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Oddities of salivary calculi
Oddities of salivary calculi Tewance A. Rust, D.D.S.,” Wheeling, W. Vn. WHEELING
rind Charles D. dlesserly,
D.D.S.,“”
HOSPITAL
T
he sialolith or salivary stone consists of molecules of abnormal mucoid material coalescing into a gel and eventually into a laminar structure. The organic matrix, acting as a framework or central nidus, allows for deposition in circular layers of calciferous crystalal The matrix or central nidus is composed of various carbohydrates and amino acids.2 The calciferous crystals are 74.3 per cent tribasic calcium phosphate and 11.1 per cent calcium carbonate, 6.2 per cent soluble salts, 6.2 per cent organic matter, and 2.2 per cent watcr.3 The sialolith may be round, ovoid, or elongated, and it may measure from a millimeter to a few centimeters. The surface of the stones may vary from smooth to rough. The color of the sialolith varies from whit.e to dark brown. The sialolith appears in all age groups. Eleven cases of stones in the submaxillary glands of children have been reported in the literature. Doku and Berkman4 removed a sialolith from a ‘ilQ&year-old white girl. Levy, ReMine, and Devines reported that their youngest patient was 12 years old. Kaufman6 reported a stone of the parotid gland in a 4-year-old child. The sialolith appears most common in the submaxillary gland. Levy and associates5 in their review of 180 patients with salivary calculi, noted that 144 of these stones were in the submaxillary gland. We have eighty-one cases of salivary stones, seventy-five of which are from this gland. It is our purpose to show a number of sialoliths, exemplifying the various sizes, shapes, colors and surface structures. (Figs. 1 and 2, Table I). Figs. 3 and 4 show salivary stone oddities, including a sialolith measuring 5.1 em. in length (Fig. ,3) and another measuring 3.4 by 2.5 by 1.8 cm. (Fig. 4). Fig. 5 shows a stone removed from a lil/‘$month-old child. *Resident, Department **Chief, Department
862
of Oral Surgery. of Oral Surgery.
Oddities
Volume 28 Number 6
Table I. Statistics Age
of salivary
calculi
863
of Fig. 1 Sex
5% M. 18 ,rs. 19 yrs. 23 yrs. 26 yrs. 47 yrs. 38 yrs. 51 yrs. 66 yrs. 71 yrs. 38 yrs. 58 yrs. 49 yrs. 61 yrs.
Fig. 1. Note differences Fig. b. Sialolith from
M M F : iz E M ii F F
Size (mm.)
2.2 1”; 21.5 1; 10.5 26 51 21.5 28 35 23 25
Color
Rrown Rrown Light Gray Gray White Light White White Dark Light Light Dark Light
brown
brown brown brown gray brown brown
in size, shape, color, and surface structure. a 71-year-old womxn, Note prickly surface
Surface
Smooth Smooth Rough Rough Rough Smooth Rough Rough Smooth Prickly Rough Smooth Rough Rough
structure.
Fig.
1
Fig.
8
O.S., OX & O.P. Dercmher, 1969
Fig. 3. Sialolith removed from a G’6-year-old man. This stone occupied the entire length of Stensen’s duct. The smaller sialolith was located at the most proximal part of the duct. Fig. 4. Sialolith removed from a Z-year-old man. Note the size. This patient had bilateral st,ones. The other stone was of approximately the same size. Unfortunately, it erupted spontaneously at home and was kept by the patient. The stone shown here was removed by the oral surgeon.
Fig. 5. Sialolith from a 5%.month-old infant. The mother noticed the swelling at feeding time when the child was 3% months old. Upon referral from the pediatrician, we saw the child at 5y2 months at which time the stone was palpated. By milking of the duet, the stone was advanced to the orifice and it was removed through a small incision.
Volume Number
28 6
Oddities
of
salivary
calculi
865
CONCLUSION We have found that salivary stones are seemingly unpredictable in all respects. They will vary greatly in size, shape, color, and texture. Although sialoliths are usually found in the fourth decade of life, they may be found in infants and in the very old. The surgeon’s approach with regard to treatment of sialoliths may vary because of size, recurrences of the stone, surface structure, and location. We have found that the longer the sialolith has been retained, the darker in color it becomes. REFERENCES
1. Harrill, J. A., King, J. S., Jr., and Boyce, W. H.: Structure and Composition of Salivary Calculi, Tr. Am. Larygn., Rhin. & Otol. Sot. 62: 496-507, 1959. 1. Structure and Mineralogical Com2. Blatt, I. M., and others: Studies in Sialolithiasis: position of Salivary Gland Calculi, Ann. Otolaryng. 67: 595-617, 1958. ed. 2, 3. Shafer, W. G., Hine, M. K., and Levy, B. M.: A Textbook of Oral Pathology, Philadelphia, 1963, W. B. Saunders Company, p. 457. 4. Doku, H. C., and Berkman, M.: Submaxillary Salivary Calculus in Children, Am. J. Dis. Child. 114: 671-673, 1967. 5. Levy, D. M., ReMme, W. IX, and Devine, K. D.: Salivary Gland Calculi, J. ,4. M. A. 181: 11151119, 1962. 6. Kaufman, S.: Parotid Sialolithiasis in a Child, Am. J. Dis. Child. 115: 623-624, 1968. 7. Smith, H. B., and Coon, :E. H.: Salivary Calculi, Med. Times & Long Island M. J. 62: 215, 1934. 8. U. S. Naval Dental School: Color Atlas of Oral Pathology, Philadelphia, 1956, J. B. Lippincott Company, p. 103.
