Sialolithiasis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Salivary calculus

Overview

Sialolithiasis refers to the formation of stones in the salivary glands. Stones are most commonly found in the submandibular gland and parotid gland, where stones can obstruct Wharton's duct and Stenson's duct respectively.

Causes

It is frequently associated with chronic infection (Staphylococcus aureus, Streptococcus viridans) of the glands, dehydration (phenothiazines), Sjögren's syndrome and/or increased local levels of calcium, but in many cases can arise idiopathically.

Natural History, Complications and Prognosis

Complications include persistent obstruction of the duct, leading to bacterial invasion, overgrowth and infection (sialoadenitis). This can require IV antibiotics such as nafcillin, and sometimes surgical drainage.

Diagnosis

History and Symptoms

Pain, when present, usually originates from the floor of the mouth, although in many cases the stones cause only intermittent swelling.

Physical Examination

Since chewing promotes release of saliva, symptoms tend to increase during meals. A palpable lump or visible swelling in the area of the gland is often noted.

X Ray

Diagnosis is usually made by characteristic history and physical examination. Diagnosis can be confirmed by x-ray (80% of salivary gland calculi are visible on x-ray), or by sialogram or ultrasound.

Treatment

Medical Therapy

Some current treatment options are:

  • For small stones, hydration, moist heat, NSAIDs occasionally, and having the patient take any food or beverage that is bitter and/or sour. Sucking on citrus fruits, such as a lemon or orange, may increase salivation and promote spontaneous expulsion of the stone.
  • Sialendoscopy
  • To prevent infection while the stone is lodged in the duct, sometimes antibiotics are used. In some cases when stones continually reoccur the offending salivary duct is removed.

Surgery

Template:Oral pathology

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