Salivary
Sialolithiasis
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Sialolithiasis
, Salivary Gland Calculus, Salivary Duct Obstruction, Sialolith
See Also
Sialadenitis
Recurrent Parotitis of Childhood
Acute Nonsuppurative Sialoadenitis
(Viral)
Acute Suppurative Sialoadenitis
(
Bacteria
l)
Chronic Sialoadenitis
Sialolithiasis
Salivary Gland Tumor
Definition
Calculus within
Salivary Gland
duct
Epidemiology
Most common in ages 30 to 50 years (rare in children)
Pathophysiology
Salivary Gland
duct calculus
Submandibular Gland
duct or
Wharton's Duct
obstruction (80-90% of cases)
Located adjacent to frenulum
Parotid Gland
duct or
Stensen's Duct
obstruction (10-20% of cases)
Adjacent to second upper molar
Etiologies
Trauma
or local inflammation
Chronic disease
Stasis of
Saliva
and change in composition
Infection
Viral Infection
(e.g.
Mumps
)
Bacterial Infection
Staphylococcus aureus
Streptococcus
viridans
Streptococcus Pneumoniae
Haemophilus
Influenza
e
Symptoms
Localized pain and swelling at affected gland
Usually occurs at
Submandibular Gland
(angle of jaw)
Pain increases immediately before meals
Persists after the meal
Differential Diagnosis
Sialadenitis
Lymphadenitis
Dental abscess
Diagnosis
Calculi occur in
Submandibular Gland
s in 90% of cases
Ultrasound
Sensitive in identifying
Saliva
ry calculi
CT Reconstruction
Most sensitive for calculi
Sialogram
Demonstrates 80% of radiopaque calculi
Labs
Indicators of infectious
Sialadenitis
White Blood Cell Count
increased
C-Reactive Protein
(
C-RP
) increased
Serum Amylase
increased
Management
Removal of stone by massage or milking gland
Oral antibiotics
Augmentin
Cefzil
or
Ceftin
Clindamycin
Sialologues
Lemon drops induce
Saliva
tion, help clear stone
Maintain hydration with 64 ounces water per day
Avoid
Diuretic
s (
Caffeine
or
Alcohol
)
Otolaryngology for surgical management
Indicated if
Saliva
ry calculus does not pass within 5-7 days
Sialendoscopy (calculus removal with small endoscope)
Effective alternative to surgical excision of calculus
Best efficacy when implemented early in course
Witt (2012) Laryngoscope 122(6): 1306-11 [PubMed]
Luers (2012) Head Neck 34(4): 499-504 [PubMed]
Surgical excision of stone indications
Submandibular stones are accessible to local excision if palpable in the anterior floor of the mouth
Salivary Gland
excision indications (if failed sialendoscopy)
Submandibular hilar stones
Parotid duct stones
Complications
Obstructive Sialadenitis
(
Bacteria
l
Sialadenitis
)
References
Fedok in Noble (2001) Primary Care Medicine, p. 1770-1
Wilson (2014) Am Fam Physician 89(11): 882-8 [PubMed]
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