23 Nov 2020

What are the symptoms of salivary gland stones?
When spit (saliva) cannot exit a blocked tube (duct), it backs up into the gland, causing pain and swelling of the gland. The most common symptoms are pain and swelling of the affected gland at mealtime. Some people with salivary gland stones have no symptoms at all. A stone may be found by chance on an X-ray picture taken for another reason.

What is the treatment for salivary duct stones?
Most stones that cause symptoms will not go away unless they come out or are removed. Sometimes a small stone comes out into the mouth by itself. If that does not occur, possible treatment options and procedures include the following:

Gentle probing into the tube (duct) from inside the mouth with a thin blunt instrument can sometimes free a stone lodged at the opening of the duct, which then falls into the mouth.

Sialendoscopy. This is a similar procedure to that described above. It also uses a very thin tube (endoscope) with a camera and light at the tip. The endoscope is introduced into the duct. If a stone is seen, then a tiny basket or pair of grabbers attached to the tube is used to grab the stone and deliver it out. This technique can successfully remove stones about 4 mm in diameter. The procedure can be done under general anesthesia or local anaesthesia.  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  with forceps or laser and the fragments are then pulled out.  Occasionally a combined approach may be needed, where sialendoscopy can localise the stone and dissection in the oral cavity will be able to remove the stone. 

A small operation to cut out the stone is the traditional treatment but is not recommended, as therapeutic sialendoscopy has become available. It may still be needed if therapeutic sialendoscopy is not an available option, or if it fails (as a combined procedure).

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 or are removed with sialendoscopy

A salivary stone is usually a one-off event. After it is removed there are usually no further problems. However, some people develop one or more further stones at some later time. Sometimes several stones form in the same gland. 

An operation to remove the whole gland is  recommended  option for people who develop recurring or multiple stones, recurrent infections or with very large stones.  The earlier the intervention the smaller the stone will be and can be removed by endoscopy.

With the advent of Sialendoscopy , the effort is to prevent scars, external surgeries, and save the glands.  The rationale is to save every gland possible and not remove it for a non tumour indication.

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