I have salivary stones… Do I need surgery?

Salivary gland stones, called sialolithiasis, are small calcium deposits that block the flow of saliva in the salivary glands. It is fairly common in both men and women, but affects men more frequently. Salivary gland swelling, pain, inflammation, and infection can occur if the stones are not removed. Salivary gland stones range in size and appearance, and these factors help to determine the best treatment and removal of the stones. Conservative treatments are most often used to remove a salivary gland stone; however, stones deep in the salivary duct or chronic stones may require surgical removal. Dr. Babak Larian, an expert salivary gland surgeon, at the CENTER for Advanced Parotid & Facial Nerve Surgery diagnoses and treats salivary gland stones.

Salivary stones form when chemicals in the saliva accumulate in the duct or gland, but the exact cause is unknown. However, any condition that thickens your saliva or slows its production can cause salivary stones, including:

• Dehydration
• Autoimmune diseases, such as lupus and Sjögren’s syndrome
• Medications such as diuretics, antihistamines, blood pressure drugs, psychiatric drugs, and bladder control drugs
• Smoking
• Salivary gland trauma
• Radiation therapy to your mouth
• Gum disease
• Nutrionally poor diet
• Not eating often enough

It’s unclear what causes salivary stones, which are not generally associated with other health problems. While there’s no conventional way to prevent them from occurring, staying hydrated and maintaining a healthy lifestyle can reduce the likelihood of developing salivary stones.

If you have salivary stone symptoms, Dr. Larian will take a medical history and examine you by gently feeling the salivary glands inside your mouth. If a stone is detected, he may recommend imaging to rule out other conditions, such as:

• Salivary gland tumor
• Salivary gland infection
• Sjögren’s syndrome
• Malnutrition
• Radiation exposure
• Reaction to iodine as part of an imaging exam

Imaging studies can detect salivary stones and distinguish them from other problems. Some examples of imaging and tests that Dr. Larian may order include:

• Computed tomography (CT)
• Ultrasound
• X-ray

If a stone is detected, treatment aims to remove it. Salivary stone removal may include:

• For tiny stones, stimulating saliva flow by sucking on a lemon or sour candies
• In other cases where stones are small, Dr. Larian may massage or push the rock out of the duct
• For larger, harder-to-remove rocks, making a small incision in the mouth can remove the stone
• Sialendoscopy uses tiny lighted scopes and micro instruments inserted into the gland’s opening in the mouth to remove the stone
• Surgical removal of the gland may be necessary for people with recurrent stones or irreversible damage to the salivary gland
• Antibiotics are prescribed if salivary stones have caused an infection

A salivary gland stone that is close to the exterior portion of the salivary duct can usually be massaged and squeezed out by a specialist. Sucking on citrus fruit can also remove stones that are small and close to the opening of the duct because of extra saliva that is produced. However, stones that are larger or located deep in the salivary duct may require minimally invasive sialendoscopy, or even salivary gland removal.

Sialendoscopy is a minimally invasive surgery technique used to remove salivary gland stones that are either too large or too deep in the salivary duct to be removed using more conservative methods. This cutting-edge technique uses a small endoscope to find the stone in the duct, which is removed using a specialized tool. This type of surgery has become the standard for salivary gland stone removal because of the minimal recovery time and reduced risk of damage and scarring to tissue.

Sialadenitis is a salivary gland infection caused by salivary stones. It most often occurs in those with chronic dry mouth, elderly people, and those with anorexia. Acute sialadenitis can occur with poor oral hygiene, which includes symptoms such as fever, swelling, pain, and chills. There is generally no reoccurrence with acute sialadenitis. Recurrent infections lead to chronic sialadenitis, which occurs when the salivary duct is blocked possibly due to factors such as scarring.

Increasing water intake and antibiotics can most often treat acute sialadenitis because saliva flow and texture is regulated. However, surgery may be required to treat chronic sialadenitis. Salivary gland removal may be recommended in order to treat the symptoms caused by chronic sialadenitis. Dr. Larian and expert parotid team can perform a submandibular gland excision or minimally invasive parotidectomy to safely remove the affected gland.

To find out more information about salivary gland stones or sialadenitis and to schedule your consultation, contact Dr. Larian at the CENTER for Advanced Parotid & Facial Nerve Surgery today, please call 310-997-2409.