Before you agree to have your submandibular duct operation it is sensible to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices of treatment for stones in submandibular gland with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.
What is the problem?
A stone (calculus) has formed in your submandibular duct and is blocking it. You may have pain and swelling when eating. The pain and swelling may disappear between meals only to return when you next eat.
What is the submandibular duct?
The word ‘submandibular’ means under the jawbone (mandible). The submandibular duct is a tube, which runs from under the front of the tongue to the submandibular gland. There is a submandibular gland under the side of the jawbone on each side. They are about the size a plum.
Submandibular
Submandibular 2
The gland is one of the glands that make spit (saliva). These are called the salivary glands. Saliva is important in the breaking down of the food that we eat. It makes food moist, lubricating it as it passes from the mouth to the gullet. Saliva is produced in the gland; it trickles through the submandibular duct into the mouth and mixes with food when we are chewing.
What has gone wrong?
The stone in the duct is stopping saliva from flowing into the mouth when you eat and chew. When eating and chewing, the gland works hard and makes a lot of saliva. The blockage makes the gland swell up and become painful because the saliva cannot pass through. After a meal, the saliva has time to seep past the stone. The swelling and pain then settle down.
You may be able to feel the stone by pressing with a finger in the floor of your mouth, under your tongue.
The aims
The aim is to remove the stone from the submandibular duct with an operation performed inside the mouth.
You will have a general anaesthetic and be completely asleep while this is done.
The benefits
With the stone out of the way, saliva will be able pass down the submandibular duct into the mouth. The submandibular gland will not swell up at mealtimes.
Are there any alternatives?
There are no drugs or x-ray treatments that will safely dissolve the stone. The treatment given would depend on the exact position of the stone in the duct. You may have an x-ray examination, called a sialogram, to find out exactly where the stone is. If the stone is in, or close to, the submandibular gland, the surgeon may choose to completely remove the gland with the stone. This operation is called submandibular gland excision and is covered in more detail in a separate information leaflet within this series.
If the stone is further along the duct towards the opening in the mouth, there are other techniques that can be used. In some hospitals, shock waves are used to shatter the stone into tiny fragments that can then pass through the duct and into the mouth.
Another technique is to pass a very fine telescope into the duct through the mouth. Instruments are then guided inside to grasp the stone so that it can be pulled out.
The various options should be discussed with your ENT surgeon.
What if you do nothing?
If you do nothing, the stone will slowly increase in size and may eventually block the tube completely. The submandibular gland will then remain swollen.
Who should have it done?
Any person with a submandibular duct stone, causing submandibular gland swelling, should have the stone removed.
Who should not have it done?
People who have other medical conditions that would make it unsafe for them to have a general anaesthetic should not have one.
Sometimes it is possible to remove the stone using a local anaesthetic by numbing the tissue over the stone with an injection under the tongue. The surgeon will tell you if your stone would be suitable for a local anaesthetic.
Author: Mr Robert Ruckley MB. ChB. F.R.C.S. Consultant ENT surgeon.
© Dumas Ltd 2006
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