Thanks to a quick and pain-free minimally-invasive procedure, Rodney can swallow freely without pain again. For five years, salivary stones in his mouth had been causing recurring discomfort and swelling, making it extremely difficult to eat.
In an effort to relieve his symptoms and recover his ability to swallow normally, Rodney turned to Hao “Mimi” Tran, M.D., F.A.C.S., a board-certified otolaryngologist at the Ear, Nose, Throat & Plastic Surgery Associates.
“The best benefit is that I no longer have to worry about infection or swelling in my throat,” says Rodney. “The procedure was painless and quick, and my recovery was almost instantaneous.”
So immediate was Rodney’s recovery, that he spent the rest of the day shopping with his mother and then going out for dinner. “My mother and I were in the stores for five or six hours just puttering around, and she kept asking me, ‘are you okay?’ And I answered ‘yeah, I’m fine,’” says Rodney. “We went out for dinner, and the next day, everything was great. When I woke up, there was no pain, and you wouldn’t have known that anything had taken place the day before.”
What Is a Salivary Stone?
Salivary gland obstruction is the most common problem of the salivary gland affecting roughly 12 in 1,000 adults; it is a blockage that prevents saliva from exiting the duct as it should. The condition is most often caused by a “stone” lodged within the main salivary duct, scarring of the duct caused by trauma or previous infection, or inflammation of the gland that produces pressure on the duct, pinching it off.
Symptoms of a salivary stone may include:
- Swelling and pain of the salivary gland with eating, known as mealtime syndrome
- Dry mouth
- Thick foul drainage in the mouth
- Recurrent salivary gland infections
The risk factors for developing salivary obstruction and stones include dehydration, smoking, and autoimmune disease. A thorough head and neck exam, imaging studies, and possibly blood work done by an ear, nose, and throat physician can diagnose the condition.
“About five years ago when I was living in Philadelphia, I went out for dinner and all of a sudden, I felt my throat start to swell up,” says Rodney. “After about thirty minutes, it looked like I had a softball underneath my throat. My friends and family were asking me, ‘can you breathe?’ And I said, ‘yes, I can breathe, but I think I need to go to the hospital.’”
What Is Salivary Endoscopy?
Salivary endoscopy (also known as sialendoscopy) is a procedure that uses miniature 0.8-1.6mm scopes to access the salivary system through the mouth and remove salivary stones typically with a basket. Areas of scar tissue can be dilated and steroids can be instilled directly through the scope to swollen tissue. The procedure can also be diagnostic in certain cases when the reason for salivary gland obstruction is unknown. Patients typically go home the same day as their surgery and feel completely back to normal in one to two days.
After medication failed to resolve his symptoms, Rodney met with Dr. Tran to discuss further options for treatment. “I took my chances with medicine which killed the infection, and I was hopeful things would work their way out, but that wasn’t the case,” says Rodney.
“I came in and spoke with Dr. Tran. She was excited about this new procedure, and her excitement turned into my excitement. The thought of having a minimally-invasive procedure where I didn’t have to endure any cutting or sutures was really promising. I had the procedure at the hospital, and three hours later, I was going on with my day like it was any other day.”
The Benefits of Salivary Endoscopy
In the past, the traditional standard for treating salivary duct stones was the surgical removal of the gland that involved an incision in the neck and an overnight stay in the hospital. However, salivary endoscopy spares the gland without risk to adjacent vital structures such as the tongue and facial nerves. The procedure usually has a success rate of over 90% for stones 5mm or less and patients can go home and return to a regular diet the same day. For stones greater than 5mm, salivary endoscopy is still an option and may be successful in removing the stone.
This innovative, minimally invasive technique allows for benefits such as:
- No external scarring
- Preservation of the salivary gland
- Less traumatic procedure compared to complete removal of the affected salivary gland
- Improved quality of life
- Decreased risk of facial nerve injury compared to open neck surgery
- Quicker recovery – patients are discharged on the same day as the procedure and can resume normal activity and work the following day
- Lower morbidity – especially for older patients with co-occurring disorders
After his successful salivary endoscopy, Rodney is grateful for finally being free from the long-lasting restrictions in his mouth and throat.
“I was joking with Dr. Tran because I told her that I was dealing with this (salivary) stone for roughly five years and that it was strange to wake up the next morning and not have it there,” he says. “You get so used to feeling the stone down there like a little part of your mouth. All of a sudden, it was gone, and I couldn’t poke at it or anything. It was a nice relief not to have any attachment in the mouth.”
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