OVERVIEW

Where are the salivary glands that secrete saliva located?

Human saliva, which is continuously produced, comes from the salivary glands. The major salivary glands include the parotid, submandibular, and sublingual glands, while the minor salivary glands consist of the labial, buccal, lingual, palatal, glossopalatine, and retromolar glands.

Their locations are easy to identify: the parotid glands are near the ears in the cheeks; the submandibular glands, as the name suggests, lie beneath the lower jaw; and the smaller sublingual glands are located under the tongue. The minor salivary glands are embedded in the mucous membranes of the lips, cheeks, palate, and gums.

How does saliva travel from the salivary glands to the mouth?

Salivary glands not only produce saliva but also drain it through ducts that open into the mouth, allowing saliva to be secreted.

Each salivary gland has ducts opening at different locations in the mouth. If a problem with a specific gland is suspected, doctors can locate its duct opening and perform examinations or treatments through it.

What is sialolithiasis?

Sialolithiasis, or salivary gland stones, is a common condition where calcified masses (stones) form in the salivary glands or ducts, leading to various symptoms.

Patients often experience swelling and pain in the glands under the tongue or lower jaw while eating, which subsides afterward. Sometimes, hard lumps can be felt with tenderness.

The condition can recur and may lead to secondary infections like maxillofacial infections. It most frequently affects the submandibular gland, followed by the parotid gland, and rarely the minor glands of the upper lip or cheeks. Sialolithiasis is common in young and middle-aged adults, with episodes lasting from days to years.

Treatment focuses on removing the stones and relieving obstruction. For unremovable stones or recurrent infections causing gland atrophy, surgical removal of the affected gland may be necessary.

SYMPTOMS

What are the symptoms of sialolithiasis?

Patients with sialolithiasis often experience swelling in the salivary gland areas while eating, such as in front of the ears, under the chin, or beneath the tongue, which may cause pain or discomfort, even sharp stinging sensations. Additionally, severe cases may involve radiating pain to the head and neck around the ears. However, symptoms usually gradually subside after eating stops.

For some severe cases, symptoms may persist for several days without fully resolving. If the salivary gland ducts—primarily the submandibular duct running along the lingual frenulum on both sides or the sublingual folds near the floor of the mouth—are gently pressed, tenderness may be felt.

Sialolithiasis can recur repeatedly and, in severe cases, may lead to secondary infections such as maxillofacial infections.

Could facial discomfort while eating indicate sialolithiasis?

Not necessarily, as other conditions can also cause swelling and pain in the salivary glands or surrounding tissues. Additionally, certain issues with the temporomandibular joint may cause discomfort when opening the mouth.

CAUSES

Why do people get sialolithiasis?

The exact cause of sialolithiasis is not entirely clear, but it may be related to the inability of saliva to flow out of the salivary glands due to various reasons. It could also be associated with metabolic disorders in the body. Some patients with sialolithiasis may also have stones in other parts of their body.

DIAGNOSIS

How do doctors diagnose sialolithiasis?

The diagnosis of sialolithiasis is primarily based on medical history. Patients often report swelling and pain in the salivary glands while eating.

During an oral examination, redness and swelling at the duct opening of the salivary gland may be observed, and pressing the area may release pus. Some patients describe a salty taste when licking the affected area.

Additionally, doctors may palpate the area and sometimes feel the stone within the duct.

Apart from these examinations, imaging tests such as X-rays, CT scans, and ultrasounds are commonly used for diagnosis, while sialography is less frequently employed. These methods all aid in confirming the condition.

What conditions can be confused with sialolithiasis?

Typical sialolithiasis is easy to diagnose. However, sometimes swelling and pain in the salivary glands or surrounding tissues may be caused by other conditions, such as tumors in the sublingual or submandibular glands, submandibular lymphadenitis, chronic sclerosing sialadenitis, or submandibular space infections.

Patients should remember that whether it’s sialolithiasis or any of the above conditions, proper medical treatment is essential—avoiding medical care due to fear or hesitation is never advisable.

TREATMENT

Which department should I visit for sialolithiasis?

Dentistry.

How is sialolithiasis treated?

Generally, the primary goal of treating sialolithiasis is to remove the stone and eliminate the obstruction.

• For very small stones in the submandibular gland or its duct, conservative treatment may be used. Patients can hold a cotton swab dipped in citric acid or a vitamin C tablet in their mouth, or consume acidic fruits to stimulate saliva production, which may help small stones pass spontaneously.
• For larger ductal stones in a functional gland, surgical intervention is recommended. The salivary duct can be incised to remove the stone.
• With technological advancements, newer methods like extracorporeal shock wave lithotripsy can break stones in the submandibular gland or duct into particles smaller than 2 mm, allowing them to pass naturally or with stimulation. Additionally, fiberoptic endoscopy can be used to extract stones from the submandibular duct. However, these methods are not yet widely used clinically.
• For stones that cannot be removed by the above methods, or cases where the submandibular gland is repeatedly infected or atrophied, surgical removal of the salivary gland may be necessary.

How is the stone removal surgery for sialolithiasis performed?

For superficially located salivary gland stones, especially those near the duct opening, the procedure can be performed under local anesthesia in an outpatient setting. It is a quick procedure where the mucosa is incised to remove the stone, followed by suturing.

DIET & LIFESTYLE

What should be noted after stone removal surgery for sialolithiasis?

After surgery, pay attention to oral hygiene. You can brush your teeth and rinse gently after eating. Minimize irritation to the wound, and stitches will be removed after one week. If the doctor deems it necessary, antibiotics may be prescribed.

Additionally, avoid overly acidic foods after surgery to prevent excessive saliva stimulation.

Can I still take calcium supplements if I have sialolithiasis?

Sialolithiasis is mainly related to calcium, phosphorus, protein types in saliva, and the anatomy of the salivary glands and ducts, but it is not associated with oral calcium supplements. Therefore, there is no claim that calcium supplements should be avoided if you have salivary gland stones.

PREVENTION

Can sialolithiasis be prevented?

The cause of sialolithiasis is not yet fully understood, so it is difficult to prevent.