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sialolithiasis (salivary stone)
Etiologu:
- decreased salivary gland flow predisposes
- risk factors
- hypovolemia
- diuretics
- anticholinegics
- smoking
- periodontal disease
- history of nephrolithiasis
Epidemiology:
- 1/15,000 to 1/30,000 per year
Pathology:
- stone generally in the duct of a major salivary gland
- submandibular gland Wharton duct in the floor of the mouth
- parotid gland Stensen duct opens opposite 2nd upper molar
- stones cause sialadenitis
Clinical manifestations:
- parotid or submandibular gland swelling
- much more common in submandibular glands than parotid glands [4]
- repetitive swelling during meals
- acute pain & swelling may occur in anticipation of eating or during eating
- pain & swelling is often transient but may persist
- a stone may be palpable
Complications:
- bacterial infection
Differential diagnosis:
- salivary gland neoplasm:
- generally painless
- lymphadenopathy & facial paralysis suggest malignancy
- sarcoidosis & Heerfordt syndrome:
- fever, uveitis, & parotitis with or without facial nerve palsy
- Sjogren syndrome: dry eyes, dry mouth, no mass lesion
Management:
- stimulation of saliva production with warm compresses
- sialogogues: sour candies or vitamin C lozenges
- salivary gland massage
- increase oral fluid intake
- oral hygiene
- sialendoscopy for removal of salivary stones
- lithotomy
- surgical resection
- extracorporeal shock wave lithotripsy (investigational)
Related
salivary gland
sialadenitis
General
abnormal morphologic structure (malformation)
calculus
References
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 186
- Aetna: Clinical policy bulletin
Sialolithiasis (Salivary Stones)
http://www.aetna.com/cpb/medical/data/700_799/0716.html
- Marchal F and Dulguerov P
Sialolithiasis Management: The State of the Art
Arch Otolaryngol Head Neck Surg. 2003;129:951-956.
http://archotol.ama-assn.org/cgi/content/full/129/9/951
- NEJM Knowledge+