by Dr Pandula Siribaddana

Created on: December 04, 2009

Introduction:

In humans, there are 3 types of salivary glands namely the parotids, submandibular and sublingual. These glands will produce the saliva and will transport the secretions in to the oral cavity via salivary ducts. The amount of secretions will increase when a person takes a meal and would be continuous throughout in a smaller amount to maintain the moisture of the cavity.

Formation of calculi:

In certain instances, similar to other organs in the body, calculi can be formed in the salivary glands and the process of such formation is still unknown. Most often, these calculi are composed of calcium and are asymptomatic while they are in the gland.

In practice, the salivary gland calculi are often seen in the submandibular salivary glands and to a lesser amount in the parotid glands.

The symptoms and signs:

At times, the calculus can dislodge and obstruct the flow of saliva and can result in the build up of pressure within the gland. This can stretch the tissues and stimulate the pain sensors thus causing swelling as well as extreme pain. Due to the fact that, many calculi do not fully obstruct the flow, the swelling and pain would not be significantly felt in certain occasions. But, at times of increased salivation such as when a person eats, the stretching would be at its maximum and so does the pain. Usually, the pain subsides after about 1-2 hours and can recur.

In rare occasions, the obstruction can lead to an infection which can be manifested as red, swollen gland along with pus discharge from the opening of the duct.

The diagnosis:

In most cases, the diagnosis can be made through clinical history and in order to intervene, the exact location of the calculi should be known. Thus, x-ray would be the initial investigation option as it will be non-invasive as well as show the calculi as an opaque area. A sialogram would be specific in the diagnosis and it will demonstrate the actual structure of the salivary duct system including the site of the calculi.

The treatment:

The treatment includes several procedures and most often the clinicians are able to probe the duct outlet at the oral cavity using a blunt instrument which can dislodge the calculi. But, if the calculi are lodged relatively at a distance, a technique similar to an endoscopy can be used to visualize the duct and catch the calculi using an instrument which will be anchored to the end of a thin endoscopic probe. The practice of open surgery is increasingly going down and has become obsolete in many places.

Prevention:

It has been postulated that, by taking enough water, a person can avoid the formation of such calculi, but this has not been proved by research.

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