Therapy
The therapy of salivary stones depends on the size of the stone and its location. It is best if the salivary stone is located at the end of the excretory duct and is not too large. Then one can try to remove the stone by massage.
If this does not succeed, a small cut can help to push it out. But if the stone is too large or too far inside the duct, one can try to smash the stone with ultrasound and remove the fragments by increased salivation. Acidic foods or juices can be used to stimulate salivation.
If all these measures do not lead to success, only one more operation is possible. This can lead to the loss of the entire salivary gland, especially if there is a chronic inflammation. A distinction is made between a location near the gland and a location far from the gland.
Salivary stones far from the gland are located near the opening of the excretory duct, where they can be massaged out. For this purpose, acidic lozenges are often prescribed during therapy to stimulate the production of saliva so that the salivary stone is shifted towards the opening of the excretory duct. The practitioner then massages the stone manually through the opening into the oral cavity.
If this therapy does not succeed, as for example with large salivary stones, there is another possibility in the form of the duct slit. Here, the excretory duct is slit at the level of the stone with a scalpel after local anesthesia. The salivary stone can then be easily removed.
The newly created opening of the excretory duct is then sutured to the oral cavity. This creates a new, widened opening, which should prevent possible new salivary stones.Before considering surgical removal of a salivary stone, one should try to remove the stone by glandularly sparing measures. Targeted, light massages of the salivary gland can help to remove a small salivary stone by itself.
In addition, regular sucking of lemon slices by increasing the salivary flow should help to flush the stone out of the glandular duct. Many doctors also recommend chewing gum or sucking sweets more often. In addition, a patient suffering from a salivary stone stuck in the glandular duct should be careful to drink plenty of fluids.
Many treating physicians also recommend their patients to take more exercise. In general, all measures that increase the flow of saliva are considered a sensible method for the self-removal of salivary stone. If the stone does not come off despite observing the above mentioned measures and/or symptoms of illness such as fever, malaise and fatigue occur, a doctor should be consulted urgently.
If removal of the salivary stone by conservative therapy does not show the desired success, the only option is surgery. Before the operation, the physician should be consulted as to whether anticoagulant medication, if taken, should be discontinued. These are for example Aspirin, Reflundan or also Marcumar.
The oral cavity should be thoroughly cleaned, i.e. brush teeth, use mouthwash, etc. Either the procedure is performed under general anesthesia or only under local anesthesia, which depends on the individual situation and the patient. If local anesthesia is used, smoking and eating is prohibited several hours before the procedure.
Liquids can be ingested up to 2 hours before. The chances that the operation will be successful are high and the salivary stone causing the problem will be removed. The procedure of removal begins with an incision in the excretory duct of the salivary gland.
This allows the stone to be removed. Suturing of the open excretory duct is usually not necessary. This is the procedure for a more problem-free treatment.
However, if there is severe inflammation or if the salivary stone has grown together with the surrounding tissue, a larger incision must be made in the skin so that the gland can be exposed and removed. The respective gland is thus completely removed, but this is rather rare. The actual surgical procedure must be performed with great care.
On the one hand, this care is necessary to remove the salivary gland as gently as possible, and on the other hand, there is also the risk of damaging various facial nerves (facial nerve, lingual nerve, hypoglossal nerve) during such an operation. Since the nerve responsible for supplying the facial mimic muscles (facial nerve) is also at risk, paralysis can occur when this nerve is injured. Furthermore, during surgery to treat a salivary stone, there is a risk of injury to the lingual nerve (nervus lingualis), which is primarily used to convey various taste sensations.
If this nerve is injured, disturbed taste sensations (sweet, salty and sour) may occur in the area of the front two thirds of the tongue. As one of the 12 cranial nerves, the hypoglossal nerve is a motor nerve that transmits signals to the muscles of the tongue and the floor of the mouth. If this nerve is accidentally damaged, paralysis can occur in the aforementioned supply areas.
Even after a problem-free surgical removal of a salivary gland, it is recommended that the patient concerned remain in inpatient care for at least a few days. In this way, if bleeding or wound infections occur in the area of the surgical site, effective and above all prompt action can be taken. The surgical removal of a salivary gland due to a salivary stone is generally well tolerated by most patients.
The function of the removed salivary gland can be well compensated by the remaining glands. After the operation, the patient must take a few things into consideration to ensure a good healing process. First of all, heavy physical strain such as sports activities should be avoided.
Smoking should be avoided until the healing process is complete, as it can lead to wound healing disorders. Cooling the wound externally has a pain-relieving effect and helps the healing process, whereas heat is rather harmful.In the first few days after the operation, I should limit my food intake to water and tea or mushy food or soups. Only when the incision has healed can the diet be slowly adjusted to the usual level.
However, coffee or alcohol should not be drunk. After eating, adequate oral hygiene must be ensured in order to remove any remaining food that could cause an infection. Brushing the teeth should rather be done with a soft toothbrush and care should be taken with the operated area.
The wound will be painful immediately after the operation. Bleeding or bruising may occur, as well as an abscess. Infections are also possible, which is why the risk of these should be kept to a minimum by proper aftercare.
A short-lasting numbness is also possible. If complications occur, you should consult the doctor in charge. The disintegration is done by shock wave treatment.
It is performed from the outside through the skin. No anesthesia is required and no operation is performed. An ultrasound or sonography is used to locate the stone.
The correct setting requires a lot of experience and precision, so it should be done by an oral and maxillofacial surgeon. The shock waves are directed at the stone with continuously increasing intensity. After about 2000- 4000 shock waves the stone is shattered.
However, the treatment must usually be carried out a total of 3 times at intervals of 4-12 weeks. Another option is a targeted massage of the affected salivary gland. During the massage, the stone is massaged in the direction of the gland outlet.
This can be done by the doctor or at home. Usually this is a method combined with sucking a little acid to try it without surgery for the time being. The massage is usually associated with pain, for which painkillers can be taken to be able to massage well at all.
However, this often only has an effect when the stone is still relatively small. It is important to take regular and plenty of fluids. Because if the saliva is more liquid, no solids are deposited in the passage.
The best foods are those that additionally stimulate the flow of saliva. Citrus fruits, apples or vegetable broth are best for this purpose. During the day, chewing gum and sour candies also stimulate the salivary glands.
One should only make sure that the chewing gums are sugar-free, so that the teeth are protected. Myrrh is considered a remedy. It works effectively if the myrrh tincture is massaged into the excretory duct.
Alternatively, you can dilute the tincture with water and rinse your mouth with it. Other medicinal herbs are chamomile, sage, thyme or bertram. These herbs can be infused as tea or applied externally as a cream on the skin.
Horseradish and onion are also considered helpful. However, they have a negative aftertaste. In addition to herbal remedies, there are also homeopathic remedies that fight against salivary stones.
Common preparations are Mercurius solubilis D12 or potassium bromatum D6. Three times a day 5 globules are taken without liquid. In the case of acutely occurring salivary stone, an ear specialist or dentist should be consulted urgently.
However, if the tendency to salivary stones has existed for years, therapy with homeopathic globules is advisable to prevent salivary stones in principle. Preparations such as “Wobenzym” or “Grapefruit extract” stimulate the flow of liquid saliva. The therapy with the extracts should be carried out over a period of 6-8 weeks in order to observe possible chances of healing.