HWN Suggests

My Cold Turned Out to Be Giant Salivary Stones

When I Googled my symptoms (swollen glands, mouth pain, difficulty eating) the phrase “salivary stones” kept popping up. I quickly learned (and saw in disturbing YouTube videos) that salivary stones are mineral deposits that block your saliva flow. I could tell the doctor thought I was one of those annoying patients who uses the internet to diagnose themselves. She said she thought I had a cold, and told me she’d only seen salivary stones two or three times in her 25-year career. But after taking a look at the salivary ducts in the back of my mouth under my tongue, she referred me to an ear, nose, and throat (ENT) specialist.

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Featured

 A Sizable Stone: Sonography in Sialolithiasis

Analgesia with anti-inflammatory agents or opioids should be provided. Antibiotics are indicated if fevers, leukocytosis or clinic signs of infection are present. Tintinalli’s recommends the use of cephalexin or clindamycin first-line. Emergency medicine providers may be able to expel a sialolith <5mm by using a combination of gentle massage, warm compresses, and sialogogues. ENT consultation is warranted for stones >5mm, as they often require specialized removal techniques

 Sialolithiasis

Stone without infection—conservative management: Adequate hydration, topical heat packs, massaging of gland, and sialagogues (sour candy/lemonade) to stimulate the gland.

Articles of Interest

Salivary stones: symptoms, aetiology, biochemical composition and treatment

Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. Sialoliths are more frequently located in the submandibular gland (84%), than in the parotid gland (13%). The majority of the submandibular stones are located in Wharton's duct (90%), whereas parotid stones are more often located in the gland itself.

Sialendoscopy Removes Salivary Stones, Spares Glands, Speeds Recovery

Despite its introduction in the 1980s, sialendoscopy is still not widely available in the U.S. That’s because the procedure requires specialized surgical training and tiny, fragile, and expensive fiberoptic endoscopes. “You’re talking about something that is the size of the tip of a ballpoint pen.

Treatment of Sialolithiasis: What Has Changed?

Treatment for sialolithiasis has undergone significant changes since the 1990s. Following the development of new minimally invasive and gland-preserving treatment modalities, a 40–50% rate of gland resection was reduced to less than 5%. Extracorporeal shock-wave lithotripsy (ESWL), refinement and extension of methods of transoral duct surgery (TDS), and in particular diagnostic and interventional sialendoscopy (intSE) are substantial parts of the new treatment regimen.

When That Pain in Your Mouth Is a Salivary Stone

Pain in your mouth can make the joy of eating disappear — especially if the pain seems to worsen right as you’re about to eat. If you’re experiencing this mysterious pain while you’re eating, this is the hallmark symptom of a salivary gland stone, or sialolithiasis. It’s not one of the more common causes of mouth pain, but it’s one that can be identified and usually treated successfully...

Resources

Anesthesia Key

Patients of any age may develop salivary duct stones, although they are more common in men of age 30 to 60 years and less common in children. Most salivary stones occur in the Wharton duct from the submandibular gland. The patient is alarmed by the rapid swelling that suddenly appears beneath his jaw while he is eating. The swelling may be painful but is not hot or red and usually subsides within 2 hours.

StatPearls

Sialolithiasis is the most frequent cause of salivary gland swelling, affecting the major salivary glands: parotid, submandibular, and sublingual glands. The condition predominantly affects individuals of 30 to 60 years old and is more common in males. The most frequent symptom is cyclical gland swelling and pain associated with meals. Initial management is conservative, with various minimally invasive surgical options available for persistent cases.

TeachMe Surgery

Sialolithiasis is the presence of calculi in the salivary glands or ducts. Stones will form in the salivary gland or ducts following the stagnation of saliva; they are typically composed of calcium phosphate and hydroxyapatite, as the saliva is rich in calcium.