Salivary Stones, & How it can be Treated?

Salivary stones, as the name suggests, are stones that develop within the salivary ductal system. They can cause obstruction of saliva and pain especially during meal times. They occur due to deposition of calcium and phosphorus in the duct of the salivary gland that hardens with time forming a stone. You might be wondering from where the calcium & phosphorus will come. Well, it comes from your mouth. One of the many constituents of saliva is Calcium & Phosphorus. However, it still remains unclear as to why the deposition occurs.

There are three major salivary glands in the mouth & face. First, there is the parotid gland which is located in front of the ear on both sides of the face and its ductal opening is located inside the mouth on your cheek which is called as the Parotid Papilla.

Parotid Papilla

The second major salivary gland is the sublingual gland which is located beneath the tongue. Its ductal opening consists of many small pores right underneath the tongue. The third gland is the submandibular salivary gland, which is located below but inside of your lower jaw & slightly positioned at the back. Its duct travels quite long and its design being tortuous makes it the most susceptible for calcium deposition and therefore forming stones. Its duct opens underneath but in the middle of tongue.

There is no any age predilection for the formation of salivary stones, they can happen in both male & females. However, it most frequently occurs in young and middle-aged adults. Salivary stones causes pain and swelling of the affected gland especially during meal times. Because this is the time where saliva gets secreted profusely and because of the obstruction, it won’t be able to pass into the mouth clearly.

Salivary stones has to be treated by an Oral & Maxillofacial surgeon who should be familiar with this kind of problem. He/she might order some radiographic examinations like X-Rays, Ultrasound, CT Scans, & Sialography to determine the location & size of the stone.

Treatment of the salivary stones depends on the size and location of the stone. If the stone is small and can pass through the duct, a gentle massage of the gland might help in moving the stone toward the duct orifice. Your doctor might be prescribing some drugs which can increase or stimulate the salivary flow known as sialogogues that should help in milking the stone toward the duct orifice. If however, the stone is large and there is significant inflammation, a surgical removal of the stone or the gland itself might be performed, depending on the severity.

There are some new minimally invasive techniques known as Extracorporeal Shock Wave Lithotripsy, & Interventional Sialendoscopy with Basket Retrieval of which both can help in removing the stone with low morbidity and may preclude the need for surgical gland removal.

References: Oral & Maxillofacial Pathology, Fourth Edition by Neville, Damm, Allen, & Chi

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