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Saturday, February 23, 2013

Salivary Stones: The Mouth’s Version of Kidney Stones

Most people have heard of kidney stones (technically referred to as renal calculi) but not many people have heard of salivary stones. The formation of stones in the salivary glands is technically referred to as sialolithiasis.

These stones (pictured above) are most commonly found in the submandibular glands (also known as submaxillary glands) which are located below the floor of the mouth. These glands produce about 70% of saliva. Salivary stones can also occur in the parotid glands, which is the largest of the salivary glands.

The most common signs and symptoms include mouth pain (usually in the floor of the mouth) and intermittent swelling in the area of the gland. The diagnosis is usually made after the doctor has performed a physical examination and obtained a clinical history but imaging techniques provide a more definitive indication. The most commonly used imaging techniques to diagnose salivary stones are x-rays, ultrasound scanning, and sialograms (a special x-ray technique of the salivary glands). Ultrasound scanning is a procedure that uses high-frequency sound waves to produce images of internal body structures. There are various surgical and non-surgical options available to remove the stones.

About 97% of cases of salivary stones occur in adults but rarely, these stones also occur in children. One such case is soon to be published in an upcoming issue of the Archives of Disease in Childhood. The case is that of a 14-year-old boy with a 6-year history of intermittent swelling on the right side of the neck, associated with pain on swallowing. It would last for several hours and then go away. Initially, his doctor thought that he had a swollen lymph node and treated him with antibiotics. This is a common initial diagnostic error. However, when the antibiotics did not work, the doctor felt the stone upon physical exam, confirmed the diagnosis by x-ray, and removed it through surgery.

Suggested reading: Salivary Gland Disorders and Diseases: Diagnosis and Management

Reference: Liu NM, Rawal J. (2013). Submandibular sialolithiasis in a child. Arch Dis Child.

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