Fact-sheet: Salivary lithiasis
Updated on 12/17/2022 at 5:39 PM
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Definition
Presence of calcium phosphate stones, usually radiopaque, within the excretory ducts of the major salivary glands, causing mechanical and inflammatory complications.
Much more common in the submandibular glands.
Clinical features
Mechanical events: -salivary hernia (Garel's hernia): sudden swelling of the salivary gland at the start of a meal, resolving by the end of the meal while the patient feels a flow of saliva into the mouth. -salivary colic (Morestin's colic): sudden intense pain in the floor of the mouth during a meal. Infectious events: -Whartonitis. -Periwhartonitis. -Submandibulitis
Causes to consider in the setting of an inflammatory, painful cervical swelling.
Radiography
Occlusal film: usually demonstrates a radiopaque calculus.
Sialography: enables detection of a posterior calculus and shows the state of ductal sclerosis; radiolucent calculi appear as a negative filling defect within the opaque contrast column, along with any associated complications.
Ultrasound
- increased gland volume
- hyperemia on color Doppler
- dilatation of the excretory duct (Wharton's duct for the submandibular gland, Stensen's duct for the parotid gland)
- impacted calculus (hyperechoic with posterior acoustic shadowing)
CT
- increased gland volume
- increased arterial enhancement after contrast material injection
- dilatation of the excretory duct
- value of an unenhanced acquisition to look for a calculus
- value of contrast injection to look for complications (e.g., cervical cellulitis)
Management
Calculus < 3 mm: sialendoscopy
If infectious complications:
- antibiotic therapy + analgesics
- emergency surgical drainage, extraoral or intraoral