Evaluation of the Relation of Smoking, Gallstones, and Renal Stones With Sialolithiasis in Patients Referred to Oral Medicine and ENT Department of Tabriz University of Medical Sciences

Background: The exact mechanism of the formation of salivary gland stones is unknown. Elucidating pathophysiology of the formation of salivary stones might prevent both their formation and the need for implementing invasive surgical procedures. Therefore, this study aimed to evaluate the effects exerted by some etiological factors on the formation of salivary gland stones. Methods: In this case–control study, the records of 80 patients with sialolithiasis were studied as a census from April 2011 to June 2019. These patients were referred to the Oral Medicine and the ENT departments of Tabriz University of Medical Sciences. The control group consisted of the same number of the patients with no sialolithiasis. Two groups were compared in terms of stone size, smoking, gallstones, and renal stones. Chi-squared, independent t-test, and Mann-Whitney U test were adopted to examine the quantitative variables. The data were analyzed using SPSS 17. Statistical significance was set at P<0.05. Results: Overall, 96.2% of sialoliths were found in the submandibular gland, of which 78.8% were single. Moreover, 32.5% of the patients with a history of sialolithiasis were smokers, whereas this frequency was 23.8% in the control group. In the case and control groups, 2.5% and 5% of the patients had a history of renal stones, respectively. Only one patient who had undergone a surgical procedure to remove salivary gland stones had a history of gallstones, while none of the patients in the control group had a history of gallstones. Conclusions: The results showed that the formation of salivary gland stones was not associated with smoking, history of renal stones, and gallstones. Furthermore, it was found that the numbers and sizes of salivary stones were not affected by smoking.

A Novel Approach for the Treatment of Sialolithiasis that Preserves Salivary Duct Anatomy

Objective: The sialendoscopy era in the treatment of salivary gland stones has reduced the use of classical surgical methods. However, the miniature ducts and tools may cause difficulties in removing large sialoliths. Therefore, invasive combined oral surgeries or gland resection may be considered. We searched for the most suitable method in order to stay in line with the minimally invasive approach that preserves the ductus anatomy, and that can reduce the surgical fears of patients. Materials and Methods: The study included 84 cases (23 parotid and 61 submandibular) in whom stones were fragmented by pneumatic lithotripsy and removed between January 2015 and January 2020. The parotid cases comprised 7 females and 16 males, and the submandibular cases comprised 25 females and 36 males. Intraductal lithotripsy was performed using pneumatic lithotripter. This study has fourth level of evidence. Results: Based on total number of cases (n = 84), success rate was 67/84 (79.7%) immediately after sialendoscopy, and overall success rate was 77/84 (91.6%). Based on number of stones treated (n = 111), our immediate success rate was 94/111 (84.6%), and overall success rate was 104/111 (93.7%). The success criteria were complete removal of the stone and fragments in a single sialendoscopy procedure and resolution of symptoms. Conclusions: We successfully treated salivary gland stones, including L3b stones, in our patient cohort with sialendoscopy combined with pneumatic lithotripsy. The lithotripsy method that we have adapted seems to be more useful and cost-effective compared to its alternatives. We were also able to preserve the ductus anatomy and relieve patients’ concerns. Level of Evidence: Level IV

Classification of submandibular salivary stones based on ultrastructural studies

IntroductionSialolithiasis remains a clinical problem with unclear etiopathogenesis, lack of prevention methods and only surgical treatment.Materials and MethodsAn ultrastructure examination of submandibular sialoliths obtained from patients with chronic sialolithiasis was conducted using a scanning electron microscope and X-ray photoelectron spectroscopy.ResultsBased on the results, we divided sialoliths into three types: calcified (CAL), organic/lipid (LIP) and mixed (MIX). The core structure of the CAL and MIX is very similar. The core of the LIP has a prevalence of organic components. The intermediate layers’ structure of the CAL is different from LIP and MIX. In LIP and MIX, the organic component begins to increase in intermediate layers rapidly. The structure of the superficial layers for all types of sialoliths is similar.ConclusionsWe introduced a new classification of the submandibular salivary gland stones. Based on the results, it can be said that sialoliths type CAL and LIP have their separate path of origin and development, while MIX is formed as CAL stone, and the further pathway of their growth passes as LIP stones. Organic components was much more than inorganic in all layers of salivary gland stones, which highly prevents their dissolution in the patient’s salivary gland duct.

