Salivary gland stones are a common condition, but you may have never heard about them before. Most people have heard of kidney stones, and while they are similar to salivary stones, they are not related and have different causes, but both can cause pain and infections. Salivary stones are thought to occur due to a particle of debris in the salivary duct that then becomes encrusted in protein and calcium, similar to how an oyster forms a pearl from a grain of sand.
Salivary stones are often suspected in a patient with recurrent swelling of the neck or cheek associated with eating. There is typically a visible lump in the neck or below the ear depending on which gland is involved. Confirmation of the diagnosis is by either CT scan or Ultrasound which will detect a stone in most cases, although small stones may not show up well. Once a stone is diagnosed, treatment is typically surgical, although some stones will pass spontaneously with time. If the symptoms are mild, a course of hydration by drinking extra water and a so called “sialogogue” or sour candy may be attempted. Antibiotics are only helpful if infection is suspected.Prior to the development of sialendoscopy, the treatment of salivary gland stones was to excise the gland. This required an incision on the neck or face with risk to several important nerves and loss of the gland as a source of saliva. This may still be necessary in some patients who have very large or multiple stones that may not be able to be removed with sialendoscopy. For most stones, sialendoscopy is currently the preferred treatment.
When salivary gland stones become lodged in our saliva ducts or within a gland, removal of the stone may be necessary. With the use of a new, minimally invasive technique known as a sialendoscopy, surgeons can now remove salivary stones as an outpatient procedure, enabling the patient to return to a regular diet and activity immediately after the procedure. The procedure uses a tiny telescope, that is about half the size of a spaghetti noodle, which is inserted into the salivary duct through the mouth. Once inside the duct, a variety of instruments are used to clean out the duct and remove the stones. This procedure typically takes about 1 hour and is done with the patient asleep under anesthesia.Sialendoscopy is an excellent treatment for individuals who suffer from chronic salivary gland stones or those who are have larger stones that cause pain and block saliva ducts. This minimally invasive procedure comes with several benefits, including:
Once you have recovered from anesthesia, you will be allowed to return home. You may resume a regular diet as soon as you feel well, and resume full activity in a day or two as you feel able. It is a good idea to drink some extra water for the first 2 weeks to aid in the return to normal function of the gland. Pain is usually minimal, but you may be prescribed some pain medications as needed. Following sialendoscopy, it's very common to notice an increase in the flow of saliva and the production of saliva. This is normal as the gland is now able to function more normally. This will not cause a problem and may aid in swallowing, etc.
The surgical procedure that is used to remove tumors of the Parotid gland, or sometimes stones or chronic infection of the gland, is called Parotidectomy. The term itself means to remove the parotid gland, and it is a misnomer, in that the entire gland is almost never entirely removed. This is due to the fact that a large part of the gland extends deep into the neck and is not commonly involved in the disease process.The skin incision for a Parotidecomy is typically either what is called a “modified Blair incision” which runs in front of the ear and down onto the neck, or a facelift incision, which extends behind the ear instead of down into the neck and is therefore more hidden than the Blair incision.Once the skin flap is elevated out over the Parotid, dissection is carried down to identify the Facial Nerve, which runs from the skull base behind the ear out into the face. This is the nerve that allows us to smile, wink etc- ie it is the nerve of facial expression. In most cases, this nerve can be identified and preserved, but on occasion, it may need to be removed such as in cases of cancer that involve the nerve itself. It is common for the nerve to be weak for a period of time following surgery, but recovery is complete in most cases.Once the tumor or gland is removed, there will often be a sunken in or depressed area in front of the earlobe or below it. The doctor will commonly use a material such as Alloderm™ to help fill in the defect, or in some cases with a larger defect, fat from the abdomen or a muscle flap may be used to fill in the deformity instead.Commonly, a plastic tube called a drain is placed into the wound to allow blood or serum to drain from the wound for several days, this is usually removed at the first postoperative visit. The skin may be closed with sutures or staples. Most patients heal well with minimal deformity.True complications are not common after a Parotidectomy, but there are several side effects that are common- the skin in front of the ear and the earlobe itself is typically numb for months after surgery, and some numbness is permanent. This is not usually a problem for most patients.
There also exists a situation called Frey's syndrome, or gustatory sweating, where the side of the face over the parotidectomy may sweat and blush when eating. This is due to the regrowth of nerves that incorrectly go to the sweat glands in the skin after the surgery. This is very common, but is usually mild and not bothersome. In some patients, it may be more pronounced and bothersome. There are several ways to treat this, Botox injections are effective, but it is best avoided by the use of Alloderm or other methods to prevent it. Your doctor will likely talk to you about this.
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