Salivary stone disease — sialoliths: symptoms and treatment
In the practice of a dentist often, this pathology of the salivary glands, as the salivary stone disease (sialolithiasis). This pathology is one of the varieties of inflammation of the salivary glands (sialadenitis), a characteristic of a blockage in glands formed in it with a rock. When sialolithiasis minerals saliva to form calculus, which prevents the excretion of saliva into the oral cavity by blockage of alveolus or duct. In this salivary fluid continues to be produced and to accumulate in a confined space, which leads to a local inflammatory process or aggravate it. Mainly affects one of the submandibular glands, less likely to be affected parotid, sublingual and small submucosal glands.
The reasons for the development
- The inflammatory process. It initiates a fall in the structural elements of the gland microorganisms that multiply and cause stagnation and alkalization of saliva. Its mineral components are precipitated and form a concretion;
- Mechanical duct injury with subsequent scarring to prevent the release of saliva;
- Slow salivation, increase in viscosity, stagnation and crystallization, the transformation in stone;
- Contact duct of a foreign body of small size that will not cause blockage of the main ducts, so some time may go unnoticed, gradually causing inflammation and causing a blockage;
- Metabolic disorders primarily associated with the increase in the concentration of calcium. Such pathologies include thyroid disease, pituitary.
To sialolithiasis may cause one of the infections: mumps, syphilis, tuberculosis, actinomycetes.
To identify sialoliths, the doctor, after examination and collection of complaints sends the patient for further examination.
The x-ray method is good to visualize the presence of stones. The main thing — to choose the right projection to distinguish calculus from bone structure. Sialography most successfully used method, is based on the x-ray radiation with a preliminary introduction to the flow of a contrast agent. The blockage of a gland stone solution cannot spread in the course of the ducts, so will set more reliable localization.
If the previous methods did not help to determine the location of the stone, and palpation education find does not work, you can assign the ultrasound. It also makes sense to ultrasonography, if the patient is contraindicated x-ray.
The most accurate and modern method of diagnosis — a study using computed tomography. The resulting image allows to judge about the exact size, density and localization with an accuracy of tenths of a millimeter.
The clinical picture
The initial symptoms
At the beginning of salivary stone disease does not manifest itself brightly. The patient begins to notice pain in the affected gland, reminiscent of tingling. May noted swelling, increased contours on palpation.
Further, the pain increases, attacks become more frequent. As a result of inflammation is suppuration of the tissues of the gland, manifested General symptoms: fever, General malaise. There is a definite pattern: the closer the stone is to be released in the oral cavity, the more symptoms.
The acute phase
Often the symptoms of salivary stone diseases look similar and differ only in the localization of the glands on the face and in the mouth appear as follows:
- Swollen neck or face (unilateral swelling in the pathology of the parotid glands), the redness in this area;
- Chewing, opening the mouth or swallowing may be difficult in connection with the compression of the responsible muscles, or spread them inflammation;
- The feeling of dryness of the mucous membranes (symptom of sjögren’s);
- Increased viscosity of saliva, as the predominant part of the mucosa, unpleasant taste and smell;
- Trouble speaking with a large amount of stone;
- Pain, over time growing and is manifested even at rest;
- Swelling from the oral cavity in the area of the stone;
- With the defeat of parotid salivary gland observed ottopyrivanie ear lobe.
Primarily the disease is treated promptly, however, if you have a chance to conduct an effective medical therapy, surgery try to prevent. The treatment pursues the following objectives:
- Removal of calculus from duct gland;
- The removal of the inflammatory phenomena;
- Ensuring patency of the previously occluded duct;
- Correction of mineral metabolism in the case that the stone was formed as a result of hypermineralization gland;
- Treatment of infection, if it led to sialolithiasis.
Drug therapy is indicated for the small size of the stone, combined with massage of the gland to stimulate the release of stone in the mouth.
Analgesic therapy aimed at relief of sensations from the compression of the tissues of the gland and the inflammatory process. With this purpose, prescribed analgesics from the group of nonsteroidal anti-inflammatory means of the action. This group of drugs reduces the main signs of inflammation such as redness, swelling, the symptoms of General weakness. However, by themselves, these drugs will not be effective without addressing the causes.
