What are the salivary glands?
There are three pairs of glands that make saliva. Saliva drains into the mouth from these glands down short ducts (tubes). The salivary glands include the parotid (lying along the jawline beneath the ear), submandibular (under the jaw) and sublingual (under the tongue) pairs of glands, along with a large number of minor salivary glands. The parotid and submandibular glands drain into a single duct each, but the sublingual glands drain into eight to 20 ducts, so obstruction by a stone is rare.
What are the symptoms of salivary gland stones?
Salivary duct stones – called ‘calculi’ – are generally made up of calcium carbonate and calcium phosphate. Symptoms include swelling of the face or neck, pain in the face or mouth and a dry mouth. These symptoms are usually most noticeable while eating or drinking.
Some stones sit within the gland and cause no symptoms. In other cases, the stone may block the glandular duct either partially or completely. When this happens, the gland typically becomes painful and swollen, and usually infected, and saliva flow is partially or completely blocked.
How can you help to prevent future salivary duct stones?
* drinking six to eight glasses of water a day
* massaging the salivary gland after meals to break up thickened saliva
* seeking effective treatment for autoimmune disorders
* using only prescription antihistamines instead of over-the-counter versions. You could also try herbal help in the form of ‘bitters’ – chamomile flowers, chicory root, dandelion root and leaf, Calendula flower, gentian, horehound, motherwort, mugwort and vervain – all of which increase the flow of saliva
* stopping smoking
* eating a healthy diet
* practising good oral hygiene, with regular toothbrushing and flossin
What is the treatment for salivary gland stones?
* Gentle probing into the duct from inside the mouth with a thin blunt instrument can sometimes free a stone which then falls into the mouth. This is done by a doctor.
* Therapeutic sialendoscopy. This is a similar procedure to that described above. It also uses a very thin endoscope (tube) with a camera and light at the tip. The tube is pushed into the duct. If a stone is seen, then a tiny ‘basket’ or pair of ‘grabbers’ that are attached to the tube is used to grab the stone and pull it out. This technique can successfully remove about 17 in 20 stones. Local anesthetic is usually injected into the duct first to make this procedure painless. In some cases, where the stone is rather large, the stone is broken up first and then the fragments are pulled out.
* A small operation to cut out the stone is the traditional treatment, but is done less and less as therapeutic sialendoscopy has become available. It may still be needed if therapeutic sialendoscopy is not an available option, or if it fails.
* ‘Shock wave’ treatment (lithotripsy) may be an option. This uses ultrasound waves to break up stones. The broken fragments then pass out along the duct. This is a relatively new treatment for salivary stones (although it has been used for some years to treat kidney stones). However, it is not done commonly. Sometimes shock waves are used to break up a large stone when therapeutic sialendoscopy is done to make smaller fragments which can be more easily removed.
ENT London is one of UK’s leading Nose Surgeon London clinics, and can be contacted on 0207 580 6970.