From the Research
The management of sialolithiasis should prioritize a multimodal treatment algorithm that escalates from conservative measures to minimally invasive techniques, reserving surgical gland removal as a last resort, as this approach has been shown to improve patient-perceived health-related quality of life in over 94% of cases 1.
Initial Management
Initial treatment of sialolithiasis includes:
- Hydration
- Warm compresses
- Sialagogues (lemon drops or sour candy) to stimulate saliva flow
- Gentle massage of the affected gland to help expel the stone
- Pain management with NSAIDs like ibuprofen (400-600mg every 6-8 hours) is recommended
- Antibiotics such as amoxicillin-clavulanate (875/125mg twice daily for 7-10 days) are indicated if infection is present, manifesting as fever, purulent discharge, or significant swelling
Surgical Intervention
For stones less than 5mm in the duct, conservative management is often successful within 1-2 weeks. Larger stones, those in the gland parenchyma, or cases with persistent symptoms require surgical intervention. Minimally invasive techniques include:
- Sialendoscopy for stone removal or fragmentation
- Transoral sialolithotomy for accessible submandibular or parotid duct stones Sialadenectomy (complete gland removal) is reserved for recurrent cases or stones deeply embedded in the gland.
Follow-up Care
Follow-up care should include increased fluid intake and good oral hygiene to prevent recurrence, as sialolithiasis results from calcium salt precipitation around organic debris in the ductal system, often exacerbated by dehydration or decreased salivary flow 2, 3, 4, 5.
Key Considerations
The use of a multimodal treatment algorithm allows for a tailored approach to each patient, taking into account the size and location of the stone, as well as the patient's overall health and preferences 1. This approach has been shown to be effective in improving patient outcomes and reducing the need for surgical gland removal.