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__NOTOC__
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{{Sialolithiasis}}
{{Sialolithiasis}}
{{CMG}}; {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu]
{{CMG}}; {{AE}}{{MA}}  
==Overview==


==Historical Perspective==
==Historical Perspective==
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==Classification==
==Classification==
There is no established system for the classification of sialolithisis, but it may be classified according to location of the stone, [[radiopaque]] or radiolucent, [[symptomatic]] or [[asymptomatic]].
There is no established system for the classification of sialolithiasis, but it may be classified according to the location of the stone, [[radiopaque]] or radiolucent, [[symptomatic]] or [[asymptomatic]].


==Pathophysiology==
==Pathophysiology==
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==Causes==
==Causes==
The exact etiology of sialolithiasis is not well understood, but relative stagnation of salivary flow and calcium concentration may be important.
The exact etiology of sialolithiasis is not well understood, but the relative stagnation of salivary flow and calcium concentration may be important.


==Differentiating Hereditary pancreatitis from Other Diseases==
==Differentiating Hereditary pancreatitis from Other Diseases==
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==Diagnosis==
==Diagnosis==
===Diagnostic study of choice===
===Diagnostic study of choice===
Sialolithiasis is mainly diagnosed by history and physical examination. Diagnosis can be confirmed by [[computed tomography]], [[ultrasound]], magnetic resonance sialography, conventional [[sialography]]. High resolution noncontrast computed tomography (CT) scanning is the study of choice for the diagnosis of sialolithisis.
Sialolithiasis is mainly diagnosed by history and physical examination. Diagnosis can be confirmed by [[computed tomography]], [[ultrasound]], magnetic resonance sialography, conventional [[sialography]]. High resolution noncontrast computed tomography (CT) scanning is the study of choice for the diagnosis of sialolithiasis.


===History and Symptoms===
===History and Symptoms===
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===Ultrasound===
===Ultrasound===
Ultrasound may be helpful in the diagnosis of sialolithiasis. Findings on ultrasound suggestive of sialolithiasis include hyperechoic points or lines with distal acoustic shadowing and dilation of excretory duct.
Ultrasound may be helpful in the diagnosis of sialolithiasis. Findings on ultrasound suggestive of sialolithiasis include hyperechoic points or lines with distal acoustic shadowing and dilation of the excretory duct.


===CT scan===
===CT scan===
Head and neck CT scan is the study of choice for the diagnosis of sialolithiasis. Findings on CT scan suggestive of sialolithiasis include hyperdensity of gland with stranding and enlargement of gland in acute obstruction. In chronic sialolithiasis, fatty atrophy and reduction in salivary gland parenchymal volume may be seen.
Head and neck CT scan is the study of choice for the diagnosis of sialolithiasis. Findings on CT scan suggestive of sialolithiasis include hyperdensity of gland with stranding and enlargement of the gland in acute obstruction. In chronic sialolithiasis, fatty atrophy and reduction in salivary gland parenchymal volume may be seen.


===MRI===
===MRI===
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===Surgery===
===Surgery===
Many cases of sialolithiasis may not be cured by using medical therapy alone; invasive, or open [[surgery]] methods can be used for the salivary gland stones. Most common used methods are sialoendoscopy, [[laser lithotripsy]], and stone removal with wire basket. If all of above methods fails, open surgical intervention should be used.
Many cases of sialolithiasis may not be cured by using medical therapy alone; invasive, or open [[surgery]] methods can be used for the salivary gland stones. Most commonly used methods are sialoendoscopy, [[laser lithotripsy]], and stone removal with wire basket. If all of above methods fail, open surgical intervention should be used.


===Primary Prevention===
===Primary Prevention===
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[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
​​

Revision as of 17:19, 7 February 2018

Sialolithiasis Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Sialolithiasis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

Echocardiography or Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]

Historical Perspective

Sialolithiasis was first discovered by Küttner in 1986. Sialadenoscope were used for the first time in 1991.

Classification

There is no established system for the classification of sialolithiasis, but it may be classified according to the location of the stone, radiopaque or radiolucent, symptomatic or asymptomatic.

Pathophysiology

Sialolithiasis is the presence of stones within the salivary glands or the salivary gland ducts.The exact pathogenesis of sialolithiasis not fully understood but the relative stagnation of salivary flow and calcium concentration may be important. 75 percent of sialolithiasis cases are single. 3 percent of stones are bilateral and most of them are located in parotid glands. Stone formation is 80 to 90 percent in the submandibular gland, 6 to 20 percent in the parotid glands and 1 to 2 percent in the sublingual or minor salivary glands. Sialoadenitis is inflammation of a salivary gland. Acute sialoadenitis may be caused by viral or bacterial infection. Chronic sialoadenitis is caused by repeated episodes of inflammation. On gross pathology, hard yellow -white spherical depositions usually less than 1 cm are seen. On microscopic pathology, dilated ducts with squamous metaplasia or calculi are usually present.

