Sialolithiasis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Pain, swelling, and tenderness may resemble parotitis | *Pain, swelling, and tenderness may resemble [[parotitis]] | ||
**Sialolithiasis is exacerbated by meals and may develop over course of minutes when eating | **Sialolithiasis is exacerbated by meals and may develop over course of minutes when eating | ||
*Typically unilateral | *Typically unilateral | ||
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*80% of submandibular and 60% of parotid able to been seen on XR | *80% of submandibular and 60% of parotid able to been seen on XR | ||
*CT and MRI | *CT and MRI | ||
* | *[[Ultrasound]] visualizes both the gland and the stone | ||
**High frequency intra-oral probes | **High frequency intra-oral probes | ||
**Hyperechoic lines with posterior acoustic shadowing | **Hyperechoic lines with posterior acoustic shadowing | ||
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==Management== | ==Management== | ||
*Antibiotics only indicated if concurrent infection | *Antibiotics only indicated if concurrent infection | ||
**Augmentin or | **[[Augmentin]] or [[clindamycin]] | ||
*Palpable stones in the distal duct may be 'milked' out | *Palpable stones in the distal duct may be 'milked' out | ||
**From a posterior to anterior direction | **From a posterior to anterior direction | ||
Revision as of 22:36, 30 September 2019
Background
- Development of a calcium carbonate and calcium phosphate stone in a stagnant salivary duct
- >80% occur in the submandibular gland
Clinical Features
- Pain, swelling, and tenderness may resemble parotitis
- Sialolithiasis is exacerbated by meals and may develop over course of minutes when eating
- Typically unilateral
- A stone may be palpated within the duct and the gland is firm
Differential Diagnosis
Facial Swelling
- Buccal space infections
- Dental problems
- Canine space infection
- Facial cellulitis
- Herpes zoster
- Masticator space infections
- Maxillofacial trauma
- Neoplasm
- Parapharyngeal space infection
- Salivary gland diagnoses
- Parotitis
- Ranula
- Sialoadenitis
- Sialolithiasis
- Superior vena cava syndrome
Evaluation[1][2]
Imaging will likely not change management in the ED setting as treatment involves conservative measures
- 80% of submandibular and 60% of parotid able to been seen on XR
- CT and MRI
- Ultrasound visualizes both the gland and the stone
- High frequency intra-oral probes
- Hyperechoic lines with posterior acoustic shadowing
- Small stones < 2 mm may not shadow
- Able to assess radiolucent stones
- In obstruction, gland enlarged and ducts proximal to stone may be dilated
Management
- Antibiotics only indicated if concurrent infection
- Palpable stones in the distal duct may be 'milked' out
- From a posterior to anterior direction
- Give lemon drops or other sialogogues