Parotid Duct Obstruction

What is parotid duct obstruction?

In parotid duct obstruction, part of your parotid duct becomes blocked. As a result, saliva can’t flow normally from your parotid gland into your mouth.

The parotid gland is one of the major salivary glands. These glands make saliva. This is the watery substance used to lubricate your mouth and start the digestion process. The parotid gland wraps around the back of your lower jaw. From there, saliva travels through a tube called the parotid duct. The saliva dumps out from the end of the duct and into your mouth.

The parotid duct can become blocked for different reasons. When this happens, the area can become inflamed. Generally, your gland starts to make saliva during a meal. But because of a blockage, the saliva might start to back up into the parotid gland. This can cause pain and swelling. Sometimes the gland and duct can become infected as a result.

Men may be at a slightly higher risk for parotid duct obstruction. The condition is rare in children. In general, parotid duct obstruction is not very common.

What causes parotid duct obstruction?

Parotid duct obstruction can occur for many reasons, such as:

• Salivary gland stones made of calcium and other minerals (most common)

• Scar tissue

• Mucous plugs

• Foreign bodies

• Abnormal growth of cells

Who is at risk for parotid duct obstruction?

Several factors raise your risk for salivary gland stones, and increase your risk for parotid duct obstruction. These factors include:

• Inflammation of the parotid gland (from an infection)

• Fluid loss (dehydration)

• Water pills (diuretics)

• Anticholinergic medicines, such as atropine

• Injury to the duct

• Gout

• Smoking history

What are the symptoms of parotid duct obstruction?

If you have parotid duct obstruction, you may have symptoms, such as pain and swelling, near the back of your jaw. Some people have only swelling or only pain. Symptoms may often come and go. They are often worse during eating, when your salivary gland makes more saliva.

Sometimes, an object only blocks the parotid duct off and on. If this is the case for you, you might sometimes go without symptoms for days or weeks.

If your gland stays blocked for a long time, it may over time stop making saliva. At this point, your parotid gland might feel firm. But it may no longer be painful or swollen.

Complications from parotid duct obstruction may cause other symptoms.

The symptoms of parotid duct obstruction may look like other health conditions or problems. Always see your healthcare provider for a diagnosis.

How is parotid duct obstruction diagnosed?

Diagnosis begins with a health history and exam. Your healthcare provider will examine the inside of your mouth. They will also likely touch the skin outside your gland to see if it is sore. In some cases, your provider may be able to feel the stone during the exam. They will need to rule out other conditions that can cause similar symptoms, such as inflammation of the parotid gland from some other cause.

You may also need imaging tests for diagnosis, especially if your provider can’t find the stone during the exam. Possible imaging tests include:

• CT. This is currently the test of choice. X-rays and computer technology create detailed cross-sectional images of your body. The images are analyzed by a computer.

• X-rays. Electromagnetic radiation waves create images of your organs and other structures inside your body.

• Ultrasound. High-frequency sound waves are used to see tissue and organs inside your body.

• Sialography. This test takes X-rays of your salivary gland. It is better at finding sources other than stones.

How is parotid duct obstruction treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Your healthcare provider may start with treatments, such as:

• Increasing fluids (water)

• Putting moist heat on the area

• Massaging the gland and duct

• Sucking on citrus fruit or candies to promote saliva secretion

• Using pain medicines

• Stopping use of any medicines that decrease saliva production, if medically possible

Many symptoms go away quickly with these types of treatments. If your symptoms don’t improve, over time you may need treatments, such as:

• Lithotripsy. This procedure uses shock waves to break up the stone.

  • Sialoendoscopy and laser lithotripsy. This method is used for stones larger than 4 mm.

  • Extracorporeal lithotripsy. This method isn't approved by the FDA. But it's used because it seems to work well for stones that are within a duct (intraductal) and less than 7 mm.

• Wire basket retrieval. This removes the stone through the duct.

• Sialoendoscopy. This also accesses the stone through the duct.

• Open surgery. This may include removing the parotid duct, if other methods fail.

Complications from parotid duct obstruction might need treatment as well.

Most of the time, your parotid gland will work as normal after the blockage is removed.

What are possible complications of parotid duct obstruction?

Sometimes obstruction of the duct also leads to infection of the gland and duct. This is very common in older adults. If you have an infection due to parotid duct obstruction, you may have other symptoms, such as fever. Your pain might get worse as well. If so, you may need other treatments, such as antibiotics.

Most of the time, these infections soon clear up with antibiotics and don’t cause many problems. But other, more significant infections do happen sometimes. You may have an infection of the deep layers of the skin. This might lead to a pus-filled infection (abscess) in your gland or neck. If such symptoms don’t improve in a week or so, you may need to see an ear, nose, and throat healthcare provider (ENT or otolaryngologist).

When should I call my healthcare provider?

Call your healthcare provider if your symptoms don't go away. Call your provider or get medical care right away if you have signs of infection, such as high fever or pain in your neck.

Key points about parotid duct obstruction

• Parotid duct obstruction is when part of your parotid duct becomes blocked. Saliva then can’t flow normally from the parotid gland into your mouth.

• Salivary gland stones are the most common cause of this condition.

• Symptoms can include pain and swelling in the area around the back of your jaw.

• The condition often goes away on its own with little treatment.

• You may need additional treatment, such as surgery, to get rid of the stone.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.