Sialolithiasis

Key Features

• Calculus formation is more common in Wharton duct (draining the submandibular glands) than in Stensen duct (draining the parotid glands)

Clinical Findings

• Patient may note postprandial pain and local swelling, often with a history of recurrent acute sialadenitis

Diagnosis

• Stones in Wharton duct are usually large and radiopaque, whereas those in Stensen duct are usually radiolucent and smaller

• Stones very close to the orifice of Wharton duct may be palpated manually in the anterior floor of the mouth and removed intraorally by dilating or incising the distal duct

Treatment

• Stones more than 1.5–2 cm from the duct are too close to the lingual nerve to be removed safely in this manner

• Dilation of Stensen duct, located on the buccal surface opposite the second maxillary molar, may relieve distal stricture or allow a small stone to pass

• Sialoendoscopy for the management of chronic sialolithiasis is superior to extracorporeal shock-wave lithotripsy and fluoroscopically guided basket retrieval

• Repeated episodes of sialadenitis are usually associated with stricture and chronic infection

• If the obstruction cannot be safely removed or dilated, excision of the gland may be necessary to relieve recurrent symptoms