Causes

The exact etiology of sialolithiasis is not well understood, but the relative stagnation of salivary flow and calcium concentration may be important.

Differentiating Hereditary pancreatitis from Other Diseases

Sialolithiasis must be differentiated from other diseases that cause swelling in salivary glands, such as acute bacterial sialadenitis, chronic bacterial sialadenitis, viral sialadenitishuman immunodeficiency virus, radiation, and systemic diseases such as, sarcoidosis, and sjögren's syndrome.

Epidemiology and Demographics

The incidence of sialolithiasis is approximately 100 per 100,000 individuals in autopsy studies worldwide. The prevalence of sialolithiasis is approximately 450 per 100,000 individuals worldwide. Sialolithiasis commonly affects individuals between the ages of 30 and 60 years. There is no racial predilection to sialolithiasis. Men are more commonly affected by sialolithiasis than women.

Risk Factors

Common risk factors in the development of sialolithiasis include dehydrationduiretics, local traumasjögrens.

Screening

There is insufficient evidence to recommend routine screening for sialolithiasis.

Natural History, Complications, and Prognosis

If left untreated, patients with sialolithiasis may progress to develop secondary infection and chronic sialadenitis. Common complications of sialolithiasis include infection and recurrence. Prognosis is generally good.

Diagnosis

Diagnostic study of choice

Sialolithiasis is mainly diagnosed by history and physical examination. Diagnosis can be confirmed by computed tomographyultrasound, magnetic resonance sialography, conventional sialography. High resolution noncontrast computed tomography (CT) scanning is the study of choice for the diagnosis of sialolithiasis.

History and Symptoms

A positive history of intermittent pain and hard lumps is suggestive of sialolithiasis. The most common symptoms of sialolithiasis include pain and swelling. Less common symptoms of sialolithiasis include painless swelling, pain without swelling and bad breath.

Physical Examination

Patients with sialolithiasis usually appear normal. Physical examination of patients with sialolithiasis is usually remarkable for tenderness of the involved gland, palpable hard lump and pus discharging from the duct in cases of acute bacterial sialadenitis.

Laboratory Findings

There are no diagnostic laboratory findings associated with sialolithiasis. In the case of superimposed inflammation and infection, high ESR or leukocytosis may be seen.

Electrocardiogram

There are no ECG findings associated with sialolithiasis.

X-ray

An x-ray may be helpful in the diagnosis of sialolithiasis. Radiopaque stones can be seen in x-rays.

Ultrasound

Ultrasound may be helpful in the diagnosis of sialolithiasis. Findings on ultrasound suggestive of sialolithiasis include hyperechoic points or lines with distal acoustic shadowing and dilation of the excretory duct.

CT scan

Head and neck CT scan is the study of choice for the diagnosis of sialolithiasis. Findings on CT scan suggestive of sialolithiasis include hyperdensity of gland with stranding and enlargement of the gland in acute obstruction. In chronic sialolithiasis, fatty atrophy and reduction in salivary gland parenchymal volume may be seen.

MRI

Magnetic resonance sialography may be helpful in the diagnosis of sialolithiasis Findings on Magnetic resonance sialography suggestive of sialolithiasis include low signal regions outlined by saliva ( high signal regions) on T2 weighted images. MRI can distinguished acute from chronic obstruction.

Other Imaging Findings

Sialography may be helpful in the diagnosis of sialolithiasis. Findings on sialography suggestive of sialolithiasis include filling defect and the contrast agent not passing through the duct due to complete obstruction.

Other Diagnostic Studies

There are no other diagnostic studies associated with sialolithiasis.

Treatment

Medical Therapy

Conservative treatment is the first line of therapy in the most patients. The most commonly used treatment options are hydration, moist heat, gland massage, and pain control. Antibiotics can be used in the case of superimposed infection. Many cases of sialolithiasis may not be cured by using medical therapy alone; invasive, or open surgery methods can be used for the salivary gland stones.

Surgery

Many cases of sialolithiasis may not be cured by using medical therapy alone; invasive, or open surgery methods can be used for the salivary gland stones. Most commonly used methods are sialoendoscopy, laser lithotripsy, and stone removal with wire basket. If all of above methods fail, open surgical intervention should be used.

Primary Prevention

Effective measures for the primary prevention of sialolithiasis include healthy oral care regimen and increased water intake. There are no available vaccines against sialolithiasis.

Secondary Prevention

Effective measures for the secondary prevention of sialolithiasis include healthy oral care regimen, treatment of underlying disease and avoiding anticholinergic and diuretic medications.

References


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