Only marginally less gross than that tongue eating fish parasite
June 15, 2014 12:13 PM   Subscribe

Sialoliths are typically small, like María’s. But occasionally physicians run across monsters (sometimes referred to as megaliths): One paper describes a seven-centimeter stone the size of a “hen’s egg.” The big ones, of course, must be surgically removed, something I learned when I stumbled across a horrifying, yet mesmerizing video of a sialolith excision. (That video led me to another, and then another, and . . . well, let’s just say the rabbit hole of sialolith surgeries is bottomless. I’ll save you some time and just point you to the best one.) For smaller stones, however, doctors like to avoid the scalpel. While surgery might save some pain and suffering, the salivary glands are really close to some facial nerves that you definitely don’t want to cut.
So it turns out the salivary glands can also suffer from something like kidney or gall stones. Yes, the author, Cassandra Willyard, is so kind as to link to a video of a sialolith extraction. Link via Io9, who have a nice image of a megalith taken out of somebody's salivary glands.
posted by MartinWisse (36 comments total) 10 users marked this as a favorite
Furiously runs his tongue over the bottom of his mouth. "Phew!"
posted by smidgen at 12:18 PM on June 15, 2014

Usually when I watch youtube clips like these, it's in the middle of the night and I'm naked covered in leeches and hen blood.
posted by Foci for Analysis at 12:19 PM on June 15, 2014 [8 favorites]


But seriously, as a tonsillolith sufferer, this is the stuff of nightmares for me.
posted by ApathyGirl at 12:35 PM on June 15, 2014 [1 favorite]

Yep. Luckily they are VERY rare, just like very large tonsiliths are very rare. But if you're prone to any type of stone formation, you may be prone to them.

Besides, this is no where near as bad as a tear duct stone... (do not google this if you have a weak stomach).
posted by strixus at 12:37 PM on June 15, 2014

I cannot watch these.

I've had one sialolith, which caused me five days of pain and a disfigured face before a thing the size of a very small splinter's tip finally came out and the swelling was basically gone 2 hours later. My mother had one that was larger but sub-surgical and the swelling permanently damaged her already TMJ-affected jaw.

I just can't even think about how awful an actual surgical-grade stone must be.
posted by Lyn Never at 12:40 PM on June 15, 2014

oh god why did I click
posted by Mary Ellen Carter at 12:59 PM on June 15, 2014 [2 favorites]

I will now live in fear of getting one of these or WHAT IF I ALREADY HAVE ONE AND SOON IT'LL BE BIG ENOUGH TO FEEL for the rest of my goddamned life.
posted by delfin at 1:03 PM on June 15, 2014 [1 favorite]

Blah, blah, blah translucent, blah blah, blah AIEIEEEEEEEEEEEEEEEEEEEEEEEEEEEEE OH MAH GAWD!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
posted by Asbestos McPinto at 1:11 PM on June 15, 2014 [2 favorites]

Looks like something you'd pull from a bag of Chex Mix.

I guess I won't be eating that for a while.
posted by Pudhoho at 1:13 PM on June 15, 2014

I had a kidney stone. It was loosed with a sneeze while lying in bed at 7AM and passed at home 6 hours later as I was convulsing and about to call an ambulance, not a cab, and no insurance be damned. The stone struck the toilet bowl with a tiny "tink" sound. The relief started immediately but passing a kidney stone made me scared - of everything.
posted by vapidave at 1:17 PM on June 15, 2014 [4 favorites]

Am I the only one who just drank a gallon of water with a bag of lemons squeezed into it?
posted by arcticseal at 1:33 PM on June 15, 2014 [2 favorites]

MartinWisse, every time I think "wow, that's an odd topic", there's your name under it. Which is to say, thank you for broadening my horizons!
posted by Omnomnom at 1:37 PM on June 15, 2014 [1 favorite]

Eh. Mine's bigger.
posted by Brandon Blatcher at 1:59 PM on June 15, 2014

posted by univac at 2:11 PM on June 15, 2014 [1 favorite]

I had a salivary gland stone once- every time I wanted to eat something, that side of my face would swell painfully and I'd have to massage my face to squeeze out the backed up saliva. After a few days something like a small grain of sand popped out, followed by a gush of saliva, and it was over.

