The Salivary Glands
The salivary glands are responsible for producing saliva, which helps with digestion, keeps the mouth moist, and protects teeth from bacteria. There are three main pairs of major salivary glands: the parotid glands (in front of and just below the ears), the submandibular glands (under the jaw), and the sublingual glands (under the tongue). These glands are connected to the mouth by ducts that carry saliva. Salivary gland stones, also called sialoliths, occur when minerals in the saliva crystallize and form hard deposits within the ducts or glands. These stones can partially or completely block saliva flow, leading to swelling, pain, and sometimes infection. The blockage is often more noticeable during meals, when saliva production increases, causing the affected gland to swell and become tender.
Understanding Sialoliths
Salivary gland stones can cause a range of symptoms, which may vary depending on the size and location of the stone. Common features include:
- Swelling of the affected gland: Often noticeable just in front of the ear, under the jaw, or beneath the tongue, especially around mealtimes.
- Pain or tenderness: The gland may become sore, particularly when eating or thinking about food.
- Dry mouth or reduced saliva flow: Blockage of the duct can make the mouth feel dry or sticky.
- Infection signs: In some cases, the gland may become red, warm, or develop pus, which can cause fever or general malaise.
- Intermittent symptoms: Pain and swelling may come and go, often linked to eating.
Most stones are small and may cause only mild discomfort, but larger or persistent stones can significantly affect quality of life and may require treatment.
Causes & Risk Factors
Salivary gland stones, also known as sialoliths, form when minerals in saliva crystallize and block the ducts of the salivary glands. The exact cause isn’t always clear, but several factors can increase the risk:
- Reduced saliva flow Dehydration, certain medications (like antihistamines or diuretics), or conditions that reduce saliva production can make stones more likely.
- Saliva composition Higher concentrations of calcium or other minerals in saliva can contribute to stone formation.
- Gland anatomy Some people have narrower ducts or anatomical variations that make blockages more likely.
- Medical conditions Chronic inflammation of the salivary glands or certain autoimmune conditions may increase risk.
- Lifestyle factors Low fluid intake or poor oral hygiene can contribute to stone development.
Diagnosing Salivary Gland Stones
Diagnosis usually begins with a clinical assessment. Your healthcare provider will examine the affected gland for swelling, tenderness, or signs of obstruction. They may gently press along the duct to see if saliva flows normally or if pus is present, which can indicate infection.If a stone is suspected, imaging tests can help confirm the diagnosis and guide treatment:
- Ultrasound A first-line, non-invasive test that can identify stones, duct dilation, inflammation, or structural changes in the gland. It’s particularly useful for stones in the larger salivary glands.
- CT Scan Provides a more detailed view, especially for stones that are small, deep within the gland, or difficult to detect on ultrasound.
Treatment Options
Treatment depends on the size and location of the stone, as well as whether there is infection or duct blockage.
- Conservative management Small stones may sometimes pass on their own. Measures include massaging the gland, staying well-hydrated, and using sour candies to stimulate saliva flow.
- Medications Pain relief and anti-inflammatory medicines can help manage discomfort or swelling, and antibiotics may be prescribed if an infection is present.
- Minimally invasive procedures Stones near the duct opening may be removed using small instruments, often under local anaesthetic. Ultrasound guidance can assist in locating the stone.
- Sialendoscopy A tiny camera is inserted into the duct to locate and remove stones, offering a minimally invasive option for larger or deeper stones.
- Surgery In rare cases, particularly if the stone is large or deep within the gland, surgical removal of the stone or part of the affected gland may be required.