Introduction
Sialolithiasis, occurring in 0.1 to 1% of the global population, refers to the formation of calcified stones in the salivary gland duct system1. Sialolithiasis occurs primarily in the submandibular gland (72 – 95%) and parotid gland (4 – 28%), while sublingual and minor salivary glands are seldom involved2 .
Symptoms include recurrent gland swelling after meals, pain, and acute suppurative inflammation, which can lead to gland atrophy and fibrosis due to repeated inflammation. Calculi literally refers to abnormal formation of mineral salts inside the body. ‘Sial’ refers to salivary gland and sialolith refers to salivary gland calculi3.
Although various theories exist on the mechanisms of stone formation in salivary glands, consensus remains elusive. Generally, stone formation results from multiple factors, such as saliva secretion disorders, micro-stone formation, and organic lesion deposition as pathogenic elements 1, 4, 5
Figure1- Courtesy: Sialolithiasis @ENTClinicSydney Updated January 16, 2014 [Cited 20 Sep 2019]
The length of the submandibular gland duct (Wharton’s duct) is 5cm.This is the site where stones are developed frequently. In salivary calculus, the swelling becomes prominent when lemon juice or chocolates are given to the patient to drink or to eat.
The genesis of stone formation lies in the stagnation of calcium rich saliva. The submandibular duct has long tortuous path and thicker mucoid secretion that may be responsible for its greater tendency to form salivary calculi5.
Management of these stones is usually done with conservative measures. This includes applying moist heat and gentle m***age to the salivary gland. Staying well hydrated is important. Lemon drops can help stimulate salivation.
Ibuprofen or other nonsteroidal anti-inflammatory drugs can reduce pain and swelling. If your surgeon notices evidence of infection, an antibiotic may be prescribed6. For larger, harder-to-remove stones, the oral and maxillofacial surgeon can make a small incision in the mouth to remove the stone.
Another treatment option involves a less invasive technique called sialendoscopy7, 8. This technique uses small lighted scopes inserted into the gland’s opening in the mouth to visualize the salivary duct system and locate the stone. Then, using small instruments, the surgeon can remove the stone8.
Case Report
Case presentation: On 3rd May 2021, a 55-year-old male diagnosed with Sialolithiasis in 2016 via ultrasound neck (Fig.2) presented to the homeopath.
Figure 2. Ultrasound Neck Dated 25th January 2016
History of presenting complaints: Patient was apparently well when he started complaining of the gradually increasing swelling in the floor of the mouth. The opening of the mouth became painful 6 years ago. The size of the swelling started increasing gradually. In between, the pain got better when he took antibiotics and pain killers. Then it would come back again.
Homeopathic Consultation: At the initial anamnesis, the patient presented with a ball like swelling (3-4 cm) at the floor of the mouth.
Physical Generals:
Desires: Salty, sour (lemon or pickles with every meal).
Aggravations: Rich food (high in fat content) made him worse.
Thirst: Drank water in sips, thirsty for cold drinks. (because of the swelling he could not drink large quantities of water)
He was a warm-blooded person.
Comorbidities: He was suffering from hypertension from past 10 years.
Past Medical History: Cardiac stenting was done in the year 2017. He was taking treatment for the cardiac ailments.
Family History: Father and mother both were healthy, and they p***ed away due to age related complications. His two older brothers suffered from diabetes mellitus and hypertension.
Homeopathic ***ysis of the case
His physical symptoms included a ball like swelling (3-4 cm) in the floor of the mouth on the right side. It was painful when opening his mouth. He used a straw to take liquid diet. The pain sometimes radiated to his ear. He had a tendency to clench his teeth which ameliorated the pain. The mental emotional picture of the person showed that he was a dutiful person who had been working as a driver for 30 years.
After the diagnosis of the stones and the stenting, he had been in constant grief. He was dissatisfied in his life as he did not find happiness in anything. He was afraid of having surgery or injections. He was anxious about his health, always thinking that he may die soon and who then would look after the family.
He got angry very easily, did not like to talk much and avoided company. He didn’t like to eat any outside food because he thought he would catch some major disease. He was also very anxious about the family members that they would catch disease.
He was very much dutiful, never missing a day from duty for his own sake. He liked to read about diseases, like he was trying to find out the cause for the stones in his mouth.
The software used for the reperatrization was Vithoulkas Comp***. Repertorial Analysis revealed that the two keynotes which characterise his pain ***ociated with the gland were covered by the remedy Phytolacca decandra.
In this case, the patient was constantly taking the pain killers and the antibiotics for the inflammation of the gland. He did not want to go for the surgery due to his fear and belief that he will get some relief with the alternative treatment. The sadness and the fear were a result of the diagnosis of the disease and not his primary pathology. Therefore, the patient’s physical symptoms were focused upon in selection of the remedy, although Phytolacca did not cover the mental – emotional picture of the patient, and was covering only 4 rubrics out of the 20 rubrics taken, it was considered.
