Surgical Treatment of Sialolithiasis Leads to Improvement in the Complete Blood Count

What is the impact of previous cholelithiasis on sialolithiasis: A systematic review and meta-analysis

Introduction

A sialolith is a salivary stone usually presenting with swelling and pain in the affected salivary gland, most commonly the submandibular gland. There have been speculations about the association between this condition and other systemic diseases, especially those forming stones, such as nephrolithiasis and cholelithiasis. This systematic review and meta-analysis aimed to summarize the studies assessing the relationship between cholelithiasis and sialolithiasis.

Methods

PubMed/MEDLINE, Scopus, Web of Science, and Embase electronic databases were searched according to the keywords related to both disorders without any publication date or language restriction. Case-control and cohort studies evaluating the relationship between salivary and biliary stones were considered eligible. Quality assessment was performed following Newcastle-Ottawa Scale (NOS) for quality assessment of case-control studies. All meta and statistical analyses were performed with Comprehensive Meta-Analysis software.

Results

Two studies fully complied with the defined eligibility criteria and were included, both of which were case-control studies using national-scale databases. In both surveys, the prevalence of previous gallstones in patients with sialolithiasis was compared to that of a control group. Though one of the studies found that there is no relationship between sialolithiasis and cholelithiasis, the meta-analysis revealed that previous cholelithiasis is significantly more prevalent among patients with sialolithiasis (P = 0.000), with an odds ratio of 2.04.

Conclusion

It seems that cholelithiasis is significantly associated with an increase in salivary stone formation. Therefore, a thorough salivary examination in all patients declaring current or past cholelithiasis is recommended. However, more studies, especially prospective cohorts, are needed to make firmer conclusions.

Lactoferrin and the development of salivary stones: a pilot study

Salivary stones (sialoliths) are calcified structures located in the ductal system of the major salivary glands. Their exact cause is not clear but in general they are characterized by concentric inorganic (hydroxyapatite) layers. The formation is a slow intermittent process which may result in enlargement of the sialolith causing obstruction of saliva secretion resulting in mealtime related pain and swelling of the affected salivary gland. Various studies reported the presence of organic material such as proteins and lipids in the core of sialoliths. In the present study the protein composition of twenty submandibular sialoliths was analyzed. It was found that proteins contributed on average 5% to the dry weight of submandibular stones whereby small salivary stones contained more extractable proteins than large salivary stones. Using a combination of SDS-PAGE gel electrophoresis and Western blotting, we identified α-amylase (in all stones; 100%), lysozyme (95%), lactoferrin (85%), secretory-IgA (75%), MUC7 (60%), complement C4 (60%) and C-reactive protein (35%). The presence, and the combinations, of lactoferrin, lysozyme, s-IgA and α-amylase in sialoliths was confirmed by ELISA. The gradually increasing size of a sialolith might provoke a local inflammatory response in the duct of the submandibular gland whereby the relatively low concentrations of lactoferrin and lysozyme may originate from neutrophils. The interaction of lactoferrin with s-IgA could contribute to the accumulation of lactoferrin in sialoliths. In summary, these results suggest a new pathophysiological role for lactoferrin, in the formation of sialoliths.

Lactoferrin and the development of salivary stones: a pilot study

Salivary stones (sialoliths) are calcified structures located in the ductal system of the major salivary glands. Their exact cause is not clear but in general they are characterized by concentric inorganic (hydroxyapatite) layers. The formation is a slow intermittent process which may result in enlargement of the sialolith causing obstruction of saliva secretion resulting in mealtime related pain and swelling of the affected salivary gland. Various studies reported the presence of organic material such as proteins and lipids in the core of sialoliths. In the present study the protein composition of twenty submandibular sialoliths was analyzed. It was found that proteins contributed on average 5% to the dry weight of submandibular stones whereby small salivary stones contained more extractable proteins than large salivary stones. Using a combination of SDS-PAGE gel electrophoresis and Western blotting, we identified α-amylase (in all stones; 100%), lysozyme (95%), lactoferrin (85%), secretory-IgA (75%), MUC7 (60%), complement C4 (60%) and C-reactive protein (35%). The presence, and the combinations, of lactoferrin, lysozyme, s-IgA and α-amylase in sialoliths was confirmed by ELISA. The gradually increasing size of a sialolith might provoke a local inflammatory response in the duct of the submandibular gland whereby the relatively low concentrations of lactoferrin and lysozyme may originate from neutrophils. The interaction of lactoferrin with s-IgA could contribute to the accumulation of lactoferrin in sialoliths. In summary, these results suggest a new pathophysiological role for lactoferrin, in the formation of sialoliths.