Sialolithiasis

A calculus measuring about 0.5 x 0.7cm within the opening of the Stensen’s duct.

X-ray of the oral cavity showing a single radiopaque stone (arrow) in the submandibular gland.

Extracted stone measuring approximately 1cm with two small fragmented pieces.

Sialolithiasis is the formation of a stone(s) within the salivary gland duct or parenchyma. Approximately 90% of the cases of silalolithiasis occur in the submandibular gland. Parotid gland comprises about 10% of sialolithiasis. Calculous stones are generally not found in sublingual or minor salivary glands. Clinical presentation depends on the location and the quality of the calculi. Patients typically present with pain and swelling of the affected region. Submandibular gland calculi may also be associated with sore throat/pharyngitis that is refractory to the antibiotics therapy. Bacterial infection (most commonly with S. viridans) can occur with prolonged obstruction that results in stasis of saliva. X-ray of the affected region can be helpful in the diagnosis. Treatments for small stones are conservative with the goal of aiding in passage of the stone and restoration of salivary flow. Increased fluid intake, sialogogues, moist heat, and massage. NSAIDS can be used for pain control. Antibiotics are used for superimposing bacterial infection. Surgical excision of the affected gland may be required for large stones or chronic recurrent infections.