Sialolithiasis

Lateral radiograph of the neck shows a very large, well-defined calcification with layered appearance overlying the inferior aspect of the mandible.

Axial CT image confirms the location of the stone in the left submandibular gland. Dilated submandibular duct is also present (not shown).

Facts:

• Stone disease (sialolithiasis) is the most common disease of the salivary gland; male more common than female; very rare in children
• Submandibular gland is the most common location of stones in the salivary gland (80% of all)
• Stone disease is a common cause of acute and chronic salivary gland infections
• Stones consist of mainly calcium phosphate

Imaging:

• 20% of submandibular stones, and 40% of parotid stones are non-opaque
• Occlusal radiographs useful in showing radiopaque stones
• Sialography is useful in patients suspected of having non-opaque stones but it is contraindicated in acute infection
• CT and ultrasound can show stones with high accuracy
• Gland may be diffusely or focally enlarged with a stone in the duct

References:

1. Siddiqui SJ. Sialolithiasis: an unusually large submandibular salivary stone. Br Dent J 2002;193:89-91.
2. Yousem DM, et al. Major salivary gland imaging. Radiology 2000;216:19-29.