A Salivary Stone Can Be Frightening: What is it?
Without wanting to put too fine a point on it, whichever way you want to put it, salivary stones are disgusting. The word salivary is; any body part with stone added to it is; and even its medical term, “sialolithiasis” is.
How you’re meant to say that if you have one is anyone’s guess.
Don’t read this while you’re eating. Or if you ever want to eat again.
If you haven’t already guessed, salivary stones are stones that form in blocked salivary ducts. They’re concrements of calcium and other minerals naturally found in saliva, which block, build and harden beneath the surface of the tongue.
Should you be curious enough and gross enough to look at one under a microscope, you’d see a mineralised nucleus, laminated in layers of organic and inorganic substances.
Organic substances in stones we get; but inorganic? Like what? Steel wheels? A voodoo lounge? Tumbling dice?
It’s a lot less exciting than that: hydroxyapatite, carbonate apatite, whitlockite and brushite. All related to calcium it seems; but when most of us are only modest science buffs, Google exists to fill all the holes. Sometimes with goop, so you’ve gotta watch that.
Back to unblocking the mystery of blocked ducts and what is created. These rocks can cause pain and swelling, especially when saliva flow is stimulated. A few years ago, the gross removal of a sublingual one (under the tongue) after about five days of pain was YouTube-viralled.
It was frightening few centimetres in length, and left a noticeable hole.
More frighteningly still, it could happen to any of us. Sometimes too, the entire side of your face can swell.
Salivary stones are often extremely irritating for several days. Whenever food is eaten, saliva becomes trapped in the gland causing it to swell, accompanied by pain and discomfort. It’s not always easy to see what’s going on, even when the site of the issue can be identified.
However it’s not always obvious or painful. It’s not uncommon for people to not be aware of anything at all, until it starts to displace their tongue. For some patients, they arrive at the dentist not because their mouth hurts, but because their dentures don’t fit properly.
How incredibly disconcerting that would be… thinking your jaw had changed almost overnight.
Most commonly, these stones occur in the Wharton duct: the submandibular excretory duct. It drains saliva from the three pairs of salivary glands: the parotid (below each ear), the submandibular (along the lower jaw), and the sublingual. It’s about 5cm long (hence the freaky length of the viral video) and it is via this duct (see what I did there?) saliva drains to the sublingual caruncle, which is at the base of the underside of the tongue.
These are not things to think about the next time you’re kissing.
Fortunately most salivary stones are small, and will often remove themselves when saliva flow is increased by drinking lots of water, and sucking tart lemon lozenges through the day. It basically creates a river to flush out the stone; in much the same way kidney stones are initially treated.
Your dentist or doctor will usually suggest this be tried for a couple of days, and if it doesn’t resolve itself or it’s causing a lot of pain, you may need a surgical extraction. Trying this yourself with a pair of tweezers or any other implement is most certainly not recommended. Firstly because you don’t really know what you’re doing; and secondly you’ll see things you will never be able to unseen.
It’s a simple, inexpensive process. A small incision is made, the monster is removed, and normally there are no stitches. The mouth heals very quickly because mucous tissue is highly vascular. This richness in blood and its flow brings increased oxygen and nutrients to wounds. It’s why mouth burns from hot food and drink repair so readily.
Being more accustomed to oral surgery, a dentist will use a local anaesthetic should this procedure be necessary, and more often than not a doctor will use a general.
Just when you thought that was surely enough about the horrors of salivary glands, scientists have discovered a new set of salivary glands set deep in the upper part of the throat.
The nasopharynx region behind the nose was not thought to host anything but microscopic, diffuse, salivary glands; but the newly discovered set are almost 4cm long. Because they’re located over the torus tubarius a piece of cartilage, these new glands have been dubbed the tubarial salivary glands. It is thought that these glands lubricate and moisten the upper throat behind the nose and mouth.
The discovery was accidental. Researchers at the Netherlands Cancer Institute were using a combination of CT and PET scans to study prostate cancer.
If you’re thinking someone went in upside down and voila! new glands were discovered and the champagne flowed like lemony saliva you’ll be rather disappointed.
For CT-PET scanning, a radioactive “tracer” is injected into the patient. This tracer binds well to the protein PSMA, which is elevated in prostate cancer cells. PSMA PET-CT scanning also happens to be very good at detecting salivary gland tissue – also high in PSMA.
Until now, there were only the three previously mentioned salivary glands in humans. Beyond those, there are perhaps a thousand microscopic salivary glands scattered throughout the mucosal tissue of the throat and mouth, according to the Netherlands Cancer Institute.
“So, imagine our surprise when we found these,” Vogel said.
To confirm the discovery, 100 patients were imaged and of all of them had these newly discovered glands. Two cadavers were also dissected and the nasopharynx region consisted of newfound mucosal gland tissue and ducts draining into the nasopharynx.
This is an important discovery in the treatment of cancer. Radiation treatment on the head and neck always endeavours to avoid irradiating the salivary glands, because damage here can drastically impact quality of life.
Patients may have trouble eating, swallowing or speaking.
Because nobody knew about these tubarial salivary glands, radiation was often focussed in that area. Researchers examined more than 700 patient records from the University Medical Centre Groningen, and found that the more radiation received in this specific area the more side effects patients reported. This recent discovery will translate to fewer side effects for cancer patients, better recovery time and have overall benefit to life quality during and after treatment.
The next step is to find out how these newly identified salivary glands can best be protected, and in which patients – bringing huge benefit in overall quality of life during and after treatment.
One can only presume these glands too small for salivary stones; certainly the possibility of having a thousand or so brings a whole new meaning to having rocks in your head.
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