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salivary duct stones Images (Click to view larger image)
Alternative Names
sialolithiasis, submandibular duct stones, parotid duct stones
Definition
Salivary duct stones are accumulations of calcium and phosphate crystals in the duct of either the parotid, submandibular, or sublingual glands. The parotid glands lie just behind the angle of the jaw, in front of the ears. The submandibular and sublingual glands are deep in the floor of the mouth.
What is going on in the body?
There are 3 major pairs of glands that produce saliva: the parotid glands, submandibular glands, and sublingual glands. Stone formation is most likely in the submandibular gland.
Saliva is formed in response to smell and taste stimuli. Its most important function is to provide a healthy environment for the teeth and to help break down complex starches, using an enzyme called amylase. When the water content of saliva is reduced, such as during dehydration, then calcium and phosphate in the saliva can form a stone.
What are the signs and symptoms of the condition?
A person may notice discomfort and swelling of the affected saliva gland, usually in association with meals. This problem becomes exaggerated with acidic or sour foods, which stimulate more saliva than other food types. The saliva may have a gritty feel or unusual taste. The swelling and discomfort often go away over several hours.
Sometimes the stone blocks the draining of saliva, which causes a bacterial infection of the gland. If an infection occurs, the gland becomes tense, swollen, very painful, and sore to the touch. The person may have a fever. The location of the swelling will vary, depending on the salivary gland that is affected: - If the parotid gland is acutely affected, the swelling is usually in front of, and just below, the earlobe.
- If the submandibular gland is involved, the swelling is usually under the back part of the jaw.
- If the stone is in the sublingual gland, which is quite rare, the swelling will be just behind the chin.
What are the causes and risks of the condition?
Any disorder that thickens saliva can lead to stone formation. A person who is dehydrated is at higher risk. Drying medications are also frequent causes, including antidepressants, antihistamines, and diuretics.
A person with certain diseases associated with thickening of the saliva is more prone to salivary duct stones. One example is Sjogren syndrome, which is a chronic inflammatory disorder characterised by excessive dryness of the mouth, eyes and other mucous membranes.
In some autoimmune disorders, the body attacks its own salivary glands, causing a thicker form of saliva. When this type of salivary gland disease is severe, the person will have many cysts on the salivary glands.
What can be done to prevent the condition?
Drinking 6 to 8 glasses of water per day and sucking on sour lollies will help keep saliva flowing. The doctor can prescribe medications to further increase saliva flow. Avoiding older-style over-the-counter antihistamines in favour of newer, non-sedating brands may be useful. It is also beneficial to choose antidepressants that have less drying effects. For those recovering from a previous stone, massaging the gland forward after meals helps clear any thickened saliva.
How is the condition diagnosed?
Diagnosis is based on physical examination. Stones can often be felt, particularly in the submandibular glands. Because most of these types of stones are easily seen on x-ray, an x-ray can help confirm diagnosis. A special test called a sialogram where dye is injected into the salivary duct and then pictures are taken also is used to confirm the diagnosis.
What are the long-term effects of the condition?
Long-term effects can occur if chronic bacterial infection sets into the gland. Scars form in the area and removal of the stone is much more difficult.
What are the risks to others?
There are no risks to others.
What are the treatments for the condition?
The stone may be squeezed directly out of the duct if it is small enough. For larger stones that cannot completely pass out of the duct opening, a small incision can be made to remove it. The only alternative is to remove the gland and the duct containing the stone.
What are the side effects of the treatments?
Surgical removal of the stone may lead to scarring of the duct opening. This can then cause failure of the gland to drain properly. Other problems may then arise, such as additional stone formation and infection. If the entire gland is removed, complications involve damage to the nearby nerves. This can result in paralysis and loss of sensation in the tongue or face.
What happens after treatment for the condition?
After successful stone removal, if the duct and/or gland have not been injured, the condition usually returns to normal. For recurrent acute or chronic infection, gland removal may be needed.
How is the condition monitored?
A person with occasional gland swelling or uncomplicated stone formation should be watched. If there is an increased frequency of eating-related gland swelling, pain, or redness, a doctor should be contacted.
Author: Mark Loury, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Contributors
Potential conflict of interest information for reviewers available on request |
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