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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

Treatment

  • Dilation or incision of distal Wharton duct:

    • Stones very close to the orifice may be removed intraorally

    • 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

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