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 passageway called the parotid duct. The saliva dumps out from the end of the duct and into your mouth.

The passageway into your mouth can become blocked for various reasons. When this happens, the area can become inflamed. Generally, your gland starts to make saliva during a meal. However, 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. As a whole, parotid duct obstruction is fairly uncommon.

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)
  • Dehydration
  • Diuretic medicines (water pills)
  • Anticholinergic medicines (like 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 like 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 eventually stop producing 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 medical conditions or problems. Always consult your health care provider for more information.

How is parotid duct obstruction diagnosed?

Diagnosis begins with a medical history and physical exam. Your healthcare provider will examine the inside of your mouth. He or she 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. He or she will need to rule out other conditions that can cause similar symptoms, like 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 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?

Your healthcare provider will figure out the best treatment for you based on:

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle certain medicines, treatments, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

Your healthcare provider may start with treatments such as:

  • Increasing fluids
  • Applying moist heat to the area
  • Massaging the gland and duct
  • Sucking on 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 might need treatments such as:

  • Lithotripsy. This uses shock waves to break up the stone.
  • Wire basket retrieval. This removes the stone through the duct.
  • Sialoendoscopy. This also accesses the stone through the duct.
  • Open surgery. This might include removal of the parotid duct, if other methods fail.

Complications from parotid duct obstruction might require treatment as well.

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

What are the complications of parotid duct obstruction?

Sometimes, obstruction of the duct also leads to infection of the gland and duct. This is particularly common in older adults. If you have an infection due to parotid duct obstruction, you might have additional symptoms like fever. Your pain might worsen as well. If so, you may need additional treatments, like 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 might develop an infection of the deep layers of the skin. This might lead to an abscess in your gland or neck. If such symptoms don’t improve within a week or so, you may need to see an ear, nose, and throat doctor (otolaryngologist).

When should I call my healthcare provider?

Call your healthcare provider if your symptoms do not resolve. Call your provider right away if you have signs of infection, like high fever or pain in your neck.

Key points

  • 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.
  • Parotid duct obstruction can cause symptoms like pain and swelling in the area around the back of your jaw.
  • The condition often goes away on its own with minimal treatment.
  • You might need additional treatment, like surgical procedures, to get rid of the stone.
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