Salivary stone gland

Did you know that if your mouth stops getting saliva, you will be having problems chewing, and swallowing? Also not having enough saliva in your mouth will lead to more frequent gum infections and dental caries. Your body has special saliva-making glands, so you should not have a dry mouth. But sometimes rather than protecting your mouth, the Salivary stone gland can give you bigger problems.

 

 

What is a salivary gland stone?

 

There are many major and minor salivary glands in your body surrounding the oral cavity. Major salivary glands release the saliva into your mouth via small tubes called salivary ducts. While minor salivary glands secrete saliva directly into the mouth.

 

Your saliva is rich in some essential minerals like calcium phosphate and calcium carbonate. As these substances have the tendency to crystalize in certain conditions, crystallization may lead to hardening and stone formation. These stones are called sialoliths or salivary stones and their size ranges from millimeters to centimeters.

What causes salivary gland stone?

 

Salivary stone formation is a common phenomenon, the majority of the stones pass unnoticed and so doesn’t lead to any problem. Here are a few of the factors which are linked with salivary stone formation-

 

• Fibrotic or mucous plugs- these plugs are common in the salivary duct and act as a nidus for stone formation
• Sjogren’s syndrome- a condition that leads to reduced secretion of saliva and stone formation
• Juvenile recurrent parotitis
• Dehydration
• Trauma/ injury
• Any factor which leads to stagnant or sluggish flow of saliva through the gland-like viral or bacterial infections
• Drugs- antihistamines, anti-hypertensives, anti-psychotics, etc.
• Radiotherapy
• Kidney related diseases

 

Salivary stones are more common in males with advancing age.

Symptoms of salivary gland stones

 

salivary glands play important role in secreting saliva and any obstruction to the free flow of saliva will lead to symptoms related to blockage, dry mouth, and inflammation. these symptoms are-

 

• Swelling below jaws or ears
• Inflammation over the duct opening
• Redness of skin overlying gland
• Tightness or traction of cheeks
• Pain
• Fever
• Pus discharge from the duct opening
• Inflammation or swelling near the opening of the duct

 

Sometimes you may also feel a gritty sensation underneath your tongue, which can be a stone in the salivary duct.

What are different salivary stones and where are they found?

 

There are three major salivary glands in pairs on each side-

 

• Parotid gland- near and underneath your angle of the jaw.
• Submandibular glands- as the name suggests are at the base of the jawline.
• Sublingual glands- underneath the tongue.

 

Stones near upper molar teeth-

 

Parotid glands secrete their saliva into the mouth by a duct named Steensen’s duct which opens near the upper second molar tooth, and stones found in that area are parotid stones.

 

Stones at the floor of the mouth-

 

Submandibular glands secrete their saliva via Wharton’s duct which opens into the floor of the mouth near the frenulum of the tongue. These are more common and often palpable. Also, stones of sublingual glands will also be found underneath the tongue on the floor of the mouth.

What are the options to treat or manage salivary gland stones?

 

As mentioned earlier blockage of salivary flow will lead to various problems and to avoid any further complications it is advisable to go to your doctor to rule out salivary stones.

 

Your ENT (ear nose and throat) doctor might subject you to different tests like Ultrasound, Sialo gram, CT scan, or MRI to know different aspects of this disease.

Home remedies for salivary gland stones

 

Sometimes gentle massage over the area of glands can increase the flow of saliva and can dislodge the stone. You may also try citrus fruits or lemon juice to increase salivary flow. Protect yourself from dehydration. Drink plenty of fluids. Avoid smoking.

 

Medication

 

Sometimes few drugs may help relieve the symptoms of pain, swelling, and other associated symptoms of salivary stones. These are-

 

• Anti-inflammatory
• Analgesics
• Sialagogues
• Antibiotics
• Medicated gargles

Sialo endoscopy

 

Sialo endoscopy is the direct visualization of salivary ducts and their branches by a tiny camera. It’s a technique through which the doctors examine your salivary gland duct and look for stones or any other obstruction.

 

Sialo endoscopy can be divided into two types –

 

1. Diagnostic Sialo endoscopy- In which a very tiny endoscope is introduced into the parotid duct via oral openings. As the salivary duct diameter ranges from 0.5 to 3mm only, this procedure needs delicate instruments and a good camera.

 

Diagnostic scale endoscopy can be done in OPD as well, and is a relatively painless procedure and can be easily done under local anesthesia. It is considered the gold standard test for patients who are suffering from symptoms of salivary gland swelling and pain with no obvious cause.

 

2. Interventional Sialo endoscopy-

 

When sialo endoscopy is being done with the intent of removal of a causative factor then we call it interventional sialo endoscopy. In this procedure, the doctor visualizes the stone and removes it with special instruments like forceps or dormia baskets. If the stones are large enough, they are broken down into pieces via different technologies like lithotripsy, LASER, burrs, etc, and then removed through oral routes.

 

Advantages of sialo endoscopy –

 

Sialo endoscopy is a very atraumatic, or minimally invasive procedure. The recovery after the procedure is almost immediate with no post-operative pain or swelling.

 

Apart from these benefits this procedure also allows the patient to go home and saves the patient from a major surgery in which the gland is removed entirely or partially via an external facial scar. Not only it’s a major surgery but also it has its own complications like-

 

• Bleeding
• Pain
• Postoperative morbidity and hospital stay
• Injury to nerve and paresis of nerve
• Taste disorders etc.

Salivary gland stones Surgery

 

As mentioned earlier open surgical removal of duct or gland is also done sometimes if the stone can not be removed via sialo endoscopy or if it is embedded in gland tissue.  This surgery is called gland excision/parotidectomy/sialoadenectomy, depending upon the tissue to be removed. Surgery carries its own complications and postoperative morbidity, but it becomes unavoidable.

The Bottom Line

 

Salivary stones are very common and the majority of us don’t notice them unless it causes other problems. If you feel you are suffering from the symptoms mentioned above, consider showing an ENT specialist for further evaluation and plan of management.

 

Salivary stones can be very simple to manage sometimes. Early diagnosis and management not only save you from complications but also make it easy for stone removal while they are still small.