Torus mandibularis and its implication as a risk factor for the formation of sialolithiasis.

Sialolithiasis is the formation of a stone within the salivary gland, and approximately 80% of them occur within the submandibular gland. Sialolithiasis can lead to swelling and pain of the gland in the immediate phase and if left untreated, can lead to sialadenitis and even atrophy of the gland. Certain factors have already been established in the formation of sialolithiasis such as dehydration, tobacco smoke, autoimmune disorders and certain medications. One factor we theorise contributes to the formation of sialolithiasis is bony outgrowths on the tongue surface of the jaw, called mandibular tori. These outgrowths can lead to external compression of the submandibular duct, which leads to impeded salivary flow and the potential for sialolith formation. We present two cases in which individuals had submandibular sialolithiasis in the setting of extensive mandibular tori.

Identifying sialoliths through SEM technology.

OBJECTIVE: To define SEM characteristics that may aid identification of sialoliths. MATERIALS: Two sialoliths from modern patients affected by sialadenitis. METHODS: Samples were coated with silver and subjected to scanning electron microscopy using an energy-dispersive X-ray spectroscopy detector. Samples were then sectioned to permit study of the internal structure. RESULTS: Sialoliths show an external smooth surface with no distinctive features. Internal structures consist of a distinctive aggregate of coarse granules of different sizes surrounded by a lamellar coat. Elemental composition consists of carbon, phosphate, calcium and oxygen, with traces of magnesium. The proportion of these elements differs between the core and the surface. CONCLUSION: Although elemental composition is not specific, SEM analyses of sialoliths greatly differ from those of sesamoid bones, gallstones and nephroliths. Therefore, SEM analysis constitutes a useful tool for the precise identification of small calcified structures recovered during archaeological excavations. SIGNIFICANCE: Precise identification of calcified structures may provide information about nutritional and/or pathological aspects of past individuals. LIMITATIONS: Sialoliths are less common than other types of calcifications, and only two cases were analyzed in this study. FUTURE PROSPECTS: SEM technology should be applied to identify the etiology of all minute calcified remains recovered during archaeological excavations of burial sites.

Sialendoscopic removal of gold filament thread-induced sialolith in the duct of the parotid gland.

Foreign body-induced sialolith is very rare. We report minimally invasive sialendoscopic removal of gold filament thread-induced sialolith in the duct of the parotid gland. A 51-year-old woman with recurrent swelling of the left parotid gland was referred to our hospital. She had undergone insertion of 0.1-mm-diameter gold filament threads into the subdermal skin for facial rejuvenation previously. Computed tomography showed many gold filament threads in the subdermal skin and a sialolith (9.5×4.1×7.9mm) including a gold filament thread in the left parotid duct. The patient underwent endoscopic removal of the sialolith using a 1.6-mm-diameter sialendoscope and Holmium laser under general anesthesia. The sialolith was completely removed with basket and forceps after laser fragmentation, and the broken fragments contained gold filament thread. There was no recurrence of parotid gland swelling after the removal.

A case-control study of the association between sialolithiasis and osteoporosis.

OBJECTIVE: The purpose of this study was to evaluate the association between osteoporosis and salivary gland stone using a population-based claims database. DESIGN: A case-control design. SETTING: Taiwan. PARTICIPANTS: We retrieved the sample for this case-control study from the Taiwan "Longitudinal Health Insurance Database 2005." All 557 patients aged 40 years or older with a diagnosis of sialolithiasis were cases, and 1671 matched controls (without sialolithiasis) were selected. SUBJECTS AND METHODS: We used the chi-square test to explore differences between cases and controls on socio-demographic characteristics. Furthermore, conditional logistic regressions were used to examine the association of sialolithiasis with previously diagnosed osteoporosis. RESULTS: Of 2228 sampled patients, 171 (7.68%) had ever been previously diagnosed with osteoporosis; 58 (10.41%) among cases and 113 (6.76%) among controls (P = 0.005). Conditional logistic regression analysis found that the odds ratio (OR) of prior osteoporosis for cases was 1.79 (95% confidence interval [CI]: 1.24-2.59, P = 0.002) relative to controls after adjusting for urbanisation and the selected medical co-morbidities. Furthermore, we found that among patients aged ≥65 years, the adjusted OR of prior osteoporosis for cases was 1.89 (95% CI = 1.02-3.51). No significant relationship was observed among patients aged <65 years old. CONCLUSION: This study demonstrates an association between sialolithiasis and osteoporosis. Although the finding warrants further investigation, the results call for more awareness of the possible concurrence of osteoporosis among physicians and patients with salivary gland stones.

