Times of India
30 August 2010
By Sumitra Deb Roy

Endoscopic Method Helps Two People Keep Their Saliva Glands
Muzaffar Mohammed (22) from Kashmir was recently in the city, after having scouted several other places, seeking an answer to why he had huge facial lumps during or after meals. The pain and irritation forced him to stay away from food even when he was extremely hungry. Sion resident Bharat Meitari (25) too found his cheeks swelling during and after meals. Both their conditions had deteriorated to such an extent that their respective surgeons had advised that they get rid of the glands inside the mouth.

However, doctors at the civic–run BYL Nair Hospital found that both were suffering from a condition called Sialolithiasis–formation of tiny stones inside salivary glands–and suggested that they had the technique to get rid of the stones without really removing the glands.

The condition Sialolithiasis itself remains less known, though its incidence is significantly high. The salivary glands, found in and around the mouth and throat have ducts (small passageways) that drain saliva. But, chemicals, mostly calcium, in saliva can lead to formation of stones which obstructs the ducts, much like stones in kidneys. Obstruction invariably causes pain that can take anything between a few minutes to a few hours to subside.

Associate professor of ENT at Nair Hospital, Dr Milind Navalakhe, used a relatively new technique called Sialendoscopy and managed to preserve their salivary glands.

But what causes the swelling in mouth? Navalakhe explained that there is saliva formation every minute that is used to initiate digestion, protect teeth decay and moisten mouth. "But, stones in the duct obstruct the drainage of saliva. So, swelling is maximum during and after meals as salivation is at its peak," he added.

Muzaffar travelled thousands of miles from Kashmir to Mumbai when he learnt the stones could be removed without losing his salivary glands, in fact without even his mouth being cut open. His 4mm stone was removed using Sialendoscopy. "We inserted an endoscope inside the tiny duct of his mouth and removed the stone," said Navalakhe.

In Bharat’s case though, it was not one but several stones ranging from 2–5mm. "I had about six stones, which were removed one after another," he said.

Navalakhe claimed the use of the endoscope to take care of salivary glands diseases can avoid the fear of undergoing a facial surgery in many patients. "In open surgery, doctors have to cut open a side of the cheek for better access to the stone area. Use of endoscopes definitely saves possible complications like damage to important facial nerves," added the doctor.

But, as is the case with every technology, this too comes with its share of disadvantages. "It is an invasive procedure as against medical management of the pain," said a senior ENT surgeon of a suburban hospital. "Also, it may not be an ideal option for stones bigger than 6 mm size and one may have to combine the technique with few others for optimum results. Not to mention that it is an expensive procedure," he added.