Management of sailoliths or salivary gland stones

1. Obstructed salivary Gland
disease
Dr. Naveed Iqbal

2. Causes of salivary gland obstruction
• Intraductal causes are stones, mucus plugs
and strictures.
• Extraductal causes are Trauma and pressure
from adjacent neoplasm.

3. Sialolithiasis ( salivary stones)
• 85 % of stones occur in submandibular gland.
• 10 % in parotid gland
• 5 % in sublingual gland
Rare in minor salivary glands.
80 % of submandibular stones are Radiopaque.
40 % of parotid stones are radiopaque.

4. Why stones are more common in
submandibular gland?
• Increased Concentration of calcium in
submandibular secretion.
• Alkaline PH
• Warthon’s duct has long course with 2 sharp
curves. One at posterior border of mylohyoid and
2nd at duct opening.
• Small size punctum. These factors causes stasis
and precipitated material, mucus and cellular
debris are easily trapped as compared to parotid
gland.

5. Clinical features of sailolithiasis
• Meal time pain and swelling
• Infection of the gland
• Swelling in floor of the mouth
• Pus discharge from duct
• Absent salivary flow

6. Diagnosis
• Diagnosis is made on the basis of
• 1. clinical features
• 2. plain radiogrphs for radiopaque stones initial
investigation..
• 3. ultrasound.. initial investigation stone appears white
with dilation of proximal duct.
• 4. saliography uses radiopaque contrast medium
injected into duct and radiographs are to examine the
gland. It is used to exclude other causes of obstruction.
It shows stone, atrophy of gland and dilation and
costriction of duct. ‘’Sausage Link appearance’’
• 5. sailoendoscopy uses small video camera inserted
into duct for examination.

7. Treatment of submandibular stones
• Treatment depends on location of stone
• Submandibular stones are classified anterior or
posterior in relation to the line between first molars.
• Anterior stones can be visualized on occlusal view and
are removed with intraoral incision opening of duct is
called sailodochotomy, removal of stone is called
sailolethectomy, and Sailodochoplasty suturing of duct
to floor of the mouth.
• Posterior stones are not visualized on occlusal film and
OPG or CT scan is required. Posterior stones are
located at hilum or with in the substance of gland.
These stones and gland are removed with extraoral
approach.

8. Other approaches of treatment
• Extracorporeal lithotripsy: This technique uses
electromegnatic waves to break the small
stones which are removed by normal flow of
saliva.
• Endoscopic removal with balloon catheter or
basket or lithotripsy.

9. Treatment of Parotid stones
• Anterior or distal stones close to orifice can be
removed with dilatation of duct orifice.
• Posterior stones at hilum of gland require
extraoral approach to remove superficial lobe
and stone.