Lack of evidence that nephrolithiasis increases the risk of sialolithiasis: A longitudinal follow-up study using a national sample cohort.

OBJECTIVE: The objective of this study was to evaluate the risk of sialolithiasis in nephrolithiasis patients. METHODS: Using data from the national cohort study from the Korean Health Insurance Review and Assessment Service, we selected 24,038 patients with nephrolithiasis. The control group consisted of 96,152 participants without nephrolithiasis who were matched 1:4 by age, sex, income, region of residence, diabetes, hypertension, and dyslipidemia. The incidence of sialolithiasis in the two groups was compared, with a follow-up period of up to 12 years. The crude and adjusted hazard ratio (HR) of nephrolithiasis to sialolithiasis was analyzed with a Cox-proportional hazard regression model. RESULTS: The rates of sialolithiasis in the nephrolithiasis group and the control group were not significantly different (0.08% vs. 0.1%, P = 0.447). The crude and adjusted hazard ratios of nephrolithiasis to sialolithiasis were not statistically significant (crude HR = 0.82, 95% confidence interval [CI] = 0.50-1.35, P = 0.448; adjusted HR = 0.81, 95% CI = 0.49-1.33, P = 0.399). Subgroup analyses according to age and sex also failed to reveal statistical significance. CONCLUSION: There is no evidence of an increased risk of sialolithiasis associated with nephrolithiasis. We suggest that routine evaluation for sialolithiasis in all patients with nephrolithiasis is not necessary.

Cystinuria: One Possible Reason for Kidney and Salivary Gland Lithiasis Relationship.

Salivary gland lithiasis affects 1 to 2% of adults. The submandibular glands are concerned in 87% of cases. An association between kidney and salivary lithiases, although often mentioned, has rarely been observed. We relate an exceptional case of parotid and submandibular cystine sialolithiasis with kidney cystine lithiasis in a patient with cystinuria. Cystine lithiasis occurs in 1% of kidney lithiasis cases. The purpose of this article is to discuss the arguments, diagnosis, and therapeutic attitude in front of salivary cystine lithiasis. The patient was a 56-year-old woman treated for cystinuria undergoing a consultation for parotid lithiases. We obtained a panoramic view and performed a cervicofacial computed tomography scan, sialo-magnetic resonance imaging, and sialendoscopy. We found multiple lithiases in the distal portions of the Stensen duct, and 2 days after sialendoscopy, the patient expelled small sialoliths. Salivary lithiasis in patients with cystinuria has the same biochemical composition as kidney lithiasis. A computed tomography scan is efficient in most cases, but sialo-magnetic resonance imaging may be the only noninvasive method to diagnose small cystine salivary lithiases, such as those that can be seen in patients with cystinuria. Sialendoscopy is still an efficient diagnostic and therapeutic method for every type of salivary lithiasis.

Association of serum electrolytes and smoking with salivary gland stone formation.