Antimicrobial therapy (antibiotics, antivirals sometimes) is assigned individually, based on the detection of a suspected pathogen. Because of the large number of side effects, self medication of antibiotics is strictly contraindicated.
To stimulate saliva, that is, the acceleration of leaching of rock, prescribe low-concentrated citric acid which is injected directly into the duct. Another positive feature is the acidification of the environment, which not only prevents the increase of stone, but contributes to its gradual dissolution.
In the complex of treatment in parallel can be assigned to drugs that is similar to the therapy of urolithiasis. Perhaps the appointment physiotherapy, however, when increasing the symptoms of inflammation that it should be closed and go to surgical methods.
If the treatment of salivary stone disease impossible drug, and the delay may cause complications, it falls under the supervision and appointment of the surgeon.
A relatively gentle methods are physical — the doctor may attempt of galvanic (electrical current) or ultrasonic waves to crush the stone to flow out of the pieces. If these manipulations do not lead to the desired results and in case if there is abscess formation, are shown invasive surgery. During surgery any surgeon strives to save their own breast tissue, however if you are unable to remove the stone without damaging critical structures, the doctor has to excise the gland completely or partially.
Surgical intervention and postoperative services with this diagnosis always takes place with the use of antibiotics and means, relieving inflammation.
The progress of the operation
If the stone is close to the mouth of the duct, the operation takes little time and is performed on an outpatient basis. In more complicated cases the patient sent to the hospital. The surgeon, identifying the location of the concretion, holds a local anesthetic, then bandaging the duct, makes it the incision. After extracting the stone installs drainage, the stitches do not need. As a rule, duct or independently overgrown in its original form, or it formed an additional branch.
In situations where salivary stone disease has led to abscess formation, required not only to remove the blockage and cleanse the prostate of pus. Depending on the gland in which is formed a purulent lesion, under local anesthesia spend incision and drainage set. Usually the stone is released into the oral cavity with purulent masses, and additional interventions are required.
Especially in children
In children, salivary stone disease is uncommon. Main precipitating factor is the mumps — inflammation of parotid glands of the infectious process. The disease is caused by pathogen viral origin, primarily aged 3-15 years.
Treatment is possible at home, but in the case of complicated forms necessarily hospitalization.
- Abscesses or diffuse phlegmon — abscess around the blocked area, leading to the loss of health of body which may not recover even after surgery. Not diagnosed on time, the purulent process may lead to a fatal outcome because the blood supply to the head is very intense and the microbial flora extends with high speed, including the brain;
- During surgery on the parotid gland, there is a danger of damage to the facial or lingual nerve, which leads to neuritis, sometimes paresis, and paralysis of facial muscles. When injured arteries and large veins, passing in the affected area may bleed;
- When blockage of the ducts there is a risk that formed a fistula opening on the skin;
- Cicatricial changes in the thickness of the gland;
- Pushing the stones into the ducts, making it difficult to remove and may lead to resection of the gland;
- The removal of the prostate gland is not a dangerous procedure, however the oral cavity loses part of the volume of salivary fluid, and this has a negative impact on mineral exchange of enamel that gradually leads to development of caries;
Fault diagnosis and lack of treatment can cause late detection of the formed tumor formation.
To prevent this unpleasant and dangerous for its complications, the disease should follow simple rules:
- To give as possible of harmful habits;
- Observe the indicators of mineral metabolism. Especially true if the disease is already manifested and you want to prevent recurrence;
- Balanced diet, vitamin therapy;
- Congenital anomalies of organs of the oral cavity, in particular the violation of structures of the ducts of the glands are subject to correction in a planned manner;
- Good oral hygiene helps to prevent problems not only salivary glands but also many other diseases in the oral cavity.
At the appearance of disturbing symptoms it is necessary to contact the dentist. If there are doubts about the causes of complaints, suffice it to refer to a therapist, who will prescribe to a narrow specialist.