Jubilee Hospital, Trivandrum.
Salivary gland calculi (stone) account for the most common disease of the salivary glands. The majorities of calculi occurs in the Submandibular gland or its duct and are a common cause of acute and chronic infections.
Submandibular sialolithiasis is more common as its saliva is more alkaline with increased concentration of calcium and phosphate, and a higher mucous content than saliva of the parotid and sublingual glands.
Sialolithiasis typically causes pain and swelling of the involved salivary gland by obstructing the food related surge of salivary secretion. Calculi may cause stasis of saliva, leading to bacterial ascent into the parenchyma of the gland, and therefore infection, pain and swelling of the gland. Some may be asymptomatic until the stone passes forward and can be palpated in the duct or seen at the duct orifice.
Diagnosis
Careful history and examination are important in the diagnosis of sialolithiasis. Pain and swelling of the concerned gland at mealtimes and in response to other salivary stimuli are especially important. Complete obstruction causes constant pain and swelling, pus may be seen draining from the duct and signs of systemic infection may be present.
Bimanual palpation of the floor of the mouth, in a posterior to anterior direction, reveals a palpable stone in a large number of cases of Submandibular calculi formation.
CT Scan studies are very useful for diagnosing sialolithiasis. Occlusal radiographs are also useful in showing radiopaque stones. Sialography is, however, contraindicated in acute infection or in significant patient contrast allergy.
Treatment
Firstly conservative management, especially if the stone is small.
Almost half of the Submandibular calculi lie in the distal third of the duct and are amenable to surgical release through an incision in the floor of the mouth.
The duct needs opening to retrieve the stone. This involves a transoral approach where an incision is made directly onto the stone. In this way more posterior stones, 1–2 cm from the punctum, can be removed by cutting directly onto the stone in the longitudinal axis of the duct. Care is taken as the lingual nerve lies deep, but in close association with the submandibular duct posteriorly. Subsequently, the stone can be grasped and removed. No closure is done leaving the duct open for drainage.
If the gland has been damaged by recurrent infection and fibrosis, or calculi have formed within the gland, it may require removal of the gland too.
Removal of Submandibular duct calculi using Co2 Laser
Removal of calculi by incising the duct causes troublesome bleeding and also can result in embarrassing displacement of stones after giving local anesthetic.
I am using Co2 laser to make an incision over the calculi and removal is made easy as there is no bleeding at the site of surgery.
(Please see pictures)
For Appointment– call 0471-2334561/62/63/64, 6452020,407822 Fax-0471-2330925
Email: drpaulose@yahoo.com
Clinic hours: Mon-Wed-Friday (8AM -1 PM)
Operation Days: Tue-Thu-and Saturdays (8AM-4PM)
To reach Jubilee Hospital: jubileehospitaltrivandrum
