Sialolithiasis pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]

Sialolithiasis is the presence of stones within the salivary glands or the salivary gland ducts.The exact pathogenesis of sialolithiasis not fully understood but the relative stagnation of salivary flow and calcium concentration may be important. 75 percent of sialolithiasis cases are single. 3 percent of stones are bilateral and most of them are located in parotid glands. Stone formation is 80 to 90 percent in the submandibular gland, 6 to 20 percent in the parotid glands and 1 to 2 percent in the sublingual or minor salivary glands. Sialoadenitis is inflammation of a salivary gland. Acute sialoadenitis may be caused by viral or bacterial infection. Chronic sialoadenitis is caused by repeated episodes of inflammation. On gross pathology, hard yellow -white spherical depositions usually less than 1 cm are seen. On microscopic pathology, dilated ducts with squamous metaplasia or calculi are usually present.

• Presence of stones within the salivary glands or the salivary gland ducts.

• The exact pathogenesis of sialolithiasis not fully understood but the relative stagnation of salivary flow and calcium concentration may be important.

• Component of salivary stones include: ^[2]
  • Calcium phosphate
  • Hydroxyapatite
  • Magnesium
  • Ammonium
  • Potassium

• Parotid, submandibular, sublingual glands and minor salivary glands are prone to the development of stones.^[3][4]

• Parotid glands and stensen ducts are located anterior to the external auditory canal.

• Submandibular glands and wharton ducts are located beneath the floor of the mouth.

• Sublingual glands are located beneath the mucous membrane of the floor of the mouth.

• 75 percent of sialolithiasis cases are single

• 3 percent of stones are bilateral and most of them are located in parotid glands.

• Submandibular stones are the largest ones and are often located in the wharton ducts.

• Parotid stones are the smaller than submandibular stones, and they are more located within the glands and they are more multiple.

• Stone formation is 80 to 90 percent in the submandibular glands, 6 to 20 percent in the parotid glands, 1 to 2 percent occur in the sublingual or minor salivary glands.^[5]

• Stones occur equally on the right and left sides.

• Sjögrens^[6]
• Medications such as anticholinergics^[6]

• On gross pathology, hard yellow -white spherical depositions usually less than 1 cm in diameter is characteristic finding of sialolithiasis.^[6]

• On microscopic histopathological analysis,
  • Dilated ducts with squamous metaplasia or calculi
  • Chronic inflammation
  • Destruction of acini
  • Fibrosis in sialadenitis

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