Sialadenitis with an obstructing sialolith in the right submandibular gland duct

Findings

Coronal and axial post contrast CT images show a swollen right submandibular gland with dilatation of the intraglandular ducts and an obstructing stone.


Diagnosis: Sialadenitis with an obstructing sialolith in the right submandibular gland duct


The most common cause of sialadenitis of the SMG is an obstructing calculus with subsequent suppurative sialadenitis. Less common causes are suppurative sialadenitis leading to duct stenosis and chronic sialadenitis. Rare etiologies include include Sjogren syndrome, AIDS and bacterial/viral infection.

SMG accounts for 10% of sialadenitis of all major salivary glands. Other diagnostic considerations in SM space include reactive submandibular lymph node, mandibular osteomyelitis, benign mixed tumor, submandibular carcinoma and metastases.

Calculi are more common in the SMG duct. Compared to the parotid gland, the saliva in the SMG is thicker, much more mucinous and more alkaline. The SMG duct courses superiorly which makes it more prone to stasis. SMG duct is larger in diameter.

When sialadenitis is present therapy may depend on stone location. If the stone is in the anterior portion of the duct, the stone can be removed and gland salvaged. If stone is in the posterior duct, the duct and gland will likely be removed with the stone.