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By Erik Paulson, D.O.

By Erik Paulson, D.O. History. CC- 15 y.o. male c/o pain and swelling in jaw. Began yesterday, thought it might be strep throat or something so he began taking left over Amoxicillin from last year. NKDA Seasonal allergies relieved by Claritin and Benadryl. No other meds

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By Erik Paulson, D.O.

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  1. By Erik Paulson, D.O.

  2. History • CC- 15 y.o. male c/o pain and swelling in jaw. • Began yesterday, thought it might be strep throat or something so he began taking left over Amoxicillin from last year. • NKDA • Seasonal allergies relieved by Claritin and Benadryl. • No other meds • Vaccinations up to date

  3. Physical exam • Vitals- 101.2, 95, 16, 122/80 • Swollen, tender and slightly erythematous area on left side of neck just inferior to mandible. • Decreased in size after pressure was applied.

  4. Differential Diagnosis • Infection • Lymphadenitis • Mono • Strep • Sialadenitis • Mumps- vaccinations are up to date • Stone • Sjogren’s • Abscess • Neoplastic

  5. Labs • CBC- Increased white count w/ left shift • Rapid strep – • Mono spot – • All other labs normal

  6. Diagnosis • Sialolithiasis with secondary sialadenitis

  7. Quiz time • Duct from Parotid gland is called? • Stensen’s duct • Duct from Submandibular gland is called? • Wharton’s duct

  8. Pathophysiology • Dehydration • Concentration of saliva • Fasting or Anorexia • Stasis of saliva • Drugs- Anti-histamines, Anti-cholinergics. • Decrease production of saliva • Stone can cause stasis of saliva and subsequent bacterial ascent into the gland. • Infection most commonly from S. aureus or Strep Viridans.

  9. Fun Facts about Sialolithiasis • Twice as common in males • 1% incidence at autopsy • Stones are usually made of calcium phosphate

  10. Treatment • Conservative • Warm compresses • Sour candy • Pain relief- Ibuprofen 800mg. PO Q8hrs PRN pain. • Oral fluids • Discontinue anti-histamines • Oral antibiotics- Cefalexin 500mg PO QID X 7d. • Surgical • Wire basket retrieval under fluoroscopy. • Duct cannulation • Gland removal for recurrent cases • Lithotripsy

  11. Osteopathic treatment • Gentle massage of the salivary gland may free calculi that are near the end of the duct. It may also decrease the amount of saliva retained in the gland and provide symptomatic improvement. • Lymphatic pumps to improve immune function. • Increase/ normalize parasympathetic tone, decrease/ normalize sympathetic tone.

  12. Outcome • Unknown, but he did not return to the ED within the next two weeks.

  13. References • http://0-www.utdol.com.library.touro.edu/online/content/topic.do?topicKey=prim_ent/7995&selectedTitle=1~2&source=search_result • http://www.learningradiology.com/archives04/COW%20096-Sialolithiasis/sialolithcorrect.htm • http://www.emedicine.com/ent/topic598.htm

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