Research Article| Volume 60, ISSUE 10, P1385-1390, December 2022

Sialolithiasis: mineralogical composition, crystalline structure, calculus site, and epidemiological features

Published:August 22, 2022DOI:


      The purpose of this paper was to describe the characteristics of salivary calculi and their relationship to epidemiological factors, through a cross-sectional study. We analysed 100 calculi obtained in 2017–2021. Patient data including age, time since onset of symptoms, gland involved, and site of location in the salivary system were studied. The calculi were studied to determine their morphological features using scanning electron microscopy and energy dispersive plain radiographic analysis. Most of the calculi had formed in the submandibular gland (SG) (82%). The mean age of patients at onset was 45.83 years; patients presenting parotid gland (PG) stones were somewhat older (p = 0.031). The mean time since the onset of symptoms was longer in PG calculi (p = 0.038). The most common lithiasis site was the main duct (74%), followed by the hilum (22%). Hilar stones were the largest (p < 0.05) and heaviest (p = 0.028). Octacalcium phosphate (OCP) was the most common crystalline phase (Cp) founded, followed by hydroxyapatite (HA) and whitlockite (WH). Specifically, OCP had a higher presence in PG calculi (p = 0.029) and WH was the most common phase in SG calculi (p = 0.017). The most prevalent site of lithiasis was the main duct, and the largest and heaviest calculi were found in the SG. PG stones were associated with a longer history of symptoms and older age. OCP was the most frequent Cp of the calculi studied, and the main Cp in PG stones. WH was the predominant Cp in SG stones. The Cp of the calculi was not influenced by location, patient age, or time of symptoms.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Marchal F.
        • Dulguerov P.
        Sialolithiasis management: the state of the art.
        Arch Otolaryngol Head Neck Surg. 2003; 129: 951-956
        • Capaccio P.
        • Torretta S.
        • Ottavian F.
        • et al.
        Modern management of obstructive salivary diseases.
        Acta Otorhinolaryngol Ital. 2007; 27: 161-172
        • Schrøder S.A.
        • Andersson M.
        • Wohlfahrt J.
        • et al.
        Incidence of sialolithiasis in Denmark: a nationwide population-based register study.
        Eur Arch Otorhinolaryngol. 2017; 274: 1975-1981
        • Huoh K.C.
        • Eisele D.W.
        Etiologic factors in sialolithiasis.
        Otolaryngol Head Neck Surg. 2011; 145: 935-939
        • Kraaij S.
        • Karagozoglu K.H.
        • Forouzanfar T.
        • et al.
        Salivary stones: symptoms, aetiology, biochemical composition and treatment.
        Br Dent J. 2014; 217: E23
        • Harrison J.D.
        Causes, natural history, and incidence of salivary stones and obstructions.
        Otolaryngol Clin North Am. 2009; 42: 927-947
        • Marchal F.
        • Kurt A.M.
        • Dulguerov P.
        • et al.
        Retrograde theory in sialolithiasis formation.
        Arch Otolaryngol Head Neck Surg. 2001; 127: 66-68
        • Teymoortash A.
        • Buck P.
        • Jepsen H.
        • et al.
        Sialolith crystals localized intraglandularly and in the Wharton's duct of the human submandibular gland: an X-ray diffraction analysis.
        Arch Oral Biol. 2003; 48: 233-236
        • Epivatianos A.
        • Harrison J.D.
        • Dimitriou T.
        Ultrastructural and histochemical observations on microcalculi in chronic submandibular sialadenitis.
        J Oral Pathol. 1987; 16: 514-557
      1. Harrison JD. Histology and pathology of sialolithiasis. In: Witt RL, editor. Salivary Gland Diseases. Thieme; 2005. p. 71–8.

        • Zenk J.
        • Hosemann W.G.
        • Iro H.
        Diameters of the main excretory ducts of the adult human submandibular and parotid gland: a histologic study.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85: 576-580
        • Martín-Ramos J.D.
        • Díaz-Hernández J.L.
        • Cambeses A.
        • et al.
        Pathways for quantitative analysis by x-ray diffraction.
        in: Aydinalp C. An introduction to the study of mineralogy. IntechOpen, 2012: 73-92
      2. Martin JD. Using XPowder: A software package for Powder X-Ray diffraction analysis. D.L. GR 1001/04.ISBN 84-609-1497-6. Spain; 2004. 105 p.

        • Sigismund P.E.
        • Zenk J.
        • Koch M.
        • et al.
        Nearly 3,000 salivary stones: some clinical and epidemiologic aspects.
        Laryngoscope. 2015; 125: 1879-1882
        • Lustmann J.
        • Regev E.
        • Melamed Y.
        Sialolithiasis: a survey on 245 patients and a review of the literature.
        Int J Oral Maxillofac Surg. 1990; 19: 135-138
        • Nahlieli O.
        • Eliav E.
        • Hasson O.
        • et al.
        Pediatric sialolithiasis.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 90: 709-712
        • McGurk M.
        • Escudier M.P.
        • Brown J.E.
        Modern management of salivary calculi.
        Br J Surg. 2005; 92: 107-112
        • Nahlieli O.
        Modern management preserving the salivary glands.
        J Oral Maxillofac Surg. 2007; 67: 115-117
        • Burnstein L.S.
        • Boskey A.L.
        • Tannenbaum P.J.
        • et al.
        The crystal chemistry of submandibular and parotid salivary gland stones.
        J Oral Pathol. 1979; 8: 284-291
        • Ekberg O.I.
        • Isacsson G.
        Chemical analysis of the inorganic component of human salivary duct calculi.
        Arch Oral Biol. 1981; 26: 951-953
        • Kasaboğlu O.
        • Er N.
        • Tümer C.
        • et al.
        Micromorphology of sialoliths in submandibular salivary gland: a scanning electron microscope and X-ray diffraction analysis.
        J Oral Maxillofac Surg. 2004; 62: 1253-1258
        • Rakesh N.
        • Bhoomareddy Kantharaj Y.D.
        • Agarwal M.
        • et al.
        Ultrastructural and elemental analysis of sialoliths and their comparison with nephroliths.
        J Investig Clin Dent. 2014; 5: 32-37