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SialolithiasisAka: Salivary Gland Calculus, Salivary Duct Obstruction, Sialolith

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  1. Definition
    1. Calculus within Salivary Gland duct
  2. Epidemiology
    1. Most common in ages 30 to 50 years (rare in children)
  3. Pathophysiology: Salivary Gland duct calculus
    1. Submandibular Gland duct (Wharton's Duct) obstruction
      1. Located adjacent to frenulum
      2. Most commonly affected gland (90%)
    2. Parotid Gland duct (Stensen's Duct) obstruction
      1. Adjacent to second upper molar
      2. Not Uncommonly affected
  4. 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. Haemophilus Influenzae
  5. Symptoms
    1. Localized pain and swelling at affected gland
      1. Usually occurs at Submandibular Gland (angle of jaw)
    2. Pain increases immediately before meals
  6. Differential Diagnosis
    1. Sialadenitis
    2. Lymphadenitis
    3. Dental abscess
  7. Diagnosis
    1. Calculi occur in Submandibular Glands in 90% of cases
    2. CT Reconstruction is most sensitive for calculi
    3. Sialogram shows the 80% of radiopaque calculi
  8. Labs: Indicators of infectious Sialadenitis
    1. Increased White Blood Cell count
    2. Increased C-Reactive Protein
    3. Increased Serum Amylase
  9. Management
    1. Removal of stone by massage or milking gland
    2. Consider ENT referral for surgical removal
      1. If stone does not pass in first 5-7 days
    3. Oral antibiotics
      1. Augmentin
      2. Cefzil
      3. Ceftin
    4. Sialologues
      1. Lemon drops induce Salivation, help clear stone
    5. Maintain hydration with 64 ounces water per day
      1. Avoid Diuretics (Caffeine or Alcohol)
  10. Complications
    1. Obstructive Sialadenitis (Bacterial Sialadenitis)
  11. References
    1. Fedok in Noble (2001) Primary Care Medicine, p. 1770-1

Sialolithiasis (C0036091)

Definition (MSH)Calculi occurring in a salivary gland. Most salivary gland calculi occur in the submandibular gland, but can also occur in the parotid gland and in the sublingual and minor salivary glands.
ConceptsDisease or Syndrome (T047)
ICD9527.5
EnglishCalculus of salivary gland, Calculus of salivary gland or duct, Salivary calculus, Salivary Gland Calculi, Salivary Gland Calculus, Salivary Gland Stone, Salivary Gland Stones, Salivary stone, Sialolith, Sialolithiasis, Sialoliths, Stone of salivary gland, Stone of salivary gland or duct
Spanishcálculo de la glándula salival, cálculo salival, calculo de la glandula salival, calculo salival, lito salival, piedra de la glándula salival, piedra de la glandula salival, sialolitiasis, sialolito
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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