Study on Chemical Composition of Urinary and Salivary Gland Stones in Relationship with Laboratory Parameters and Lifestyle Habits of Patients with Lithiasis

Lithiasis is a disease with increasing incidence, may occur in the urinary tract, salivary glands and bile ducts. Genetic susceptibility, diet, low fluid intake, endocrine disorders, infections and other factors can influence the development of the disease and its recurrences. The aim of the study was to reveal the relationship between chemical composition of the stones, lifestyle and dietary habits and the results of laboratory analysis in patients with urinary tract and salivary gland lithiasis. The data of 258 patients with urinary tract and salivary gland lithiasis collected between September 2009 � May 2016 were studied. The subjects were from the Urology and Oral Surgery Hospital, and from the Marmed and Procardia medical units in Tirgu Mures. We evaluated the lifestyle habits using a questionnaire, microscopical examination, size measurement and chemical analysis of the stones were made and we processed the results of urinary strip analysis and sediment. In a subgroup of patients (48 samples) calciuria, phosphaturia, serum uric acid, calcium, phosphate, alkaline phosphatase and parathormone (PTH) levels were determined; in case of pathological values calcitonin measurement and endocrinology consultation were performed. The most frequent composition was the combination of calcium oxalate and phosphate in case of both urinary and salivary gland stones, in several uroliths we detected uric acid/xanthine crystals, rarely cystine and carbonate were found. The incidence of hematuria and leukocyturia exceeded 70%. Excessive calcium intake was observed in the diet of the several patients having calcium oxalate stones. In the subgroup tested for biochemical and hormonal analyses we found increased serum PTH concentration in 20.83% of the patients. Some of the subjects had pathological serum calcium, uric acid and alkaline phosphatase results, or the elimination of minerals in the urine was out of the normal range. We found pathological laboratory results in several patients suffering from lithiasis. Proper diet and medical treatment in many cases could prevent the recurrences of stone formation, but first a complex investigation of the patients is necessary to adapt the treatment plan to individual requirements.

The Role of Fetuin-A and Electrolytes in the Etiology of Sialolithiasis

Objective The aim of this study was to investigate serum and saliva fetuin-A, protein, and electrolyte levels in patients with sialolithiasis. Study Design Prospective randomized controlled study. Setting Tertiary center. Subjects and Methods Twenty patients with recurrent sialadenitis secondary to submandibular salivary gland stones and 20 asymptomatic healthy volunteers without salivary gland stones were included in the study. Bimanual palpation and ultrasonography were performed in the patient and control groups. The electrolyte, protein, and fetuin-A levels of the serum and saliva were measured. Results The serum calcium, phosphorus, and potassium levels of the patients were significantly lower than those of the control group (respectively, P = .04, P = .01, P = .04). There was no statistically significant difference between the serum fetuin-A levels of the 2 groups ( P = .06). The saliva phosphorus values of the patients were higher than those of the control group ( P = .05), as were their saliva fetuin-A and total protein values ( P = .001, P = .01). A positive correlation was determined between the saliva fetuin-A levels and the saliva phosphorus and potassium levels of the patients ( P = .04, P = .02). The magnesium level, which has been argued to be a factor in the prevention of calcification, showed an increased correlation with the total protein in the patient group ( P = .02). Conclusion It is possible that the high levels of saliva fetuin-A, total protein, and phosphorus with insufficient of saliva magnesium levels may make a contribution to the formation of sialoliths.

Asymptomatic Large Sialolith of Wharton's Duct

ABSTRACT Aim Giant salivary gland stones (more than 15 mm) considered to be rare and a few of well-documented studies report it. In this literature, we report an asymptomatic, 15 mm sialolith in a 47-year-old man with whole procedure of treatment. Materials and methods A patient without symptom of Wharton's duct sialolith was detected and treated. Occlusal cross-sectional of mandibule film was used to guide of surgery, transoral approach was made to dissection of stone. Results Fifteen millimeters yellow sialolith was obtained, antibiotic therapy done for 1 week was after surgery and 2-month follow-up was done. Conclusion Sialoliths are responsible for the obstruction of salivary secretion. More than 80 to 90% of sialoliths, occurs in the submandibular glandular parenchyma or its duct. There is man predilection in parotid or submandibular sialolith. Giant salivary gland stones (more than 15 mm) considered to be rare and a few of well-documented studies report it. Removal of sialolith with intraloral approach is treatment of choice in the anterior duct submandibular gland. How to cite this article Begom JT, Azimi S, Rankohi ZE. Asymptomatic Large Sialolith of Wharton's Duct. Int J Experiment Dent Sci 2015;4(2):143-145.