March 20th, 2018 by Sepehr Oliaei, MD

Since last year when I last wrote about this topic, there has been significant advances in terms of gland sparing, endoscopic or endoscope assisted minimally invasive salivary duct surgery. These techniques are typically used to remove stones or dilate narrowings in the ducts of saliva glands in and around the mouth.

Stones in the saliva glands located in the cheeks or under the jaw can block the flow of saliva. This can result in minor discomfort to severe pain and swelling. In some cases, stones can cause infections severe enough to require hospitalization. In other cases, conditions such as Sjogren’s disease or Juvenile Recurrent Parotitis can cause narrowing and inflammation of the saliva ducts.

Traditionally, many of these cases led to complete removal of the saliva glands such as parotid or submandibular glands which was invasive and harbored risks of surgical complications. These days with advent of continuously refined sialendoscopic techniques, use of ultrathin endoscopes and various tools such as microbaskets and graspers, stones can be removed in a targeted fashion without big incisions in the neck or removal of functional glands.

As techniques have refined over the past year, larger stones are now being retrieved with assistance of endoscopes through the mouth. Incisions in the ducts are more readily repaired with availability of specially made salivary duct stents. As a result, more and more cases are able to be done in a minimally invasive fashion using sialendoscopes. In addition we are beginning to identify benefits from dilation and delivery of steroids using sialendoscopes into the depths of the glands for patients suffering from inflammatory saliva gland diseases such as Sjogren’s or juvenile parotitis of childhood.

Size of the stone and its location are major determinants of the type of intervention required. The larger the stone, and the further along the duct that it is located, the more challenging its removal via minimally invasive techniques. Stones that are less than 5mm are considered small, 5-7mm medium sized, and >7mm are considered large stones. Presence of multiple stones may also present unique challenges. Discuss sialendoscopy with your Ear Nose and Throat doctor to see if they offer it and whether you would be a candidate for it.

 

 

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May 12th, 2017 by Sepehr Oliaei, MD

You may have heard about kidney stones or gallbladder stones, but did you know that your saliva leaves behind deposits that can also turn into stones? These stones can form deep within the saliva glands or saliva ducts throughout the mouth — or even within the crevices of the tonsils.

Stones in the saliva glands located in the cheeks or under the jaw can block the flow of saliva. This can result in minor discomfort to severe pain and swelling. In some cases, stones can cause infections severe enough to require hospitalization.

Just like other types of stones that can form in our bodies, there are not many proven methods to prevent salivary gland stones. Staying well hydrated only gets you so far when your body is predisposed to form these stones.

If you are experiencing periodic cheek swelling or swollen glands under the jaw, often occurring during or immediately after eating food, you may have salivary stones. If you have a blockage that has caused an infection, the swelling can become even more painful and persistent and will not clear up without antibiotics.

In the past, we generally diagnosed these stones with imaging studies, such as ultrasound or CT scan. There are cases that are difficult to diagnose with imaging studies, however. Some stones are invisible on x-rays because of their size, and occasionally something other than a stone (such as a scar band inside the mouth) can cause blockage of a saliva duct.

Fortunately a new, minimally invasive technology using ultrathin endoscopes (less than 2mm diameter) called sialoendoscopy now allows us to see directly into the salivary glands to diagnose and even treat various salivary gland disorders. Small stones in the ducts can be seen, grasped and removed using this special endoscope. Dilations and directed medication delivery can also be performed with sialendoscopes.

Despite technological advances, certain stones still cannot be retrieved in a minimally invasive fashion. Large stones located within the depths of the saliva glands generally can’t be taken out and so we must remove the entire gland. Fortunately, there are many salivary glands located throughout the mouth and throat to make up for the loss of a single gland.

 

Do you have any interesting personal stories about saliva gland stones or their retrieval? Please share in the comment section below. (note: comments are publicly visible)

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