Salivary Duct Stones in Children

What are salivary duct stones?

Salivary duct stones (sialoliths) are deposits of minerals in the ducts or tubes that drain the salivary glands. When blocked partially or totally by tiny, calcium-rich stones, the saliva backs up and causes pain and swelling.

Salivary duct stones can lead to a painful infection of a salivary gland in children. Staph or strep bacteria may cause the infection or sialadenitis. Sialadenitis can occur in babies during the first few weeks of life and the exact cause is unknown.

Salivary duct stones may be related to:

  • Dehydration, which thickens the saliva
  • Decreased food intake, which lowers the demand for saliva
  • Medications that decrease saliva production, including certain antihistamines, blood pressure drugs, and psychiatric medications

Salivary duct stones are one of the most common salivary gland disorders. Salivary duct stones most often affect the submandibular glands, which are located under the jaw and empty behind the lower front teeth. They can also affect the parotid glands, located in the upper part of both cheeks, near the ears. The duct of each parotid gland empties onto the inside of the cheek, near the top back teeth. Less frequently, they are found in the sublingual glands, which sit beneath the tongue and empty saliva onto the floor of the mouth.

Symptoms of salivary duct stones

Symptoms are often present when eating or drinking. Eating triggers the salivary glands to produce more saliva, and symptoms appear when it can’t flow into the mouth due to a blockage.

Common symptoms include:

  • Problems opening the mouth or swallowing
  • Dry mouth
  • Pain in the face or mouth
  • Swelling of the face or neck (more severe when eating or drinking)

Diagnosis of salivary duct stones

A pediatric otolaryngologist or Pediatric ENT provider will perform an examination and provide a diagnosis. Depending on the location and type of duct stones, the provider will palpitate the neck and look inside the mouth. The provider may find the stone during an exam by feeling under the tongue, but imaging will confirm the diagnosis.

Imaging tests include:

  • X-rays of the salivary gland (called a sialogram). X-rays are taken before and after a special contrast dye is inserted into the salivary gland may confirm a blockage. 
  • a CT scan, which uses a combination of X-rays to take detailed pictures of the inside of the body
  • an MRI, which uses strong magnets and radio frequency waves to produce images of the body
  • an ultrasound of the neck, which uses sound waves to create images inside of the body

Treatment of salivary duct stones

A Pediatric Otolaryngologist or Head and Neck Surgeon surgically removes the salivary duct stones unless the stone only partially blocks the duct. Stones may be flushed out by drinking lots of water and increasing saliva production. Common treatments include sucking on sour food, like sugar-free lemon drops or pickles.

The doctor may be able to push the stone out by massaging the gland with heat or using a new technique called sialoendoscopy. 

Sialoendoscopy can diagnose and treat stones in the salivary duct using tiny cameras and instruments. This procedure is non-invasive and performed in the operating room under anesthesia. 

A camera pinpoints the location of the stone, often undetected by imaging, allowing retrieval and removal with a basket-like tool.

If the stone or stones are significant, a surgery called sialolithotomy may be necessary to remove the stone. 

Prevention of salivary duct stones

To prevent the recurrence of salivary duct stones, children should drink plenty of water. 

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