PAROTID GAND AND DUCT STONES
WHAT YOU MIGHT FEEL
PAIN AND DISCOMFORT
Where It Hurts
The pain usually starts in front of your ears and can extend towards your cheeks.
When It Hurts
You’ll likely feel a sharp pain when you’re eating, as this is when the glands are most active in producing saliva.
SWELLING
Where You'll See It
The swelling is often visible in front of your ears or on your cheeks.
When It Happens
It’s usually more noticeable when you eat and will likely reduce after you’ve finished your meal.
DRY MOUTH
How It Feels
You might experience some dryness in your mouth, although this is generally less severe than with Submandibular Gland stones.
DIFFICULTY IN SWALLOWING OR SPEAKING
How Often
To remove any debris or discharge. Ear toilet under a microscope is a pivotal procedure in treating ear infections. It enables targeted removal of infected material and debris, reducing the bacterial/fungal load while minimizing risk of trauma to sensitive ear structures, including the eardrum. It also facilitates accurate sample collection for microbiological analysis, aiding in targeted antibiotic therapy.
HOW IT'S DIAGNOSED?
DETAILED CLINICAL HISTORY
Onset of Symptoms
Dr Sandeep aims to establish when the symptoms began, whether they were gradual or sudden, and any specific triggering events.
Character of Pain and Discomfort
Detailed questions about the nature of the pain (e.g., dull, sharp, constant, intermittent) are asked to understand its severity and implications.
Aggravating and Relieving Factors
Understanding what exacerbates or alleviates symptoms can provide critical clues. For instance, increased pain during meals suggests salivary stasis due to a stone.
Swelling and Physical Changes
Dr Sandeep enquires about any noticeable swelling, its location, and whether it comes and goes or has been persistent.
Oral and Dental History
Information about oral hygiene, recent dental work, or history of dental infections may be relevant, especially to rule out differential diagnoses.
Previous Episodes
A history of similar episodes could suggest recurrent stones or chronic issues with the parotid glands.
Associated Symptoms
Symptoms like dry mouth, fever, or difficulty in swallowing and speaking are explored to assess the extent of the condition.
Medical History
Existing medical conditions, medications, and any history of autoimmune diseases can be relevant in diagnosis and treatment planning.
Lifestyle Factors
Dietary habits, hydration levels, and lifestyle choices like smoking and alcohol consumption are considered, as they can influence salivary gland function.
Family History
Although rare, a family history of salivary gland issues or stones can be pertinent.
PHYSICAL EXAMINATION
When faced with a patient presenting symptoms indicative of Parotid Duct stones, Dr Sandeep would conduct a thorough and methodical physical examination. His vast experience and specialisation in ENT conditions guarantee a precise evaluation, allowing for targeted treatment plans. Here is what Dr Sandeep Uppal’s physical examination process would entail:
Visual Inspection
Dr Sandeep starts by visually inspecting the patient’s face and neck, particularly looking for any asymmetry, swelling, or changes in skin colour.
Palpation of the Parotid Region
Employing a careful and systematic palpation technique, Dr Sandeep assesses the size, shape, and consistency of the parotid gland, as well as any associated tenderness.
Examination of Salivary Duct
Dr Sandeep inspects the opening of the Stenson’s duct which drains the saliva from th Parotid gland. This is located inside the mouth opposite the upper second molar, checking for any redness, swelling, or signs of discharge.
Salivary Flow Assessment
To assess salivary flow, he might use sialagogues like lemon juice to stimulate salivation. During this, he observes whether this induces or exacerbates any pain.
Bimanual Examination
Dr Sandeep uses one hand inside the mouth and another on the skin surface to feel for any hard, immobile masses that could indicate the presence of a stone.
Facial Nerve Function
The integrity of the facial nerve is verified by asking the patient to perform facial expressions such as smiling, frowning, and closing the eyes. The function of the nerve may be compromised if the parotid gland swelling turns into an abscess.
Lymph Node Assessment
Any lymph nodes in the neck and submandibular regions are also palpated to rule out secondary infection or other underlying conditions.
Assessment of Associated Symptoms
If the patient has reported additional symptoms like dry mouth, difficulty swallowing, or speaking, these aspects are evaluated during the examination.
Synthesizing Findings
All findings from the physical examination are cross-referenced with the patient’s medical history to form a comprehensive understanding of the condition.
IMMEDIATE MANAGEMENT
In cases where a stone is palpable and proximal to the duct opening, Dr Sandeep might proceed with an immediate extraction attempt under aseptic conditions, offering instant relief to the patient.
Through his meticulous physical examination process, Dr Sandeep Uppal ensures that the diagnosis of Parotid Duct stones is as accurate as possible. This sets the foundation for the most effective treatment plan tailored to each patient’s specific needs.
IMAGING
An ultrasound is usually the first step, and in more complex cases, a CT scan might be necessary to identify the position and number of stones in the parotid duct.
TREATMENT OF PAROTID DUCT STONES
For patients experiencing this condition, understanding the range of available treatment options can be empowering. Here’s a detailed guide:
CONSERVATIVE MANAGEMENT
Sialagogues
Substances like lemon juice or sour candies stimulate saliva production and flow, they can sometimes help to naturally flush out smaller stones.
Warm Compresses and Massage
Applying a warm cloth to the affected area and gentle massage can facilitate the movement of the stone towards the ductal opening.
Hydration
Adequate hydration can help maintain optimal saliva consistency, aiding in stone expulsion.
Antibiotics
They’re used primarily when there’s evidence of a secondary bacterial infection. They help in resolving the infection to reduce inflammation and pain.
Minimally Invasive Procedures
SIALOENDOSCOPY
It is a minimally invasive procedure that uses a tiny camera (endoscope) to enter the duct, directly visualize the stones and remove them without the need for more invasive surgical approaches. The patient can go home the same day with complete relief of symptoms.
LITHOTRIPSY
A procedure that uses ultrasonic shock waves to break the stone into smaller pieces. The fragmented stone can then be more easily passed naturally or extracted.
SURGICAL EXCISION
It’s typically reserved for larger stones or those that are not accessible via minimally invasive techniques. Removal of the stone, and sometimes part of the gland, through a surgical incision may be required. If an abscess forms due to the stone, it may be drained first for symptomatic relief and removal of stone performed at a later date after the inflammation settles.
ALLEVIATE DISCOMFORT WITH SPECIALIZED PAROTID DUCT STONE REMOVAL
End the pain and discomfort of parotid duct stones with our dedicated care. Dr. Sandeep Uppal and our team offer specialized treatment to safely remove stones from the parotid duct, ensuring you return to comfort while preserving gland function.
Our tailored approach emphasizes gentle, effective techniques for stone extraction, prioritizing your swift recovery and long-term well-being. If you’re troubled by parotid duct stones, let us restore your comfort. Schedule your personalized consultation today and take the step towards a pain-free life.