Salivary Gland Stone Treatment Frequently Asked Questions

Dr. Atilla Şengör, one of the pioneers of the sialendoscopy method in our country, answered the most frequently asked questions by patients about the treatment of salivary gland stones.

Are Salivary Gland Stones Dangerous?

Salivary gland stones are not a fearful condition like cancer. The possibility of this turning into cancer in the future is almost zero. However, when these stones block the salivary gland ducts, they can cause swelling and inflammation. If the inflammation is severe, it can turn into an abscess; this can be dangerous. Because it is possible for the abscess to spread to various nerves, veins or other vital structures in the neck area. These are quite troublesome and painful conditions. Since the stones grow 1 mm per year, this risk increases over time. It is useful for patients to know that we cannot perform sialendoscopy during the inflammatory period.

How to Prevent Salivary Gland Stones?

The most common common feature in patients with salivary gland stones is that they consume little fluid. There is also a smoking habit and a diet poor in vegetables. It is known that kidney stones are caused by diseases related to calcium metabolism. This relationship has not been shown in salivary stones. Gout is the only disease that is associated with salivary gland stones. However, I have only seen 3 cases in 20 years.
Patients taking plenty of fluids and quitting smoking positively affect saliva secretion. It would be good for patients to have a balanced diet. However, if there is a salivary gland stone, the measures taken do not reduce it. At this stage, it is necessary to get the opinion of a specialist working on sialendoscopy and have it treated. However, after the stone is removed, these recommendations are applied to prevent new stones that may form in the future.

Is There a Method Other Than Sialendoscopy for Salivary Gland Stone Removal?

Canal incisions can be made from inside the mouth. There is also a definition for these in medicine: sialodochotomy or sialolithotomy. These can be applied to stones that can be felt by hand in the mouth or on the cheek. Before the sialendoscopy era, either these were done; if not, the entire gland was removed. However, most patients do not accept the removal of the salivary gland along with the stone. They do not want to lose their salivary glands and saliva. They also do not want to take risks such as nerve paralysis and vascular injuries. In incisions made inside the mouth, even if the stones that are sometimes felt are removed, the ones at the bottom of the canal usually cannot be reached. Unfortunately, there are many such patients. There may be other stones deep in the canal or inside the gland. However, with sialendoscopy, we can see and remove these as well; we control the canal. If the canal is not repaired after the incision, there may be narrowing in the canal. Today, if an incision needs to be made inside the mouth, we definitely do this under the guidance/accompaniment of sialendoscopy. Otherwise, the chance of sialendoscopic treatment is eliminated in patients whose salivary ducts are completely blocked due to adhesions.

There is also the ESWL method. It means breaking stones with external sound waves/shock waves. However, stones cannot be removed during this procedure; the stone pieces are expected to fall out on their own. This is a method frequently used in those with kidney stones. However, unlike the urinary tract, the salivary ducts are very thin (2-2.5 mm). Moreover, the mouth of the salivary duct opening into the mouth (0.2 mm) is very narrow. Therefore, it is very difficult for stones broken down with the ESWL method to fall out on their own. They can get stuck in the canal or at its exit. ESWL was performed in Germany for a long time; later, it was necessary to enter again with sialendoscopy and remove the stone pieces from the canal. If sialendoscopy is to be performed, I have been breaking inside the canal since 2004. There is no need to take risks or incur new costs. We can perhaps use the ESWL shock wave breaking method in patients whose stones cannot be reached with sialendoscopy. However, after the canal is widened in this way, there may be a chance for the broken stones to fall out. Finally, unfortunately, I do not know of any center in our country that works specifically on ESWL for salivary stones. I have not tried this method on any of my patients to date due to the possibility of damaging the teeth.

Surgical removal of the salivary gland is still recommended as a definitive solution for salivary gland stone treatment. The main reason for this is that salendoscopy opportunities are not available everywhere. Since endoscopes and tools are very expensive, continuity cannot be provided when they break down. In addition, sialendoscopy is a method that requires advanced training and experience. It is very important for the physician to follow current developments. When these are not complete, the physician offers the only option he has; he recommends removing the gland. In addition, not everyone knows the level that sialendoscopy and crushing methods have reached. Even in centers where sialendoscopy is performed, if crushing methods are not applied, success is very difficult. Because 80% of stones need to be crushed. Today, we prefer organ-preserving methods in all surgical branches. If there is sufficient equipment and experience, we prefer removing the stone instead of removing the gland.

Does the Salivary Gland Work After the Stone is Removed?

