Sialolithiasis

1. Sialolithiasis

2. Introduction
• Sialolithiasis is the presence of calculi in the
salivary glands or ducts.

3. • Stones will form in the salivary gland or ducts
following the stagnation of saliva; they are
typically composed of calcium phosphate and
hydroxyapatite, as the saliva is rich in calcium

4. Risk Factors
• Medication, commonly diuretics or anti
cholinergics
• Dehydration
• Gout
• Smoking
• Chronic periodontal disease
• Hyperparathyroidism

5. Clinical Features
• asymptomatic,
• intermittent facial swelling associated with
eating, which can be painful or painless.
• Symptoms are usually unilateral in nature.
• When the gland is palpated, saliva can be seen
at the duct orifice, along with the presence of
small stones.
• On palpation, a stone may be palpable in the
duct and the gland may feel tender in the
presence of infection.

7. Investigations
• Most cases of suspected sialolithiasis are
investigated* with either ultrasound or
radiographs.

8. Management
• Most patients are managed conservatively
with oral hydration, analgesia, and
sialologues, such as lemon juice, which
promote saliva production. Milking /
massaging the gland can help as well.
• If the gland becomes infected and the patient
develops sialedenitis, then antibiotics are
typically indicated.

9. Definitive Management
• Interventional radiology procedures are most
commonly trialled, which involve fluoroscopic
control such that the stones are visualised in
the duct and then extracted with a basket.

10. • A surgical approach can be used to remove
some more difficult stones; a transoral
approach can be used if the stones are distal
or a transcervical approach for proximal
stones (or where the transoral approach has
been unsuccessful).

11. • Gland removal is last resort. Excision of the
parotid or submandibular gland are only
performed for patients with chronically
persisting symptoms.