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Sialolithiasis
Stone in Whartonís 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 Whartonís (submandibular) or Stensenís (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

 

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