Sialolithiasis and sialadenitis (submandibular gland)

Posted By Wael Nemattalla
Sialolithiasis and sialadenitis (submandibular gland)

58 years old female with left-sided neck pain.

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  • Wael Nemattalla 2014-01-02 12:03:55

    Sialolithiasis





    Sialolithiasis refers to formation of concrements (sialoliths) inside the ducts or parenchyma of salivary glands, and most commonly occurs in the submandibular glands and their ducts.



    Epidemiology

    Sialolithiasis is most common disease of salivary glands, accounting for approximately 50% of all major salivary gland pathology 5. The submandibular salivary gland is most commonly affected (80-90% of cases) with almost all the remaining cases located in the parotid duct 1-2,5.

    Sialolithiasis is a disease of adults, typically between 30 and 60 years of age. There is a male predilection 5.



    Clinical presentation

    Typically patient presents with a history of recurrent swelling and pain in the involved gland usually associated with eating due to obstructions of the draining duct, e.g.submandibular duct, thus slowing down or disabling flow of saliva. This in turn predisposes infection of the gland proximal to the obstruction, resulting in bacterial sialoadenitis.

    In chronic cases of obstruction the gland undergoes fatty atrophy and becomes asymptomatic, unless secondarily infected.



    Radiographic features

    Multimodal imaging can be used to evaluate these stones.



    Plain film

    Not all stones are radiopaque. Plain radiography is able to visualise only 80-90% of submandibular stones and ~60% of parotid duct stones, presumably due to differences in the composition of the secretion of the parent glands 2-3. Oblique views are often required to project the stones away from adjacent bone and teeth.



    Sialography

    Sialography excels at delineating the exact size and location of stones with in salivary gland ducts. The stone will be visualised as a filling defect within the duct. In some cases contrast will not be able to pass beyond the stone.

    If active infection is suspected sialography is however contraindicated due to the risk of exacerbating the extent of infection 2.



    Ultrasound

    Ultrasonography is well-established in cases of clinical suspicion of sialolithiasis, able not only to visualise the stone in many instance but also the gland 2-3. Stones appear as strongly hyperechoic lines or points with distal acoustic shadowing represent stones. Small stones (ay need to be excised.

    Increasingly non-surgical options exist to treat symptomatic stones, including 4:

    • extracorporal sialolithotripsy

    • endoscopic stone removal

    • endoluminal balloon dilatation and stone extraction





    Differential diagnosis

    The differential diagnosis really depends on the modality however in general there is little confusion as clinical presentation is relatively specific. For plain film and CT the differential is that of other calcific foci, and includes 2:

    • haemangioma/phlebolith

    • atherosclerotic calcification

    Filling defects on sialography may be caused by:

    • injected bubble of air

    • tumour

    • blood clot





    source:

    http://radiopaedia.org/articles/sialolithiasis

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