To further define potential factors that may contribute to stone formation in salivary glands (sialolithiasis), a retrospective chart review was performed of patients diagnosed with sialolithiasis between March 1, 1998 and February 29, 2012. Information on salivary gland stone number, location and size, medical history, medications, and serum electrolyte levels were collected. Associations between electrolyte levels and stone characteristics (such as stone number and size) were examined. Fifty-nine patients were identified; their median age was 58 years (range 25-89 years) and most were male (95%). Salivary stones were most commonly located in the submandibular glands (83%). Thirty-five patients (59%) had a smoking history, with 16 (27%) reported as current smokers. There was a significant association between current smoker status and stone size (mean largest stone size 12.4±8.8mm vs. 7.5±4.8mm in current smokers vs. non-smokers; P=0.03). Serum sodium levels (r=0.32, P=0.014) and serum potassium levels (r=0.31, P=0.017) showed significant positive correlations with stone size. While the aetiology of sialolithiasis remains unclear, smoking (which can contribute to reduced saliva flow) and higher serum sodium levels (which can reflect volume depletion) are associated with larger salivary stones.

A population-based study on the association between chronic periodontitis and sialolithiasis.

OBJECTIVES/HYPOTHESIS: Whereas the impression that poor oral hygiene is linked to the development of sialolithiasis may be widely accepted, very few studies provide evidence to support this. This study therefore aimed to evaluate the association between chronic periodontitis (CP) and the subsequent development of salivary gland stone based on a nationwide coverage database. STUDY DESIGN: A case-control study. METHODS: A total of 987 subjects with sialolithiasis were included as cases. In a ratio of five controls per case, 4,935 controls matched in terms of sex and age group were selected. Conditional logistic regression analysis was performed to determine the possible association of sialolithiasis with previously diagnosed CP. RESULTS: The prevalence of prior CP between cases and controls demonstrated that 1,831 (30.9%) out of the 5,922 sampled subjects had prior CP. By Chi-square test, there was a significant difference in the prevalence of prior CP between the cases and controls (36.8% vs. 29.7%, P < 0.001). By conditional logistic regression analysis, the odds ratio (OR) of prior CP for cases was 1.37 (95% confidence interval [CI], 1.19-1.56) compared to the controls after adjusting for geographic location and tobacco use. Further analyzing the relationship between sialolithiasis and prior CP according to sex, sialolithiasis was associated with prior CP regardless of sex. The adjusted OR of prior CP for the cases was 1.34 (95% CI, 1.10-1.64) and 1.41 (95% CI, 1.15-1.73) for males and females, respectively, when compared to controls. CONCLUSION: This study demonstrates an association between CP and sialolithiasis. LEVEL OF EVIDENCE: 3b.

Association of sialolithiasis with cholelithiasis: A population-based study.

BACKGROUND: The purpose of this study was to evaluate the association between cholelithiasis and developing sialolithiasis using a population-based coverage database. METHODS: The data for this study were sourced from the Taiwan Longitudinal Health Insurance Database. We included 745 subjects with sialolithiasis as cases and 3725 sex-matched and age-matched subjects without sialolithiasis as controls. RESULTS: Chi-square test revealed a significant difference in the prevalence of prior cholelithiasis between the cases and controls (8.6% vs 4.1%; p < .001). Furthermore, conditional logistic regression analysis indicated that the odds ratio (OR) of prior cholelithiasis for the cases was 2.19 (95% confidence interval [CI] = 1.62-2.98) when compared with the controls after adjusting for monthly income, geographic location, urbanization level, and tobacco use disorder. The adjusted OR of prior cholelithiasis for cases was 2.20 (95% CI = 1.46-3.33) and 2.15 (95% CI = 1.38-3.42) than controls for men and women, respectively. CONCLUSION: This study demonstrates an association between sialolithiasis and cholelithiasis.

Does drinking water influence hospital-admitted sialolithiasis on an epidemiological level in Denmark?

