From the Guidelines
Yes, tonsillar or salivary gland calculi can cause unilateral tonsillar, submental, and submandibular lymphadenopathy. When these stones form, they can trigger localized inflammation and infection in the surrounding tissues. The body responds to this inflammation by activating regional lymph nodes, causing them to enlarge on the affected side.
Key Points to Consider
- Tonsil stones typically form in the crypts of the palatine tonsils and can lead to tonsillar lymphadenopathy, while salivary gland stones most commonly affect the submandibular gland, resulting in submandibular and submental lymph node enlargement 1.
- Treatment typically involves addressing the underlying stone through removal, hydration, warm compresses, and sometimes antibiotics if infection is present.
- For persistent or recurrent stones, surgical intervention may be necessary.
- The lymphadenopathy usually resolves once the inflammation from the stone is addressed.
- If lymph node enlargement persists for more than 2-3 weeks after stone treatment or is accompanied by concerning symptoms like unexplained weight loss or night sweats, further evaluation is warranted to rule out other causes, as outlined in guidelines for the evaluation of neck masses in adults 1.
Important Considerations for Differential Diagnosis
- A thorough history and physical examination are crucial to identify characteristics suspicious for malignancy, such as age over 40, tobacco and alcohol use, pharyngitis, dysphagia, and unexplained weight loss 1.
- Imaging and ultrasound can be useful in diagnosing salivary gland stones and assessing lymph node enlargement 1.
- Referral to oral/maxillofacial surgeons or other specialists may be indicated for further management 1.
From the Research
Tonsillar and Salivary Gland Calculi
- Tonsillar or salivary gland calculi can cause various symptoms, including obstruction of salivary flow and inflammation of the tonsils 2.
- Salivary stones, also known as sialoliths, are more frequently located in the submandibular gland (84%) than in the parotid gland (13%) 3.
- The formation of a sialolith within the remaining Wharton's duct can be associated with isolated aplasia or atrophy of a unilateral submandibular gland 4.
Lymphadenopathy
- Unilateral tonsillar enlargement can be associated with cervical lymphadenopathy, and the presence of other clinical features such as chronic pain, dysphagia, or tonsillar mucosal abnormality can increase the likelihood of malignancy 5.
- However, the prevalence of malignancy in tonsils with asymmetry and no other clinical features is very low, and a "watch and wait" policy may be initially more appropriate 5.
- There is no direct evidence to suggest that tonsillar or salivary gland calculi can cause unilateral tonsillar, submental, and submandibular lymphadenopathy, but it is possible that the inflammation and obstruction caused by the calculi could contribute to lymphadenopathy 3, 2.
Diagnosis and Treatment
- Diagnosis of salivary gland stones is usually straightforward, and treatment is aimed at stone removal 2.
- Tonsilloliths, or tonsil stones, are managed expectantly, and small tonsilloliths are common clinical findings 6.
- Rarely, surgical intervention is required if the stones become too large to pass on their own 6.