When minor glands are rarely involved, caliculi are more likely in the minor glands of the buccal mucosa and the maxillary labial mucosa. Submandibular stones are further classified as anterior or posterior in relation to an imaginary transverse line drawn between the mandibular first molar teeth. Stones may be radiopaque, i.e. they will show up on conventional radiographs, or radiolucent, where they not be visible on radiographs (although some of their effects on the gland may still be visible). They may also symptomatic or asymptomatic, according to whether they cause any problems or not. Signs and symptoms
Signs and symptoms are variable and depend largely upon whether the obstruction of the duct is complete or partial, and how much resultant pressure is created within the gland. The development of infection in the gland also influences the signs and symptoms. Pain, which is intermittent, and may suddenly get worse before mealtimes, and then slowly get better (partial obstruction). Swelling of the gland, also usually intermittent, often suddenly appearing or increasing before mealtimes, and then slowly going down (partial obstruction). Tenderness of the involved gland. Palpable hard lump, if the stone is located near the end of the duct. If the stone is near the submandibular duct orifice, the lump may be felt under the tongue. Lack of saliva coming from the duct (total obstruction). Erythema (redness) of the floor of the mouth (infection). Pus discharging from the duct (infection). Cervical lymphadenitis (infection).
Minimally invasive:
Sialendoscopy
Surgical:
An ENT or oral/maxillofacial surgeon may cannulate the duct to remove the stone (sialectomy). A surgeon may make a small incision near the stone to remove it. In some cases when stones continually reoccur the offending salivary duct is removed. Supporting treatment:
To prevent infection while the stone is lodged in the duct, antibiotics are sometimes used. Epidemiology
The prevalence of salivary stones in the general population is about 1.2% according to post mortem studies, but the prevalence of salivary stones which cause symptoms is about 0.45% in the general population. Sialolithiasis accounts for about 50% of all disease occurring in major salivary glands, and for about 66% of all obstructive salivary gland diseases. Salivary gland stones are twice as common in males as in females. The most common age range in which they occur is between 30 and 60, and they are uncommon in children. References


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