Stones can develop in salivary glands and cause a blockage to the ducts or tubes that drain saliva from the gland in to the mouth.
This usually presents with a painful enlarged salivary gland more commonly under the jaw (Submandibular gland) but also sometimes the parotid gland which is in the cheek in front of the ear. This can classically – but not always – be linked to meal times. This can cause inflammation and infection of the gland, called Sialadentits.
Investigations for suspected salivary stones
US (Ultrasound Scan)
This is a straightforward non-invasive test, performed by a consultant radiologist who is able to examine the glands with a handheld probe.
They can normally detect changes in the gland consistent with infection (sialadenitis) and also the presence of any stones causing a blockage of the drainage from the gland. When this happens the duct from the gland is seen to enlarge and becomes more visible on the scan.
This is a test where a radio-opaque contrast is flushed into the gland and can demonstrate changes in the architecture of the gland duct system and the presence of obstruction caused by a stone.
Sometimes patients can get intermittent symptoms of obstruction due to debris or mucous plugging. These symptoms can often be improved by the washing out of the gland that occurs with a sialogram.
Sometimes stones show up on conventional x-rays including OPT radiographs. Dental infections can also present with similar symptoms. Examination should include the teeth and assessment for any infection and an OPT can be a useful part of this.
Gland-preserving / minimally invasive techniques
Endoscopic / Basket retrieval
Gland-preserving techniques available include endoscopic or basket retrieval. This involves passing tiny cameras in to the opening of the salivary gland in the mouth and then removing the stone with specially designed small baskets.
Surgical stone removal
Sometimes it’s not possible to remove the stone endoscopically, perhaps because the stone is too big. In these cases the duct can be exposed surgically by a small operation usually under a general anaesthetic and the stone removed.