Q: Dr. Eppley, Last week I was in the office for some Botox and asked your nurse to share with you an unusual medical issue I have had on and off for a about six weeks.
A “salivary stone” was initially diagnosed by my internist and he suggested I treat it with sour lemon drops and massaging my jaw. Yes it finally disappeared but then it reappeared. Upon the stone recurrence, I was referred to an ENT, by the time of the appointment it had disappeared and the Dr. gave me the same advice as before.
Long story short, the stone or whatever it is, comes and goes. Currently, it has nearly disappeared, yet, the right side of my jaw is still slightly sensitive, very peculiar. I was thinking it may be a cyst?!
Knowing your maxillofacial/dentistry background I’m hoping you will be able to ascertain where I should go with this? Perhaps I should visit my dentist?
I am simply uncomfortable with unfamiliar signs or symptoms when it comes to my body.
I have respected your opinion, throughout the years, your knowledge and guidance has been so very helpful and a comfort. Thank you for your time.
A: What you are describing certainly sounds like a parotid duct stone. The lemon drops (to increase salivary flow output) and the massage (to milk the stone along) are all designed to help the stone pass…not dissimilarly to that of a kidney stone. (drinking fluids although no massage is used) It is very possible these actions causes the parotid duct to partially relieve the backup of saliva behind the stone, but the stone did not actually move, and the salivary backup resumed causing persistent discomfort.
Having said all of that, have you ever had a CT scan that has actually made that diagnosis or even a plain x-ray to see of there really is a stone obstructing the parotid duct. That would be the first diagnostic test. To date it all has been theory (and it may well be accurate) but you really don’t have a definitive diagnosis yet. If it is a true salivary stone it may pass on its own if it is small enough. But large ones can merely sit there and serve as a partial obstruction without ever passing and may need to be surgically extracted by balloon dilatation.
Dr. Barry Eppley