ABSTRACT
BACKGROUND: Salivary stones are calcified structures most often found in the main duct of the submandibular or parotid salivary gland. They contain of a core surrounded by laminated layers of organic and inorganic material. MATERIAL AND METHODS: Submandibular and parotid sialoliths (n=155) were collected at the department of Oral and Maxillofacial surgery of a general hospital between February 1982 and September 2012. The weight of the sialo-liths was determined and the consistency was subjectively classified. Subsequently, the biochemical composition of the stones was determined by wet chemical methods or FT-IR spectrometry. Age and gender of the patients were retrieved from their medical records. Data were statistically analyzed using Fisher's exact tests. RESULTS: Sialoliths are mainly composed of inorganic material. Carbonate apatite was identified in 99% of the stones, phosphate in 88%, calcium in 87%, magnesium in 68%, struvite in 44%, oxalate in 38% and carbonate in 35%. Solid salivary stones contain more frequently struvite than stones with a soft consistency (p = 0.05). Larger stones (> 100 mg) contain more frequently carbonate (p = 0.05). Stones from older patients (≥ 38 years) showed an almost significant trend towards more frequent presence of phosphate (p = 0.083). CONCLUSIONS: The biochemical composition of submandibular and parotid sialoliths is related to stone-related factors, probably to age but not to the gender of the patient
No disponible
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Young Adult , Adult , Middle Aged , Aged , Salivation , Salivary Calculi/chemistry , Spectrometry, X-Ray EmissionABSTRACT
Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. Sialoliths are more frequently located in the submandibular gland (84%), than in the parotid gland (13%). The majority of the submandibular stones are located in Wharton's duct (90%), whereas parotid stones are more often located in the gland itself. Salivary stones consist of an amorphous mineralised nucleus, surrounded by concentric laminated layers of organic and inorganic substances. The organic components of salivary stones include collagen, glycoproteins, amino acids and carbohydrates. The major inorganic components are hydroxyapatite, carbonate apatite, whitlockite and brushite. The management of salivary stones is focused on removing the salivary stones and preservation of salivary gland function which depends on the size and location of the stone. Conservative management of salivary stones consists of salivary gland massage and the use of sialogogues. Other therapeutic options include removal of the stone or in some cases surgical removal of the whole salivary gland.
Subject(s)
Salivary Calculi , Humans , Massage , Oral Surgical Procedures , Salivary Calculi/chemistry , Salivary Calculi/diagnosis , Salivary Calculi/therapy , Salivation/drug effectsABSTRACT
OBJECTIVE: Intraductal laser lithotripsy is a preferred method to fragment large, immobile intraglandular salivary stones. A number of different laser systems has been investigated for this purpose. It was our aim to study the effectiveness of a 980nm diode laser when fragmenting salivary stones in an experimental set up. METHODS: In an experimental set up we used a 980nm diode laser for the lithotripsy of 9 salivary stones. The temperature circle around the laser fibre tip was measured and stone remnants were chemically analysed for their composition. RESULTS: The salivary stones had a mean diameter of 6.7mm×5.6mm×3.0mm. Laser fragmentation with the diode laser was successful at all stones. The temperature next to the salivary stone increased to around 30°C during the active lithotripsy with continuous rinsing (fluid temperature 21°C). At a distance of 2mm the temperature around the laser fibre's tip is reduced by already about 50%. The salivary stones mainly consisted of carbonate apatite, followed by ß-calcium phosphate and other calcium phosphates. CONCLUSION: The fragmentation of salivary stones with a 980nm diode laser is possible in principle. Under a continuous irrigation with a positioning of the laser fibre's tip at the centre of the stone, no relevant temperature increase in the vicinity of the stone occurs. However, before the laser is used in humans, in vivo experiments on animal material seem to be advisable.
Subject(s)
Lasers, Semiconductor , Lithotripsy, Laser/methods , Salivary Calculi/therapy , Apatites , Calcium Oxalate , Calcium Phosphates , Cohort Studies , Humans , Prospective Studies , Salivary Calculi/chemistry , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Sialolithiasis is a common disease of salivary glands. The etiology of these calculi is little known and their exact mechanism of formation is unknown. METHODS: The composition and structure of 21 sialoliths were studied and the composition of the saliva of each corresponding patient was determined (pH, calcium, magnesium, phosphorus, citrate and phytate). RESULTS: Eighteen sialoliths exhibited similar macro and microstructure, being constituted by hydroxyapatite (HAP) and organic matter, normally arranged in a multilayer structure. The three remaining sialoliths were exclusively constituted by organic matter. The salivary Ca of patients with HAP calculi was significantly higher than that found in the saliva of the healthy group. The salivary phytate concentration of patients with HAP calculi was significantly inferior to that found in patients with calculi exclusively formed by organic matter, as well as to that found in saliva of healthy group. Significant differences between the salivary magnesium concentrations of patients with HAP calculi and the control group were also observed. No significant differences between pH and citrate concentrations of the three groups were found. CONCLUSIONS: It was concluded that the deficit of crystallization inhibitors such as myo-inositol hexaphosphate (phytate) was also an important etiologic factor implied in the sialolith development.
