Salivary Gland Stone (Sialolithiasis)
A salivary gland stone, also known as a sialolith, is formed in the salivary glands or ducts and consists of calcium crystals found in saliva. These stones can lead to the blockage of the salivary duct, hindering the flow of saliva and causing painful swellings.
They are most commonly encountered in the submandibular salivary gland, while occasionally appearing in the parotid salivary gland, and rarely in the sublingual and minor salivary glands.
In adults, especially those aged 40 and above, salivary gland stones occur more frequently compared to children.
Causes of Salivary Gland Stones:
- Reduced saliva production
- Accumulation of calcium in dead cell debris
- Inadequate fluid intake
- Narrowing of salivary gland ducts
- Certain medications
- Infections
Symptoms of Salivary Gland Stones: While salivary gland stones may sometimes be asymptomatic, they generally manifest as:
- Painful swelling under the jaw and cheek, especially during meals (more pronounced if the food is acidic or sour)
- Severe pain, local warmth, and swelling of adjacent lymph nodes (indicating concurrent salivary gland inflammation)
- If the stone is small, swelling may decrease in the hours after eating, only to reappear when eating again.
Treatment of Salivary Gland Stones: Larger stones in the submandibular salivary gland and smaller stones in the parotid salivary gland are typically treated using sialendoscopy. In this method, an endoscope is inserted directly into the salivary gland duct for both diagnosis and treatment simultaneously. If the stone is too large, procedures such as laser lithotripsy or shock wave lithotripsy may be performed before removal.
Salivary Gland Surgery: For larger stones or cases with chronic inflammation, the entire gland may need to be removed through surgery. The surgery is conducted under general anesthesia, and the gland is separated from surrounding tissues. The hospital stay usually lasts one or two days.
Postoperative Care for Salivary Gland Surgery:
- Patients remain in the hospital for 1 or 2 days after the surgery.
- No food or drink is consumed until the effects of anesthesia wear off (3-4 hours). Soft and liquid foods are gradually introduced, and normal eating can resume after 1 day.
- Mild pain, if present, is managed with simple pain relievers.
- Drains are removed 1-2 days after surgery, and dressings are typically kept for 3-4 days.
- Stitches are removed 7 days after the operation.
- Patients can take a shower 7 days after the surgery.
- Some temporary numbness in the operated area may occur for up to a year.
- Mild facial paralysis that resolves spontaneously within a few days may occur, but permanent facial paralysis is rare.
Reducing the Risk of Salivary Stone Recurrence: After the removal of a salivary gland stone, patients should take the following precautions to reduce the risk of recurrence:
- Increase fluid intake throughout the day.
- Perform massages that regulate and support saliva flow.
- Use medications that enhance saliva production.
- Undergo cortisone treatment to prevent duct narrowing, as recommended by a doctor.
Salivary Gland Tumors: Approximately 80% of salivary gland tumors are benign (non-cancerous), with the most common occurring in the parotid salivary gland.
Symptoms of Benign Salivary Gland Tumors:
- Painless swelling (under the earlobe, in front of the ear, jawbone, or under the tongue)
- Slow growth of the lump
- Movable mass
- Well-defined, palpable lump
Symptoms of Malignant Salivary Gland Tumors:
- Rapid growth of the lump
- Immobility upon examination
- Pain
- Occasionally facial paralysis
Diagnosis of Salivary Gland Tumors: After a detailed examination, imaging methods such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are utilized. Needle biopsy is performed to determine the type of tumor.
Treatment of Salivary Gland Tumors: The primary treatment for salivary gland tumors is surgery. If the tumor is benign, surgery alone may suffice. If the tumor is malignant, chemotherapy or radiation therapy may be necessary after surgery. In cases of malignant tumors, removal of lymph nodes in the neck may also be required. Treatment success depends on the type and extent of the tumor.
In surgery, not only the tumor but the entire gland should be removed to prevent the risk of recurrence.
