Remove salivary stones - what are the options?
Many people are familiar with the problem of suddenly experiencing pain as soon as you think of something delicious to eat or when your mouth is watering.
The cause of this can be a salivary stone, which is in the duct through which the salivary gland drains saliva into the mouth, the excretory duct. The saliva stone completely or partially closes the duct and thus prevents the saliva from being transported into the oral cavity.
The accumulation of saliva in the gland can cause pain. It is therefore essential to remove the stone in order to be able to enjoy the meal without pain again.
How can a salivary stone be removed?
There are different methods of removing a saliva stone, depending on how big the stone is and how deep it is. If you want to remove the stone without surgery, extracorporeal shock wave lithotripsy can help in addition to massage. This is a method in which the saliva stone is mechanically crushed from the outside. Sound waves are built up in a generator and brought into the body via a transmitter on the skin. If the saliva stone is exactly in the center of the waves, this method works and the stone breaks.
With saliva-stimulating medication, the fragments can then be directed outwards via the normal duct of the gland. Although lithotripsy has a high probability of success, if it fails, surgical removal of the stone must be considered to alleviate the pain.
Surgical removal of a salivary stone means surgical removal. This can usually be done in two different ways: If possible, a passage slot is carried out. Only the salivary duct is opened to remove the stone. If this is not possible because the salivary stone is too deep in the passage, the entire gland must be removed. This can also be the case if the stone is already too strongly fused with the surrounding tissue.
Can you remove a saliva stone yourself?
If a salivary stone has formed, there are a few methods that can help the salivary stone to come off by itself.
- Massage is an often used procedure. For this, the saliva stone must be massaged with the fingers in the direction of the gland outlet. In the case of the lower salivary glands this lies behind the ligament of the tongue, in the case of the parotid gland it is at the level of the 1st upper molar teeth. Since this often does not work on the first try, it should be tried again at various intervals.
- However, if the stone sits deeper, the formation of saliva can be stimulated in order to flush the stone further towards the exit. This works best with acidic foods, e.g. Lemon juice or candy. In addition, you should drink enough and exercise to keep the saliva fluid.
- If the stone is too big, these methods won't help. So they should only be tried at the beginning of the symptoms. If they do not help, it is essential to get medical help, as the larger the size, more tissue must be removed during an operation.
You may also be interested in this topic: Home remedies for salivary stones
Operations to remove a salivary stone
An operation can be performed both under general anesthesia (with glands removed) and under local anesthesia, the local anesthetic. Usually, the duct slitting is first attempted in the mandibular salivary glands. The salivary gland is found with an instrument and then widened with a scalpel to the point where the stone is located. Then the stone can be removed and the place sewn. However, the duct is not sewn back together (reconstructed) so that no stenosis (narrowing) occurs.
The execution path ends at the point where the stone was previously. If the stone has already grown together with the environment or if it is close to the gland, then usually only the removal of the glands remains. During this operation, the entire gland including its duct is removed. In most cases it requires a skin incision from the outside. An attempt is made to cut into natural skin folds so that no cosmetically annoying scars are visible later. The surgeon must be careful not to damage any nerves.
The lingual nerve must be spared when the mandibular salivary gland is removed and the facial nerve when the parotid gland is removed. This nerve is responsible for the movement of the facial muscles, for example the tip of the lips.
Risks associated with the surgical removal of salivary stones
The main risks associated with removing saliva stones are associated with the surgical treatment method. The probability of injuring a vessel or a nerve is very high here. A nerve cord, which is responsible for the movements of the face, runs right near the parotid gland. If this is injured, various movements can no longer be performed. A removal should therefore be carefully considered and only carried out if there is no other treatment method.
But even with conservative treatment, there is a risk of inflammation of the salivary gland if the stone cannot be removed. A decision about the right treatment method should therefore be made relatively quickly. Inflammation can spread to surrounding tissues and have even worse consequences.
