II. Definition

  1. Calculus within Salivary Gland duct

III. Epidemiology

  1. Most common in ages 30 to 50 years (rare in children)

IV. Pathophysiology: Salivary Gland duct calculus

  1. Submandibular Gland duct or Wharton's Duct obstruction (80-90% of cases)
    1. Located adjacent to frenulum
  2. Parotid Gland duct or Stensen's Duct obstruction (10-20% of cases)
    1. Adjacent to second upper molar

V. Etiologies

  1. Trauma or local inflammation
  2. Chronic disease
    1. Stasis of Saliva and change in composition
  3. Infection
    1. Viral Infection (e.g. Mumps)
    2. Bacterial Infection
      1. Staphylococcus aureus
      2. Streptococcus viridans
      3. Streptococcus Pneumoniae
      4. HaemophilusInfluenzae

VI. Symptoms

  1. Localized pain and swelling at affected gland
    1. Usually occurs at Submandibular Gland (angle of jaw)
  2. Pain increases immediately before meals
    1. Persists after the meal

VII. Differential Diagnosis

  1. Sialadenitis
  2. Lymphadenitis
  3. Dental abscess

VIII. Diagnosis

  1. Calculi occur in Submandibular Glands in 90% of cases
  2. Ultrasound
    1. Sensitive in identifying Salivary calculi
  3. CT Reconstruction
    1. Most sensitive for calculi
  4. Sialogram
    1. Demonstrates 80% of radiopaque calculi

IX. Labs: Indicators of infectious Sialadenitis

X. Management

  1. Removal of stone by massage or milking gland
  2. Oral antibiotics
    1. Augmentin
    2. Cefzil or Ceftin
    3. Clindamycin
  3. Sialologues
    1. Lemon drops induce Salivation, help clear stone
  4. Maintain hydration with 64 ounces water per day
    1. Avoid Diuretics (Caffeine or Alcohol)
  5. Otolaryngology for surgical management
    1. Indicated if Salivary calculus does not pass within 5-7 days
    2. Sialendoscopy (calculus removal with small endoscope)
      1. Effective alternative to surgical excision of calculus
      2. Best efficacy when implemented early in course
      3. Witt (2012) Laryngoscope 122(6): 1306-11 [PubMed]
      4. Luers (2012) Head Neck 34(4): 499-504 [PubMed]
    3. Surgical excision of stone indications
      1. Submandibular stones are accessible to local excision if palpable in the anterior floor of the mouth
    4. Salivary Gland excision indications (if failed sialendoscopy)
      1. Submandibular hilar stones
      2. Parotid duct stones

XII. References

  1. Fedok in Noble (2001) Primary Care Medicine, p. 1770-1
  2. Wilson (2014) Am Fam Physician 89(11): 882-8 [PubMed]

Images: Related links to external sites (from Bing)

Related Studies