Basically it was a gross but mild sideshow in my medical history that made me appreciate how few real issues I have.
posted by BuddhaInABucket at 2:12 PM on June 15, 2014 [10 favorites]

posted by PenDevil at 3:30 PM on June 15, 2014 [1 favorite]

So why would there be something in your saliva which could form a stone?

One answer might be that those things are dissolved minerals which your body could use to repair wear and other damage to your teeth-- and that explanation in turn might help explain why sour things (i.e. acidic things) elicit such a flood of saliva: yes, to dilute the liquid in your mouth to a less dangerous to your teeth pH, but possibly also to supply the minerals for a resurfacing job.

If that's the case though, lemon juice doesn't look quite so good as a treatment for the stones.

If the minerals are for repair, you'd expect them to be what teeth are made from, but I had difficulty locating a page which went very far into the composition of saliva stones; the best I could come up with implied that most are calcium phosphate, which is compatible with the hydroxylapatite mineralization of teeth. The Google search page also indicated that gout can give rise to uric acid saliva stones.

Kidney stones, by presumed contrast, are calcium oxalate (70%), calcium phosphate (10%), uric acid (5-10%), struvite-- which does contain calcium phosphate-- (10%), etc.
posted by jamjam at 4:13 PM on June 15, 2014 [4 favorites]

I love this.
posted by cocoagirl at 4:51 PM on June 15, 2014

A relative had one of these. They tried the lemon juice route, but ended up having to have an operation to remove it. Barely a scar just underneath their jaw, that you wouldn't know was there is if you didn't look for it. Only ever had one, several years ago.
posted by Solomon at 5:24 PM on June 15, 2014

I've had one since I was 10. When I yawn, it pressurizes my saliva glands and a sprinkle of water involuntarily shoots out of my mouth. If someone sees it, I spread my arms and make a gargling sound. If they're still staring I bow.
posted by hal9k at 5:39 PM on June 15, 2014 [7 favorites]

Holy shit! So that's what that lump is.
posted by EXISTENZ IS PAUSED at 5:40 PM on June 15, 2014

I have never been so glad that I live on water with lemon juice in it in my life.
posted by winna at 5:43 PM on June 15, 2014

Oh good something to replace bot flies in my nopebook.
posted by Joey Michaels at 5:54 PM on June 15, 2014 [8 favorites]

God damn it, I accidentally clicked on that i09 link when I was trying to click on a link in the innocuous post below this one. I stared at it for a second while my brain went, "What in holy hell does this have to do with Francis Fukuyama? AARGH!!" Bad bad bad.
posted by hurdy gurdy girl at 6:26 PM on June 15, 2014 [1 favorite]

Oh good something to replace bot flies in my nopebook.

I loved The Nopebook, wasn't that the one where a woman with a papercut on her tongue-string falls in love with a man who broke his penis as a result of doing something incredibly routine
posted by threeants at 6:32 PM on June 15, 2014 [10 favorites]

God damn it, I accidentally clicked on that i09 link when I was trying to click on a link in the innocuous post below this one. I stared at it for a second while my brain went, "What in holy hell does this have to do with Francis Fukuyama? AARGH!!" Bad bad bad.

Is there such thing as a cosmic Freudian slip?
posted by threeants at 6:34 PM on June 15, 2014 [2 favorites]

I too had a sialadenitis/sialoith which felt precisely like being struck squarely on the chin with a 2X4. I was told to get lemon drops and use hot packs and after days of agony I experienced relief similar to that described above.

