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If There Are Stones In The Duct Can They Be Pulverized With Ultrasound?
Question: I’ve been having problems with salivary gland swelling since several years ago, perhaps since more than 20 years ago. This happens intermittently. The affected gland is located under the jaw, on the right side. It was not until around 3 to 4 years ago that I noticed that a stone, or a few stones, would come out of the salivary duct and the swelling would go away for a while. The problem seems to be more frequent and more severe as the years go by. Perhaps the swelling happens due to my mouth being drier than normal. I suffer from anxiety and I also take trazodone, both of which would result in decrease production of saliva. On the other hand, I take 2 litres or more of water per day – so the problem doesn’t seem to be related to low water consumption.
Recently, an ENT doctor examined the salivary duct under my tongue and told me that there was no stone there. Four days later a stone came out and the swelling and pain was significantly reduced. The swelling and pain started to come back a few days later and now it is difficult to eat. Please see the file with pictures in the attachment.
My questions are:
1. Why is there swelling? Is it because stones keep building up in the duct? Could something else be causing this?
2. Would an ultrasound be able to capture a small stone in the duct?
3. Why is the problem only on the right side? Is the right gland releasing more minerals than the left gland? Is the right gland producing less saliva than the left gland?
4. How can this problem be fixed?
5. If there are stones in the duct can they be pulverized with ultrasound?
6. What would be the risks related to the different possible options to fix this problem?
Thanks a lot.
Recently, an ENT doctor examined the salivary duct under my tongue and told me that there was no stone there. Four days later a stone came out and the swelling and pain was significantly reduced. The swelling and pain started to come back a few days later and now it is difficult to eat. Please see the file with pictures in the attachment.
My questions are:
1. Why is there swelling? Is it because stones keep building up in the duct? Could something else be causing this?
2. Would an ultrasound be able to capture a small stone in the duct?
3. Why is the problem only on the right side? Is the right gland releasing more minerals than the left gland? Is the right gland producing less saliva than the left gland?
4. How can this problem be fixed?
5. If there are stones in the duct can they be pulverized with ultrasound?
6. What would be the risks related to the different possible options to fix this problem?
Thanks a lot.
Brief Answer:
Salivary duct stricture could be the cause of recurrent stone formation
Detailed Answer:
Hi,
Thanks for posting the query. I will try my best to help you with this issue.
1. Why is there swelling? Is it because stones keep building up in the duct? Could something else be causing this?
A: There could be narrowing at some part of the salivary gland duct known as a stricture. This would block the easy flow of saliva into the oral cavity. The accumulated secretions get solidified forming a stone.
The swelling in the gland is due to the continuous production of saliva that cannot get discharged into the oral cavity leading to retrograde flow into the gland and ballooning of the latter.
2. Would an ultrasound be able to capture a small stone in the duct?
A: Yes, ultrasound can easily pick up tiny stones ranging from 2-9mm.
3. Why is the problem only on the right side? Is the right gland releasing more minerals than the left gland? Is the right gland producing less saliva than the left gland?
A: Recurrent damage to the salivary duct due to stone formation can lead to stricture which in turn causes blockage.
4. How can this problem be fixed?
A: Drink frequent sips of water. Take sialogogues. You can keep sour items such as a piece of lemon, tamarind or sour orange below the tongue which would increase the saliva production and easy clearance through the narrow duct. If the problem persists, surgical removal of the gland would be the best option.
5. If there are stones in the duct, can they be pulverized with ultrasound?
A: It may not be possible with ultrasound. Endoscopic removal through the duct may be the next best option.
6. What would be the risks related to the different possible options to fix this problem?
A: Nothing significant.
Hope this answers your query. Revert back to me if you have any follow up queries.
Regards
Dr. Naveen Kumar
ENT and Head & Neck Surgeon
Salivary duct stricture could be the cause of recurrent stone formation
Detailed Answer:
Hi,
Thanks for posting the query. I will try my best to help you with this issue.
1. Why is there swelling? Is it because stones keep building up in the duct? Could something else be causing this?
A: There could be narrowing at some part of the salivary gland duct known as a stricture. This would block the easy flow of saliva into the oral cavity. The accumulated secretions get solidified forming a stone.
The swelling in the gland is due to the continuous production of saliva that cannot get discharged into the oral cavity leading to retrograde flow into the gland and ballooning of the latter.
2. Would an ultrasound be able to capture a small stone in the duct?
A: Yes, ultrasound can easily pick up tiny stones ranging from 2-9mm.
3. Why is the problem only on the right side? Is the right gland releasing more minerals than the left gland? Is the right gland producing less saliva than the left gland?
A: Recurrent damage to the salivary duct due to stone formation can lead to stricture which in turn causes blockage.
4. How can this problem be fixed?
A: Drink frequent sips of water. Take sialogogues. You can keep sour items such as a piece of lemon, tamarind or sour orange below the tongue which would increase the saliva production and easy clearance through the narrow duct. If the problem persists, surgical removal of the gland would be the best option.
5. If there are stones in the duct, can they be pulverized with ultrasound?
A: It may not be possible with ultrasound. Endoscopic removal through the duct may be the next best option.
6. What would be the risks related to the different possible options to fix this problem?
A: Nothing significant.
Hope this answers your query. Revert back to me if you have any follow up queries.
Regards
Dr. Naveen Kumar
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Thanks doctor for you detailed and clear answer.
1. How long would the surgery to remove the gland take?
2. Does the surgery require general anaesthesia? Can it be done with local anaesthesia?
3. Will removal of the gland cause my mouth to become drier? If positive, by how much (20% drier, 30% drier...)?
Thanks again.
1. How long would the surgery to remove the gland take?
2. Does the surgery require general anaesthesia? Can it be done with local anaesthesia?
3. Will removal of the gland cause my mouth to become drier? If positive, by how much (20% drier, 30% drier...)?
Thanks again.
Brief Answer:
The duration of surgery depends on the expertise of the surgeon
Detailed Answer:
Hi
Thanks for writing back
1. How long would the surgery to remove the gland take?
A: The duration of surgery depends on the expertise of the surgeon. It would take around 1.5 - 2 hours.
2. Does the surgery require general anaesthesia? Can it be done with local anaesthesia?
A: The surgery can be done either under local anaesthesia (along with mild sedation) or under general anaesthesia (most preferred).
3. Will removal of the gland cause my mouth to become drier? If positive, by how much (20% drier, 30% drier...)?
A: Not much of difference would be there as other salivary glands would compensate for the loss.
Hope this answers your questions. Wish you a great health.
Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon
The duration of surgery depends on the expertise of the surgeon
Detailed Answer:
Hi
Thanks for writing back
1. How long would the surgery to remove the gland take?
A: The duration of surgery depends on the expertise of the surgeon. It would take around 1.5 - 2 hours.
2. Does the surgery require general anaesthesia? Can it be done with local anaesthesia?
A: The surgery can be done either under local anaesthesia (along with mild sedation) or under general anaesthesia (most preferred).
3. Will removal of the gland cause my mouth to become drier? If positive, by how much (20% drier, 30% drier...)?
A: Not much of difference would be there as other salivary glands would compensate for the loss.
Hope this answers your questions. Wish you a great health.
Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Saisudha Kotla
Answered by
Dr. Dr. Naveen Kumar Nanjasetty
Otolaryngologist / ENT Specialist
Practicing since :2001
Answered : 2545 Questions
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