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Incision-Less Procedure Removes Salivary Stones in Mouth


By Christina Johnson   |   July 01, 2016
salivary stone 

Eating is one of life’s simple pleasures, but if you have a salivary stone in your mouth, mealtime may become a source of anxiety — fright with every bite. UC San Diego Health is the only hospital in San Diego offering an innovative outpatient procedure for endoscopic removal of salivary stones – calcium deposits that can obstruct salivary glands, causing pain and swelling.

The procedure, known as a sialendoscopy, has a greater than 80 percent success rate with no incisions or wound care. Most patients can return to normal daily routines within two days.

Richard Balikian, an Encinitas resident, is one of approximately 80 individuals who have benefitted from a sialendoscopy since UC San Diego Health began offering the procedure in 2012.

“My neck would swell up like a balloon. It was scary and painful. At one point, I had a meeting to go to and cancelled the trip because I had this giant lump in the neck,” said Balikian. “After the procedure, I took two days off from work and have had no symptoms since.”

Salivary stones are crystals (derived from minerals and compounds found in saliva) that can accumulate and eventually block the salivary ducts. When saliva cannot exit the gland, it may back up, causing swelling and usually pain. Anything that triggers salivary production (the aroma of a favorite dish, for example) might exacerbate the condition. Flare-ups can also occur unexpectedly and may be disfiguring.

Charles Coffee 

“I had a patient who was basically subsisting off white rice and bread because these were foods that did not trigger swelling,” said Charles Coffey, MD, a head and neck surgeon at UC San Diego Health who is currently the only surgeon in the area offering sialendoscopy. “This is a quality-of-life issue and there are long-term health implications as well.”

If left untreated, the stones can cause chronic inflammation and infection. Many patients will go on multiple courses of antibiotics before they are finally referred to a specialist, Coffey said.

Sialendoscopy makes use of advances in miniaturization that enable cameras as small as 0.8 millimeters in diameter (approximately the thickness of a pencil lead) to be housed within long, thin endoscopes. During a sialendoscopy, an endoscope is inserted into the affected duct in the mouth. Once the stone is located, the necessary removal equipment is threaded through a port in the scope to access the stone. The stone is then grasped and extracted or mechanically broken into smaller pieces, which are subsequently removed. In some cases, a stent may be implanted to widen a narrow duct.

“There is no incision because we are accessing the stone through a natural opening in the mouth. This is important because surgery can injure nerves in the area, potentially causing weakness in movement of the face or tongue, numbness or alteration of taste sensation,” said Coffey. “We can also use sialendoscopy to diagnose a person’s condition and allow delivery of medication directly to the affected area.”

“I thought the only treatment option was a surgery that would remove the gland and leave a scar,” said Balikian. “I delayed treatment and hoped the stone would go away on its own. I wish I had known about alternative approaches earlier.”

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