Salivary Gland Stone Treatment

Salivary Gland Stone (Sialolith)

Calcium crystals that form in the salivary glands or ducts and are present in saliva are referred to as salivary gland stones (sialoliths). These stones block the salivary ducts, hindering saliva flow and causing painful swelling.

They are most commonly found in the salivary gland located beneath the jaw. Occasionally, they are seen in the salivary gland in front of the ear, and very rarely, in the sublingual and minor salivary glands.

Salivary gland stones occur much more frequently in adults, particularly those over the age of 40, compared to children.

Why Do Salivary Gland Stones Form?

The formation of salivary gland stones can be attributed to:

• Reduced saliva production
• Calcium accumulation in dead cell debris
• Insufficient fluid intake
• Narrowing of the salivary gland ducts
• Certain medications
• Infections

Symptoms of Salivary Gland Stones

Although salivary gland stones may sometimes remain asymptomatic, they typically cause the following:

• Painful swelling under the jaw or on the cheek, especially during eating (this is more pronounced when consuming acidic or sour foods).
• Intense pain, warmth in the affected area, and swelling of nearby lymph nodes, indicating accompanying salivary gland inflammation.
• If the stone is small, swelling may subside within hours after eating but reappear during subsequent meals.

Salivary Gland Stone Treatment

Stones in the salivary gland beneath the chin tend to be larger, while those in the salivary gland in front of the ear are usually smaller. The primary treatment method for salivary gland stones is sialendoscopy. This procedure involves the endoscopic entry into the salivary gland duct, allowing for simultaneous diagnosis and treatment. For sialendoscopy to be effective, the stone’s diameter must not significantly exceed the duct’s diameter. If the stone is too large, techniques such as laser or shock wave therapy are used to break it into smaller pieces, which are then removed. In some cases, when the stone is located near the duct’s opening, it can be manually extracted.

Salivary Gland Surgery

If the stone is large or there is chronic inflammation, the entire salivary gland is surgically removed. The procedure is performed under general anesthesia and involves separating the salivary gland from surrounding tissues.  The typical hospital stay is one to two days.

How is Salivary Gland Stone Surgery Performed?

The duration of salivary gland stone surgery depends on the size of the stones. The procedure is carried out under general anesthesia. If the stone is located in the submandibular salivary gland (under the chin), it is accessed through an incision made inside the mouth. If the stone is in the parotid gland (in front of the ear), the incision is made on the salivary gland after lifting the overlying tissue. In cases where the stones are too large to be removed, the entire salivary gland is excised.

After Salivary Gland Surgery

The post-operative process typically includes the following steps:

• A hospital stay of one to two days after the surgery.
• No food or drink is consumed until the effects of anesthesia wear off (approximately 3–4 hours). Afterward, soft and liquid foods are introduced, and normal eating resumes within a day.
• Mild pain may occur but can be managed with simple pain relievers.
• Drains are removed after 1–2 days, and the dressing is left in place for 3–4 days.
• Stitches are removed after 7 days.
• Bathing is permitted 7 days post-surgery.
• Mild sweating or redness in the treated area may occur but is usually not bothersome.
• Numbness in the surgical site may persist for up to a year.
• Temporary mild facial paralysis may occur but typically resolves within a few days. Permanent facial paralysis is rare.

Reducing the Risk of Recurrence of Salivary Stones

To minimize the risk of salivary stone recurrence after removal, patients should:

• Increase fluid intake throughout the day.
• Perform massages to regulate and support saliva flow.
• Use medications that stimulate saliva secretion.
• Follow the doctor’s recommendations, which may include cortisone treatment to prevent duct narrowing.

Salivary Gland Tumors

Eighty percent of salivary gland tumors are benign and are most commonly found in the parotid gland (in front of the ear).

The most common benign tumors are Pleomorphic Adenoma and Warthin’s Tumor. The most frequently encountered malignant tumors are Mucoepidermoid Carcinoma, Adenoid Cystic Carcinoma, and Acinic Cell Carcinoma.  

Symptoms of Salivary Gland Tumors

Symptoms of benign salivary gland tumors:

• Painless swelling (visible under the earlobe, in front of the auricle, along the jawbone, or beneath the tongue)
• Slow-growing mass
• Mobile mass upon palpation
• Well-defined and palpable

Symptoms of malignant salivary gland tumors:

• Rapidly growing mass
• Immobile upon palpation
• Pain
• Occasionally, facial paralysis

Diagnosis of Salivary Gland Tumors

Diagnosing salivary gland tumors involves a detailed examination followed by imaging methods such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). A needle biopsy is performed to determine the tumor type.

Treatment of Salivary Gland Tumors

The primary treatment for salivary gland tumors is surgery. For benign tumors, surgical removal is sufficient. For malignant tumors, chemotherapy or radiotherapy may be required after surgery. In some cases, the lymph nodes in the neck may also need to be removed. The success of treatment depends on the type and extent of the tumor.

Surgery aims to remove not only the tumor but also the entire gland to reduce the risk of recurrence.