II. Definition
- Calculus within Salivary Gland duct
III. Epidemiology
- Most common in ages 30 to 50 years (rare in children)
IV. Pathophysiology: Salivary Gland duct calculus
-
Submandibular Gland duct or Wharton's Duct obstruction (80-90% of cases)
- Located adjacent to frenulum
-
Parotid Gland duct or Stensen's Duct obstruction (10-20% of cases)
- Adjacent to second upper molar
V. Etiologies
VI. Symptoms
- Localized pain and swelling at affected gland
- Usually occurs at Submandibular Gland (angle of jaw)
- Pain increases immediately before meals
- Persists after the meal
VII. Differential Diagnosis
- Sialadenitis
- Lymphadenitis
- Dental abscess
VIII. Diagnosis
- Calculi occur in Submandibular Glands in 90% of cases
-
Ultrasound
- Sensitive in identifying Salivary calculi
- CT Reconstruction
- Most sensitive for calculi
- Sialogram
- Demonstrates 80% of radiopaque calculi
IX. Labs: Indicators of infectious Sialadenitis
- White Blood Cell Count increased
- C-Reactive Protein (C-RP) increased
- Serum Amylase increased
X. Management
- Removal of stone by massage or milking gland
- Oral antibiotics
- Sialologues
- Lemon drops induce Salivation, help clear stone
- Maintain hydration with 64 ounces water per day
- Otolaryngology for surgical management
- Indicated if Salivary calculus does not pass within 5-7 days
- Sialendoscopy (calculus removal with small endoscope)
- Effective alternative to surgical excision of calculus
- Best efficacy when implemented early in course
- Witt (2012) Laryngoscope 122(6): 1306-11 [PubMed]
- Luers (2012) Head Neck 34(4): 499-504 [PubMed]
- Surgical excision of stone indications
- Submandibular stones are accessible to local excision if palpable in the anterior floor of the mouth
- Salivary Gland excision indications (if failed sialendoscopy)
- Submandibular hilar stones
- Parotid duct stones
XI. Complications
XII. References
- Fedok in Noble (2001) Primary Care Medicine, p. 1770-1
- Wilson (2014) Am Fam Physician 89(11): 882-8 [PubMed]