What made things worse was the doctor who insisted that this was an affliction of glassblowers, and who stared at me with strange suspicion when I insisted that I had not, in fact, recently blown glass.
posted by kinnakeet at 7:05 PM on June 15, 2014 [5 favorites]

favorite comment from the io9 post: 5 years from now Ill have forgotten I read this and just think I'm really inspired for naming the princess in my fantasy novel Sialolith
posted by threeants at 8:30 PM on June 15, 2014 [2 favorites]

I had a tiny one of these.

It sucked.

When I looked at food my neck swelled up. Painful as hell.

I went to an ENT, a younger doctor. He ran some tests and decided he was going to have to cut open my face, ostensibly to remove the stone/gland.

My dad, who is also an ENT suggested I go see another doctor, this time an old one.

The older doctor looked under my tongue, cut open the duct slightly and pulled the stone out with doctor pliers. Problem solved.

It turns out that younger doctors tend to want to operate because surgery is fun. For them i guess.
posted by Lord_Pall at 8:47 PM on June 15, 2014 [5 favorites]

doctor pliers

My high-school level physics informs me othewise but I'm pretty sure I'm taking up less space after reading the term "doctor pliers".
posted by vapidave at 10:25 PM on June 15, 2014 [3 favorites]

I am prone to tonsil stones, much to my dismay. Every so often, I turn to Google, to see if there's been some breakthrough in oral hygiene that can rid me of my terrible tonsillar curse.

One time, I came across a YouTube video, since made private, of a woman trying to figure out what was going on with her salivary gland.

Suffice to say that after watching it, I didn't feel so bad about my tonsil problem anymore.
posted by evidenceofabsence at 11:56 PM on June 15, 2014 [1 favorite]

Sialoliths, it's good to finally know what these thing are called. I had some back in the 8th grade. And the looks people gave me when I told them the reason I missed a week of school was that I had had surgery to remove "calcium deposits" from my salivary gland.
posted by zinon at 6:04 AM on June 16, 2014

No discussion of sialolithiasis is complete without mentioning a relatively new technology, sialoendoscopy. Here's a video [SLYT].

I am an ENT surgeon in my second year of private practice and the leaps in endoscopic technology just since I began my residency 7 years ago have been astounding. We now have semi-rigid scopes, smaller than a millimeter in diameter, that can be passed into the parotid and submandibular salivary ducts from inside the mouth. Not only can we diagnose salivary pathology more accurately than before (e.g., determining if a patient has a stone versus a stricture/narrowing versus "sludge"), but we can actually intervene through tiny ports in these scopes and use baskets or drills or lasers (LASERS!) to break up and remove the stones.

Lord_Pall, you're right. Surgery is fun. But, speaking for myself and to your point above, I am quite conservative with my treatment and always try nonoperative or minimally invasive intervention before jumping to a big procedure.
posted by robstercraw at 6:26 AM on June 16, 2014 [3 favorites]

I have these, recently diagnosed after one side of my jaw swelled up like I'd been punched over the course of about two hours (had not been punched). I'd had the pain on and off for years but had no other outward symptoms until the swelling. The urgent care doc prescribed lemon drops which is pretty awesome as I love sour candy. So now a regular daily ingestion of Sour Patch Kids is MEDICINAL. But I'd still rather not have them. So far, nothing big enough or noticeable enough has come out but surely one day I'll need to have something removed. The videos are pretty awesome but the pain is not cool.

I also notice I get the pain when I drink certain things: wine (red especially) and gin&tonics. I thought for a while the problem was the gin but THANK GOD it's the tonic. So something about tannins and tonic I guess?
posted by marylynn at 1:35 PM on June 16, 2014

I thought I was gonna nope out, but really, it's the best thing. It looks downright pleasant compared to the time I got my wisdom teeth removed.
posted by supermassive at 8:07 PM on June 16, 2014

Wow, I had just those symptoms for about a week a few years ago, but they went away before I saw a doctor, so I never found out what it was. Every time I ate, half my face swelled up and hurt. I figured I had gotten a bit of food in my salivary gland, but I'm glad to finally find out what it (probably) was.
posted by obvious at 8:09 PM on June 16, 2014

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