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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
  • >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


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


  • 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


  • Outpatient

See Also

External Links

Sialolithiasis Core EM


  1. Gritzmann N. Sonography of the salivary glands. AJR Am J Roentgenol. 1989;153 (1): 161-6.
  2. 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.