Overview
Salivary glands are located in the head and neck area, just under the chin, under the mandible, and before the ears. Salivary duct stenosis or obstruction refers to a narrowing (stenosis) or blockage (obstruction) in your salivary glands. The blockage may occur spontaneously or it may be caused by the presence of calcified stones in one of your salivary glands or ducts, by an autoimmune disease or, less commonly, by a tumour. Salivary stones occur in 1.2% of the population and patients are usually between 30-60 years old.
Symptoms
If there is an obstacle in one of your salivary ducts, the saliva created in the duct will stagnate in the duct and form small calcified stones; saliva will also accumulate in the salivary gland, leading to its enlargement. Symptoms of a salivary duct stenosis or blockage include pain, tenderness, swelling, redness and swollen neck lymph nodes.
If the blockage is caused by an infection, the infected area will produce pus and redness in the floor of your mouth, as well as bad breath. If there is an obstruction in a salivary duct, you may find that no saliva is released from the duct.
Diagnosis
Your doctor will diagnose you based on your medical history and a physical examination. Imaging techniques can detect the presence of calcified stones in around 80% of cases. One possible imaging method is a salivary gland ultrasound, which is a safe and easy to perform examination. Another technique is the sialogram, in which X-rays are used to show the whole length of the duct so that any problems can be revealed. A sialogram is performed under local anaesthesia and is a fast out-patient procedure. Other techniques, in difficult cases, can be represented by dedicated MRI or CT examinations, even though they are usually not necessary.
Treatment
There are a number of treatments available. Conservative treatments include citrus fruits (which increase the amount of saliva you produce, which may dislodge the stone; however, it can also increase the pain and therefore must be taken as a medical decision), hydration, fasting, moist heat therapy, antispastic drugs, massage, or shock wave therapy.
Alternatively, you may undergo a sialendoscopy, a minimally invasive treatment in which the narrowing or obstruction is treated using an endoscope (an imaging tool). Another possible treatment option is to have a surgical procedure, such as cannulation (surgically inserting a tube into the affected duct to keep the area clear) or removal of the duct.