Sialadenitis and Sialolithiasis
Sialolithiasis is a calcified stone in a salivary duct, most often the submandibular (Wharton) duct, causing postprandial colicky gland swelling; sialadenitis is gland inflammation or infection that can follow an obstructing stone or arise independently, treated with hydration, sialagogues, and amoxicillin-clavulanate 875/125 mg PO every 12 hours for infection, escalating to sialendoscopy or drainage when conservative measures fail.
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What this article covers
- Overview
Two linked entities of the salivary ductal system: sialolithiasis is a calcified stone obstructing a salivary duct, and sialadenitis is inflammation or infection of a salivary gland; an obstructing…
- Epidemiology
Sialolithiasis is the most common cause of acute, unifocal salivary gland swelling.
- Risk factors
Volume depletion and dehydration: the single strongest shared risk factor for both stone formation and infection, because reduced salivary flow promotes stasis, concentration of salivary solutes, and retrograde bacterial entry.
- Pathophysiology
Stone formation begins with salivary stasis: reduced flow allows organic debris (desquamated cells, mucin, bacteria) to serve as a nidus for calcium precipitation, forming a calculus within the duct lumen.
- Clinical features
Sialolithiasis: postprandial, colicky, unifocal gland swelling and pain that builds during or after eating (salivary stimulation) and resolves or substantially improves between meals; this cyclical…
- Differential diagnosis
Mumps parotitis: viral, multifocal, classically bilateral parotid swelling with a viral prodrome (fever, malaise, headache); confirmed by RT-PCR or IgM serology rather than expressible pus; see mumps.
- Diagnosis
Sialolithiasis and uncomplicated sialadenitis are clinical diagnoses confirmed by history and bimanual palpation: a palpable, tender, hard duct stone confirms sialolithiasis; expressible purulent…
- Management
Start conservative measures for sialolithiasis and mild sialadenitis regardless of cause: aggressive oral hydration, sialagogues (sour candies or vitamin C lozenges), warm compresses, manual gland…
- Complications
Abscess formation: requires drainage in addition to antibiotics; the most serious acute complication.
- Prognosis
Uncomplicated sialolithiasis generally resolves with conservative measures or minimally invasive stone extraction, without permanent gland damage when treated before chronic obstruction sets in.
- Prevention
Maintain adequate oral fluid intake and correct dehydration promptly, particularly in hospitalized and postoperative patients, since volume depletion is the shared driver of both stone formation and infection.
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