Value of Sonography in the Diagnosis of Sialolithiasis: Comparison With the Reference Standard of Direct Stone Identification

Abstract

Objectives The aim of this study was to assess the effectiveness of sonography for diagnosing sialolithiasis in comparison with the existing reference standard of direct identification of a stone. Methods A total of 659 glands with signs of obstructive sialadenopathy were evaluated retrospectively. Sonographic examinations of the large head salivary glands had been performed initially in all cases. Direct depiction of a stone during sialoendoscopy or transoral ductal surgery or observation of stone fragmentation with discharge of concrements after extracorporeal shock wave lithotripsy, was regarded as definitive evidence and as the reference standard for the presence of sialolithiasis. The sonographic results were compared with those for direct identification of stones. Results The sensitivity of sonography was 94.7%, with specificity of 97.4%, a positive predictive value of 99.4%, and a negative predictive value of 79.6%. Stones that were not diagnosed correctly on sonography were most often located in the distal area of the duct. Conclusions These results show that sialolithiasis can be diagnosed by sonography with a high degree of certainty. Sonography thus appears to be highly appropriate as the examination method of choice.

3D Reconstruction and Prediction of Sialolith Surgery

“…The great majority (80–90 percent) of salivary calculus occur in the submandibular gland, whereas 5–20 percent in the parotid gland [1–7] and in the sublingual gland. As for the minor salivary glands, the occurrence of calculus is less common.…”

“…According to the literature, the painful symptoms affect the patients mainly during salivary stimulation [1–3, 6–8] and, in general, this event makes them seek professional help. For Ligtenberg and Veerman, imaging findings of calcifications in large salivary glands and/or salivary ducts are usually related to salivary calculus or sialoliths [14].…”

“…For Ligtenberg and Veerman, imaging findings of calcifications in large salivary glands and/or salivary ducts are usually related to salivary calculus or sialoliths [14]. Therefore, based on such findings, it is indispensable to perform clinical examination and anamnesis [1, 3, 5, 7, 8, 11, 14]. …”

“…Sialoliths are calcified masses which occasionally affect the salivary glands [1, 2]. In general, they are asymptomatic, presenting a slight increase in glandular volume during salivary stimulation, which causes a mild sensation of discomfort [3, 4].…”

“…Several techniques are used for diagnosis of sialolithiasis, ranging from simple techniques such as palpation and inspection [2], including analysis of secreted saliva [2, 7], to complementary examinations such as radiography, sialography, computed tomography, and ultrasonography [1–7]. However, depending on the location of sialolith (e.g., mainly in the duct of the submandibular gland), occlusal radiograph can be used for its visualisation [3, 8] if it is located in the glandular parenchyma; otherwise, other imaging examinations allow a better visualisation.…”