Sialolithiasis

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
    • Bilateral parotitis
    • Suppurative parotitis
    • Viral parotitis (Mumps)
  • Ranula
  • Sialoadenitis
  • Sialolithiasis
• Superior vena cava syndrome

Diagnosis

• 80% of submandibular and 60% of parotid able to been seen on XR
• US visualizes both the gland and the stone
  • High frequency intra-oral probes
  • Stones strongly hyperechoic lines with posterior acoustic shadowing
  • Small stones < 2 mm may not shadow
  • Able to assess radiolucent stones

Treatment

• Antibiotics only indicated if concurrent infection
• Palpable stones in the distal duct may be 'milked' out
• Give lemon drops or other sialogogues

See Also

Salivary Gland Infections