Skip to content

Salivary Gland Calculi / Sialadenitis

BASICS

  • Sialolithiasis: Obstruction of salivary gland or duct by a stone, causing painful postprandial swelling.
  • Sialadenitis: Inflammation of salivary gland; can be acute (infectious) or chronic (obstructive or autoimmune).
  • Common glands affected: Submandibular (80–90% of stones), parotid (acute suppurative sialadenitis), less commonly sublingual/minor glands.

EPIDEMIOLOGY

  • Incidence: Peak age 30–60 years; rare in children.
  • Risk factors: Debilitated, dehydrated patients; 70% single stones, 30% bilateral.

ETIOLOGY & PATHOPHYSIOLOGY

  • Stone formation: Stagnation of saliva, high calcium, decreased flow (anticholinergics, dehydration, radiation).
  • Composition: Calcium phosphate, hydroxyapatite, sometimes uric acid (gout).
  • Infectious agents:
  • Bacterial: Staph aureus, Strep viridans/pyogenes, H. influenzae, E. coli, Pseudomonas.
  • Viral: Mumps, CMV, EBV, HIV, enteroviruses.
  • Predisposing factors: Poor oral hygiene, trauma, gout, nephrolithiasis, Sjögren syndrome, radiation, anticholinergic use.

RISK FACTORS

  • Hypovolemia, diuretics, anticholinergics, trauma, gout, head/neck radiation, poor hygiene, smoking, dehydration.

PREVENTION

  • Good oral hygiene, hydration, avoid xerogenic meds.

DIAGNOSIS

History

  • Acute onset swelling/pain over gland, worse with eating or anticipation.
  • Dental pain, halitosis, hypersalivation, xerostomia.
  • Worsening pain, erythema, fever → infection.
  • In children, often mumps or idiopathic juvenile recurrent parotitis.

Physical Exam

  • Palpate glands/ducts for stones (Wharton/Stensen), swelling, tenderness.
  • Purulent discharge at duct orifice = acute bacterial sialadenitis.
  • Assess facial nerve function (parotid).
  • In children, stones usually distal duct (use US + sialendoscopy).

Differential

  • Bacterial/viral parotitis, cystic fibrosis, mumps, tularemia, tumors, Sjögren, trauma.

Diagnostic Tests

  • Clinical diagnosis: Sudden swelling/pain at meals, stone visible/palpable at duct.
  • Imaging: US (detects 90% of stones ≥2mm), CT (higher sensitivity), MR sialography (inconclusive US), sialography/sialendoscopy (diagnostic & therapeutic), technetium scan (gland excretion).
  • Labs: CBC, pus culture if discharge.
  • Autoimmune workup: RF, ANA if suspected.
  • Biopsy: If concern for tumor.

TREATMENT

General Measures

  • Hydration, warm compresses, gland massage, sialagogues (lemon drops), oral hygiene.
  • Discontinue anticholinergics.

Medication

  • NSAIDs for pain.
  • Antibiotics (if infection):
  • Dicloxacillin or cephalexin 500 mg QID × 7–10 days
  • Amox/clav or clindamycin (if no response/penicillin allergy)
  • Gram negative: 3rd-gen cephalosporin, fluoroquinolone
  • Anaerobic: metronidazole, clindamycin
  • MRSA: vancomycin

Procedures/Surgery

  • Anterior submandibular stones: Intraoral excision
  • Hilum: Gland excision
  • Parotid stones: Parotidectomy often needed
  • Sialendoscopy: Removal of stones, stricture management (contraindicated in acute infection)
  • Shockwave lithotripsy (ESWL): Large/complex stones
  • Abscess: I&D if not resolving after 3–5 days antibiotics
  • Stents: For chronic strictures

Additional & Alternative Therapies

  • Sialagogues (tart/acidic candies)
  • Chlorhexidine mouth rinse
  • Complementary: Lemon drops (shown to reduce sialadenitis postop)

REFERRAL

  • Dental (abscess/poor dentition)
  • ENT (recurrent, refractory, surgical cases)

ONGOING CARE

  • Monitor: Chronic sialadenitis (risk of recurrent acute attacks)
  • Avoid: Meds causing dry mouth, sialogogues during acute attacks
  • Hydration: Maintain
  • Educate: Good oral hygiene, hydration

PROGNOSIS

  • Most resolve in ~1 week with appropriate care.
  • Chronic/autoimmune: Prolonged, recurrent.
  • Surgical recurrence after stone removal: ~18%

COMPLICATIONS

  • Local spread (cellulitis, Ludwig angina)
  • Facial, hypoglossal, lingual nerve injury
  • Dental decay (from chronic hypofunction)

ICD-10 CODES

  • K11.5 Sialolithiasis
  • K11.20 Sialadenitis, unspecified
  • K11.21 Acute sialadenitis

CLINICAL PEARLS

  • Most stones: Submandibular gland, duct.
  • Mainstay: Hydration, hygiene, sialogogues, surgical removal if needed.
  • Nonpharm sialagogues (tart candies, lemon drops) useful for prevention and mild cases.
  • Always consider infection (purulent drainage, fever) → start antibiotics.