Removing salivary stones – What are the options?

Introduction

Many people know the problem that suddenly pain occurs as soon as you think of something tasty to eat or when your mouth starts to water. The cause of this can be a salivary stone, which is located in the passage through which the salivary gland drains the saliva into the mouth, the excretory duct. The salivary stone closes the passage completely or partially and thus prevents the saliva from being transported into the oral cavity. The accumulation of saliva in the gland can then cause pain. It is therefore absolutely necessary to remove the stone in order to be able to enjoy food without pain again.

How can a salivary stone be removed?

There are different methods to remove a salivary stone, depending on how large the stone is and how deep it is located. If the stone is to be removed without an operation, extracorporeal shock wave lithotripsy can help in addition to massage. This is a method in which the salivary stone is mechanically crushed from the outside.

Sound waves are built up in a generator and brought into the body via a transmitter on the skin. If the salivary stone is exactly in the center of the waves, this method is effective and the stone breaks. By means of saliva stimulating medication, the fragments can then be directed outwards through the normal excretory duct of the gland.

Although lithotripsy has a high probability of success, if it fails, surgical removal of the stone must be considered to stop the pain. Surgical removal of a salivary stone means its surgical removal. This can usually be done in two different ways: If possible, a duct slit is performed.

Only the salivary duct is opened to remove the stone. If this is not possible because the salivary stone is too deep in the duct, the entire gland must be removed. This can also be the case if the stone has already grown too strongly into the surrounding tissue.

If a salivary stone has formed, there are several methods that can help the salivary stone to detach itself. This topic may also be of interest to you: Home remedies against salivary stones

  • A frequently used procedure is massage. For this, the salivary stone must be massaged with the fingers in the direction of the glandular outlet.

    In the case of the lower salivary glands, this lies behind the frenulum of tongue, in the case of the parotid gland, at the level of the first upper molars. Since this often does not succeed on the first attempt, it should be tried again at different intervals.

  • However, if the stone sits deeper, the salivation can be stimulated to flush the stone further towards the exit. This works best with acidic foods, such as lemon juice or sweets.

    You should drink enough and exercise to keep your saliva fluid.

  • If the stone is too big, these methods cannot help. They should therefore only be tried at the beginning of the symptoms. If they do not help, it is essential to seek medical help, because the larger the stone, the more tissue has to be removed during surgery.

Surgery can be performed under general anesthesia (for gland removal) as well as under local anesthesia, the local anesthetic.

Usually the lower jaw salivary glands are first attempted to be slit. In this case, the excretory duct of the salivary gland is searched for with an instrument and then widened with a scalpel up to the point where the stone is located. Then the stone can be removed and the site sutured.

However, the duct is not reconstructed, so that no stenosis (narrowing) occurs. The excretory duct then ends at the place where the stone was previously located. If the stone has already grown together with the surroundings or if it is near a gland, then usually only the removal of the gland remains.

In this operation the entire gland is removed, including the excretory duct. In most cases, it requires an external incision. The incision is made in natural skin folds so that no cosmetically disturbing scars are visible later.

The surgeon has to take great care not to damage any nerves. When removing the parotid gland of the lower jaw, the lingual nerve must be protected, when removing the parotid gland the facial nerve must be protected. This nerve is responsible for the movement of the facial muscles, for example, the tip of the lips.Risks of salivary stone removal occur mainly during the surgical treatment method.

The probability of injuring a vessel or nerve is very high. Especially near the parotid gland runs a nerve cord, which is responsible for the movements of the face. If this is injured, various movements can no longer be performed.

Removal should therefore be carefully considered and only be carried out if there is no other treatment method. But even with conservative treatment there is a risk of inflammation of the salivary gland if the stone cannot be removed. A decision about the right treatment method should therefore be made relatively quickly.

Inflammation can also spread to surrounding tissue and have even worse consequences. In order to remove a salivary stone, general anesthesia is normally not necessary. A simple local anaesthetic is often sufficient.

However, if complications occur or if the salivary stone lies very close to the gland itself, general anesthesia may be necessary. The gland must then be completely removed together with its excretory duct. Since this requires an incision in the skin, the procedure is only performed under general anesthesia.

However, the attending physician will inform you at an early stage if this method needs to be used. As a rule, an operation is associated with an inpatient hospital stay. The removal of a salivary stone can be performed on an outpatient basis.

A stay in hospital is usually not necessary. After an operation, the patient can leave the practice the same day. Follow-up checks of the surgical results may be necessary in the following days.

Shockwave therapy is one of many ways to destroy a salivary stone. It is often used for deep-seated stones. In this case, the salivary stone is shattered with the help of a device that emits ultrasound waves.

The resulting stone fragments can then be removed through the excretory duct of the salivary gland with the help of saliva stimulating medication. The treatment can be performed on an outpatient basis, without anesthesia and without the administration of painkillers. With the modern shock wave therapies (lithotripsy) used today, injuries to the facial nerves can be avoided.