Introduction 

Parotid duct repair post sialography requires a considerable period of time to achieve a sialographic appearance close to that of normal. We report a case of spontaneous expulsion of silaoliths and apparent sialographic restoration of ductal architecture. 

The case 

A 63 year old patient attended for a sialogram at the Royal London Hospital. Her medical history is noteable only by Hypothyroidism following radioactive iodine treatment for thyrotoxicosis and two separate instances of breast cancer in ’85 and ’95 from which she is disease free. She had a ten year history of periodic right sided pre-auricular swellings which would subside over a number of days. She was referred to The Royal London in early 2006 following a change in symptoms whereby the swellings stopped, but a tender area formed in her right cheek. Her post ultrasound sialogram showed a dilated main duct and filling defect as a consequence of a 4mm sialolith being situated within the main duct. Fourteen weeks later she re-attended for repeat sialogram and basket retrieval. On presentation at this appointment, she produced a box containing a number of small sialoliths which measured between 0.5 and 3mm in diameter. 

Discussion

From literature searches and anecdotal experience, this clinical scenario has never been reported. The sialogram screen shots clearly show the pre- and post- clinical pictures described. The parotid duct has the potential to reconstitute its architecture and integrity after spontaneous expulsion of small sialoliths. This may point to the use of atraumatic means to manage such small sialoliths.