Salivary stones: aspects of the composition, diagnosis and patient related factors

Salivary stones or sialoliths are calcifications that develop primarily in the drainage ducts of a salivary gland and less frequently in the gland itself. The submandibular salivary gland is most frequently affected (84%) and less often the parotid salivary gland (13%). Sialoliths occur incidentically in the sublingual salivary gland and accessory salivary glands. The presence of a sialolith can lead to obstruction of the excretory duct. As a result, symptoms such as recurrent, mealtime-related swelling and pain of the affected salivary gland, may occur. The severity of symptoms can vary and is determined by the localization and size of the sialolith. The aetiology of sialoliths is unclear. Several hypotheses have been put forward that have attempted to explain the etiology and pathophysiology of sialolith formation. The research described in this thesis mainly focused on submandibular sialoliths with special attention to possible factors that may be involved in sialolith formation, the radiological and clinical difference in size and volume of a sialolith and the composition of sialoliths. Chapter 2 reviews the knowledge on the aetiology, symptoms, biochemical composition and treatment of salivary stones based on current scientific literature. Sialoloiths consist of an amorphous mineralized core surrounded by concentric laminated layers of organic and inorganic substances. Successful removal of sialoliths depends on preoperative information about the exact location, size and shape of the stones. The accuracy of a preoperative CBCT-scan in determining the volume of a salivary stone has been examined in Chapter 3. This study showed that when CBCT-scans are used as a diagnostic tool, the sialoliths are actually a fraction smaller than determined by radiological examination. This is of clinical importance since cut-off values for stone size are used in choosing the type of treatment for stone removal. Little is known about the relationship between