The major salivary glands are the parotid (on both sides of the face), submandibular (under the jaw), and sublingual (under the tongue). These glands mainly make saliva to help digestion of food. Saliva drains into the bottom of the mouth, next to the upper teeth, and under the tongue through salivary ducts. Blockage of these ducts from calcified stones (calculi) is called sialolithiasis. Most stones are made of chemicals called calcium phosphate and calcium carbonate mixed with cell debris and mucus. Sialolithiasis usually affects people between 50 and 80 years old.
Salivary gland stones affect ducts to the submandibular gland in nearly 80% of cases, the parotid gland in 14%, and the sublingual gland in 6%. Stones in submandibular glands are large and usually occur as one stone when compared with stones in the parotid gland.
The cause is unknown. It’s not contagious or passed from parents to children.
The main symptoms are pain and swelling in the cheek and under the tongue. Pain becomes worse during and after eating. Other symptoms include salivary gland swelling and tenderness. If the gland becomes infected, fever and increased pain may occur.
The health care provider usually makes a diagnosis from symptoms and a physical examination. Symptoms tend to come and go. These periodic painful attacks may be called salivary colic. The stone can sometimes be felt by an examining hand. If the health care provider feels a swollen mass, computed tomography (CT) may be done to see the mass and rule out other causes, such as tumors, dental abscesses, swollen lymph glands, lymphoma, sarcoidosis, and sialadenitis (salivary gland infection). Rarely, x-rays may be taken of the gland (sialography), after a dye is injected into the duct to confirm the diagnosis. The health care provider may also order blood tests.
The goal of treatment is to reduce pain and swelling. Therapy at first may be conservative, with heat (warm soaks) applied to the area, massage, and increased fluid intake. The health care provider may prescribe an antibiotic for infected glands.
A stone can sometimes be removed by squeezing them out by hand or by making a small cut in the opening to the duct. Stones that are hard to remove may need surgery, usually done by a surgical ear, nose, and throat specialist or a head and neck specialist.
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