Disease Description (Causes and Symptoms)
- Definition: Sialolithiasis is a condition in which calcified deposits (stones) form in the salivary glands (mainly the submandibular and parotid glands) or salivary ducts, obstructing the flow of saliva.
- Causes/Pathophysiology: The exact cause is unknown, but salivary stasis, changes in saliva composition (concentrations of mucus, calcium, and minerals), and inflammation or injury of the ducts may contribute. It occurs more frequently in the submandibular gland because saliva is more viscous and the drainage pathway is longer. The stone causes mechanical obstruction within the duct, resulting in reflux, stasis, and infection.
- Main symptoms: Recurrent pain and localized swelling in the jaw, face, and mouth triggered by salivary stimulation during meals (such as eating sour foods). As the stone enlarges, a palpable lump (in the floor of the mouth or neck) and persistent pain and swelling may occur; during acute inflammation, fever and purulent discharge may develop. It may be mistaken for toothache.
Treatment Methods
- Conservative treatment (early-stage, small, mobile stones)
- Increase fluid intake, massage the salivary gland (toward the stone), use acidic foods/candy (sialogogues that stimulate saliva secretion), apply warm compresses, and control pain with NSAIDs.
- If there is evidence of infection, oral antibiotics (e.g., amoxicillin-clavulanate; clindamycin or similar drugs in cases of penicillin allergy) and, if necessary, analgesics.
- Interventional/Procedural treatment (failure of conservative treatment, recurrent symptoms, large stones)
- Intraoral local removal: If the stone is palpable in the floor of the mouth or another area, it can be removed through an intraoral incision under local anesthesia.
- Endoscopic treatment (sialendoscopy): A small endoscope is inserted into the duct to remove the stone with a basket or forceps, or to fragment it with a laser/ultrasound (endoscopic stone removal and ductoplasty). (One of the modern standards of care)
- Extracorporeal shock wave lithotripsy (ESWL): May be used to fragment large stones in selected indications.
- Salivary gland resection (general anesthesia, neck incision): Resection of the submandibular or parotid gland when the stone is located inside the salivary gland or in cases of recurrent or extensive infection. The risk of injury to surrounding structures (facial nerve and other nerves) must be considered during surgery.
- If necessary, ductoplasty may reduce the risk of recurrence.
- Treatment of complications: If an abscess forms, drainage and antibiotics are required; rarely, consultation with orthopedic and oral and maxillofacial surgery specialists may be necessary.
- Lifestyle management/Precautions
- Drink sufficient fluids, eat regular meals, use sialogogues (such as lemon), and maintain oral hygiene.
- Consult a doctor if taking anticholinergic medications that reduce saliva secretion.
- Fever, rapidly worsening swelling, difficulty breathing, difficulty swallowing, severe pain, or similar symptoms require emergency medical care.
Outpatient Visit Checklist (Including Example Questions)
- Items/records to prepare
- A list of current medications (including anticoagulants and anticholinergic drugs) and allergy information.
- Copies or a USB drive containing previous test results (CT, ultrasound, radiographs) or images, if available.
- Symptom diary: when symptoms began, whether they recur, whether they worsen during meals, pain severity (pain score), and the presence or absence of fever or purulent discharge.
- Records of previous treatment (antibiotic use and surgical history).
- Examples of information to tell the doctor during the outpatient visit
- When the symptoms first began and how they have progressed (whether they recur and whether they have worsened recently).
- Whether there is a palpable lump (in the mouth or neck) and its location.
- Accompanying symptoms such as intraoral drainage, odor, fever, or difficulty swallowing.
- Example questions to ask before the outpatient visit
- "What are the size and location of the stone (within the duct versus within the salivary gland)?"
- "Can it be removed simply through the mouth, or are endoscopy or surgery necessary?"
General Example Questions to Ask the Doctor
- What are the common side effects of this medication (the prescribed antibiotic/pain reliever)?
- What is the most appropriate treatment option for my current condition (conservative treatment versus endoscopy versus surgery)? Why?
- How long will recovery take, and when can I return to daily activities?
- How high is the risk of recurrence, and what should I do to reduce it?
Disease-Specific Example Questions
- What are the size (㎜/cm) and exact location of my stone, and can it be accessed through the mouth?
- Am I eligible for endoscopic stone removal (sialendoscopy) or ESWL? What treatment sequence is recommended?
Additional Notes (Summary)
- Emergency signs: Visit the emergency room immediately in cases of acute fever, rapidly enlarging neck swelling, difficulty breathing or swallowing, or severe pain.
- Prognosis: Most cases improve with appropriate treatment, but recurrence is possible. Removing the stone through a procedure or surgery can relieve symptoms and prevent infection.