Sialolithiasis, or salivary calculi, represents the most common salivary glands disease.

This kind of oral pathology, is mainly characterized by the presence of calcareous concretions inside
the saliva excretion ducts or inside the salivary glands.

The etiopathogenesis of sialolithiasis presents three variable etiological parameters that condition its
pathogenesis and clinical evolution:

• Individual predisposition

• Favorable organic conditions

• Individual anatomical conditions

A calculus is a concretion of mineral salts and organic compounds of variable number, size and
composition. They are composed of a central nucleus of organic substance (mucin, germs, epithelial
cells) and a peripheral inorganic component consisting of calcium phosphate, calcium carbonate and
magnesium phosphate. Based on the mineral salts content, salivary calculations are radiographically
radiolucent in the initial phase of the formation process due to the presence of the organic nucleus,
while they are radiopaque in the advanced calcification phases due to the calcareous deposition
around the organic nucleus.

They vary in quantity and size, starting from tiny concretions, to the more frequent ones of the size of
a grain of rice, up to calculations of exceptional dimensions that conform to the mold of the main duct.
They can be unique or multiple and have a more or less regular shape, based on the deforming action
produced by the organ that contains them.

At palpation they are appreciated as hard or crumbly both for their composition and for the position
taken in the duct or in the glandular parenchyma.

Salivary calculi affect the salivary glands and their respective ducts according to varying percentages:

• Wharton duct 57.96%

• Stensen duct 8.97%

• Submandibular gland 21.80%

• Parotid gland 5.13%

Scialolithiasis, usually single and unilateral, affects the male sex in the third to fifth decade of life and
rarely in pediatric patients.

Localization is more frequent in the Warthon duct due to anatomical reasons, tortuosity of the duct,
greater density and viscosity of submaxillary saliva, presence of mucin, slow elimination of saliva and
for allergic-vegetative stimuli.

Clinical examination shows two main symptoms: tumefaction and pain.

Tumefaction has characteristics of unilateral, acute, edematous volume increase that can resolve
spontaneously in the same way as it appeared due to spontaneous duct unblocking. Sometimes the
swelling is caused by the vision of food or the imminence of meals and in some cases associated with
inflammation and temperature increase due to the concomitance of intraductal purulent bacterial
infections. The pain exacerbates up to a maximum threshold (salivary colic) and is followed by a
remission phase and then resumed with greater intensity to the next episode.
From the radio diagnostic point of view the calculi can be identified by ultrasound,
orthopantomography, skull x-ray in anterior-posterior and lateral-lateral projection, sialography,
scintigraphy and computerized CT, to allow a more accurate diagnosis and a better localization of the
calculi.

Spontaneous or provoked expulsion can solve the clinical picture in some cases without relapses,
medical therapy makes use of sialagogues, muscle relaxants and antibiotics.

These are mini-invasive alternative treatments: shock wave lithotripsy with electromagnetic,
piezoelectric and laser therapy with or without endoscopy.

The surgical removal of ductal calculi is generally decisive and consists in the simple removal of the
calculus, associated with marsupialization of the duct if the calculus is in the proximal site, or plastic
in case of distal localization of the calculus or stenotic duct.

In the case of glandular sclerosis, complete removal of the affected salivary gland is used.