![]() Other causes of swollen salivary glands include Sjögren's syndrome, sarcoidosis, or salivary gland tumour (unilateral swelling). Individuals with viral infection such as mumps will present acutely with pain and swelling of both salivary glands, associated with the viral prodrome fever, malaise, headache, and myalgia. The main differential to consider for such a presentation is infection. On palpation, a stone may be palpable in the duct and the gland may feel tender in the presence of infection. 2), along with the presence of small stones. When the gland is palpated, saliva can be seen at the duct orifice (Fig. Symptoms are usually unilateral in nature. Individuals with sialolithiasis tend to be asymptomatic, however a small proportion can have an intermittent facial swelling associated with eating, which can be painful or painless. Figure 2 - A stone seen located in the submandibular salivary duct Sublingual gland - located below the mucous membrane of the floor of the mouth, they are drained by multiple small ducts that empty either into Wharton's duct or directly into the floor of the mouth.Submandibular gland - lying beneath the floor of the mouth in the submandibular triangle, it drains (via Wharton’s duct) into the floor of the mouth, beside the frenulum of the tongue.Parotid gland - located superior to the angle of the mandible, the gland is superficial to the masseter muscle and drains (via Stensen’s duct) opposite to the upper second molar.Excision of the parotid or submandibular gland are only performed for patients with chronically persisting symptoms. Other possible interventions include sialoendoscopy (whereby the stones are directly visualised via endoscopic imaging and extracted with a basket) or extracorporeal shockwave lithotripsy (for some stones in the proximal ducts, where transoral retrieval of the stone is not possible). Surgical intervention however comes with risks of damage to the hypoglossal, facial, or lingual nerves. Interventional radiology procedures are most commonly trialled, which involve fluoroscopic control such that the stones are visualised in the duct and then extracted with a basket.Ī surgical approach can be used to remove some more difficult stones a transoral approach can be used if the stones are distal or a transcervical approach for proximal stones (or where the transoral approach has been unsuccessful). Patients with recurrent or persistent symptoms should be referred for specialist treatment. If the gland becomes infected and the patient develops sialedenitis, then antibiotics are typically indicated. Milking / massaging the gland can help as well. Most patients are managed conservatively with oral hydration, analgesia, and sialologues, such as lemon juice, which promote saliva production. The duct is cannulated and radiopaque dye is injected with plain films are taken. *Sialography is not routinely performed due to its invasive nature. As most salivary gland stones are radio-opaque (80% submandibular gland, 60% parotid gland), a plain film radiograph is a simple investigation which can be performed to confirm presence of a stone. ![]() Ultrasound scans are a cheap and minimally invasive method that is very good at analysing the whole gland and periglandular structures. Most cases of suspected sialolithiasis are investigated* with either ultrasound or radiographs. Sublingual gland – located below the mucous membrane of the floor of the mouth, they are drained by multiple small ducts that empty either into Wharton’s duct or directly into the floor of the mouth.Submandibular gland – lying beneath the floor of the mouth in the submandibular triangle, it drains (via Wharton’s duct) into the floor of the mouth, beside the frenulum of the tongue.Parotid gland – located superior to the angle of the mandible, the gland is superficial to the masseter muscle and drains (via Stensen’s duct) opposite to the upper second molar. ![]() Whilst most cases are asymptomatic, some can present with facial swelling and / or facial pain. They have an incidence of approximately 27-59 cases per million population per year. Stones will form in the salivary gland or ducts following the stagnation of saliva they are typically composed of calcium phosphate and hydroxyapatite, as the saliva is rich in calcium Sialolithiasis is the presence of calculi in the salivary glands or ducts. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |