Salivary Gland Stone Treatment

I treat salivary gland stones using sialendoscopy, aiming to preserve both the gland and the natural structure of its duct whenever possible. Through the natural opening of the salivary duct inside the mouth, I insert a thin endoscope. I can remove small stones directly and, when necessary, fragment larger stones inside the duct before removing them. This allows many patients to avoid an incision or removal of the salivary gland.

I have performed sialendoscopy since 2004. In 2007, I adapted pneumatic lithotripsy for this technique, allowing me to fragment and remove even large stones that I can reach inside the duct. However, some stones cannot be reached endoscopically because of their location or the anatomy of the duct. For this reason, I evaluate each patient individually, based on examination and imaging findings.

How Do I Remove Salivary Gland Stones?

Depending on which salivary gland contains the stone, I dilate the natural duct opening in the floor of the mouth or inside the cheek. I then advance a 1.6 mm sialendoscope through the ductal system. In my clinical experience, approximately 80–85% of salivary stones are accessible by this method, allowing me to see and treat them directly.

I can remove small stones without fragmentation. For larger or impacted stones, I use pneumatic lithotripsy to break them into smaller pieces. I primarily remove these fragments using my irrigation-based flush-out technique, followed by delicate forceps when necessary.

At the end of the procedure, I inspect the original stone site and the smaller ductal branches that I can reach. In most patients undergoing stone removal, I place a temporary stent to support duct patency and healing.

You can find further technical details on my Sialendoscopic Intraductal Pneumatic Lithotripsy page.

Salivary Gland Stone Treatment with Sialendoscopy – Real Surgical Video

In this video, you can see how I fragment salivary gland stones inside the duct using pneumatic lithotripsy and remove the resulting fragments.
The video can be watched with narration in seven languages, including Turkish and English. The language can be selected in the YouTube player’s settings.

Can Every Salivary Gland Stone Be Removed by Sialendoscopy?

With the development of pneumatic lithotripsy, stone size is no longer the major limitation it once was.

Among stones that I can reach endoscopically, my complete removal rate is approximately 94%, based on my experience with this technique since 2007. Stone size often affects the duration of the procedure more than the likelihood of successful removal.

Removing large stones may take considerable time. With patience and careful, controlled fragmentation, I can remove even very large stones through the natural duct. On the other hand, a much smaller stone may sometimes be inaccessible because of its location or the anatomy of the ductal system.

Before deciding on treatment, I examine the patient and review the imaging findings. If I believe that a stone cannot be reached endoscopically, I consider other treatment options.

Examples of Salivary Gland Stones I Have Treated

The photographs below are from my own surgical cases. They show stones of different sizes that I have removed through the natural salivary duct, using intraductal fragmentation when necessary.

You can find more surgical images and examples on my Sialendoscopy Case Examples page.

What Do I Do When a Stone Cannot Be Removed by Sialendoscopy?

When I cannot reach a stone endoscopically, I first consider other treatment options that may preserve the salivary gland. Depending on its location, the stone may be removable through a combined sialendoscopic and intraoral surgical approach.

I do not consider salivary gland removal a first-line treatment, and I do not perform gland removal. However, if sialendoscopic and intraoral gland-preserving approaches are unsuccessful or unsuitable, gland removal may become necessary in some patients later on.

If symptoms persist or become more severe, the patient may discuss this option with an appropriate specialist in their home country.

Intraoral surgical procedures also carry risks, including bleeding, infection and subsequent duct narrowing. I take these possibilities into account when selecting the most appropriate treatment.

Can Salivary Gland Stones Pass on Their Own?

Small stones located near the natural opening of the salivary duct may occasionally pass on their own. Drinking sufficient water, gently massaging the gland and stimulating saliva production may help some patients pass a small stone.

Lemon does not dissolve salivary stones. It stimulates saliva production and may sometimes help a small stone pass. However, if the duct is completely blocked, increased saliva production can cause significant pain and swelling. Symptoms may become worse, particularly when infection is present.

I do not recommend that my patients delay treatment for long periods while trying these methods. The medical literature reports that salivary stones may grow by approximately 1 mm per year. Over time, some stones can become embedded in the duct wall, making them more difficult to reach endoscopically and prolonging treatment. In some cases, patients may eventually lose the opportunity for endoscopic treatment.

For patients with recurrent swelling, particularly during meals, I assess the location and size of the stone using appropriate imaging. I then determine whether spontaneous passage is realistic or an intervention is needed.

What Are the Symptoms of Salivary Gland Stones?

The most characteristic symptom of a salivary gland stone is recurrent swelling under the jaw or in the cheek, particularly during meals.

The swelling may be painful, but it can also occur without pain. It often decreases after eating and may even disappear completely.

Patients sometimes confuse this swelling with enlarged lymph nodes or dental problems. However, swelling caused by these conditions usually does not change as noticeably with meals. Repeated swelling that increases and then subsides may indicate a stone or another obstruction in the salivary duct.

If the obstruction persists, the stone grows or chronic changes develop in the gland, the swelling may become permanent.

When infection develops, symptoms may include pain, tenderness, fever and occasionally purulent discharge from the duct opening. Severe infections can be extremely uncomfortable and may require hospital treatment.

Sialendoscopy should not be performed during an acute salivary gland infection. The infection must first be brought under control. This is why I recommend examination and appropriate imaging for patients with recurrent gland swelling.

What Causes Salivary Gland Stones?

The exact causes of salivary gland stone formation are not fully understood. Changes in saliva composition, reduced salivary flow, anatomical characteristics of the ductal system, and mineral deposition are thought to contribute to stone formation.

Salivary gland stones, also called sialoliths, are hard, mineral-containing structures that form within the salivary ducts or glands. They most commonly occur in the submandibular glands beneath the jaw, but may also develop in the parotid glands.

In my clinical practice, I frequently see patients who drink little water, smoke or consume relatively few vegetables. I have also observed stones in patients with gout and in those taking certain allergy medications that may cause prolonged dry mouth. However, a direct causal relationship between these factors and stone formation has not been conclusively established.

After removing the stones, I recommend adequate hydration, avoiding smoking and maintaining a balanced diet. When necessary, medications that may cause dry mouth are reviewed together with the prescribing physician.

My goal is to support healthy salivary flow and reduce potentially contributing factors as much as possible.

For information about recurrence, gland function after stone removal and other common questions, please visit my Salivary Gland Stone Treatment – Frequently Asked Questions page.

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