Sialolithiasis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]

Overview

Conservative treatment is the first line of therapy in the most patients. The most commonly used treatment options are hydration, moist heat, gland massage, and pain control. Antibiotics can be used in the case of superimposed infection. Many cases of sialolithiasis may not be cured by using medical therapy alone; invasive, or open surgery methods can be used for the salivary gland stones.

Medical Therapy

Conservative treatment is the first line of therapy in the most patients. The most commonly used treatment options are:

• Hydration
• Apply moist heat
• Massage the gland
• Duct milking
• Using agents that increase the saliva flow, such as lemon drops.
• Discontinue of the medication that decrease the saliva flow, such as the TCAs because of their anticholinergic effects.
• Pain control with NSAIDs, or opioid analgesics, if needed.

• Antibiotics usage in the case of superimposed infection:
  • Preferred regimen(1): Dicloxacillin 500 mg q 6h PO for 7 to 10 days.
  • Preferred regimen(2): Cephalexin 500 mg q 6h PO for 7 to 10 days.

• If the patient's clinics did not change in five days of using above antibiotics, change to:
  • Preferred regimen(1): Amoxicillin/clavulanate 625 mg q 8h PO for 7 to 10 days.
  • Preferred regimen(2): Clindamycin 300 mg q 8h PO for 7 to 10 days.

• Duct discharge should be used for culture.

Many cases of sialolithiasis may not be cured by using medical therapy alone; invasive, or open surgery methods can be used for salivary gland stones. The interventional methods are discussed in the sialolithiasis surgery page.