Submandibular Salivary Calculus: Etiology, Clinical Features, Diagnosis, and Treatment Options

Answer. This is a pathological condition characterized by formation of calcified mass (sialolith) within the salivary gland or its duct.

Submandibular salivary calculus Etiology

The exact cause for sialolith or calculus formation is not clear but factors which contribute to its formation are:

Stagnation of saliva
Focus for sialolith formation resulting from ductal epithelial inflmmation and injury.
Poorly understood biological factors favoring precipitation of calcium salts.

“What Tests Diagnose Submandibular Salivary Calculus”

Hilus is the most common site for the formation of sialolith but it can arise anywhere throughout the ductal system.

80% of all salivary duct stones develop in the submandibular or Warthin’s duct.

Predisposition of sialolith formation for the submandibular gland can be due to:

“Comprehensive Overview Of Salivary Calculus Symptoms”

Composition of secretion of submandibular salivary gland is more alkaline and viscous.
Submandibular gland consists of higher concentration of calcium and phosphorus ions as compared to other major salivary glands.
Both submandibular gland and duct are placed in such an anatomically dependent position that the flow of saliva is against gravity which gives more chances for stasis of saliva inside the ducts.
Stagnation of secretions in Warthin’s duct can also due to angulation ofduct as it courses around the mylohyoid muscle and the vertical orientation of the distal duct segment.

“Recovery Process After Salivary Stone Removal”

Submandibular salivary calculus Clinical Features

Patient complains ofperiodic painful swelling when eating,interspersed with periods of remission.
Occasionally patients report spontaneous extrusion of small calculi from the ducts.
Most common fiding on examination is point tenderness in the region of the hilum or, near Wharton’s duct of the submandibular gland.
Salivary secretion may be affected slightly.
A gelatinous, cloudy, mucopurulent material is seen in basically clear and adequate saliva.
- This mucopurulent material is derived from the inflmmatory ductal changes caused by calculus blockage and salivary stagnation.
If treatment is not instituted early pronounced exacerbations are seen, characterized by an acute suppurative process with attndant systemic manifestations.
Pus may exude from the duct orifie.
Mucosa around the duct is inflmed, particularly in the flor of the mouth where swelling, redness and tenderness are present along the course of Wharton’s duct.
Glands are enlarged, tender and tense. Palpation of the gland and the duct causes pain and a flow of pus.

“Dealing With Pain Caused By Salivary Stones”

Submandibular salivary calculus Investigations

Occlusal radiograph
Intraoral periapical radiograph: Submandibular stones are mostly radioopaque.
Ultrasound (Excellent non-invasive method)
Sialography: A retrograde injection of a radiopaque dye as neohydriole into the duct of salivary gland.
(Occluded submandibular salivary duct can be best observed by simple palpitation.

Submandibular salivary calculus Treatment

Stone in the submandibular duct:

Small stone in the distal part of the duct is removed manually.
Stone in deeper parts require operation. This can be removed by incising the mucosa over the flor of the mouth, after stabilizing the stone.

“Living With A History Of Salivary Calculus Tips”

If the stone is present inside the gland:

This requires excision of submandibular salivary gland.
Three steps of dissection of gland includes incision, mobilization and excision
Incision: It should be a skin crease incision over the lower pole of the gland.

“The Role Of Imaging In Detecting Salivary Calculus”

Mobilization of the gland: Division of the facial artery twice, once in deeper plane on the posterolateral aspect and another at the superolateral aspect close to the lower border of the mandible which gives mobilization of the gland.
Excision of the gland: It is done by ligating and dividing the submandibular duct.

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