HOW I LOST A STONE! ; A Blocked Saliva Gland Was Making Me Look Like a Hamster. A Revolutionary Operation Was My Last Hope

PATRICIA TAYLOR, 55, a personal assistant, lives in Monks Kirby near Rugby, with her husband Roger, 60, a motor executive. Last month, she underwent an innovative procedure to remove a pea-sized salivary stone which was blocking the saliva duct in her mouth.This affects one per cent of the population. Here she describes the experience to THEA JOURDAN, and her surgeon, Professor Mark McGurk, explains the operation.

THE PATIENT FOUR years ago, I realised I had a problem. Every time I ate something, the right side of my jaw would swell up. It did not matter what I ate – although it was worse if I had spicy food. It was very embarrassing, because I looked just like a hamster.

It was also quite uncomfortable because I could not close my teeth at the back and chew my food properly. It felt like a lot of pressure was building up. Slowly, the swelling would subside, but it was such a nuisance that my husband and I ended up turning down dinner invitations and staying in quite a lot.

Then I started to get painful infections.

It felt like a throbbing, stinging pain under my ear. If I turned around suddenly I would get very dizzy because it was affecting my balance.

Eating was so painful that I ate only very bland food, and just enough to keep me alive. I used to love food, but I began to hate mealtimes because they were torture to me.

I ended up taking antibiotics every three months or so to calm the infections. After about six months, I decided it must be an abscess in a tooth, so I went to see my dentist, Claudia Print.

She told me she thought I was suffering from salivary stones.

Apparently, tiny mineral stones can form in saliva, blocking the duct that leads from the gland to the mouth. She referred me back to my GP, who sent me to see a consultant at the maxillofacial department at Coventry and Warwick Hospital.

THERE, the consultant confirmed the diagnosis using an ultrasound scan. It was only a tiny stone, about the size of a large pea, but it was completely blocking the duct. The saliva was building up in the gland and was causing inflammation.

Apparently stones, which are hard deposits of calcium, happen spontaneously and no one knows why some people develop them.

I started a course of treatment to try to remove the stone, but nothing worked. The doctors used ultrasound pulses to try to smash the stone up, but that just made the problem worse.

I was in so much pain I’d go for days without eating. It was a nightmare.

Then they tried pushing a probe up the salivary duct and pulling the stone out with a tiny basket, but that didn’t work either.

I was in despair. I was very run down, with almost constant infections, and I’d lost lots of weight.

Then my dentist told me about Professor McGurk’s pioneering work at Guy’s Hospital in London.

She had been to one of his lectures and was very impressed. My GP agreed to refer me to him, and I went to see him last November after three years of suffering.

I pinned all my hopes on him.

Professor McGurk felt inside my mouth and pinpointed the position of the stone. He agreed to treat me using his new technique.

He warned there was a very slight chance one of the strands of the facial nerve could become damaged, causing my lip to curl, but it was a risk worth taking.

Two months later, on January 4 this year, I had my operation. I was not nervous at all, just delighted that something was going to be done. I had a general anaesthetic and I woke up two hours later. I had a pressure bandage on my head over the scar, which ran down past my ear and an inch along my jaw. I didn’t feel any pain because I had been given pain relief. I felt great, although a bit tired.

Professor McGurk said he was delighted with the outcome. He also gave me the stone, which I still have. Two days later, I was discharged. The operation was a complete success with no side effects. The scar is so fine that I have to point it out to people.

The best thing has been that I can enjoy my food again. The other day, my husband, a fantastic cook, made a special prawn curry to celebrate. In the bad old days, I wouldn’t have tackled such spicy food.

I tucked in and I did not feel a twinge. Since the operation, I feel like a new person.

THE SURGEON

PROFESSOR Mark McGurk is an oral maxillofacial surgeon based at Guy’s Hospital, London. He pioneered the operation which helped Patricia Taylor. He says:

SALIVARY stones are made of calcium. Saliva is a watery fluid that lubricates the mouth and is saturated with calcium phosphate, which helps repair early damage caused by tooth decay.

Usually the calcium stays in solution, but occasionally it precipitates out, a bit like kidney stones. No one knows why this happens, but it may be a bit like putting a grain of sand in an oyster to make a pearl.

Tiny stones of calcium attract more calcium and can quickly build up into bigger stones up to an inch long. They become troublesome when they block the duct, which leads from the gland to the mouth.

Patricia had been suffering from a salivary stone for some time when she came to see me last year.

She had tried everything. Doctors had already tried to blast it into pieces with ultrasonic waves, but this had not worked. They had also tried the basket method, to hook the stone out with a wire trap, but that had failed, too.

This works in 75 per cent of cases, but Patricia was unlucky. When she came to me, she was quite desperate.

She did not want to have the gland taken out – the normal procedure when all else has failed.

I did an ultrasound scan and I could see the stone was stuck in a kink where the salivary duct bends at a right angle over a muscle.

She had the classic symptoms.

During a meal, she would notice a lump developing on the right side of her face. This is because the stone has caused an obstruction.

A meal really stimulates the saliva, which gushes down and the stone locks into position.

The saliva cannot get past and it blocks the gland, causing a lump for about half an hour. BACK pressure makes the gland swell. The stone can move slightly or change position, so people can have six months with no problem at all, until – through bad luck the stone moves and locks again.

Two months after the initial consultation, Patricia came to Guy’s for her operation.

After she had been given a general anaesthetic, I dilated the duct inside her mouth with a probe. This allowed me to insert the endoscope, which is 1.1mm wide.

This has a camera with a light on the end, so I can see what I am doing on a monitor. I inserted the endoscope until I could see the stone up ahead.

I washed out the area with adrenaline to minimise the bleeding.

Then I made a cut down the ear and just below the jaw and peeled back the skin to reveal the gland under the cheek. I turned the light down in the theatre, so I could see the light in the endoscope through the tissue of the gland.

That way, I could see the duct and the position of the stone.

Using the light as a beacon, I made a cut over the duct, being careful to avoid the branches of the facial nerve. I then cut down to the stone and removed it carefully with small forceps.

Once I had done that, I put the duct back together with tiny stitches and closed up the gland.

Then I put the skin over the area and sewed it back in place with invisible stitches. The whole operation took 40 minutes.

The operation went very well, and there were no complications at all.

Patricia recovered very quickly and was out of hospital two days later.

The scar is almost invisible and her facial nerve is undamaged.

The cost to the NHS was two nights in hospital (around Pounds 700 per night) and one hour’s operating time (Pounds 500). If done in a private hospital, where arrangements are more flexible, the patient may have been treated as a day case (Pounds 2,000) or kept in for one night (additional Pounds 1,000).