Finding out that you have a salivary gland stone does not automatically mean that the gland needs to be removed. Depending on the stone’s size, location, mobility, and the symptoms it causes, some stones may pass on their own or be removed using treatments that preserve the salivary gland.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
If you have been diagnosed with a salivary stone, understanding these options can help you see where salivary gland surgery fits into the overall treatment approach. In many cases, treatment can begin conservatively before more invasive procedures are considered.
What Are Salivary Gland Stones?
Salivary gland stones, medically called sialoliths, are small, hardened deposits that form inside a salivary gland or its drainage duct.
They most commonly affect the submandibular glands beneath the lower jaw, followed by the parotid glands near the ears. A stone can partially or completely block the flow of saliva.
A typical symptom is pain or swelling that becomes worse around mealtimes. This happens because the gland continues producing saliva when you eat, but the stone prevents saliva from flowing normally through the duct.
Can a Salivary Stone Come Out on Its Own?
Yes, some small and mobile salivary stones can pass naturally, particularly when they are located close to the opening of the salivary duct. Conservative measures that encourage saliva flow may help move a small stone toward the duct opening. These can include:
- Drinking plenty of water
- Gently massaging the affected gland toward the duct opening
- Using sugar-free or sour foods or lozenges to stimulate saliva, when appropriate
- Applying gentle warmth to the affected area
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
These measures are more likely to help with a small, accessible stone than with a large or deeply embedded one. They should not be used as a substitute for medical evaluation when symptoms are persistent or severe.
What If the Stone Does Not Pass Naturally?
A stone that remains stuck does not necessarily mean that the entire salivary gland has to be removed. Modern treatment aims to remove the obstruction while preserving the gland whenever this is feasible.
The choice depends on several factors, particularly:
- The size of the stone
- Its exact location
- Whether it is mobile or firmly lodged
- Whether the duct is narrowed or damaged
- How often symptoms occur
- Whether there is recurrent inflammation or infection
- The condition of the affected gland
Sialendoscopy: A Minimally Invasive Way to Remove Some Stones
Sialendoscopy has changed the way many salivary stones are treated. Instead of making a large external incision, a very small endoscope is introduced through the natural opening of the salivary duct.
The endoscope allows the doctor to see the inside of the duct and, when appropriate, remove the stone using small instruments such as a basket or forceps.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
This approach can be particularly useful for small, mobile stones that can be reached through the duct. It can also help identify other causes of blockage, such as narrowing or inflammation of the duct.
Evidence from systematic reviews supports sialendoscopy as an effective and generally safe gland-preserving treatment for obstructive salivary gland conditions, although outcomes vary depending on the stone and the anatomy involved.
What If the Stone Is Too Large to Remove Directly?
A larger stone does not necessarily mean that the gland must be removed. In selected cases, the stone can first be fragmented into smaller pieces and then removed. This process is called lithotripsy. Depending on the situation, different technologies can be used to break the stone apart.
Intracorporeal lithotripsy
With this approach, the stone is fragmented from inside the salivary duct, often under the guidance of a sialendoscope. Laser or other specialised energy devices may be used to break the stone into smaller pieces that can then be retrieved or allowed to pass through the duct.
Extracorporeal shockwave lithotripsy
Shockwaves are directed at the stone from outside the body to fragment it. The resulting pieces may then be removed or allowed to pass through the duct, depending on their size and location. The availability and suitability of lithotripsy vary between centres, and not every stone can be treated this way.
Can a Salivary Stone Be Removed Through the Mouth?
Yes. Some stones, particularly those located in an accessible part of the submandibular duct, can be removed through a small incision inside the mouth.
This is sometimes called transoral stone removal. It allows the stone to be taken out while leaving the salivary gland itself in place.
Sialendoscopy may be used alongside the procedure to help locate the stone and assess the duct. This gland-preserving approach can be especially useful when the stone is too large or firmly lodged to pass naturally but remains accessible through the mouth.
When Is Salivary Gland Removal Necessary?
Complete removal of the affected salivary gland is now reserved for selected situations rather than being the automatic treatment for a stone.
Gland removal may be considered when:
- The stone cannot be safely or effectively reached using gland-preserving techniques
- There are recurrent or persistent symptoms despite previous treatments
- The gland has sustained significant chronic damage
- There is extensive or recurrent inflammation
- The stone is deeply located within the gland and other approaches are unlikely to succeed
In some patients, a combination of techniques may provide a way to remove a difficult stone without removing the gland. The decision is based on the individual anatomy and findings on imaging or endoscopic examination.
What Happens If a Salivary Stone Is Left Untreated?
A small stone that causes no symptoms may sometimes be monitored, particularly when there is no evidence of ongoing obstruction or infection.
However, a stone that repeatedly blocks saliva flow can cause ongoing swelling and inflammation. Stagnant saliva can also increase the risk of infection.
Persistent or recurrent symptoms should therefore be evaluated rather than assuming that the stone will eventually disappear on its own.
Are Non-Surgical Treatments Always Successful?
No. Conservative treatment works best for selected small or mobile stones. A stone that remains firmly lodged may not respond to hydration, massage, or saliva stimulation.
Likewise, minimally invasive techniques such as sialendoscopy are not suitable for every stone. Stone size, hardness, location, duct anatomy, and previous treatment can all affect the likelihood of successful removal.
Published studies have reported high overall success with gland-preserving approaches, but results vary considerably between patients and techniques. This is why treatment should be individualised rather than based on stone size alone.
The Bottom Line
Not every salivary gland stone requires removal of the entire gland. Very small stones may sometimes pass naturally, while other stones can be treated using gland-preserving techniques such as sialendoscopy, lithotripsy, or transoral stone removal.
The best approach depends on the stone's size, location, mobility, symptoms, and the condition of the affected gland. When conservative measures are unsuccessful, modern minimally invasive and gland-preserving options may provide alternatives to traditional gland removal in appropriately selected patients.
