Sialolithiasis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Illu quiz hn 02.jpg|thumb|Salivary glands: #1 Parotid gland, #2 Submandibular gland, #3 Sublingual gland.]] | |||
*Development of a calcium carbonate and calcium phosphate stone in a stagnant salivary duct | *Development of a calcium carbonate and calcium phosphate stone in a stagnant salivary duct | ||
*>80% occur in the submandibular gland | *>80% occur in the submandibular gland | ||
==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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{{Facial swelling DDX}} | {{Facial swelling DDX}} | ||
== | ==Evaluation<ref>Gritzmann N. Sonography of the salivary glands. AJR Am J Roentgenol. 1989;153 (1): 161-6.</ref><ref>Jäger L, Menauer F, Holzknecht N et-al. Sialolithiasis: MR sialography of the submandibular duct--an alternative to conventional sialography and US? Radiology. 2000;216 (3): 665-71.</ref>== | ||
''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 | *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 | **High frequency intra-oral probes | ||
** | **Hyperechoic lines with posterior acoustic shadowing | ||
**Small stones < 2 mm may not shadow | **Small stones < 2 mm may not shadow | ||
**Able to assess radiolucent stones | **Able to assess radiolucent stones | ||
**In obstruction, gland enlarged and ducts proximal to stone may be dilated | |||
== | ==Management== | ||
*Antibiotics only indicated if concurrent infection | *Antibiotics only indicated if concurrent infection ([[suppurative parotitis]]) | ||
**Reasonable to start with Keflex 500 mg q6h x 5 days with close follow up | |||
**Broaden to [[Augmentin]] or [[Clindamycin]] prn | |||
*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 | ||
*Recommend lemon drops, tart candies, or other sialogogues to promote salivation and stone passage | |||
==Disposition== | |||
*Outpatient | |||
==See Also== | ==See Also== | ||
[[Salivary | *[[Salivary gland diagnoses]] | ||
==External Links== | |||
[https://coreem.net/core/sialolithiasis/ Sialolithiasis Core EM] | |||
==References== | ==References== | ||
Latest revision as of 04:45, 6 January 2022
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 (suppurative parotitis)
- Reasonable to start with Keflex 500 mg q6h x 5 days with close follow up
- Broaden to Augmentin or Clindamycin prn
- Palpable stones in the distal duct may be 'milked' out
- From a posterior to anterior direction
- Recommend lemon drops, tart candies, or other sialogogues to promote salivation and stone passage
Disposition
- Outpatient