What are the symptoms and treatment options for bilateral sialolithiasis (salivary gland stones)?

From the Guidelines

Bilateral sialolithiasis should be managed with a combination of conservative measures and referral to oral/maxillofacial surgeons for further evaluation and potential intervention, as the condition can cause significant pain and discomfort, particularly if left untreated or if complications arise 1. The symptoms of bilateral sialolithiasis typically include intermittent pain, characteristically occurring just before eating, and tenderness of the involved salivary gland, with potential associated slow or absent salivary flow from the duct. Key considerations for diagnosis and management include:

• Bimanual palpation to identify the stone
• Imaging and ultrasound to confirm the diagnosis
• Referral to oral/maxillofacial surgeons for further management Treatment options may involve:
• Conservative management, including increased hydration, warm compresses, and gentle massage of the affected gland
• Sialagogues like lemon drops to stimulate saliva flow
• Over-the-counter pain medications, such as ibuprofen or acetaminophen, to manage discomfort
• Antibiotics, like amoxicillin-clavulanate, if infection is present
• Minimally invasive procedures, such as sialendoscopy or extracorporeal shock wave lithotripsy, for larger stones or those that don't respond to conservative measures
• Surgical removal, if necessary, to prevent complications and improve quality of life.

From the Research

Symptoms of Bilateral Sialolithiasis

• Pain and swelling in the affected salivary gland 2
• Interference with the flow of saliva, causing discomfort 2
• Chronic sialadenitis and glandular atrophy if left untreated 2

Treatment Options for Bilateral Sialolithiasis

• Conservative treatment: oral analgesics and antibiotics 2
• Salivary gland massage and the use of sialogogues 3
• Removal of the stone using:
  • Endoscopic instrumentation 4, 5
  • Extracorporeal lithotripsy (ESWL) 4, 5, 6
  • Intracorporeal laser lithotripsy 4
  • Basket retrieval and sialendoscopy 2
• Surgical removal of the whole salivary gland in some cases 3

Efficacy of Treatment Options

• Endoscopic instrumentation: stones were eliminated in 96% of patients 4
• Extracorporeal lithotripsy: completely destroyed stones in 63% of cases, and fragmented stones in an additional 35% of cases 4
• ESWL: decreased pain and obstructive syndrome in patients with sialolithiasis, with better results in the parotid gland group 6