Sialolithiasis

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. HaemophilusInfluenzae
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