Q. I have a salivary duct stone and I am due to have it removed, but the doctor said there was a risk of damaging a facial nerve that would leave one side of my face numb for ever. Is this a real risk? The stone only flares up every couple of months, with some discomfort and swelling. Are there treatments other than an operation?
A. Stones in the salivary ducts can be as small as a grain of sand or as big as a pea. They form in the tiny channels that carry saliva from the salivary glands into the mouth. The glands are under the jawbone and near the angle and the front of the ear. If the saliva flow is slow, or if there's a narrowing of the ducts, stones are more likely to develop. If a stone is small, causing a partial blockage, it will only cause symptoms when there is a lot of saliva flowing; during and after a meal, say. A swelling may develop during a meal, which resolves over a couple of hours. Tiny stones near the surface can sometimes be squeezed out. If this is not possible, there are two other options. A surgeon can open the duct and manually remove the stone. Unfortunately, the facial nerve is near the duct, and there is a small but real risk of damaging this nerve. Damage to the facial nerve doesn't numb the face, but it does cause weakness and drooping of the muscles on one side. Some hospitals offer a newer technique called lithotripsy, using high-energy shock waves to smash the stones. It doesn't work for all stones, but it does remove the risk of facial nerve damage.
LINES OF WORRY
Q. My mother, who died at 77, had very wrinkly skin. I'm in my early forties, and my skin is moving in the same direction. Can I do anything to prevent it? My father's skin is relatively wrinkle-free.
A. How wrinkly your skin becomes is determined by a combination of genetic and environmental factors. There is a hope that your father's genes will stop you getting as wrinkled as your mother was, but it does sound as though you have inherited her tendency to form wrinkles. Two external factors increase wrinkling: sunlight exposure and cigarette smoking. So stay out of the sun and avoid cigarette smoke. There are creams that effectively treat fine (but not coarse) wrinkles, containing retinoids, members of the vitamin A family. The most popular are Retin-A and Zorac. Both can cause skin redness, and need a doctor's prescription.
Have your say: Readers write
JM is another reader who is confused by the variations in the prices of drugs:
On holiday in Greece last year, I bought a pack of 21 Clarityn tablets containing 10mg of loratadine from a local pharmacist for about £3.50, as opposed to £2.65 for seven in this country. It seems we are being ripped off in the UK.
Please send your questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS, or e-mail email@example.com. Dr Kavalier regrets that he is unable to respond personally to questions.Reuse content