The reason for the salivary gland swelling is that the gland is already working. Saliva is produced; the gland swells because it cannot flow. Scientific studies also confirm this. Histopathological examinations were performed on patients whose glands were removed due to salivary gland stones. It was determined that at least half of the glands were normal or close to normal. It was determined that the glands entered a repair process when the experimentally created blockage in the salivary ducts was opened. The stem cells in them turn into cells that produce saliva. What I have observed since 2004 is also consistent with this. The salivary glands of the patients whose stones I removed are working; salivary secretion returns to normal in a short time.

Does Salivary Gland Stone Recur?

It is very rare for a stone that has been completely removed with a sialendoscopy to recur. Because we enlarge and leave the salivary gland duct mouth with a small procedure during sialendoscopy. In this way, we aim to shed the sediments that may turn into stones in the future on their own. However, it would be good for those with more than one stone to pay attention to the conditions that facilitate stone formation. I recommend these patients to drink plenty of fluids, not to smoke and to have a balanced diet. Despite this, patients who have recurring stones may need to undergo a repeat sialendoscopy.

What is Good for Salivary Gland Swelling?

If salivary gland swelling occurs while eating, we think that the flow in the duct is blocked. We usually see this in cases with salivary gland stones or duct stenosis. In this case, massaging and drinking plenty of water may be good. If the person smokes, they should not smoke. If the swelling recurs, the patient should see a doctor so that the diagnosis can be made.
If it is a painful swelling that develops within days, we think of inflammation in the salivary gland. In this case, the patient should see a doctor. Thus, appropriate medications can be given according to the examination findings; the causes can be investigated.

If the swelling is not related to eating and has occurred gradually over a long period of time, a tumor comes to mind. These may be due to benign or malignant tumors. In this case, the patient should see a doctor without wasting time. Sometimes there may be atypical infections or autoimmune diseases. In these, diagnosis and treatment are determined with imaging methods and some tests, in addition to examination findings.

Is Salivary Gland Swelling Dangerous?

Whether salivary gland swelling is dangerous or not depends on the disease. The disease causing the swelling may be a salivary gland stone or duct stenosis. These are generally not considered dangerous. We can often treat such duct diseases with the sialendoscopy method. However, if they are not treated, they can lead to inflammation. When the inflammation is severe, it can be dangerous with abscessation and deep neck infection. Salivary gland swelling may also be due to a benign tumor or salivary gland cancer. Tumors and cancers can be dangerous to the structures they spread to and their stage. The sialendoscopy method is not used in these cases; the affected gland is removed with surgery.

What Causes Swelling of the Salivary Glands?

There are many different diseases and conditions that cause swelling of the salivary glands. We can simply divide them into two: conditions that block the ducts and parenchymal diseases. Parenchyma is the part where saliva is produced; we can compare this to the leafy part of a tree. The salivary gland ducts are like the trunk and branches of the same tree. When the flow of saliva is blocked in the salivary gland duct, the gland swells. The most common cause of this is salivary gland stones. There is a lot of detailed information on stones on this and my other pages. The second most common cause of duct obstruction is duct stenosis. In addition, mucus plugs, foreign objects, kinks and external pressure on the duct can also cause obstruction. Mucus plugs, i.e. the thickening/deterioration of saliva, are usually due to drinking less water. This can also be caused by fasting, diet, smoking, medications, vomiting (bulimia) and gout. Chronic sialadenitis, megaductus, sialocele and ranula can cause pooling and duct compression in the salivary ducts.

Salivary gland swelling is located according to the gland it is located in. It can be in the cheek (parotid gland), under the chin (submandibular gland) or under the tongue (sublingual gland). The swellings that worry patients the most are those caused by salivary gland masses and tumors. These are usually located in the parenchyma. However, the swellings we encounter most frequently here occur in salivary gland inflammation. These are usually caused by bacteria or viruses. For example, mumps is the most common cause of salivary gland swelling in children. Another disease seen in children is juvenile recurrent parotitis.

Autoimmune diseases (Sjögren’s disease) can affect both the parenchyma (saliva-producing cells) and the ducts. Narrowing can occur in the ducts; microcalculi formed in the parenchyma can fall into the duct and grow. It would be good to write IgG4 disease by name here. Autoimmune diseases and IgG4 disease usually cause swelling in more than one gland.

Unfortunately, some interventions and treatments (iatrogenic) can also cause swelling of the salivary glands. The first in line are incisions and surgeries made in the mouth to remove stones. These incisions can damage the canals and subsequently cause narrowing or complete closure. In addition, dental treatments, bichectomy, aesthetic applications, radiotherapy, and radioiodine treatment applied in thyroid cancers can also be included. Sometimes, even sialendoscopy that is terminated without placing a stent can develop stenosis.
A final and interesting cause is pneumoparotitis. This can happen to those who use wind instruments; air leakage into the canal can cause swelling in the cheek.