How to Treat Salivary Gland Stones

The first stage in the diagnosis of salivary gland stones is the assessment of the story given by the patient. Patients with stone state that especially sour or hot foods increasing the secretion of saliva during eating cause painful swelling in front of the ear or under the chin, which gradually go away after eating. Swelling that is observed under conditions increasing salivary production and then rapidly disappears in early periods when stones developing and gradually growing in the salivary ducts begin to block the ducts.

Symptoms begin to develop more frequently and for longer periods with the increased blockage. Frequent inflammations occur in salivary glands that contain stone, as well. Certain symptoms are also observed such as inflammation accompanied by fever, pain, change in taste sensation, purulent discharge from the salivary gland duct, increased heat and redness on the skin, enlarged cervical lymph gland, etc. with salivary stones.

During examinations of patients with salivary gland stone, usually viscous saliva, occasionally particle-containing saliva or purulent saliva discharge from the duct can be seen, when observing the points where the salivary gland duct's opening (punctum) to the mouth, while performing external massage on the glands. It is possible to feel especially stones larger than a few millimeters in the salivary ducts, when examining patients by inserting one hand inside the mouth while putting the other on the neck or the cheek.

Since salivary gland stones have a structure, 80-90% of which can be viewed through X-ray, usually they can be detected by means of standard X-rays called direct graph.

In the periods when the sialendoscopy technology was not in use, knowing the existence of stone was adequate to make a treatment plan because the treatment of the disorder almost always involved the cutting the salivary gland duct accessed through the mouth or surgical removal of the salivary gland that contain stone. 

For patients, in whom a definitive diagnosis could not be made with standard X-rays or computerized tomography, the most important diagnostic method for the evaluation of the condition of the salivary glands and ducts as well as for the verification of a diagnosis was considered to be sialography. In sialography radiologic examination of the particular gland and its ductal system is performed after application of a contrast containing liquid through the intraoral opening point (punctum) of that salivary gland’s ductus.

After the beginning of the use of sialendoscopy, a technique that provides important diagnostic and therapeutic benefits, minimally invasive approaches and protection of the salivary glands have come to the fore. Therefore, nowadays ultrasonography, computed tomography, and MRI (magnetic resonance imaging) tests—in specific cases—are preferred, which enable more detailed evaluation of the sizes, number and locations of the stones, as well as the conditions of the salivary glands and ducts are performed when planning an intervention.

On the other hand, besides its therapeutic use sialendoscopy provides important benefits for the diagnosis and treatment of certain problems such as narrowness in the salivary ducts and blockage in them due to stone, thickened secretions and residues that cannot be detected through other methods.