OBJECTIVES: Sialolithiasis, or salivary stones, is not a rare disease of the major salivary glands. However, the aetiology and incidence remain largely unknown. Since sialoliths are comprised mainly of calcium phosphate salts, we hypothesise that drinking water calcium levels and other elements in drinking water could play a role in sialolithiasis. Owing to substantial intermunicipality differences in drinking water composition, Denmark constitutes a unique environment for testing such relations. DESIGN: An epidemiological study based on patient data extracted from the National Patient Registry and drinking water data from the Geological Survey of Denmark and Greenland retrieved as weighted data on all major drinking water constituents for each of the 3364 waterworks in Denmark. All patient cases with International Statistical Classification of Diseases 10th Revision (ICD-10) codes for sialolithiasis registered between the years 2000 and 2010 were included in the study (n=3014) and related to the drinking water composition on a municipality level (n=98). PRIMARY AND SECONDARY OUTCOME MEASURES: Multiple regression analysis using iterative search and testing among all demographic and drinking water variables with sialolithiasis incidence as the outcome in search of possible relations among the variables tested. RESULTS: The nationwide incidence of hospital-admitted sialolithiasis was 5.5 cases per 100,000 citizens per year in Denmark. Strong relations were found between the incidence of sialolithiasis and the drinking water concentration of calcium, magnesium and hydrogen carbonate, however, in separate models (p<0.001). Analyses also confirmed correlations between drinking water calcium and magnesium and their concentration in saliva whereas this was not the case for hydrogen carbonate. CONCLUSIONS: Differences in drinking water calcium and magnesium may play a role in the incidence of sialolithiasis. These findings are of interest because many countries have started large-scale desalination programmes of drinking water.

Systemic diseases and the risk of developing salivary stones: a case control study.

OBJECTIVE: To investigate the possible relationship between the presence of salivary stones and systemic diseases, medication, smoking, and alcohol consumption. STUDY DESIGN: A retrospective, case control study. Medical records of patients with salivary stones and those of control patients without salivary stones were retrospectively reviewed. Data regarding the affected salivary gland, the presence of systemic disease, and the use of medication, tobacco, and alcohol were recorded. Statistical analysis was performed using the Fisher Exact tests. RESULTS: Medical records of 208 patients with salivary stones and those of 208 control patients were reviewed. Of the patients diagnosed with salivary stones, the submandibular gland was affected in 85.6% of the patients, the parotid gland in 9.6%, and the sublingual gland in 2.4% of the patients. None of the recorded systemic diseases was more prevalent in patients with salivary stones. Patients with salivary stones used significantly more antibiotics compared with the control group (P = .037). No significant differences were observed for other types of medication. There was no correlation between salivary stone formation, smoking, and alcohol consumption. CONCLUSIONS: The present study suggested that systemic diseases, medication, smoking, and alcohol consumption play no or only a limited role in the onset of salivary stones.

Salivary gland diseases: infections, sialolithiasis and mucoceles.

The three most frequently diagnosed salivary gland diseases are salivary gland infections, sialolithiasis and mucoceles. Salivary gland infections are usually of bacterial or viral etiology and can be divided into acute and chronic types. Occasionally they can result from obstruction of the salivary duct, an autoimmmune disease or cancer therapy. Infections can occur in all types of salivary glands and are observed at all ages. Sialolithiasis is characterized by the development of calcified structures in the salivary glands, especially in the submandibular gland. Sialoliths are generally attributed to retention of saliva and are usually accompanied by swelling and pain when a salivary stimulus is applied. Mucoceles can be differentiated into mucus extravasation phenomenon or mucus escape reaction, mucus retention cysts and ranulas. They result from extravasation of saliva into the surrounding soft tissues or from retention of saliva within the duct.

Unusual case of a sialolith: a case report.

Sialoliths are a common cause of salivary gland obstruction, usually affecting the submandibular gland. Although many theories are postulated for their formation (dehydration, medications that reduce salivary flow, increased salivary viscosity), no one aspect is clearly the primary etiology. This case report details an unusual case in which a facial hair of the patient apparently became entrapped in Wharton's duct, causing a nidus for the formation of a sialolith.

A retrospective case series illustrating a possible association between a widened hilum and sialolith formation in the submandibular gland.

