ear, nose, and throat disorders
Salivary Stones
Diagnosis of Salivary Stones
Clinical evaluation Sometimes imaging (eg, CT, ultrasonography, sialography) If a salivary stone is not apparent on examination, the patient can be given a sialagogue (eg, lemon juice, hard candy, or some other substance that triggers saliva flow). Reproduction of symptoms is almost always diagnostic of a stone. CT, ultrasonography, and sialography are highly sensitive and are used if clinical diagnosis is equivocal. Contrast sialography may be done through a catheter inserted into the duct and can differentiate between stone, stenosis, and tumor. This technique is occasionally therapeutic. Because 90% of submandibular calculi are radiopaque and 90% of parotid calculi are radiolucent, plain x-rays are not always accurate. Ultrasonography is being used increasingly and has reported sensitivities for all (radiopaque and radiolucent) stones of about 60 to 95% and specificities between 85 and 100% ( Diagnosis reference ). The role of MRI is evolving; reported sensitivities and specificities are > 90% and MRI appears to be more sensitive in detecting small stones and distal duct stones than ultrasonography or contrast sialography. 1.Kim DH, Kang JM, Kim SW, et al: Utility of ultrasonography for diagnosis of salivary gland sialolithiasis: a meta-analysis.Laryngoscope.2022 Jan 19. doi: 10.1002/lary.30020. Epub ahead of print. PMID: 35043982. 