Read more on the topic: Inflammation of the salivary gland
Do I need general anesthesia?
General anesthesia is usually not necessary to remove a salivary stone. A simple local anesthetic is often sufficient here.
However, if complications arise or if the salivary stone is very close to the gland itself, general anesthesia may be necessary. The gland must then be completely removed along with its duct. As this requires an incision, the procedure is only performed under general anesthesia.
However, the attending physician will indicate at an early stage when this method must be used. An operation is usually associated with an inpatient hospital stay.
Is it possible to remove the salivary stone on an outpatient basis?
A salivary stone can be removed on an outpatient basis. A hospital stay is usually not necessary. After an operation, the patient can leave the practice on the same day. Follow-up checks of the surgical result may be necessary in the following days.
Shock wave therapy
Shock wave therapy is one of the many ways to destroy a salivary stone. It is often used on deep-seated stones. With the help of a device that emits ultrasound waves, the salivary stone is smashed. The resulting stone fragments can then be removed through the duct of the salivary gland with the help of saliva-stimulating drugs. The treatment can take place on an outpatient basis, without anesthesia and without the administration of painkillers. With the modern shock wave therapies (lithotripsy) used today, injuries to the facial nerves can be avoided.
Which doctor does this?
The choice of doctor depends on size, location and symptoms.
The family doctor can use an ultrasound examination to determine whether a salivary stone is present. Usually a referral is then made to a dentist or an ear, nose and throat specialist. Small surgical interventions can be carried out by a dentist with the appropriate equipment, i.e. an oral surgeon. For major surgical interventions, an oral and maxillofacial surgeon is the right contact. Of course, the patient can also present himself directly to a doctor of his choice.
Pain from treatment
In exceptional cases, the treatment may cause pain. Especially when an operation was carried out. This creates a cut in the mouth or even on the skin that has been sewn. Then pain pills help, like Ibuprofen for relief. But even with conservative methods, removal can be uncomfortable. Moving a stone towards the oral cavity can irritate the gland duct. The too large stone pushes through the narrow passage, which is associated with pain. Stone shattering is usually painless as the stone is washed out in fragments.
Cost of salivary stone removal
The cost of removing a salivary stone depends on its size and location as well as the procedure used (e.g. shock wave therapy, salivary duct endoscopy, etc.).
If there is a medical need, most health insurances will cover the costs. Nevertheless, before starting treatment, you should inquire with your health insurance company which treatment methods they will take over or for which you have to pay your own contribution.
Duration of the salivary stone removal
The duration of a shock wave treatment depends on the size and location of the salivary stone. Sometimes it takes several repetitions to split the stone into small enough fragments.
If the surgical removal takes place under general anesthesia, the length of stay in the hospital is around 4-7 days.
The prognosis of salivary stone removal using shock wave therapy is very good.
The resulting small stone fragments can usually be diverted easily through the duct of the gland. In order to prevent the formation of a new salivary stone, you should ensure that you drink enough water, since drinking too little is the main cause of its development.
However, taking certain medications (e.g. water-excreting drugs or antidepressants) as well as certain diseases (e.g. mumps or cystic fibrosis) can lead to a renewed formation of a salivary stone, as both lead to a change in the saliva composition.
One reason in favor of an operation is the frequent recurrence. Relapse means "relapse" and means here the often recurring swelling of the salivary gland due to new stones or inflammation, although the original salivary stone has already been removed. In some cases, however, complications can arise, in which case it is common to modify the original surgical plan.
For example, the glands are then removed instead of duct slitting. However, the treating doctor will inform the patient beforehand about such complications and changes.
Whether and for how long you are on sick leave after a salivary stone has been removed depends on several factors.
The size of the stone, the method of removal and the general condition of the patient play a certain role here. If the salivary stone is only smashed out (shock wave therapy), you will usually not be put on sick leave.
If, on the other hand, a salivary gland has been completely removed, then you can expect to be absent for almost a week. This is because a large wound has been created and there may be swelling.