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Good Morning and Welcome Applicants!!

December 10, 2010. Good Morning and Welcome Applicants!!. Stensen’s duct. Wharton’s ducts. Sialolithiasis. Stones in salivary glands or ducts 80-90% arise from submandibular glands 75% are unilateral Rare in children. Sialolithiasis. Etiology Stagnation of saliva rich in Ca

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Good Morning and Welcome Applicants!!

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  1. December 10, 2010 Good Morning and Welcome Applicants!!

  2. Stensen’s duct

  3. Wharton’s ducts

  4. Sialolithiasis • Stones in salivary glands or ducts • 80-90% arise from submandibular glands • 75% are unilateral • Rare in children

  5. Sialolithiasis • Etiology • Stagnation of saliva rich in Ca • Inflammation • Dehydration • Anti-cholinergics • Trauma

  6. Sialolithiasis • History • Pain – 70% • Swelling • Aggravated by eating • Physical Exam • Flow of saliva • Stones may be visible • Stones may be palpated

  7. Sialolithiasis • Diagnosis • CT • High resolution • Imaging modality of choice • Plain films • Submandibular calculi – 80-95% • Parotid calculi – 60%

  8. Sialolithiasis • Diagnosis • Ultrasound • If >2mm • Sialography • Invasive • Stricture • MRI • Not helpful for stones

  9. Sialolithiasis • Treatment • Conservative • Hydration • Moist heat • Massage • Sialogogues • NSAIDs • Infection

  10. Sialolithiasis • Treatment • Persistent symptoms • Referral to a subspecialist • Complications • Secondary infection • Dysfunctional gland

  11. Sialadenitis • Causes • Bacteria • Staph • Oral flora • Viruses • Mumps • Flu • Coxsackie • EBV • Parainfluenza • HSV • CMV

  12. Sialadenitis • Risk Factors • Elderly • Dehydration • Intubation • Recent intensive teeth cleaning • Anticholinergic drugs • Malnutrition • Salivary calculi • Neoplasm

  13. Sialadenitis • History • Pain • Swelling • Erythema • Pus draining from duct • Fever and chills • Trismus • Dysphagia • Firm gland

  14. Sialadenitis • Diagnosis • Clinical history • Culture of any purulent drainage • Extra-oral needle aspiration

  15. Sialadenitis • Imaging • Inflammation vs obstruction or both • Abscess • Tumor • Modalities • US • CT • Most sensitive • MR sialography

  16. Sialadenitis • Treatment • Hydration • IV Antibiotics • Staph and mixed oral aerobes and anaerobes • No clinical trials • Nafcillin or antistaphylococcal penicillin or 1st generation cephalosporin PLUS • Metronidazole or clindamycin • Duration • 10-14 days total (IV + oral)

  17. Sialadenitis • Complications • Neck swelling • Respiratory compromise • Parapharyngeal space infection • Jugular thrombophlebitis • Septicemia • Osteomyelitis • Facial Nerve Palsy

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