rind Charles D. dlesserly,
D.D.S.,“”
HOSPITAL
T
he sialolith or salivary stone consists of molecules of abnormal mucoid material coalescing into a gel and eventually into a laminar structure. The organic matrix, acting as a framework or central nidus, allows for deposition in circular layers of calciferous crystalal The matrix or central nidus is composed of various carbohydrates and amino acids.2 The calciferous crystals are 74.3 per cent tribasic calcium phosphate and 11.1 per cent calcium carbonate, 6.2 per cent soluble salts, 6.2 per cent organic matter, and 2.2 per cent watcr.3 The sialolith may be round, ovoid, or elongated, and it may measure from a millimeter to a few centimeters. The surface of the stones may vary from smooth to rough. The color of the sialolith varies from whit.e to dark brown. The sialolith appears in all age groups. Eleven cases of stones in the submaxillary glands of children have been reported in the literature. Doku and Berkman4 removed a sialolith from a ‘ilQ&year-old white girl. Levy, ReMine, and Devines reported that their youngest patient was 12 years old. Kaufman6 reported a stone of the parotid gland in a 4-year-old child. The sialolith appears most common in the submaxillary gland. Levy and associates5 in their review of 180 patients with salivary calculi, noted that 144 of these stones were in the submaxillary gland. We have eighty-one cases of salivary stones, seventy-five of which are from this gland. It is our purpose to show a number of sialoliths, exemplifying the various sizes, shapes, colors and surface structures. (Figs. 1 and 2, Table I). Figs. 3 and 4 show salivary stone oddities, including a sialolith measuring 5.1 em. in length (Fig. ,3) and another measuring 3.4 by 2.5 by 1.8 cm. (Fig. 4). Fig. 5 shows a stone removed from a lil/‘$month-old child. *Resident, Department **Chief, Department
862
of Oral Surgery. of Oral Surgery.
Oddities
Volume 28 Number 6
Table I. Statistics Age
of salivary
calculi
863
of Fig. 1 Sex
5% M. 18 ,rs. 19 yrs. 23 yrs. 26 yrs. 47 yrs. 38 yrs. 51 yrs. 66 yrs. 71 yrs. 38 yrs. 58 yrs. 49 yrs. 61 yrs.
Fig. 1. Note differences Fig. b. Sialolith from
M M F : iz E M ii F F
Size (mm.)
2.2 1”; 21.5 1; 10.5 26 51 21.5 28 35 23 25
Color
Rrown Rrown Light Gray Gray White Light White White Dark Light Light Dark Light
brown
brown brown brown gray brown brown
in size, shape, color, and surface structure. a 71-year-old womxn, Note prickly surface
Surface
Smooth Smooth Rough Rough Rough Smooth Rough Rough Smooth Prickly Rough Smooth Rough Rough
structure.
Fig.
1
Fig.
8
O.S., OX & O.P. Dercmher, 1969
Fig. 3. Sialolith removed from a G’6-year-old man. This stone occupied the entire length of Stensen’s duct. The smaller sialolith was located at the most proximal part of the duct. Fig. 4. Sialolith removed from a Z-year-old man. Note the size. This patient had bilateral st,ones. The other stone was of approximately the same size. Unfortunately, it erupted spontaneously at home and was kept by the patient. The stone shown here was removed by the oral surgeon.
Fig. 5. Sialolith from a 5%.month-old infant. The mother noticed the swelling at feeding time when the child was 3% months old. Upon referral from the pediatrician, we saw the child at 5y2 months at which time the stone was palpated. By milking of the duet, the stone was advanced to the orifice and it was removed through a small incision.
Volume Number
28 6
Oddities
of
salivary
calculi
865
CONCLUSION We have found that salivary stones are seemingly unpredictable in all respects. They will vary greatly in size, shape, color, and texture. Although sialoliths are usually found in the fourth decade of life, they may be found in infants and in the very old. The surgeon’s approach with regard to treatment of sialoliths may vary because of size, recurrences of the stone, surface structure, and location. We have found that the longer the sialolith has been retained, the darker in color it becomes. REFERENCES
1. Harrill, J. A., King, J. S., Jr., and Boyce, W. H.: Structure and Composition of Salivary Calculi, Tr. Am. Larygn., Rhin. & Otol. Sot. 62: 496-507, 1959. 1. Structure and Mineralogical Com2. Blatt, I. M., and others: Studies in Sialolithiasis: position of Salivary Gland Calculi, Ann. Otolaryng. 67: 595-617, 1958. ed. 2, 3. Shafer, W. G., Hine, M. K., and Levy, B. M.: A Textbook of Oral Pathology, Philadelphia, 1963, W. B. Saunders Company, p. 457. 4. Doku, H. C., and Berkman, M.: Submaxillary Salivary Calculus in Children, Am. J. Dis. Child. 114: 671-673, 1967. 5. Levy, D. M., ReMme, W. IX, and Devine, K. D.: Salivary Gland Calculi, J. ,4. M. A. 181: 11151119, 1962. 6. Kaufman, S.: Parotid Sialolithiasis in a Child, Am. J. Dis. Child. 115: 623-624, 1968. 7. Smith, H. B., and Coon, :E. H.: Salivary Calculi, Med. Times & Long Island M. J. 62: 215, 1934. 8. U. S. Naval Dental School: Color Atlas of Oral Pathology, Philadelphia, 1956, J. B. Lippincott Company, p. 103.