(Sialolithiasis)

The ducts of the salivary glands are frequently clogged with saliva stones of calcium salts; which can lead to painful swelling and sometimes infection. The diagnosis is made clinically or by CT, ultrasound or sialography. The treatment consists in removing the stones (by saliva stimulants, manipulation, exploratory or surgical operation).

All major salivary glands are paired organs: parotid gland (parotid gland, parotid gland), Eq. submandibular (submaxillary gland), and Eq. sublingual (sublingual gland). Salivary stones usually occur in adults. 80% of the stones are formed in the lower jaw glands and move the Wharton’s duct. The remaining stones are formed mainly in the parotid gland and block the Stenon gear. In the sublingual gland is only about 1% of salivary stones. About 25% of patients is multiple stones.

The ducts of the salivary glands are frequently clogged with saliva stones of calcium salts; which can lead to painful swelling and sometimes infection. The diagnosis is made clinically or by CT, ultrasound or sialography. The treatment consists in removing the stones (by saliva stimulants, manipulation, exploratory or surgical operation). All major salivary glands are paired organs: parotid gland (parotid gland, parotid gland), Eq. submandibular (submaxillary gland), and Eq. sublingual (sublingual gland). Salivary stones usually occur in adults. 80% of the stones are formed in the lower jaw glands and move the Wharton’s duct. The remaining stones are formed mainly in the parotid gland and block the Stenon gear. In the sublingual gland is only about 1% of salivary stones. About 25% of patients is multiple stones. Etiology Most salivary stones are composed of calcium phosphate with smaller amounts of magnesium and carbonate. Gout patients sometimes have uric acid stones. Prerequisite for the concrement is a crystallization core (nidus), around which the salts precipitating during a saliva congestion. Stasis occurs in patients who are severely weakened or dried, take too little nourishment or need to take anticholinergics. Persistent or recurrent stone formation predisposed to a salivary gland infection (sialadenitis). Symptoms and signs A duct obstruction by saliva stones can cause the gland swells painful because of salivation was stimulated especially after eating. the symptoms can be a few hours later after again. The relief of symptoms can suddenly set with a gush of saliva. Some sialoliths cause only intermittently or never symptoms. More distal stuck stones can visible or in the glandular duct be palpable. Diagnosis Clinical evaluation Sometimes imaging (z. B. CT, sonography, sialography) Talk the investigation findings not unique to a concretion, can the patient a Sialagogum administer (eg. As lemon juice, hard candy or similar) in order to stimulate the flow of saliva. The reproducibility of the symptoms is almost always conclusive for a salivary stone. If the clinical diagnosis is uncertain, highly sensitive techniques such as CT, ultrasound and (now rare) sialography be used. (N. D. Übers .: Today there are special salivary duct endoscopes, with which one can distinguish between stone, stenosis and tumor. In addition to the diagnostics can be removed as by retrieval baskets and calculus.) This technique is sometimes used therapeutically. Since 90% of the parotid gland-stones radio-opaque and 90% of parotid stones are radiolucent, native X-rays are not always accurate enough. Ultrasound is used more and more, and has sensitivity to all the (radiopaque and radiolucent) stones from 60 to 95% and specificity between 85 and 100%. ; The role of MRI develops Sensitivities and accuracies are> 90%, and it seems more accurate to detect small stones and distal channels as sonography or Kontrastsialografie. Local therapy measures (z. B. Sialagoga, massage) Gelegentlic expressing it manually, or surgical removal analgesics, hydration (sufficient hydrogenation) and massage effect a relief of symptoms. By timely administration of effective antibiotics staphylococci an acute sialadenitis can often prevent. Salivary stones can come off by Sialagoga spontaneously or after excitation of the salivary flow; you should therefore encourage patients every 2-3 hours on a wedge of lemon or sour candies to suck. Sometimes a stone, which is located right in the mouth of the ductal be manually expressed his fingertips. After expansion of the canal with a thin probe, a stone is easier to extract. Only when all other attempts have failed, salivary stones are removed surgically. Stones in the excretory duct can be transoral removed while at intraglandular salivary stones often a complete Drüsenexzision is required. Stone up to a size of 5 mm are removed endoscopically. Summary About 80% of salivary stones come in Eq. submandibular ago. The clinical diagnosis is usually sufficient, but occasionally CT, sonography or sialography are needed. Many stones go spontaneously or by the application of Sialagoga and by expressing it manually, but some require endoscopic or surgical removal.

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