IS Case 426: Sialolithiasis

Jeremy Sykes, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-08-27


Patient is 45 year-old male with neck mass, difficulty swallowing and a history of smoking. Clinical concern was for tumor or abscess.


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Sialolithiasis refers to formation of calculi within the salivary glands, the majority of which are composed of hydroxyapatite. Eighty percent are found in the submandibular glands and 20% arise in the parotids. The majority of submandibular calculi are radiopaque (80–90%) and half of parotid calculi are radiopaque. Calculi are more likely to form in the submandibular gland due to its more alkaline pH which precipitates salts. Also, there is a higher concentration of hydroxyapatite and phosphatase in this location. The narrow Wharton's duct relative to the remainder of the lumen and its upward course predispose calculi to lodge here. Total duct obstruction is usually due to calculi larger than 3 mm. Treatment usually involves warm compresses, hydration, NSAIDs, and/or having the patient suck on sour hard candy to facilitate salivation and promote expulsion of the calculus. Stones may also be massaged out or removed via surgical cannulation of the duct.


  1. Weissleder R. Primer of Diagnostic Imaging, 4th Ed. Mosby Elsevier, 2007:640-41.

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