Sialolithiasis
Stone in Wharton’s Duct

  

• Most common disease of salivary glands

• Twice as common in males as females

• 80-95% occur in submandibular gland or duct

• Stones are most common cause of acute and chronic infection of salivary glands

• 80% of submandibular stones are opaque; 60% of parotid are opaque

  • Consist of mainly calcium phosphate

    • Not associated with systemic calcium abnormalities

  • Very unusual for patients to have a combination of radio-opaque and non-opaque stones

• Signs and symptoms

  • Pain and swelling of involved gland

    • Sialolithiasis causes pain and swelling of the involved salivary gland by obstructing the food-related flow of salivary secretions

    • Calculi may cause stasis of saliva facilitating bacterial ascent into the gland and subsequent infection

    • Some may be asymptomatic

• Imaging

  • Plain radiography

    • Opaque stone in course of Wharton’s (submandibular) or Stensen’s (parotid) ducts

  • CT

    • Stone in duct

    • Ductal dilatation

Contrast-enhanced CT of the neck demonstrates a stone (blue arrow) in the submandibular region of a dilated Wharton's Duct (red arrow)

• MR

  • Inflammation of gland

• Sialography is contraindicated in acute infection or in a patient with a significant contrast allergy

• Treatment

  • Conservative

  • Surgical removal

  • Lithotripsy