Description

• Inflammation or “stones” involving ≥1 salivary gland
• Sialolithiasis is the cause of ~90% of all obstructive salivary gland diseases.
• Salivary obstruction is clinically characterized by a food-related painful swelling of the affected gland, known as “mealtime syndrome.”
• The submandibular gland is more commonly affected by sialolithiasis and infection than is the parotid gland.
• Can be acute or chronic
• Types:
  • Infectious
  • Obstructive (sialolithiasis)
  • Autoimmune
• System(s) affected: Gastrointestinal

Epidemiology

• A review of British patients showed an incidence of symptomatic sialolithiasis of 27–59/1,000,000 population per year (1)[B].
• Predominant sex: Male > Female
• Predominant age: Peak incidence is 30–60 years
• Most common in debilitated patients

• Salivary calculi can be found in 1.2 % of the adult population.
• Only 3% of all cases occur in the pediatric population.
• In those with sialographic evidence of benign intraductal obstruction, the obstruction is caused by salivary calculi in 73.2% of cases.

Risk Factors

• Dehydration
• Anticholinergic use
• Antihistamine use
• Diuretic use
• Poor oral hygiene
• Malnutrition
• Head/Neck radiation
• Tuberculosis (TB)
• HIV
• Failure to immunize (mumps)
• Gout

• Sjögren syndrome
• Polygenic cause, with several loci under investigation

General Prevention

• Adequate postop hydration
• Maintain proper oral care.
• Avoid antihistamines, anticholinergics, and other causes of xerostomia.

Pathophysiology

• Decreased salivary outflow from anticholinergics, dehydration, or radiation is thought to allow bacterial infection of salivary glands.
• Salivary calculi are thought to form as the result of deposition of calcium phosphate around an initial organic matrix consisting of altered salivary mucins, bacteria, and desquamated epithelial cells. Predisposing factors include salivary stasis, increased alkalinity of saliva, salivary infection, and physical trauma to salivary duct or gland (2)[B].
• Systemic abnormalities of calcium metabolism do not cause salivary stones. Gout is the only systemic disease known to be associated with salivary stones development. In gout, sialoliths are composed of uric acid.

Etiology

• Bacterial:
  • Staphylococcus aureus
  • Streptococcus viridans
  • Streptococcus pyogenes
  • Haemophilus influenza
  • Escherichia coli
• Viral:
  • Mumps
  • Cytomegalovirus (CMV), Epstein-Barr virus (EBV)
  • HIV
  • Enteroviruses

Commonly Associated Conditions

• Postop dehydration
• Radiation-induced xerostomia
• Drug-induced xerostomia
• Sjögren syndrome
• Hypercalcemia