What is a salivary gland stone?
When flow of saliva through the salivary gland slows down, material in the duct can form stones. These stones block the outflow of saliva, causing swelling and pain in the gland. They are composed of calcium oxalate, phosphorus and other minerals.
Where does this happen?
Stones can form in any of the major salivary glands. These include the parotid gland, submandibular gland and sublingual gland
What are the symptoms?
Pain/"Full feeling" (parotid causes cheek pain, submandibular stones cause jaw and mouth pain)
- Swelling of the face
- Eating makes the pain/discomfort worse
- Bitter taste in mouth
How do I know if I have stones?
Symptoms suggestive of stones should be evaluated by an otolaryngologist (ENT) that specializes in salivary gland disease. You should have an examination and may also have a CT scan done to confirm the presence of a stone.
What are my treatment options?
Traditional treatment options
Traditionally, the only treatment option for persistent salivary gland stones associated with inflammation was surgery. Surgery could include removal of the entire salivary gland and duct with stone removal.
Other methods of treatment focused on prevention. These include:
- sialogogues which are substances that naturally increase salivary flow; lemon wedges, sour candies, gum, etc. MighTea Flow is a line of products including gum and lozenges made of all natural green tea with xylitol moisturizer. These products can be obtained here.
- hydration to increase the amount of saliva, preventing stasis and build-up of stones in the duct system, 6-10 glasses of water daily
- massage of the gland to manually move stones through the system, preventing large stone formation
- antibiotics to prevent infection from duct obstruction
Although these methods are helpful, they are only temporary measures and eventually some patients find themselves faced with surgical removal of the entire gland to stop their symptoms.
Salivary gland surgery has some important potential complications. Salivary glands are located close to nerves that are necessary for normal facial movement, taste, and sensation. Complications associated with injuries to these nerves include:
- Loss of oral sensation
- Loss of taste
- Facial weakness
- Scarring associated with surgical incisions
- Facial deformity
- Occasionally, if the duct with the stone is not removed completely, recurrent symptoms may occur
Modern Treatment Options
Jonathan Lindman, from Augusta ENT has extensive experience with sialoendoscopy, a cutting edge procedure that allows successful stone removal without injury to surrounding structures, thereby avoiding overly aggressive surgery. There is no external incision.
What is sialoendoscopy?
Sialoendoscopy involves the use of miniature endoscopes to enter the small ducts of the salivary system in search of disease. The most common disease processes obstructing the salivary gland duct are stones and/or stenosis (narrowing) of the duct from chronic inflammation. Once the problem is identified, it can be treated by a variety of methods, all of which spare total gland removal. This would include stone removal to relieve blockage or duct dilation to prevent recurrent obstruction.
Stones are not the only cause of recurrent salivary gland swelling. The ducts from the glands can have strictures or narrowing that block passage of the saliva. Certain diseases, such as Sjogren’s syndrome and rheumatoid arthritis, can cause inflammatory changes and scarring in the ductal system and glands. In rare cases, foreign bodies such as hair and fish bones have been retrieved from the ducts.
This equipment is ideally designed for its purpose. In adults, we use scopes that are only 1.1 to 1.6 mm in diameter. The pediatric scope is slightly smaller. The semi-rigid scope can be effectively used to dilate strictures of the duct. We can even use balloon catheters through a side port to widen strictures, or put tiny forceps through the sheath to grasp and remove thick saliva or small stones. We also have a basket tool that can grab and remove stones.
For stones that are too large or wedged too tightly, or for strictures that have been too tight for too long, we can use the endoscope to assist in an intervention that is more advanced. Lindman has used a combined procedure for large stones lodged deep within the parotid gland problem where the endoscope can pinpoint the location of the obstruction. He then uses a limited skin incision to access this area, leaving the gland intact. This reduces the risk of injury to the facial nerve.
This procedure is deceivingly difficult with a steep learning curve. Currently he performs the procedure under general anesthesia on an outpatient basis but hopes to offer it with local anesthesia alone in certain patients in the near future. He says, “It has been fantastic having an additional minimally-invasive treatment available for patients with complex salivary gland disease.” The tiny endoscope is the key to making this method feasible, and provides salivary gland patients with a less invasive, risk-prone option to a troubling problem.
Sialoendoscopy is a procedure that causes patients to experience little or no pain, allowing them to be discharged the same day and return home to resume normal activities and diet quickly.