OBJECTIVE: The purpose of this study was to explore any association between anatomical variances in the ductal system and sialolith formation using sialoendoscopy and acrylic resin replication of the ductal system. METHODS: A retrospective study of 372 submandibular gland sialoendoscopies was performed to review the findings of the submandibular gland duct anatomy. Using sialoendoscopy and replicated casts, a high rate of hilar widening was noted in patients with submandibular sialolithiasis. RESULTS: Sialolithiasis was detected in 326 of the patients who presented with obstructive symptoms. Around 67% (285/426) of the stones were located in the distal third of the ducts or at the hilum of the submandibular gland. During the sialoendoscopic procedure, the anatomy of the ductal system was examined and 285/326 (87.4%) of the hilums were noted to be widened like a basin. The anatomy of the duct from the replicated casts demonstrated a treelike structure and the basin-like widening of the hilum was found in all the excised submandibular glands. CONCLUSION: Using sialoendoscopy, a high number of patients presenting with sialolithiasis in the submandibular gland seem to have an anatomical variance in the hilar region. The reproduced ductal system from excised glands also demonstrated this abnormal widening of the hilum. Although further studies need to be performed, we try and explain why there is such a high prevalence of hilar widening in patients with submandibular sialolithiasis.

The management of benign salivary disease: a case series.

There are many causes for benign salivary gland disease but the most common relate to inflammation and infection. This usually revolves around duct obstruction and a reduction in the normal salivary flow from the gland into the mouth. This leads to retention of saliva, proximal to the obstruction and ascending infection from the mouth, usually because of the decrease in salivary flow. The increase in tension behind the obstruction causes significant pain and swelling, along with the inevitable infection if the obstruction is not relieved. This paper discusses the various treatments available for benign salivary gland disease, the traditional methods of treatment through to the use of endoscopic techniques which are currently available, including a discussion about the use of sialoendoscopy.

Etiologic factors in sialolithiasis.

OBJECTIVES: The purpose of this study was to investigate etiologic factors for sialolithiasis in a population of patients from the United States. STUDY DESIGN: Retrospective, cohort study. SETTING: Tertiary university. MATERIALS AND METHODS: Charts for all patients diagnosed with sialolithiasis between January 2001 and February 2010 were retrospectively reviewed. Demographic factors, smoking history, comorbid medical conditions, and medication history were recorded. Statistical analyses were then performed on the collected data. Population prevalences of smoking, diuretic usage, cholelithiasis, and nephrolithiasis were obtained through literature review. RESULTS: A total of 153 patients with sialolithiasis were identified. Of these patients, 125 (82%) had submandibular sialolithiasis, and 28 (18%) had parotid sialolithiasis. Positive smoking histories were present in 67 individuals (44%). Both the current rate of smoking and the rate of a history of smoking were higher in our cohort when compared with the general population, although the differences did not reach statistical significance. Smoking history did not correlate with the size of the primary sialolith. Diuretic usage in the cohort was observed at a rate of 20%, higher than reported population rates of diuretic use of 8.7%. The prevalences of cholelithiasis and nephrolithiasis were not different from observed population rates. CONCLUSIONS: Sialolithiasis is an uncommon condition of unclear etiology. This study represents an initial attempt to quantify the prevalence of smoking and diuretic therapy in a population of patients with sialolithiasis.

Sialolitiasis / Sialolithiasis

Para la realización de este trabajo se procedió a una revisión de la literatura sobre la sialolitiasis, una patología muy común en las glándulas salivales que puede generar numerosos síntomas desagradables en el paciente. Por lo que los profesionales deben poder identificarla, diagnosticarla y tratarla de forma precoz, evitando así mayores complicaciones. El objetivo del trabajo es presentar los conceptos esenciales sobre su etiología, características, métodos de diagnóstico y posible tratamiento; de manera a poner a disposición de los docentes y alumnos interesados un material sintético y actualizado sobre el tema.