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

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

See Also

Sialolithiasis Core EM

References
  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.
This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.