I am following a 42 years old patient with multiple stones episodes in parotids on both sides. In just one of these episodes she eliminated 10 stones spontaneously in one week.
any suggestions of clinical factors that may be associated? Calcium and parathyroid hormones are normal.
thank you
Dear Dr Leonardo Silva,
When multiple stones exist in the salivary glands, its important to look for underlying causes. The standard causes mentioned are medication intake like Diuretics and Anti-cholinergic medications, Gout and smoking. I assume that these causes have been ruled out. Hypercalcemia has been suggested in literature as a cause but you have stated that Calcium and PTH levels are normal.
I have seen a couple of patients of Sjogrens syndrome who had multiple sialolithiasis. It would be worth asking if your patient had sicca symptoms and evaluate for Sjogren's by evaluating for tear formation (Scirmer's test), testing for ANA, RF and a possible minor salivary gland biopsy. If it does indeed turn out to be Sjogrens, a variety of treatment options exist.
Hope this helps
regards
Shankar
thank you Dr Subramanian. I will investigate gout as well. Other diseases were investigated already.
Excess vitamin C can cause kidney stones, although there is little information on the relationship of this vitamin with sialoliths, it could be interesting rule out this possibility
very interesting! the repeated formation of new stone suggested some inflammatory changes that prone the tissues to dystrophic calcification as the serum calcium was normal. The history of spontaneous expelling suggest reasonably normal salivary flow thus SS can excluded.
Dear doctor,
Kindly take a follow up CT since She has expelled around 10 stones already. Next you should determine whether the stones are present closer to the oral orifice or to the gland.i.e., proximaly or distally. If the stones are distally present surgical intervention is the rule. If they are proximally present sialogogues and adequate hydration will help. MR sialography is also useful since it doesn't need contrast media and there is no danger of pushing them distally...These points should be helpful in addition to what other experts have previously mentioned..
something really interesting, it could be due to some inflammatory changes.
Sialendoscopic stone retrieval can clear the remaining stones. The stones which are in the main Stensen's duct or hilum can be taken out with forcepses or baskets during sialendoscopy. Also it helps to dilate the orifice and the channel of the duct, which can help to prevent further stone formations with increasing salivary outflow.
Dear Silva, Do you perform biochemistry analysis to know the stone structure. Congenital narrowing of parotid duct or Stensen's orifice is a common cause of such cases due to stagnated saliva. I have an experience 5 ys ago with one case came to me due to repeated left parotid region pain & feeling a bad taste, my examination of patient revealed normal sized parotid but presence of parotid duct stone & I removed under LA & I sent it for biochemistry analysis (I can not remember the result) but I gave preventive information according to the result & F/U revealed no recurrence).
The salivary glands are bilaterally enlarged indicating the possibility of a sialoadenitis (with dystrophic calcifications) in which case the calcifications are dystrophic in nature. In order to rule out the possibility of metastatic calcification calcium and vitamin D studies are suggested.
Hi Claudia/Leonardo...at least she is expelling them...most are just retained in the small gland ducts as in a sialadenitis...I did have a patient in Indiana year's back who had bilateral sialolithiasis and Type II Diabetes Mellitus, but it may have just been coincidence...DM being a prevalent as it is...
Mikulicz's and Sjogrens might also be considered, though stones are not as common, just gland destruction...