A blocked salivary gland usually occurs when a small, calcified mass, known as a sialolith or salivary stone, forms within the gland or its ductal system. This condition, called sialolithiasis, is the most frequent cause of salivary gland swelling. The submandibular glands are affected in approximately 80% to 90% of cases, primarily because their ducts are longer and more winding, and their saliva has a higher mineral content. The blockage prevents saliva from draining into the mouth, causing it to back up into the gland. A primary symptom is pain and swelling of the affected gland, which characteristically worsens just before or during meals as the body stimulates saliva production.
Immediate Relief and Home Management
The initial approach to managing a blocked salivary gland focuses on encouraging the stone to pass and reducing swelling through simple self-care methods. Staying well-hydrated is important because drinking plenty of water helps thin the saliva, potentially making it easier for the stone to move through the duct.
Employing sialogogues, or substances that stimulate saliva flow, is a common technique used to increase pressure behind the stone. Sucking on sour candies, lemon wedges, or using lemon juice can significantly increase saliva production, which may be sufficient to flush a small stone out of the duct. Immediately following the use of a sialogogue, gently massaging the affected gland can help push the stone toward the duct opening.
Massaging the area beneath the jaw or on the cheek where the gland is located can physically help dislodge the stone and provide relief from pain. Use clean hands to apply gentle, upward pressure along the path of the duct, moving from the gland toward the opening in the mouth. Applying moist heat, such as a warm compress, to the skin over the affected gland may also help reduce swelling and discomfort.
Professional Assessment and Diagnosis
While home care is often successful, you should seek medical attention if symptoms are severe or persistent, particularly if the blockage does not resolve within 24 to 48 hours. Immediate professional assessment is necessary if you experience signs of infection, such as fever, chills, or significantly worsening pain and swelling. An infection, known as sialadenitis, can occur when stagnant saliva pools behind the obstruction.
A medical professional will begin the diagnostic process with a physical examination, feeling the area to determine the size and location of the swelling and potentially palpating the stone near the duct opening. Imaging techniques are then used to confirm the presence, size, and exact position of the salivary stone. A simple X-ray can often visualize stones, especially those that are highly calcified, which is common with submandibular stones.
If the stone is not visible on a standard X-ray, or if a detailed view of the ductal system is needed, an ultrasound or a Computed Tomography (CT) scan may be performed. Ultrasound is useful for visualizing stones and assessing the gland’s health. A CT scan provides a comprehensive, cross-sectional view that can detect smaller or less calcified stones and rule out other causes of swelling.
Minimally Invasive Medical Treatments
For blockages that do not pass with home management, a physician may attempt manual removal if the stone is located close to the duct opening. Using sterile instruments, the doctor can sometimes milk the stone out or use a small probe to widen the duct opening and extract the stone. This procedure is typically quick and can be performed in an outpatient setting.
Another minimally invasive approach is duct flushing, also known as cannulation or irrigation. This involves inserting a very fine tube into the duct and flushing it with a sterile saline solution. The fluid pressure helps to wash out any small debris, mucus plugs, or tiny stones, relieving the obstruction and restoring the normal flow of saliva.
If a secondary bacterial infection is diagnosed, antibiotics will be prescribed to clear the infection and reduce inflammation within the gland. Treating the infection is a necessary step before or alongside efforts to remove the stone, as it helps prevent complications like abscess formation. The underlying stone must still be addressed to prevent recurrence.
Advanced Procedures for Persistent Blockages
When stones are larger, deeply embedded, or the blockage leads to recurrent symptoms, more advanced procedures are considered. Sialendoscopy is a highly specialized, minimally invasive technique that involves inserting a tiny endoscope (0.8 to 1.6 millimeters in diameter) directly into the salivary gland duct. The endoscope allows the physician to visualize the inside of the duct, precisely locate the stone, and then use micro-instruments, such as small wire baskets or forceps, to retrieve it.
Sialendoscopy may also be used in conjunction with other techniques, such as laser lithotripsy. Here, a laser fiber is passed through the endoscope to break up larger stones into smaller, more manageable fragments. This approach is effective for stone removal while preserving the gland’s function. If the stone is too large or firmly lodged for removal via the endoscope alone, a small incision may be made in the floor of the mouth to extract the stone under direct visualization.
Traditional surgical removal of the entire salivary gland, such as a submandibular gland excision, is considered a last resort. This major surgery is reserved for cases where the blockage is extremely complex, the stone is inaccessible, or the gland has suffered permanent damage from chronic infection and inflammation.