EpistemisSalivary colic
Specialty: Otolaryngology.
Why it occurs
- Sialolithiasis or presence of stones in the Wharton duct (submandibular gland) or in the Estenon duct (parotid gland)
- Stenosis or inflammatory scarring stricture of the main salivary duct after previous infections
- Dense mucus plug that temporarily obstructs the flow of saliva in dehydrated patients
- Extrinsic compression of the salivary duct by benign masses or tumors of the floor of the mouth
Initial workup
Bimanual palpation of the affected salivary duct on the floor of the mouth or cheek, high-resolution ultrasound of salivary glands (allows calculations larger than 2 mm to be visualized), conventional or CT sialography (sialo-CT) of fine sections, and diagnostic and interventional sialogendoscopy.
red flags
High fever with chills, persistent swelling of the gland with hot and fluctuating skin erythema to the touch, clear pus coming out of the orifice at the mouth of the duct (suppurative sialadenitis), or difficulty swallowing or breathing due to displacement of the floor of the mouth.
Standard management
- Analgesics and anti-inflammatories such as ibuprofen (600 mg orally every 8 hours) to control gland spasm
- Natural or chemical sialogogues such as pilocarpine — 5 mg orally every 8 hours, to stimulate saliva flow and promote stone expulsion, if there is no persistent total obstruction
- Antibiotics such as amoxicillin-clavulanic acid if bacterial superinfection is suspected.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 4
- Treatment options
- 3