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
- Ranula
- Sialoadenitis
- Sialolithiasis
- Superior vena cava syndrome
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