Oral surgery :: Salivary stone disease

In other words - stones in the salivary glands. It is a very common disease, accounting for 51.5% of all diseases of these glands. Its causes and development are still unclear, but three theories are proposed:

Microbial, according to which the cause of the formation of salivary stones are microorganisms, especially actinomycetes, which have entered the glandular duct. On the one hand, they cause inflammation, and on the other, they serve as the nucleus around which salts of saliva precipitate.
Mechanical - according to this theory, foreign bodies that have fallen into the canal are of major importance: fish bones, hair from toothbrushes, cereal grains, tartar pieces, etc. They irritate, cause inflammation and become the nucleus around which salts precipitate. . Supporting this theory is the fact that in the middle of the salivary stone quite often found some of the listed foreign bodies.
Compression - it explains the formation of salivary stones by squeezing the gland duct from adjacent inflammatory and other processes, which slows the flow of saliva and leads to the deposition of its salts.

Some studies have also found impaired calcium-phosphorus metabolism in patients with salivary stone disease. Other prerequisites are anatomical anomalies in the shape of the canal, which slows down the flow of saliva. In addition, during the inflammatory process, the mucous membrane upholstery drains faster, resulting in multiple nuclei for salt deposition. Finally yet importantly is the role of the nervous system. Under certain conditions, long-lasting spasms occur in the duct and, in addition to all of the above, conditions exist for the deposition of salts of the saliva. Most often-salivary stones formed in the submaxillary salivary gland and in its duct.The stones can be single and multiple. We observed a unique case with over 500 stones removed from the canal of a single gland. The stones also differ in shape and weight. The maximum weight described is 36 g. Most often, they are round or oval. Their color varies from yellow to off-white. In the cross section, concentric circles of layers formed around one center. In composition, they are similar to that of tartar - 70 - 75% of inorganic substances, mainly calcium phosphate, calcium carbonate, traces of chlorine, manganese, iron and about 25 - 30% of organic substances - protein, mucin, epithelial cells, and bacteria.The course of salivary stone disease depends primarily on the size of the stone and its location. If it is in the gland itself the disease is going on for a long time asymptomatic, but if it is in the canal, it often clogs it and there is swelling in the gland itself, especially during feeding. Stagnation of saliva causes inflammation, reaching even suppuration. Sometimes the stone discarded, but we usually discovered accidentally at X-ray for something else. There are also stones, which are not X-ray contrasted. To detect them we use contrast radiography, called sialography. When examining a patient, the stone can be touched, and in some cases, it see through the mucosa and we can see the stone. We provide you with an X-ray and a photo of a stone in the submandibular salivary gland - a clinical case in our practice.



The patient himself found a bump under the tongue and took it with his mobile phone / photo on the left /. The swell disappeared, reappeared, which led him to a doctor who in turn appointed a scanner. The X-ray (scanner slice) on the right shows a circular-shaped stone about the size of a small pea located in the channel of the submandibular gland and in the photo the same stone that protrudes through the mucous membrane. Touching the index finger on both hands from outside under the chin and inside on the translucent stone, its shape, approximate size and firmness are well established.

The treatment is by administering salivary, anti-inflammatory and enlargement channels in small stones and surgically in large ones. In the case of particularly large salivary stones located within the gland itself, the entire gland is removed operatively, and this is done with an approach outside the oral cavity, through the skin, which is done in a hospital setting and with complete anesthesia. In this case, under local anesthesia, a ligature of the gland duct was made behind the location of the salivary stone, and then a diode surgical laser cut the mucosa over the stone, through which it was removed with ease (see photos below). Depending on wound size, we can put suture or left it without such. In this case, no sewing was required.



At particularly large stones, we insert a probe into the canal. We place a seam above the probe to restore the patency of the canal itself. In our case, we did not have a suture because the wound would never close and thus formed a new outlet of the gland through which the saliva would drain.


 

Here is what the place looks like one week after the stone removal operation. The arrow shows a fine cicatrix from the laser cut. The patient has no complaints.Another case of stone in the duct of the salivary gland.



This picture shows a bump on the floor of the oral cavity. We can find a hard formation upon palpation.



On the radiography, we can see a stone in the canal.It has shape like a bullet.



The stone after operation




The length of the stone is 10 mm Another case of a stone in the channel of the submandibullary salivary gland



We conducted salivary treatment and the stone discarded.Another case with multiple stones in both salivary glands
It is about a young woman who has a swelling in the submaxillary area for a year, intensifying with eating and afterwards.
Here is what we saw on the scanner - the relatively large stones in the two under the jaw salivary glands.









The 3D image shows, in addition to the two large stones and a few small ones, located on the left below the jawbone.
Initially, the stones were in the gland itself. After salivary therapy, they moved forward as the left entered the canal and the right stood at the entrance to the canal itself. This gave surgical access and we first removed the left stone. The patient scored 4 - 5 small pebbles due to salivary therapy.



However, the question was not with the right stone. He was never able to enter the canal because of its irregular shape and naturally because of its large size. With a little more effort, we were able to pull it out into the three large debris you see in the next picture.

As we dried the blood from the operative wound of the gauze, we also found a fourth fragment that you see in the next picture. We also see that the largest fragment is the size of the left salivary stone.



Finally, when the patient said that he was touching "something like a ball" just behind the lower incisors with his tongue, we found that another stone had emerged from the canal of the right submandibular salivary gland. Here it is in the next picture. As you can see from the picture, its length is about 4 mm....
 



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