Sialendoscopy for Removal of Salivary Stones
Sialolithiasis (salivary gland stone) is the most common disease of the salivary glands, affecting 12 in 1000 people in the adult population. It can occur at any age and most commonly occurs in the salivary gland that are located under your jaw, called submandibular glands. They also occur in the parotid gland, which is located in your cheek. These occur when calcium deposits in the duct of the gland, blocking the flow of saliva, causing pain and discomfort associated with eating. This page contains information about the symptoms and treatment of this common condition.
What is a salivary gland stone?
When flow of saliva through the salivary gland slows down, material in the duct can form stones. These stones block the outflow of saliva, causing swelling and pain in the gland.
Where does this happen?
Stones can form in any of the major salivary glands. These include the parotid gland and the submandibular gland.
What are the symptoms?
- Pain (parotid causes cheek pain, submandibular stones cause jaw and mouth pain)
- Swelling of the face
- Pain with eating
How do I know if I have stones?
Symptoms suggestive of stones should be evaluated by an Ear, Nose, and Throat physician that specializes in salivary gland disease. You should have a careful examination and may also have a CT scan done to confirm the presence of a stone.
What are traditional treatment options?
Traditional treatment options
Traditionally, the only treatment option for persistent salivary gland stones associated with inflammation was surgery. Surgery could include removal of the entire salivary gland and duct or marsupialization of the duct with stone removal.
Other methods of treatment focused on prevention. These include:
- sialogogues substances that naturally increase salivary flow
- hydration to increase the amount of saliva, preventing stasis and build-up of stones in the duct system
- massage of the gland to manually move stones through the system, preventing large stone formation
- antibiotics to prevent infection from duct obstruction
Although these methods are helpful, they are only temporary measures and eventually patients find themselves faced with surgical resection of the entire gland to stem their symptoms.
Salivary gland surgery has many potential complications. Salivary glands are located close to nerves that are critical for normal facial movement, taste, and sensation. Complications associated with injuries to these nerves include:
- Loss of oral sensation
- Loss of taste
- Facial weakness
- Scarring associated with surgical incisions
- Facial deformity
- Occasionally, if the duct is not removed completely, recurrent symptoms may occur
Endoscopes used in sialendoscopy
Modern Treatment Options
Dr. Ryan F. Osborne, from Osborne Head and Neck Institute, pioneered the use of sialendoscopy, a cutting edge procedure that allows successful stone removal without injury to surrounding structures, avoiding overly aggressive surgery. There is no incision and patients are able to return to a normal diet with normal salivary gland function in all of their salivary glands.
What is sialendoscopy?
Sialendoscopy involves the use of miniature endoscopes (1-3mm wide) to enter the small ducts of the salivary system in search of disease. The most common disease processes obstructing the salivary gland duct are stones (or calculi) and/or stenosis of the duct from chronic inflammation. Once the problem is identified, it can be treated by a variety of methods, all of which spare total gland removal. This would include stone removal to relieve blockage or duct dilation to prevent recurrent obstruction. The overall success rate of the procedure is over 90%.
Basket deployed through working endoscope
channel, grasping stone
Extraction of stone from the salivary gland duct
Measurement of stones after extraction
What are the benefits of sialendoscopy?
- No surgery, No incision, No scar
- No risk of nerve damage
- No risk of bleeding
- Fast recovery time
- Preservation of normal salivary gland and duct
- Same day procedure in a safe outpatient setting
- Early return to normal diet
How is the recovery?
After the procedure, you are discharged home the same day. There is minimal pain and you are able to consume liquids for the first day. You will gradually increase to a normal diet over a few days. You will be instructed to use certain measures that increase salivary flow for the first few days, to improve healing. A follow up appointment will be scheduled for you within a week of the procedure, to ensure that healing is progressing.
How do I maintain normal gland function after my procedure?
Patients who suffer from sialadenitis or recurrent salivary gland stones will need to modify their lifestyle after sialendoscopy to help prevent recurrence. These lifestyle changes will improve hydration, decrease the risk of recurrent stone formation and infection, and help prevent repeat procedures in the future.
After your procedure, you will receive Dr. Osborne’s specialized salivary gland care protocol. The steps in this plan are crafted to help prevent recurrence of your salivary gland disease. These include instructions about hydration, diet modification, early warning signs and symptoms, and clues for prevention.
Do not risk having your salivary glands removed unnecessarily. Come for a consultation to see how you can improve your quality of life with this low risk, minimally invasive procedure. A phone consultation is free!