Salivary lithiasis

A salivary lithiasis is the formation and migration of calcic concretions in the ways excrétrices of the Salive. Very frequent pathology as from 5 years without known etiology. The submaxillary gland is most frequently reached.

Symptomatology

1. Phase of latency

no functional signs. It can be fortuitously discovered during a clinical examination (slightly painful hard core at the time of palpation). Radiography reveals an opacity of the oral floor.

2. Clinical phase of expression

Intra-canal abscess

similar to a foreign body generating an abscess and an ignition (redness, heat, pain and tumefaction). Pressure made sourdre a drop of pus at the origin of the channel of Wharton.

Perish-canal abscess

diffusion of the infection. Important pain, embarrassment of the word and swallowing, possible fever

Acute lithiasic Submandibularite

The infection reaches gland; inflammatory signs and pain on the level of the oral floor and the particularly important area submandibulaire

Chronic lithiasic Submandibularite

The gland is sclerosed and perceived like a firm and mobile, significant tumefaction at the time of palpation.

Radiology

Radiograph without preparation

radiographies standards of the face can confirm the lithiasis (opacity)

Sialography

injection of a liquid of contrast (LIPIODAL ultrafluide - 2 ml) after catheterization of ostium of the channel of Wharton. A stereotype all fifteen minutes during one hour and half.

normal images: integral visualization of the channel of Wharton, parallel edges then ramification in gland (hairy). This examination gives information on the anatomy and the functional capacities
the images of lithiasis: abrupt stop of the progression of the product in the channel, or retention of the product upstream of the lithiasis
indirect images: dilation of the salivary ways, punctiform aspect of the acini

Echography

If the lithiasis is not visible by radiography, or if impossibility of catheterizing the channel of Wharton.

Clinical forms

Lithiasis of parotid gland

idem that for submaxillary gland, but on the way of the Channel of Sténon and in the zone of projection of submaxillary gland

Lithiasis of additional salivary glands

seldom painful, bluish tumefaction of the oral mucous membrane corresponding to a salivary cyst. Small abscess if infection

differential diagnosis

viral attacks (mumps, virus coxsackie), bacterial. It is the evolution which will make it possible to rectify the diagnosis

treatment

medical care

Antispasmodiques (to support salivary draining) in a preventive way and at the time of the Antibiotic crisis
to broad spectrum to avoid the extension of the infection or superinfection
Anti-inflammatory drugs and analgesics
the drugs intended to increase or decrease the quantity of saliva are prescribed according to particular indications

surgical treatment

simple Exérèse of calculation: in the case of a single lithiasis near to ostium, under local anesthesia
glandular Exérèse: only radical treatment
Under-maxillectomie: respect of the nervous elements (nerve facial, lingual, hypoglosse), and closing plan by plan on aspiration drainage.

The care Male nurse S

slightly compressive Bandage to fill the vacuum, remade after 48 hours in the same way, then reduced 24 to 48 hours after suppression of the drainage
Retrait of the drainage as of stop of the production (2° or 3° day)
Retrait of the points to the 5° or 6° day
Prescriptions post operational variables (antibiotic and analgesics according to the cases)
Surveillance of a possible facial paralysis (protection of the cornea by application of eye lotion and night palpebral occlusion)

See too

Lithiasis

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