Sialolithiasis

Aka: Sialolithiasis, Salivary Gland Calculus, Salivary Duct Obstruction, Sialolith

advertisement

II. Definitions

  1. Sialolithiasis
    1. Calculus within Salivary Gland duct and secondary obstruction

III. Epidemiology

  1. Most common in ages 30 to 50 years (rare in children)
  2. Most common cause of Salivary Gland swelling (50% of cases)
  3. Lifetime Prevalence: 0.45%

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. Causes

  1. See Xerostomia
  2. Trauma or local inflammation
  3. Chronic disease
    1. Stasis of Saliva and change in composition
    2. Dehydration
    3. Malnutrition
    4. Medications
  4. Infection
    1. Viral Infection (e.g. Mumps)
    2. Bacterial Infection
      1. Staphylococcus Aureus
      2. Streptococcus viridans
      3. Streptococcus Pneumoniae
      4. Haemophilus Influenzae

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. See Salivary Gland Enlargement
  2. Sialadenitis
  3. Lymphadenitis
  4. Dental abscess

VIII. Imaging

  1. Calculi occur in Submandibular Glands in 90% of cases
  2. Imaging is indicated for obstructive Sialoadenitis without improvement in 48 hours
  3. Ultrasound
    1. Test Sensitivity: 65 to 95%
    2. Test Specificity: 80 to 97%
  4. CT with Contrast and Reconstruction
    1. Test Sensitivity: 96 to 98%
    2. Test Specificity: 88 to 100%
  5. MRI 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. General measures
    1. Maintain hydration with 64 ounces water per day
      1. Avoid Diuretics (Caffeine or Alcohol)
    2. Gentle massage over gland may help expel the stone
    3. Moist heat
    4. NSAIDs
    5. Sialologues induce Salivation (help clear stone)
      1. Lemon drops
      2. Vitamin C lozenges
      3. Citric acid or malic acid (lemons, limes, apples, grapes)
  2. Oral Antibiotics for obstructive Sialoadenitis
    1. See Bacterial Sialoadenitis for complicated infections
    2. Amoxicillin-Clavulanate (Augmentin) 875/125 mg every 12 hours OR
    3. Cefuroxime (Ceftin) 500 mg every 12 hours AND Metronidazole 500 mg every 8 hours OR
    4. Clindamycin 300 to 450 mg orally three to four times daily
  3. 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
      2. Salivary Gland excision indications (if failed sialendoscopy)
        1. Submandibular hilar stones
        2. Parotid duct stones
    4. Other measures
      1. Extracorporeal shockwave lithotripsy
      2. Laser lithotripsy
      3. Transoral robotic surgery

XI. Complications

  1. Obstructive Sialadenitis (Bacterial Sialadenitis)

XII. References

  1. Fedok in Noble (2001) Primary Care Medicine, p. 1770-1
  2. Kim (2024) Am Fam Physician 109(6): 550-9 [PubMed]
  3. Wilson (2014) Am Fam Physician 89(11): 882-8 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Sialolithiasis." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

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 196507003, 109767003, 155656006, 28826002
English Gland Calculi, Salivary, Gland Calculus, Salivary, Salivary Gland Calculi, Sialoliths, Calculi, Salivary Gland, Calculus, Salivary Gland, Sialolithiasis NOS, salivary calculus (diagnosis), salivary calculus (physical finding), salivary calculus, 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, Calculus of salivary gland or duct, Stone of salivary gland or duct, Salivary Gland Calculi [Disease/Finding], sialoliths, sialolithiasis, glands salivary stone, salivary gland stone, salivary gland stones, salivary stone, gland salivary stone, glands salivary stones, salivary stones, sialolith, gland salivary stones, Salivary stone (disorder), Sialolithiasis NOS (disorder), Sialolith, Calculus of salivary gland, Stone of salivary gland, Salivary calculus, Salivary stone, Sialolithiasis (disorder), 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, cálculo salival, lito salival, sialolito, sialolitiasis, SAI (trastorno), lito salival (concepto no activo), sialolitiasis, SAI, cálculo de la glándula salival, piedra de la glándula salival, sialolitiasis (trastorno), sialolitiasis, Cálculo de glándula salival, Sialolitiasis, Cálculos de las Glándulas Salivales, Piedras de las Grandulas Salivales
Swedish Spottkörtelstenar
Japanese ﾀﾞｾｷｼｮｳ, ﾀﾞｴｷｾﾝｹｯｾｷ, 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
Norwegian Spyttkjertelstener, Spyttkjertelstein, Konkrementer i spyttkjertel, Spyttkjertelsten, Spyttkjertelsteiner
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Salivary Gland Disorders

advertisement

2025 Family Practice Notebook, LLC. Terms | Privacy | About | Site Map | Newsletter | Blog

Footer Site Logo