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Sialolithiasis: What You Need To Know About Salivary Gland Stones

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Introduction

Sialolithiasis (spelt out pronounciation: see-ya-lo-lee-thigh-ya-sis) is a fancy, complicated-sounding name for salivary gland stones. “Sialo” is the medical prefix for anything related to salivary glands. “Lithiasis” means stone-forming disease. I am sure you have heard of kidney stones (nephrolithiasis), gallstones (cholelithiasis) or bladder stones (vesicolithiasis) before. These conditions are much more famous. But salivary glands can get stones too, albeit uncommonly. 

salivary glands location
Credit: http://upload.wikimedia.org/wikipedia/commons/d/df/Blausen_0780_SalivaryGlands.png

Structure Of The Salivary Glands

Sialolithiasis is basically a disease where a calcified mass or stone forms in the salivary duct. A normal human being is born with 6 main salivary glands (2 glands each of 3 different types) and many other minor salivary glands. Sialolithiasis generally occurs in the main salivary glands. 

The majority of salivary stones form in the submandibular gland. These are located just below your jawline and produce 70% of your saliva. The saliva secreted here is more mucous than watery, hence it is more likely for stones to form. 

The parotid glands are the largest of the salivary glands and are located behind your jawbone. They are in charge of producing saliva especially in the presence of starches and the saliva secreted here is more watery. 

The sublingual glands are located below your tongue. The secretions from here are also more mucous but they only produce about 5% of the saliva that enters your mouth.

"I woke up this morning and I looked like a bullfrog."

This is exactly what my sister said to me over the phone when she first told me about the swelling that had developed below the left side of her jaw. So, how exactly do you suspect that you have a salivary gland stone?

Sialolithiasis can present with a swelling of the whole affected gland or a small hard lump at the opening of the salivary duct. This swelling may not be constantly there. The skin outside of the swelling may be red and very painful. 

Pain is another feature of sialolithiasis. This is increased particularly when more saliva is produced. That means having more pain when you are hungry, thinking of or smelling food since these all stimulate salivary production. 

Sometimes there may also be some pus coming out of the duct that you can taste it in your mouth.

submandibular swelling
Credit: http://3.bp.blogspot.com/-7zDEA_kjhm4/T0Y8tfrMj_I/AAAAAAAAErk/aSu4hgH8Hcc/s1600/Submandibular+sialadenitis+swelling+at+the+angle+of+the+mandible+and+the.png

submandibular swelling

Possible Causes

There have been a few proposed theories as to why these stones form. Factors like abnormal calcium levels in the body, not enough water, certain medications, previous salivary gland trauma and reduced rate of salivary flow have been considered. Some scientists believe it is due to an altered pH in the body due to infection causing the salts to crystallise. Others suggest that food debris and bacteria from food may enter the duct and start the stone-forming process. 

Most of the stones are found in the submandibular gland. This is because the concentration of calcium in the submandibular gland secretions are almost twice that of other glands. In addition, the structure of the duct is such that the saliva has to flow against gravity to empty. The saliva passes through a longer course with 2 bends before exiting through a smaller hole. All these reasons make the formation of stones more likely in the submandibular gland. 

salivary gland massage
Credit: http://3.bp.blogspot.com/-iOxB2f1eIVc/Tic9kV9JWPI/AAAAAAAAEEc/kEFXzXxpFDQ/s1600/IMG_4019.JPG

salivary gland massage

Treatments Available

The most accurate way to diagnose salivary gland stones are via ultrasound or CT scan and sialograms, which are specialised imaging tests for the salivary duct.

Home remedies that have been advocated include lemons or eating sour candy. Sour foods are known to increase the amount of salivary production. Whilst this may be counter-productive in terms of dealing with the pain, it is suggested that the increase in the salivary production will increase the pressure inside the gland the move the stone outwards.

Those who are fans of homeopathy will be happy to note that there are a few choices available. Willow tree bark contains salicortin which metabolises into salicylic acid in our body. This therefore acts in a similar way to aspirin. Cleavers is a plant with yellow flowers. It may be used as an anti-inflammatory agent as it has high levels of tannins and flavoniods. It is a great lymphatic system cleaner. Poke plant roots and berries have been used to reduce swelling in viral infections like mumps which also affect the salivary glands. 

Smaller stones can sometimes be treated conservatively. That means drinking lots of water to prevent dehydration and dilute the concentration of the saliva, massaging the gland from the outside to try to dislodge the stones, and using a hot compress and anti-inflammatory medication to relieve the pain. Antibiotics may sometimes be needed.

Another modality sometimes used is extracorporeal shockwave lithotripsy (ESWL) which is also used in kidney stones. Basically, high energy sound waves break up the stone into smaller fragments which are hoped to be easier to pass out naturally. You will need to be sedated or given general anaesthesia for this procedure.

poke plant berries
Credit: https://c1.staticflickr.com/5/4105/5011668206_5b5fa6f424_z.jpg

poke plant berries

Medium sized stones may be treated using sialoendoscopy. Just like any endoscopic technique, this is minimally invasive. It involves general anaesthetia to put you to sleep and then putting a small camera inside the duct to identify the stones. The stones may then be crushed, fished out with a basket or grasped and pulled out. The use of sialoendoscopy is advantageous as it does not result in any visible scars. 

Large stones may require a cut to be made at the opening of the duct to allow its passage or, in a few cases, removal of the entire salivary gland. 

Sialoendoscopy is much preferred over surgical removal of the gland wherever possible. This is because removal of the parotid and submandibular glands involves a surgical risk of injury to surrounding nerves and vessels. Injury to these nerves may result in paralysis or numbness of part of the face. In addition, there will be a visible scar.  Removal of one salivary gland will not affect your long term production of saliva. 

sialogram before and after stone removal
Credit: http://www.salivarystone.com/images/figure2.JPG

sialogram before and after stone removal

Sialolithiasis is not exactly a life-threatening condition. But recurrent pain and swelling will definitely disrupt your daily activities and sleep. In addition, people with sialolithiasis are unable to eat normally for a few days. Thankfully it is a condition that usually resolves completely once the stone is removed. 

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