December 10, 2010. Stensen’s duct Wharton’s ducts.
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Transcript of December 10, 2010. Stensen’s duct Wharton’s ducts.
GOOD MORNING AND
WELCOME APPLICANTS!!
December 10, 2010
Wharton’s ducts
Sialolithiasis
Stones in salivary glands or ducts
80-90% arise from submandibular glands
75% are unilateral Rare in children
Sialolithiasis
EtiologyStagnation of saliva
rich in CaInflammationDehydrationAnti-cholinergicsTrauma
Sialolithiasis
HistoryPain – 70%SwellingAggravated by eating
Physical ExamFlow of salivaStones may be visibleStones may be palpated
Sialolithiasis
DiagnosisCT
○ High resolution○ Imaging modality of
choicePlain films
○ Submandibular calculi – 80-95%
○ Parotid calculi – 60%
Sialolithiasis
DiagnosisUltrasound
○ If >2mm
Sialography○ Invasive○ Stricture
MRI○ Not helpful for stones
Sialolithiasis
TreatmentConservative
○ Hydration○ Moist heat○ Massage ○ Sialogogues○ NSAIDs○ Infection
Sialolithiasis
TreatmentPersistent
symptoms○ Referral to a
subspecialist
ComplicationsSecondary
infectionDysfunctional
gland
Sialadenitis Causes
Bacteria○ Staph○ Oral flora
Viruses○ Mumps○ Flu○ Coxsackie○ EBV ○ Parainfluenza○ HSV○ CMV
Sialadenitis
Risk FactorsElderlyDehydrationIntubationRecent intensive teeth cleaningAnticholinergic drugsMalnutritionSalivary calculiNeoplasm
Sialadenitis
HistoryPainSwellingErythemaPus draining from ductFever and chillsTrismusDysphagiaFirm gland
Sialadenitis
DiagnosisClinical historyCulture of any
purulent drainageExtra-oral needle
aspiration
Sialadenitis
ImagingInflammation vs obstruction or bothAbscessTumor Modalities
○ US○ CT
Most sensitive
○ MR sialography
Sialadenitis
TreatmentHydrationIV Antibiotics
○ Staph and mixed oral aerobes and anaerobes○ No clinical trials
Nafcillin or antistaphylococcal penicillin or 1st generation cephalosporin PLUS
Metronidazole or clindamycin
○ Duration10-14 days total (IV + oral)
Sialadenitis
ComplicationsNeck swelling
○ Respiratory compromise
○ Parapharyngeal space infection
○ Jugular thrombophlebitis
SepticemiaOsteomyelitisFacial Nerve Palsy