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WELCOME APPLICANTS!!

December 10, 2010

Stensen’s duct

Wharton’s ducts

Sialolithiasis

Stones in salivary glands or ducts

80-90% arise from submandibular glands

75% are unilateral Rare in children

Sialolithiasis

EtiologyStagnation of saliva

rich in CaInflammationDehydrationAnti-cholinergicsTrauma

Sialolithiasis

HistoryPain – 70%SwellingAggravated by eating

Physical ExamFlow of salivaStones may be visibleStones may be palpated

Sialolithiasis

DiagnosisCT

○ High resolution○ Imaging modality of

choicePlain films

○ Submandibular calculi – 80-95%

○ Parotid calculi – 60%

Sialolithiasis

DiagnosisUltrasound

○ If >2mm

Sialography○ Invasive○ Stricture

MRI○ Not helpful for stones

Sialolithiasis

TreatmentConservative

○ Hydration○ Moist heat○ Massage ○ Sialogogues○ NSAIDs○ Infection

Sialolithiasis

TreatmentPersistent

symptoms○ Referral to a

subspecialist

ComplicationsSecondary

infectionDysfunctional

gland

Sialadenitis Causes

Bacteria○ Staph○ Oral flora

Viruses○ Mumps○ Flu○ Coxsackie○ EBV ○ Parainfluenza○ HSV○ CMV

Sialadenitis

Risk FactorsElderlyDehydrationIntubationRecent intensive teeth cleaningAnticholinergic drugsMalnutritionSalivary calculiNeoplasm

Sialadenitis

HistoryPainSwellingErythemaPus draining from ductFever and chillsTrismusDysphagiaFirm gland

Sialadenitis

DiagnosisClinical historyCulture of any

purulent drainageExtra-oral needle

aspiration

Sialadenitis

ImagingInflammation vs obstruction or bothAbscessTumor Modalities

○ US○ CT

Most sensitive

○ MR sialography

Sialadenitis

TreatmentHydrationIV Antibiotics

○ Staph and mixed oral aerobes and anaerobes○ No clinical trials

Nafcillin or antistaphylococcal penicillin or 1st generation cephalosporin PLUS

Metronidazole or clindamycin

○ Duration10-14 days total (IV + oral)

Sialadenitis

ComplicationsNeck swelling

○ Respiratory compromise

○ Parapharyngeal space infection

○ Jugular thrombophlebitis

SepticemiaOsteomyelitisFacial Nerve Palsy