Salivary Gland Stones.Care & specialists in New Zealand

Salivary gland stones (sialolithiasis) are calcium-rich deposits that form in a salivary duct or gland and block the flow of saliva. They cause painful swelling that flares with meals and settles between them. About 80-90% form in the submandibular gland under the jaw; most can now be removed without taking out the gland.

A salivary stone produces firm, painful swelling under the jaw or in front of the ear that comes on with eating, peaks during the meal, and gradually fades over 1-2 hours. Some patients describe a hard lump that can be felt with the tongue in the floor of mouth or with fingers behind the angle of the jaw.

Salivary stones form when saliva flow slows and minerals such as calcium phosphate precipitate around a nidus of debris or bacteria. Dehydration, mucus-rich submandibular saliva, anticholinergic medication, smoking, and chronic gland inflammation are the main risk factors. Gout, hypercalcemia, and hyperparathyroidism contribute in some recurrent cases.

Diagnosis combines history (mealtime swelling), bimanual examination of the floor of mouth, and imaging. Ultrasound is the first-line modality with 85-94% sensitivity. Plain dental radiographs detect most submandibular stones. Cone-beam or non-contrast CT, sialendoscopy, and MR sialography are used for difficult cases.

Yes — small stones under 3-4 mm can pass spontaneously in up to 50% of patients with increased hydration, sialogogues (sour candies), warm compresses, and gland massage. Larger or symptomatic stones usually need sialendoscopy, ESWL, or surgical removal to clear.

Sialendoscopy is a minimally invasive procedure in which a 0.8-1.6 mm endoscope is passed through the duct opening in the mouth to visualize stones, stenoses, and inflammation. Small stones are retrieved with baskets or graspers; larger ones can be fragmented with a laser. The gland is preserved in over 90% of cases.

Less often than before. Modern minimally invasive techniques preserve the gland in 80-95% of treated stones. Gland excision is reserved for deep intraglandular stones, end-stage fibrosis, or failure of endoscopic and transoral approaches. When surgery is required, recovery and nerve risks are well managed in experienced centers.

Yes. Obstruction allows bacteria to ascend and cause acute sialadenitis with fever, redness, induration, and pus from the ductal opening. Deep-neck-space spread (Ludwig's angina from a submandibular abscess) is a medical emergency. Treatment is antibiotics, hydration, sialogogues, and drainage when an abscess forms.

Recurrence is approximately 5-15% over 5 years after gland-preserving treatment. Risk is higher with persistent dehydration, smoking, anticholinergic medication, or untreated systemic conditions such as hypercalcemia and gout. Hydration, sialogogues, and lifestyle changes reduce recurrence substantially.

Most are uncomfortable rather than dangerous, but untreated obstruction can lead to recurrent infections, chronic gland damage, abscess, and deep-neck-space spread. Persistent gland firmness or a non-fluctuating mass requires imaging and sometimes biopsy to exclude tumor.

Most patients return to normal eating within a week. Mild gland swelling and a metallic taste are common for 1-3 days. Driving and most desk work resume the next day; vigorous physical activity within 48-72 hours. Follow-up ultrasound at 3 and 12 months checks for residual or recurrent stones.

Extracorporeal shockwave lithotripsy fragments stones up to 7 mm. Stone-free rates are 35-50% after one session and 60-80% after multiple sessions over weeks. ESWL is better for parotid than submandibular stones and is available in a limited number of centers worldwide.

No drug specifically prevents salivary stones. Hydration, sialogogues (citrus drops, sugar-free gum), smoking cessation, and review of anticholinergic medication reduce recurrence. In patients with hypercalcemia or hyperuricemia, treating the underlying cause lowers stone-formation risk.

Yes, although they account for under 5% of sialolithiasis cases. Pediatric stones are usually submandibular and managed with the same gland-preserving techniques. Recurrent parotitis in children is more often juvenile recurrent parotitis without stones and is treated separately.

Most patients can eat soft, well-hydrated foods with smaller bites. Sour or spicy foods often trigger the most pain at the start of a meal. After successful stone removal, normal diet resumes within 1-2 weeks. Long-term dietary restriction is not required.

There is a modest association in some studies, particularly with systemic disorders of calcium metabolism (hypercalcemia, primary hyperparathyroidism). Most patients with salivary stones do not develop kidney stones and vice versa, but recurrent stone formers should be screened for shared metabolic causes.

Eating stimulates saliva production; when a stone blocks the duct, saliva cannot drain, the gland distends, and pain develops within minutes. Once stimulation stops and saliva pressure falls, the gland gradually empties via leak around the stone and swelling resolves. The pattern is highly specific for stone obstruction.

Smoking reduces salivary flow, alters salivary composition, and is linked to higher rates of recurrent sialolithiasis in observational studies. Stopping smoking is one of the most effective lifestyle changes to prevent recurrence after stone removal.

Small asymptomatic stones may be monitored, particularly in elderly patients with significant comorbidity. Symptomatic stones — pain, recurrent swelling, infection — should be treated to prevent progressive gland damage and abscess. Shared decision-making with an ENT specialist is appropriate.

Sialolithiasis is the presence of stones in the salivary system; sialadenitis is inflammation or infection of the gland, which can be caused by stones, viruses, or autoimmune disease. Most cases of obstructive sialadenitis in adults are caused by sialolithiasis.

Drink 2-3 L water daily, chew thoroughly, use sugar-free citrus drops at meals, stop smoking, review xerogenic medications, maintain oral hygiene, and treat systemic conditions such as gout or hyperparathyroidism. Follow up with ultrasound at 3 and 12 months after treatment to detect any new stone early.