, this phenomenon disappears within a few minutes.
- Swelling of the neck, face. This is due to an increase in the parameters of the stone and blockage of the salivary gland channels. There are no complaints of pain, but upon palpation of the pathological area, unpleasant sensations and tingling occur. During such an examination, the doctor can palpate a dense formation - the location of the calculus. If the stone is located in the parotid region, the patient experiences swelling near the ears, and the earlobe is somewhat protruding.
- An increase in body temperature, severe pain (especially when chewing), redness of the mucous membrane in the area of the tongue and cheeks indicate the development of an inflammatory process. There may be pain radiating to the throat and tongue (if the stone is located in the submandibular area). Sometimes purulent discharge appears from the opening of the canal, but this does not happen often.
- Decreased salivation, which manifests itself as a constant feeling of dry mouth. As the composition of saliva changes, bad breath may occur.
To recognize this disease, the following methods are used:
- Examination of the salivary canal with a special probe, which helps to identify the stone, determine the size of the mouth, and calculate the distance from the mouth to the stone. Such a device should not be used if the disease is in the acute stage.
- X-ray of the parotid gland. To do this, the film is placed in the oral cavity in the area of the mouth, and the picture is taken so that the rays fall perpendicular to the cheek. Radiation of the submandibular gland is carried out through a lateral projection. This diagnostic method is not always effective: shadows from the bones may overlap the desired stone, or it may be low-contrast.
- Sialography, which involves the use of contrast agents that are easily soluble in water. This method makes it possible to identify the localization of the stone and examine the structure of the duct.
- Ultrasound of the salivary glands. It is indicative if there are small stones that the doctor is not able to palpate. For the same purpose, a CT scan of the gland may be prescribed.
- Secret cytogram. Helps identify inflammatory processes in the gland. It should be carried out in combination with other methods.
All treatment methods for salivary gland stones – when is surgery needed?
Often, the treatment of the disease in question is complex.
However, if the size of the stone is small and it is localized near the mouth of the canal, doctors try conservative therapy.
- Taking medications that increase salivation: Canephron, pilocarpine hydrochloride, potassium iodide. The use of knotweed herb will also be useful: a quarter glass 3 times a day for a month.
- Bougienage of the canal mouth. The salivary umbrella should be of large diameter, and after insertion it is left for at least 30 minutes, after which it is removed.
- Special diet. Acidic foods increase salivation. Before eating, you can hold a thin slice of lemon in your mouth. Sauerkraut, cranberries (including cranberry juice), squash, beets, and rosehip decoction will help eliminate congestion in the salivary gland. But the amount of fish and cottage cheese in the daily diet should be minimized.
- Massage of the gland, dry heat, and oily compresses have a positive effect on salivation, and also help relieve swelling and reduce pain. To relieve severe pain, penicillin-novocaine blockades can be used, which are injected into the damaged area.
- The stone is located in the parotid duct. It is removed by resection of the area on the inside of the cheek along the trajectory of the closure of the teeth. Sometimes (if the stone is located in the middle/posterior section of the parotid canal), the surgeon cuts out a flap using an intraoral or extraoral approach.
- The stone is localized in the submandibular canal. The operator makes an incision under the tongue, and after removing the stone, a new opening is created. To carry out the described manipulations, anesthesia is required, and there is no need to go to the hospital. Today, stones can be removed through endoscopy (a minimally invasive method) or by crushing with ultrasound. There are practically no contraindications to these methods; the only drawback is the cost.
- The calculus is located in the intraglandular ducts of the submandibular gland; chronic sialadenitis is diagnosed. The patient has the gland removed in a hospital setting.
After the operation, no stitches are applied - the wound heals quickly.
Antibiotics, painkillers, and herbal rinses may be prescribed.
In addition, in 10-20% of cases there is a relapse of the disease. In these cases, it is recommended to remove the entire salivary gland.
When an abscess forms, the doctor opens it, during which the stone can come out on its own.
Prevention of salivary gland stones and forecasts for the future
- Deterioration of dental condition.
- Errors in the functioning of the gastrointestinal tract.
- Xerostomia.
- Monitor the mineral balance in the body. Calcium levels in the blood can be determined using a urine test.
- Improve vitamin metabolism through the use of special vitamin complexes.
- Take measures to eliminate defects in the salivary gland channels (if any).
- To refuse from bad habits.
