Salivary Gland Stones Treatment Options

About Dr. Ryan Osborne

Ryan F. Osborne, M.D. is the Director of Head and Neck Surgery at OHNI and is an internationally renowned expert in head and neck oncology. He has developed a special interest for the treatment of parotid gland tumors and focuses on the use of minimally-invasive techniques in the care of patients needing parotid surgery.

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How do I know if I’m a candidate for Sialendoscopy of my salivary gland stones?

Question:   I just got back from the ENT. I had a CAT scan of my neck to diagnose the size of a salivary gland stone. I was told that my stone is too large to have a scope procedure [sialendoscopy]. He said it was huge. According to him the stone is almost 15 mm on its largest side. I think from looking at the CAT scan that its 12mm x 8mm? He wants to go at it under the tongue, and if that fails wants me to consent to removal through my neck. I want a second opinion, as the scope method seems much less invasive.

Figure 1. Right Parotid Salivary Gland Stone appears on CTscan to be one large stone.

Figure 2. Aggregate of small clustered stones removed via sialendoscopy.

Discussion:   A CT scan is the best non-invasive study to diagnosis the presence of a salivary gland stone. However, while the CT scan confirms the presence of a stone, it cannot accurately tell you how many stones are present or there exact size.  The reason for this ambiguity?  Many times a group of tiny crowded stones will appear on CT scan to be one large stone when in fact there are many small stones that are amenable to sialendoscopy (endoscopic diagnosis and removal of salivary gland stones).   This is due to limits of resolution of the CT scanning machines (think High-Definition 1080p versus your old 19 inch).  In other words we don’t always see the forest for the trees.  Unfortunately, many patients will have unnecessary surgery for “large stones” that are really a group of small stones that could be removed with a less invasive procedure that requires no hospitalization, no incision, no scar, and zero percent risk of facial nerve paralysis.

Key Points:

  • Diagnosis- On CT Scan many small crowded stones may present as one big stone
  • Best ProcedureSialendoscopy remains the best first choice in salivary gland stone evaluation and treatment-not surgery.  There’s no risk of scarring, no hospitalization, and zero risk of facial paralysis with Sialendoscopy.

Sialendoscopy demonstrating the removal of several stones with wire basket:


Read patient stories about Dr. Osborne and Dr. Hamilton
from the Salivary Gland Center, at the Osborne Head & Neck Institute

To learn more about Sialendoscopy and Dr. Ryan Osborne & Dr. Jason Hamilton, visit: