The clinical features of 109 patients with recurrent unilateral parotid swelling (24 patients with Sjögren's disease were excluded) have been analysed to explore the best system of management. The cause was definitely a parotid duct calculus in 36 patients, and evidence is presented that the same diagnosis probably applied to another 59 patients. Features suggesting a diagnosis of calculus included age (greater than 29 years); duration of the attacks of pain (less than 24 hours); cessation of salivation on the affected side; and a spurt of saliva heralding the relief of symptoms. Only three patients in the definite calculus group (8.3%) had no physical signs. However, had physical examination not included inspection and palpation of the parotid duct and its orifice from within the mouth 75% of the proven calculi would have been missed. The intraoral and anteroposterior plain radiographs are likely to be helpful, and sialography even more so. A sialographic appearance of a stricture in the main duct with proximal dilatation is usually due to a claculus. It would appear that calculi are the cause of recurrent unilateral parotid swelling (after exclusion of Sjögren's disease) in an overwhelming proportion of patients with this symptom.
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