Chronic cheek biting can be caused by many reasons, and can lead to a number of serious consequences, including a precancerous condition. Therefore, the regular appearance of ulcers in the oral cavity is a reason to immediately contact a dentist for a proper examination and adequate treatment.→
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Salivary stone disease (sialolithiasis) - causes and methods of treating the disease
Salivary stone disease is a very unpleasant common phenomenon, which is characterized by the formation of stones in the salivary gland.
When the ducts become clogged, severe pain may be felt, a significant enlargement of the gland, and in an advanced stage, even the appearance of phlegmon or an abscess.
It is extremely difficult to detect the disease at an early stage, due to the absence of pronounced symptoms, and the pain may not last long.
Stones may leave the salivary gland on their own, or complex treatment may be required. As a rule, in case of complications, conservative therapy is prescribed, as well as a number of medical methods to quickly eliminate the problem and prevent relapses.
Characteristics and symptoms
The process of blocking the ducts with mineral formations, which can be from one to a whole group, is also called sialolithiasis of the submandibular salivary gland. This disease occurs in no more than 1% of the population in middle age.
Stones can form in glands such as:
A stone in the salivary duct can occur in almost everyone, but the difference is that small particles are washed out independently by saliva in the absence of disorders and pathologies. Problems begin if salivation is weakened or stones are large and in the plural.
They can be completely different in shape. As a rule, the salivary stone, which forms closer to the gland itself, has a more rounded shape, as well as a distorted surface. Stones that appear directly in the duct are more elongated and pointed in appearance.
Stone in the salivary gland: photo of the extracted formation
A stone in the duct of the salivary gland is characterized by a yellowish-grayish tint and a layered structure. One stone has a base in the center, the so-called core, around which the remaining parts - salts - are layered. If you look closely, you can find small channels through which saliva follows.
The size and weight of stones may vary depending on the nature of their occurrence and the severity of the disease. Thus, they can reach several centimeters and weigh up to several tens of grams, but their weight and size are not interrelated.
At the very beginning of the onset of sialolithiasis, no symptoms may be observed.
In addition, at this stage, stones can independently leave the body along with saliva.
The presence of a foreign body in the ducts and glands can be detected randomly during examination of another disease.
However, for those who have any pathologies, there may be a delay in the secretion of salivary fluid, which is why the stones cannot be removed, but only become more clogged. The same applies to large stones, which, among other things, were formed in the submandibular duct.
As the disease progresses, pain begins to be felt when eating, as well as some discomfort, similar to “bloating” of the gland.
This phenomenon is called salivary colic and can last from several minutes to several hours. Once it has stopped, it may be triggered again by the next meal.
It can be quite difficult to detect the disease at this stage. In addition, pain may not bother you for years, but the ducts may not have been fully cleaned. As a rule, the nuance can be determined only through a detailed examination and identification of a slightly enlarged gland.
As the disease “ripens” and the stone grows, pain may occur when swallowing and also radiate to the ear. In addition, low-grade body temperature, general malaise and fatigue, headache, and heaviness may be observed. If the ducts are severely blocked, cellulitis or abscesses may form.
Causes of sialolithiasis
If there are malfunctions in the functioning of salivation, causing the fluid to be released weakly, foreign bodies are not properly removed by saliva, but are retained in the ducts and form blockages.
There is often a situation where a small fish bone, some small grains, etc. can get stuck in the ducts. The weak secretion of saliva cannot cope with such an “object”, and then it lingers there, weakening the pressure even more.
The second group of reasons includes diseases and disorders in the body, against the background of which sialolithiasis can develop:
- gout;
- urolithiasis disease;
- diabetes;
- hyperparathyroidism;
- avitaminosis;
- failure of calcium metabolism.
It is worth clarifying that physical pathology, for example, curvature or narrowing of the walls, can contribute to the formation of stones in the salivary gland. Active smokers, as well as those taking certain medications (psychotropic, antihistamines, etc.) are also susceptible to a similar problem.
Diagnosis of the disease
At the initial stage of sialolithiasis, it is extremely difficult to identify it, especially if there is no feeling of discomfort or pain.
In fact, only a detailed examination can help detect changes in the size of the gland, and this can occur when determining another disease.
However, another way to identify the problem is through bimanual palpation.
It allows you to determine pain and a certain structure. If the duct is probed, a neoplasm can also be detected. In some, the disease may manifest itself through the release of purulent secretion when the gland duct gapes.
