From the Guidelines
Sialoliths can occasionally pass without exiting the salivary duct, but this is not a common outcome and medical intervention is often necessary to prevent complications. The management of salivary gland disorders, including sialoliths, is crucial to prevent pain and potential infections in the trigeminal nerve, as noted in a study published in the British Journal of Anaesthesia 1.
Key Considerations
- Salivary stones are most frequently found in the submandibular gland and can cause intermittent pain, especially before eating, along with tenderness of the involved gland.
- Bimanual palpation can help identify the stone if it is in the duct, and imaging or ultrasound can be useful for further diagnosis.
- Referral to oral/maxillofacial surgeons is often indicated for further management.
Management and Treatment
- Small stones (less than 2mm) may occasionally dissolve within the duct system if salivary flow increases significantly, which can be encouraged by staying well-hydrated, sucking on sugar-free sour candies, or using sialagogues like lemon juice.
- Warm compresses, gentle massage of the gland, and anti-inflammatory medications can help manage symptoms while waiting to see if the stone will pass or dissolve.
- If symptoms persist or worsen, medical intervention, including minimally invasive procedures or surgery, may be necessary to prevent complications like infection.
From the Research
Sialoliths and Salivary Ducts
- Sialoliths, or salivary stones, can cause symptoms by obstructing salivary flow 2
- The majority of salivary stones are located in the submandibular gland, with most of these stones found in Wharton's duct 3
- Salivary stones can range from tiny particles to several centimeters in length and may be asymptomatic or cause minimal discomfort, but larger stones can interfere with saliva flow and cause pain and swelling 4
Treatment and Removal of Sialoliths
- Treatment of salivary stones is focused on removing the stone and preserving salivary gland function, which depends on the size and location of the stone 3
- Conservative management of salivary stones consists of salivary gland massage and the use of sialogogues, while other therapeutic options include removal of the stone or surgical removal of the whole salivary gland 3
- There is no direct evidence to suggest that sialoliths can pass without exiting the salivary duct, as the focus of treatment is on removal of the stone to restore salivary flow and prevent complications such as chronic sialadenitis and glandular atrophy 4, 2, 5
Formation and Composition of Sialoliths
- Sialoliths are formed through the precipitation of calcium onto degenerating cellular membranes, often as a result of chronic obstructive sialadenitis and secretory inactivity 5
- The composition of salivary stones includes an amorphous mineralised nucleus surrounded by concentric laminated layers of organic and inorganic substances, such as hydroxyapatite, carbonate apatite, and collagen 3