How to Diagnose Salivary Gland Stones

Treatment of Salivary Gland Stones

If patients diagnosed with salivary gland stones have symptoms such as swelling of the glands accompanied by pain, fever, purulent discharge into the mouth, redness and tenderness on the skin in the site of the salivary gland due to active infection, first the acute infection should be treated with appropriate antibiotics, painkillers, and edema-reducing medications as well as plenty of fluid intake and massage practices.

After the elimination of the active infection symptoms, the size, number and locations of the stones, and the condition of the salivary glands and ducts should be assessed through ultrasonography.

Stones with a diameter of few millimeters located in the salivary gland duct, which have a smooth surface, can be spontaneously discarded without the need for carrying out any procedural intervention, with just plenty of fluid intake and massages performed in the direction from the salivary gland, where the stone exists, toward the intraoral orifice of the duct.

If the stones are found to be eligible for being removed with sialendoscopy, based on the result of ultrasonography, it is useful to make a detailed evaluation of the locations, sizes and number of the stones through computed tomography, before any endoscopic procedures.  

The sialography procedure considered to be the most important procedure in the diagnosis of such stones, which is performed by giving contrast agents—visible in X-rays—to the salivary gland ducts, began to be performed less commonly because of its implementation challenges, allergy risks and unavailability in cases of infection, especially after computed tomography and sialendoscopic evaluations became popular.

Salivary gland stones cannot be treated with medications and should be removed with interventional surgical procedures.

Today, the most contemporary and effective treatment option for stones smaller than 3-4 mm is sialendoscopy whereas larger stones can be treated through sound waves, with devices providing compressed air and by carrying out a breaking process with the aid of laser, which can be followed by a sialendoscopy where necessary.

There are also different surgical procedures intended for the treatment of larger stones, which are in the salivary gland, not in the salivary ducts. Such stones in the submandibular salivary gland can be accessed through incisions made inside the mount, whereas stones in the salivary gland located in front of the ear (parotid) can be accessed by making an incision on the salivary gland, under the guidance of the endoscope’s light in the duct, after lifting the skin on the salivary gland. For stones that cannot be removed with these procedures, the conventional treatment that involves complete removal of salivary gland is preferred.

The therapeutic approach of surgical removal of the salivary glands in patients with salivary gland stones has today become considerably less common, after the beginning of the availability of the technologies that make it possible to reduce large stones by breaking them with the sialendoscopy procedure.

Various treatments are recommended with intent to reduce the risk of recurrence after the removal of stones.

These can be listed as follows;

• Taking drugs that increase the secretion of saliva,

• Increasing the water intake,

• Massage that promotes the salivary flow,

• Antibiotic treatments intended for preventing infections,

• Cortisone treatments intended to prevent stricture (narrowing) formation in the ducts.