A 63 y.o. woman comes in with a swelling in her neck

what do you see?

hint: there is a fluid collection on the right

Our patient had sialolithiasis, or a salivary duct stone,  with an abscess forming behind the stone. The name comes from the Greek word, sialon meaning saliva. The stones are usually calcium although they can be uric acid in patients with gout.  Because the content of Ca in submandibular salivary glands is twice that produced by the parotid and their ducts are long compared to the parotid; 85% of stones are found in the submandibular salivary glands as was the case in our patient.

Risk factors for development of stones include: hyperparathyroidism, chronic infection, phenothiazine use, and Sjogrens disease.   Less than 1% of the population have sialolithiasis and they are generally ages 30-60.  Most individuals note pain with production of saliva; whether eating or thinking of eating.

small stone is visible at the gland sphincter

The diagnosis is often made on CT but 15-20% of the stones are insufficiently calcified to be seen on CT. Our patient underwent surgery and her stone appears below.   She recovered uneventfully.

Our patients stone

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Kelly I, Dick R. Interventional sialography: Dormia basket removal of Wharton’s duct calculus. Clin Radiol 1990;43:205.

Stack B, Norman J. Sialolithiasis and primary hyperparathyroidism. ORL J Otorhinolarygol relat Spec 2008;70(5)331-4.