Sialendoscopy Removes Salivary Stones, Spares Glands, Speeds Recovery

Outpatient Procedure Requires Special Equipment and Expertise Available at Duke

When Darlene Carroll complained about pain and swelling in her neck while eating, her doctor told her “it had something to do with my saliva.” A salivary stone—a hardened build-up of minerals, similar to a kidney stone—was blocking the flow of saliva from a gland under Carroll’s chin. Rather than remove the gland, Duke head and neck surgeon Liana Puscas, MD, MHS, performed salivary endoscopy (also called sialendoscopy) to remove only the stone. Less than a week later, the 31-year-old mom of four was able to eat Thanksgiving dinner with her family pain-free.

What Are Salivary Stones?

Also called sialolithiasis, salivary stones are calcified mineral deposits that can get stuck in the glands that produce saliva or the ducts that transport saliva to the mouth. Common symptoms include pain and swelling while eating, a lump under the tongue, bad breath, dry mouth, and bitter-tasting or gritty saliva. Left untreated, salivary stones can cause pain, swelling, tooth decay, infection, and even breathing problems.

Doctors review CT scans or ultrasound imaging to determine the size, location, and shape of the salivary stone(s) when deciding whether sialendoscopy is the best option. They also consider whether the duct or gland is infected and any other health concerns that could play a role.

"I was worried about healing in time for Thanksgiving, but actually, the last stitch came out the night before and I could eat perfectly fine. I was like, ‘Thank you, God.’"

- Darlene Carroll, patient

What Is Sialendoscopy?

Despite its introduction in the 1980s, sialendoscopy is still not widely available in the U.S. That’s because the procedure requires specialized surgical training and tiny, fragile, and expensive fiberoptic endoscopes. “You’re talking about something that is the size of the tip of a ballpoint pen.” Dr. Puscas said. “They require extra gentle handling, and you need to have several in reserve. That’s one reason why there aren’t many community otolaryngologists offering this.”

Traditionally, large salivary stones are treated by surgically removing the obstructed gland. This leaves a scar, requires a lengthy recovery, and runs the risk of damaging nearby facial nerves. In contrast, during sialendoscopy a surgeon uses tiny tools to widen the opening of the affected salivary duct. Then a tiny metal basket traps and retrieves the stone. Finally, a few stitches are added to ensure the opening of the duct stays open so that saliva can flow freely. It takes about 90 minutes from start to finish and doesn’t require a hospital stay.

Follow-Up and Beyond

Carroll’s sialendoscopy was scheduled for the Friday before Thanksgiving at Duke University Hospital in Durham. After the procedure, her mouth was sore for a few days, so she stuck to eating soft foods. “I was worried about healing in time for Thanksgiving, but actually, the last stitch came out the night before and I could eat perfectly fine. I was like, ‘Thank you, God,’” she said.

According to Dr. Puscas, once the swelling from the procedure goes down, patients usually notice a difference right away. The follow-up visit can be done in person or through a virtual or telehealth visit, which was the case for Carroll. “The team that cared for me during and after my surgery was just amazing. They took really good care of me,” Carroll said.

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Otolaryngology Care at Duke