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  Etiology Stagnation of saliva rich in Ca Inflammation Dehydration Anti-cholinergics Trauma

Sialolithiasis  History Pain – 70% Swelling Aggravated by eating  Physical Exam Flow of saliva Stones may be visible Stones may be palpated

Sialolithiasis  Diagnosis CT ○ High resolution ○ Imaging modality of choice Plain films ○ Submandibular calculi – 80-95% ○ Parotid calculi – 60%

Sialolithiasis  Diagnosis Ultrasound ○ If >2mm Sialography ○ Invasive ○ Stricture MRI ○ Not helpful for stones

Sialolithiasis  Treatment Conservative ○ Hydration ○ Moist heat ○ Massage ○ Sialogogues ○ NSAIDs ○ Infection

Sialolithiasis  Treatment Persistent symptoms ○ Referral to a subspecialist  Complications Secondary infection Dysfunctional gland

Sialadenitis  Causes Bacteria ○ Staph ○ Oral flora Viruses ○ Mumps ○ Flu ○ Coxsackie ○ EBV ○ Parainfluenza ○ HSV ○ CMV

Sialadenitis  Risk Factors Elderly Dehydration Intubation Recent intensive teeth cleaning Anticholinergic drugs Malnutrition Salivary calculi Neoplasm

Sialadenitis  History Pain Swelling Erythema Pus draining from duct Fever and chills Trismus Dysphagia Firm gland

Sialadenitis  Diagnosis Clinical history Culture of any purulent drainage Extra-oral needle aspiration

Sialadenitis  Imaging Inflammation vs obstruction or both Abscess Tumor Modalities ○ US ○ CT Most sensitive ○ MR sialography

Sialadenitis  Treatment Hydration IV Antibiotics ○ Staph and mixed oral aerobes and anaerobes ○ No clinical trials Nafcillin or antistaphylococcal penicillin or 1 st generation cephalosporin PLUS Metronidazole or clindamycin ○ Duration days total (IV + oral)

Sialadenitis  Complications Neck swelling ○ Respiratory compromise ○ Parapharyngeal space infection ○ Jugular thrombophlebitis Septicemia Osteomyelitis Facial Nerve Palsy