Fig 2: Repertorisation of the case at intake, on 3rd May 2021
Prescription on 3rd May 2021: Based on reportorial totality and the Materia medica, Phytolacca decandra 12C/three times a day/15days was prescribed in the pill form.
Rationale behind the prescription
Phytolacca was chosen because of its specific action on the glandular system. The two keynotes which it covered were desire to clench the teeth and clenching the teeth made the pain ameliorate. The potency selected was a low (12C) potency, because of the action was expected purely on the physical plane.
Table 1. Follow up of the Case
| Date | Symptoms/Observations | Homeopathic Prescription |
| 14-06-2021
|
The pain decreased with Phytolacca 12C, but the swelling increased. There was no sand coming in his mouth while eating. He did not take any painkillers or antibiotics after the Phytolacca.
A remedy was needed which could act on the stone first because the symptoms from the presence of the stone were not letting the picture of the layers below become clear. |
Hydrangea Arborescens 30/ twice a day for 5 days
|
| 26-07-2021 | The stone came out while eating breakfast two days prior.
He seemed to be in a better state of the health as the physical, emotional and mental symptoms had ameliorated. The pain had decreased, and he seemed to be more relaxed. He was able to eat and open his mouth. The energy levels were better. |
He was asked to wait and no remedy was prescribed, as the patient didn’t want to address his cardiac issues |
Figure 4. Ultrasound Neck dated 25-07-2021
Figure. 5 Picture of the stone that was released.
Discussion
This case of Sialolithiasis, required two remedies Phytolacca and Hydrangea in managing the case. This was a potentially surgical case as the anatomy of the duct would never allow the stone of 11mm diameter to p*** through it. The remedies were selected here only on the physical symptoms. Phytolacca helped in decreasing the inflammation of the gland, while Hydrangea acted on the stones and helped extracting the stones.
Materia medica by John Henry Clarke states: “Like some other members of the Saxifragaceae, Hydrangea has a traditional reputation as a “stone breaking” remedy and has been used in calculous diseases”.9
In this case the patient’s sadness and fears ***ociated with disease had been there for life and this had gotten worse due to his condition. The immediate need was on physical plane, with relief in this, the patient started smiling again.
Though one of the stones remained at the end of treatment, it did not cause any symptoms to the patient and he chose not to continue the treatment.
Conclusion
This case of sialolithiasis showed benefit from individualised cl***ical homeopathy despite being a potentially surgical case. Further scientific studies are required for establishing the role of homeopathy in surgical conditions.
References:
- Grases F, Santiago C, Simonet BM, Costa-Bauzá A. Sialolithiasis: mechanism of calculi formation and etiologic factors. Clinica Chimica Acta. 2003 Aug 1;334(1-2):131-6.
- Kraaij S, de Visscher JGAM, Apperloo RC, Nazmi K, Bikker FJ, Brand HS. Lactoferrin and the development of salivary stones: a pilot study. Biometals. 2023 Jun;36(3):657-665. doi: 10.1007/s10534-022-00465-7. Epub 2022 Nov 17. PMID: 36396778; PMCID: PMC10181970
- Qu LY, Zheng DN, Ling XT, Liu GQ, Xu XY, Liu DG. Microarchitecture and Crystalline Composition: A Comprehensive Exploration of Salivary Gland Stones. Oral Diseases. 2025 Jan 2.
- Marchal F, Kurt AM, Dulguerov P, Lehmann W. Retrograde theory in sialolithiasis formation. Archives of Otolaryngology–Head & Neck Surgery. 2001 Jan 1;127(1):66-8.
- Epivatianos A, Harrison JD, Dimitriou T. Ultrastructural and histochemical observations on microcalculi in chronic submandibular sialadenitis. Journal of Oral Pathology & Medicine. 1987 Nov;16(10):514-7.
- M, S. B. (2009). SRBS Manual of Surgery Third Edition. In Jaypee Brothers Medical Publishers (P) Ltd. eBooks.
- Iqbal A, Gupta AK, Natu SS, Gupta AK. Unusually large sialolith of Wharton’s duct. Ann Maxillofac Surg. 2012 Jan;2(1):70-3. doi: 10.4103/2231-0746.95327. PMID: 23483770; PMCID: PMC3591092.
- Moorthy A, Bachalli PS, Krishna S, Murthy S. Sialendoscopic management of obstructive salivary gland pathology: a retrospective ***ysis of 236 cases. Journal of Oral and Maxillofacial Surgery. 2021 Jul 1;79(7):1474-81.
- Clarke JH. A Dictionary of Practical Materia Medica. London Homeopathic Pub Co. 1925; 802
