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Sialolithiasis
From WikEM
Contents
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
- Superior vena cava syndrome
- Buccal space infections
- Dental problems
- Masticator space infections
- Parapharyngeal space infection
- Neoplasm
- Maxillofacial trauma
- Facial cellulitis
- Canine space infection
- Salivary gland diagnoses
- Viral parotitis
- Suppurative parotitis
- Sialolithiasis
- Sialoadenitis
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
- US 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
- Give lemon drops or other sialogogues
See Also
References
- ↑ Gritzmann N. Sonography of the salivary glands. AJR Am J Roentgenol. 1989;153 (1): 161-6.
- ↑ 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.