If sialolithiasis is suspected, the specialist should prescribe a more detailed examination to confirm or refute the approximate diagnosis:
- radiography;
- digital sialoscopy;
- X-ray contrast examination;
- computer sialoscintigraphy.
A sample of salivary fluid is also taken for biochemical analysis so that the composition can be determined and distinguished between sialolithiasis and other diseases, such as oral tumors and others.
Treatment of salivary stones
When making an accurate diagnosis and determining the stage of the disease, the attending physician must prescribe a specific course of treatment.
If the formations are able to independently leave the ducts along with saliva, then a special diet is prescribed.
It consists of consuming foods that promote the active formation of saliva. Doctors also advise providing yourself with thermal treatments, massaging the glands, etc.
In order to exclude the occurrence of relapse or any complications, the specialist prescribes special antibiotics. Taking them will help avoid acute sialolithiasis, and also act as a common prevention of the disease.
Dangerous formations located at the entrance to the duct can be freely removed by squeezing or using a special tool. Typically, this procedure can be performed by a dentist.
As for more complex stages of salivary stone disease, surgical intervention may be necessary.
There are quite a few surgical removal methods, and the choice of the appropriate one depends on the situation itself.
Speaking about a stone in the salivary gland, when surgery is required, endoscopy is most often used. With its help, it not only gets rid of foreign bodies, but also eliminates the scar structures of clogged ducts.
The method of removing formations using ultrasound is actively gaining popularity. With its help, stones are crushed into small pieces and removed either by a stream of saliva or by additional rinsing. This helps in cases where the stones are not too large and crushing them will not cause additional harm.
In case of complications of the disease and the formation of abscesses, it is necessary to use a full-fledged surgical intervention, which consists of opening the formation and dissecting the duct. Thus, the path is cleared for purulent discharge and stones, which makes it possible to remove them without much difficulty.
Traditional methods
In addition to radical medical or surgical methods, treatment with folk remedies is also important for stones in the salivary gland.
It is worth understanding that her methods are applicable only at the initial stage of the disease or in the absence of complications, which can only be dealt with by a more radical method.
The most popular and effective folk recipes for getting rid of stones in the salivary gland are quite simple and do not require much effort.
To eliminate inflammation and pain, you should take 1 tsp. honey, 1 tsp. sunflower or olive oil, chicken protein and a small ampoule of novocaine (0.5%).
The resulting mixture must be used to treat the entire oral cavity, but special emphasis should be placed on the site of inflammation. After a few weeks, you should start using the plant - Siberian istod.
Roots of the Siberian origin
You need to take its roots and grind them, then take a few tablespoons of the resulting mass and pour a glass of room water. Bring the mixture to a boil in a water bath (no more than 40 minutes). After this, you should consume the resulting decoction not 2 tablespoons up to 4 times a day before meals.
When undergoing a course of treatment, both traditional and medicinal, you should refresh yourself with natural juices.
Particular preference should be given to birch. It fights the formation of stones, as well as the occurrence of the inflammatory process.
It is also necessary to alternately drink cabbage and carrot juices, as well as pine infusion. The essence of such drinks is to strengthen the immune system and enhance the body's protective functions. Echinacea tea is also great for this. In addition to drinking it, you should also rinse your mouth with it. It performs an antimicrobial function, which will quickly eliminate the problem.
Disease prevention
However, this is fraught with much more serious consequences, since it causes a malfunction in the functioning of the entire oral cavity, and also disrupts the usual environment of the necessary microflora.
Therefore, first of all, one should, if possible, exclude factors that contribute to the development of such a disease and monitor the recurrent activity of the disease.
You should prevent disorders in the body that can cause the formation of stones, and also follow the recommendations of your doctor. In addition, you need to monitor the occurrence of symptoms of the disease.
Sialadenitis is inflammation of the submandibular salivary gland. Patients with this diagnosis most often complain of tingling at the site of stone formation and pain while eating.
The formation of a parotid gland cyst is often associated with a violation of the flow or retreat of secretions. Less commonly, the appearance of a cyst is associated with benign or malignant formations.
Gingivitis is the most common disease associated with gum inflammation. This disease is accompanied by bleeding, swelling of the gums and their redness.
Video on the topic
An interview about what salivary stone disease of the submandibular salivary gland is with a professor, head of the department of maxillofacial surgery.
