Sialoliths can occur in any of the major or minor salivary glands.
The most common salivary gland stones occur in the submandibular gland, accounting for 80% of sialoliths.
5 to 10% of salivary gland calculi occur in the parotid gland and 1-5% form in the sublingual gland or minor salivary glands.
Attributed to submandibular gland being more alkaline and having a higher mucin and calcium concentration then other salivary glands.
The submandibular duct has a long course and against gravity results in stagnation of salivary flow and is believed to contribute to stone formation.
Patients usually present with intermittent pain.
Eating exacerbates symptoms as the extra saliva produce with chewing ensnares in the gland.
Exact mechanism of sialith formation is not currently unknown.
Dehydration, reduced salivary flow and abnormalities in calcium metabolism are believed to contribute to stone formation.
Occasionally patients have a palpable gland in the neck along with erythema and pus discharge from the duct opening under the tongue.
CT scanning and ultrasound are the primary diagnostic modalities.
Treatment consists primarily of pain control, warm compresses and sialogogues to promote stone passes.
Small stones in the duct can be removed with massage.
Surgical removal can be performed to be removed the stone from the duct and the patient also can have removal of stones by a sialendoscope.
Uncomplicated sialolithiasis does not require antibiotic management.
Antibiotic treatment may be necessary for signs of a systemic infection , with the most frequent organisms identified a Staphylococcus aureus and Streptococcus viridans.
Untreated disease or failure for the stone to pass can be complicated by secondary infection, gland inflammation , atrophy, fibrosis, or ductal stricture.