Salivary gland stones – causes, symptoms and treatment of salivary glands

Salivary gland stones are a condition in which small stones form in the salivary gland as a result of disturbances in the production of saliva. The most common form of this ailment is submandibular salivary gland stones. Parotid calculi can be observed in approximately fifteen percent of patients. Adults are more likely to encounter this ailment (usually people over 40). The male to female ratio is two to one.

Salivary gland stones – what is this disease?

Salivary gland stones are a condition characterized by the formation of stones / deposits in the salivary gland due to a disturbance in the production of saliva. Each of us has 3 paired salivary glands, which include the salivary glands:

1. submandibular,
2. parotid,
3. sublingual.

Each of us also has salivary glands, which are located in the mucosa of the throat and the entire mouth. Some people may have other extra glands that most often appear together with the parotid glands. Most often, urolithiasis affects the submandibular glands (up to 85% of cases), less often the parotid glands. The causes of salivary gland stones have not been fully explained. The disease most often affects adults over 40 years of age, moreover, they are more often men than women.

Salivary gland stones – causes of the disease

The reason for the development of salivary gland stones is a disturbed production of electrolytes inside the salivary gland, which causes the density of saliva to increase significantly and, consequently, to form a calculus. The stone is usually small, it resembles a cherry stone, but this size is sufficient to close the salivary gland duct. Sometimes there may be several of these stones.

The causes that favor stone formation are:

1. widening or narrowing of the salivary gland duct, which causes salivary stagnation
2. inflammation of the mouth, increased saliva density or increased levels of calcium in saliva,
3. foreign objects stuck in the duct, such as toothbrush bristles, tartar, wood particles, etc.
4. dehydration,
5. Sjögren’s syndrome,
6. high levels of calcium in the body.

However, the immediate cause of salivary gland stones is unknown.

Salivary gland stones – symptoms

As a result of salivary gland stones, single or multiple stones appear in the salivary glands. They are usually stones composed of phosphates or calcium carbonates. The submandibular gland, which is the conduit for saliva or pulp, is most often blocked, although all glands can be affected. Salivary gland stones are numerous and tiny.

Salivary gland stones lead to salivary stagnation in the gland itself, causing inflammation and swelling in the patient, which is also associated with pain. Pain is greatly reduced after a meal, as simply looking at or thinking about food stimulates salivation and increases swelling and pain at the same time.

When should you contact your doctor?

If you or a family member have symptoms that may suggest developing salivary gland stones.

Types of salivary gland stones

1. Submandibular gland – is located in the submandibular triangle of the neck and is blocked by the mandible from above. This type of salivary gland has a discharge tube that is located under the oral mucosa and exits within the frenulum at the bottom of the mouth.

2. Parotid gland – is the largest salivary gland located near the angle of the jaw. The parotid gland is surrounded by a connective tissue bag, which causes pain when the salivary gland is inflamed as it is stretched. The salivary gland tube runs through the cheek and exits inside the mouth at the level of the upper second molar.

3. Sublingual gland – is classified as a large gland. It is located at the bottom of the mouth and adjoins the submandibular gland. The salivary gland duct usually connects to the submandibular (Wharton) gland duct.

4. Small salivary glands – are located inside the lips, nose, larynx, cheek, trachea and on the palate. They are treated as emergency salivary glands, because in the event of failure of any of the salivary glands, they can replace them.

Diagnosis of salivary gland stones

The doctor diagnoses salivary gland stones on the basis of the medical history and the patient’s palpation. On examination, in the area of ​​the salivary gland, a large swelling is noticeable, which has increased cohesiveness and is hard, and the touch of this area causes pain in the patient. Also, the discharge outlet may be significantly red and the extraction of saliva may be blocked. The doctor may also find a widening of the duct and the presence of a stone in it (especially in the submandibular gland). If there is a secondary bacterial infection – discharge may leak from the mouth and the nearby lymph nodes are enlarged.

Another additional examination performed to confirm the diagnosis is X-ray examination (occlusal image of the mandible useful in the diagnosis of the anterior part of the duct leading to the submandibular glands). Most of the stones are visible in the photo. In addition, sometimes ultrasound is performed (it allows the detection of salivary stones that have not been visualized in the X-ray examination) or a sialogram (imaging examination performed with the use of contrast), as well as magnetic resonance imaging and computed tomography. Ultrasonography allows for the evaluation of the salivary gland parenchyma and the location of stones that are invisible in X-ray examination.

Treatment of salivary gland stones

Treatment of salivary gland stones can be conservative or surgical. Oral hygiene is particularly important. The patient’s diet should be well-balanced and provide an adequate portion of energy, it should also be acidic to stimulate salivation and possible washing out of stones. You should drink a lot (in case of small stones). There is no limit to the patient’s activity. You can still play sports.

Doctors also recommend taking non-steroidal anti-inflammatory drugs to help relieve pain. If symptoms indicate a bacterial infection, your doctor will prescribe antibiotic therapy. It happens very often that pharmacological treatment does not bring the expected benefits, then the stones are surgically removed in hospital conditions. The procedure is performed by an otolaryngologist or maxillofacial surgeon. This causes immediate pain relief. If the scale is in the discharge duct, the treatment consists of cutting the duct and removing the deposits. If, on the other hand, urolithiasis is a recurrent condition or concerns the parenchyma of the salivary gland – it is necessary to completely remove the gland.

In the treatment of salivary gland stones, non-invasive methods of treatment have gained popularity:

1. ESWL (extracorporeal lithotripsy) – larger stones are broken with the use of ultrasound into smaller ones, which can evacuate themselves one by one;
2. endoscopic stone removal – sialoendoscopy.