Submandibular salivary stones: current management modalities.

s t l a b b t a a alivary calculi are usually unilateral in occurrence nd round to oblong, have an irregular (majority) or mooth surface, vary in size from a small grain to the ize of a peach pit, and are usually yellow.1 The stones ay occur in the duct or gland, with multiple stones ot uncommon. They are found more often in adults, lthough they also occur in children.2 The classic ymptoms are that of obstruction manifested by pain nd swelling of the involved gland during eating (Fig ). Since obstruction is rarely complete, the gland welling will subside to some degree during rest peiods. In as much as chronic gland obstruction will nvariably result in inflammation and fibrosis, some welling and induration may persist even after stone emoval. Stones apparently develop as a result of an initial rganic nidus followed by the deposition of inorganic aterial, both of which are derived from the salivary uid. The filamentous stroma or nidus is not bacterial n nature but rather precipitated mucoids and possily salivary proteins.3,4 The popular explanation of a recipitation of salts when pH, calcium, and phoshate are sufficiently elevated does not agree with the revailing concepts of calcification elsewhere in the ody. The concentration of calcium in saliva is not igh enough to precipitate spontaneously, but as andel3 stated, “The matrix provides the architecural template or geometric configuration of the initial patite crystal.” It is therefore clear that salivary stasis nd salivary viscosity, rather than the calcium content f the individual salivary gland secretion, play the ignificant role in its development. Submandibular sialoliths are more common than hose of the parotid for a number of reasons. Anatomcally, the submandibular duct is longer than the paotid, traversing upward and forward from the gland o the oral floor, whereas Stensen’s duct moves in a