It’s another long night in pod A, but luckily there is a break in the unending stream of patients. You head to your favorite green delicatessen and feeling adventurous, you pick up a bag of sour candy. So sour! Your brain instantly flashes back to the last time you prescribed sour candy as your memory-sensory axonal connections are triggered. The image of that 45 year-old man with 5 days of recurrent pain in the lower right of the mouth that was worse with eating is as clear as day. Who knew candy can be medicine?
What is sialolithiasis? What are the most common regions where it can occur?A sialolith is a stone in the salivary gland. They are most commonly found in the submandibular gland in Wharton’s duct. The remaining are found in the parotid gland (Stenson’s duct) and only rarely in the sublingual gland.
What are some risk factors for this condition?Conditions that result in decreased flow through the salivary ducts. These include trauma, radiotherapy, Sjogren’s, dehydration, and anticholinergic medications.
What is the differential diagnosis of unilateral face swelling?Other diagnoses to consider are mumps, Ludwig’s angina, malignancy, sialoadenitis, and Sjogren’s syndrome.
What are the common symptoms due to this condition?Most often there is unilateral pain, swelling, and tenderness in the affected area. The pain is often colicky and exacerbated by meals.
How is sialolithiasis diagnosed?There is a firm gland due to blockage of the duct, and the stone can occasionally be palpated. X-rays may be performed, but not all stones are radioopaque. According to some authors, CT is the best imaging modality, especially for multiple small stones. ED Bedside ultrasound is a useful modality as it is quick, efficacious, and can reduce the patient’s exposure to radiation. It can also show abscess formation.
What are the complications of sialolithiasis to be aware of?Salivary stones are the most common cause of sialoadenitis – or inflammation of the salivary glands. Be aware of abscesses and secondary infections. Salivary duct stenoses may also occur due to chronic sialolithiasis which can then lead to salivary gland atrophy.
What are the treatments?Conservative management is recommended. This includes hydration and warm compresses to the affected area. Light massage may help expel the stone. Siaologogues such as sour, hard candies will increase promote saliva production to help flush the stone out. Antibiotics may be prescribed if there are signs of an infection. Follow-up with ENT may be considered if symptoms are severe or if there are complications.
References:
EP Monthly. Levine. Three Days Pain/Swelling Below Right Jaw
Ryzmska-Grala et al.Salivary Gland Calculi – Contemporary Methods of Imaging.Pol J Radiology. 2010.75(3)
Norvell J.G. “Chapter 243. Face and Jaw Emergencies.”Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2015. n. pag. AccessMedicine.Web. 11 Sep. 2016.
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