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

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