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4.06 Sialolithiasis (Salivary Duct Stones)


Patients of any age may develop salivary duct stones. The vast majority of such stones occur in Wharton's duct from the submaxillary gland. The patient will be alarmed by the rapid swelling beneath his jaw that suddenly appears while he is eating. The swelling may be painful but is not hot or red and usually subsides within two hours. This swelling may only be intermittent and may not occur with every meal. Infection can occur and will be accompanied by increased pain, exquisite tenderness, erythema and fever. Under these circumstances pus can sometimes be expressed from the opening of the duct when the gland is pressed open.

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Salivary duct stones are generally composed of calcium carbonate and calcium phosphate. Uric acid stones may form in patients with gout. Although the majority form in Wharton's duct in the floor of the mouth, approximately 10% occur in Stenson's duct in the cheek, and 5% in the sublingual ducts. Depending on the location and the size of the stone the presenting symptoms will vary. As a rule, the onset of swelling will be sudden and associated with salivation during a meal.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD