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

  1. White Blood Cell count increased
  2. C-Reactive Protein (C-RP) increased
  3. Serum Amylase increased

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] (or open in [QxMD Read])
      4. Luers (2012) Head Neck 34(4): 499-504 [PubMed] (or open in [QxMD Read])
    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

XI. Complications

XII. References

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

Images: Related links to external sites (from Google)

Ontology: 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.
Concepts Disease or Syndrome (T047)
MSH D015494
ICD9 527.5
ICD10 K11.5
SnomedCT 109767003, 155656006, 196507003, 28826002
English Gland Calculi, Salivary, Gland Calculus, Salivary, Salivary Gland Calculi, Sialoliths, Calculi, Salivary Gland, Calculus, Salivary Gland, SIALOLITHIASIS, Sialolithiasis NOS, salivary calculus (diagnosis), salivary calculus (physical finding), salivary calculus, Salivary stone (disorder), calculus of salivary gland (diagnosis), calculus of salivary gland, Calculus salivary gland, Salivary gland calculus, Gland Stone, Salivary, Gland Stones, Salivary, Salivary Gland Stones, Stone, Salivary Gland, Stones, Salivary Gland, Sialolithiasis NOS (disorder), Calculus of salivary gland or duct, Stone of salivary gland or duct, Salivary Gland Calculi [Disease/Finding], sialoliths, glands salivary stone, salivary gland stone, salivary gland stones, salivary stone, gland salivary stone, glands salivary stones, salivary stones, sialolith, gland salivary stones, Sialolith, Calculus of salivary gland, Stone of salivary gland, Salivary calculus, Salivary stone, Sialolithiasis (disorder), sialolithiasis, calculus; salivary gland, salivary gland; calculus, Sialolithiasis, Salivary Gland Calculus, Salivary Gland Stone
Italian Calcolo della ghiandola salivare, Calcolo di ghiandola salivare, Sialolitiasi, Sialoliti, Calcoli della ghiandola salivare
Dutch sialolithiasis, calculus; speekselklier, speekselklier; calculus, speekselkliersteen, Sialolithiasis, Speekselkliersteen
French Calcul dans la glande salivaire, Lithiase salivaire, Calcul d'une glande salivaire, Calculs d'une glande salivaire, Calculs salivaires intraglandulaires, Lithiase salivaire intraglandulaire, Sialolithes, Sialolithiase
German Stein der Speicheldruese, Sialolithiasis, Speichelstein, Sialolithen, Sialothiasis, Speicheldrüsenkonkremente, Speicheldrüsensteine
Portuguese Cálculo de glândula salivar, Cálculo das glândulas salivares, Cálculos das Glândulas Salivares, Pedras das Glândulas Salivares, Sialolitíase
Spanish Cálculo en glándula salival, Sialolithiasis, cálculo de la glándula salival, cálculo salival, lito salival (concepto no activo), lito salival, piedra de la glándula salival, sialolitiasis (trastorno), sialolitiasis, SAI (trastorno), sialolitiasis, SAI, sialolitiasis, sialolito, Cálculo de glándula salival, Sialolitiasis, Cálculos de las Glándulas Salivales, Piedras de las Grandulas Salivales, Calculos de las Glandulas Salivales
Swedish Spottkörtelstenar
Japanese ダセキショウ, ダエキセンケッセキ, 唾液腺結石, 結石-唾液腺, 唾石症
Czech slinné žlázy - kaménky, sialolitiáza, Konkrement slinné žlázy, Sialolitiáza
Finnish Sylkirauhaskivet
Russian SLIUNNOI ZHELEZY KAMNI, SIALOLITIAZ, СИАЛОЛИТИАЗ, СЛЮННОЙ ЖЕЛЕЗЫ КАМНИ
Korean 타석증
Polish Kamica ślinianek, Kamienie gruczołów ślinowych
Hungarian Nyálmirigy kő, Nyálmirigykő, Sialolithiasis