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# Sialolithiasis (salivary stones)

Sialolithiasis is a stone in a salivary gland or its duct; it blocks saliva and makes the gland swell and hurt at meals, most often under the jaw.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Submandibular gland](https://durgical.com/en/anatomy/submandibular-gland/)
- [Parotid gland](https://durgical.com/en/anatomy/parotid-gland/)
- [Sublingual gland](https://durgical.com/en/anatomy/sublingual-gland/)
- [Mylohyoid](https://durgical.com/en/anatomy/mylohyoid-muscle/)
- [Lingual nerve](https://durgical.com/en/anatomy/lingual-nerve/)
- [Tongue](https://durgical.com/en/anatomy/tongue/)

## In histology

- [Salivary glands: serous and mucous acini](https://durgical.com/en/histology/salivary-glands-serous-and-mucous-acini/)

## In physiology

- [Salivary secretion](https://durgical.com/en/physiology/salivary-secretion/)

## What it is

Formation of a calculus (stone) inside a salivary gland or its duct, which blocks saliva flow and causes painful swelling of the gland at meals. It most often affects the [submandibular gland](https://durgical.com/en/anatomy/submandibular-gland/).

## Who gets it

The most common disease of the major salivary glands in middle-aged adults; uncommon in children.

## Causes

- Calcium salts precipitating around a nucleus of mucus, debris or bacteria
- Salivary stasis

## Risk factors

- Dehydration and reduced saliva flow
- Medicines that reduce saliva (anticholinergics, diuretics)
- Chronic sialadenitis
- Smoking
- Gout

## Pathophysiology

Submandibular saliva is more alkaline, richer in calcium and mucin, and flows uphill through a long Wharton duct, which favours stones there. A stone blocks the duct, so saliva backs up during meals and stretches the gland. Stasis invites retrograde bacterial infection (sialadenitis).

## Symptoms and signs

- Painful swelling of the gland during or just after meals (salivary colic)
- Swelling that settles over hours
- A palpable hard stone in the floor of the mouth
- Pus at the duct opening when infected
- Bad taste or dry mouth

## Red flags

- Fever, spreading redness and floor-of-mouth swelling (abscess or deep neck infection)
- Persistent painless hard mass (consider tumour)

## Diagnosis

**Clinical**
History of meal-time swelling and bimanual palpation of the floor of the mouth and gland.

**Tests**
Culture of pus from the duct if infected.

**Imaging**
Ultrasound is first-line; non-contrast CT detects small stones; sialendoscopy is both diagnostic and therapeutic.

## Differential diagnosis

- Acute bacterial sialadenitis
- Mumps
- Salivary gland tumour
- Cervical lymphadenitis
- Ranula

## Goal of treatment

Relieve obstruction and pain, treat infection and preserve gland function.

## Treatment

**Conservative**
Hydration, warm compresses, gland massage and sialogogues (such as sour sweets) to help small stones pass.

**Medical**
Analgesics; antibiotics for superimposed bacterial sialadenitis.

**Procedure**
Sialendoscopy with stone retrieval or transoral removal of stones near the duct opening.

**Surgical**
Excision of the gland for recurrent disease or deep stones that cannot be removed otherwise.

## Complications

- Acute or chronic sialadenitis
- Gland abscess
- Duct stricture
- Nerve injury after gland excision (marginal mandibular, lingual or hypoglossal)

## Prognosis

Most patients do well with gland-preserving treatment; stones can recur.

## Prevention

- Good hydration and oral hygiene
- Review of medicines that dry the mouth

## Test yourself

Think of the answer, then tap the question to see it.

## Which salivary gland is most often affected by stones?

The submandibular gland, through Wharton duct.

## Why do symptoms appear at meal times?

Saliva production rises with eating and backs up behind the stone, stretching the gland.

## What is the first-line imaging for sialolithiasis?

Ultrasound; non-contrast CT is used for small or uncertain stones.

## Which minimally invasive technique allows removal of salivary stones?

Sialendoscopy.

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## Related conditions

- [Mumps](https://durgical.com/en/conditions/mumps/)
- [Parotid gland tumours](https://durgical.com/en/conditions/parotid-gland-tumours/)
- [Deep neck infection and Ludwig angina](https://durgical.com/en/conditions/deep-neck-infection-and-ludwig-angina/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Sialolithiasis](https://www.ncbi.nlm.nih.gov/books/NBK549845/) (StatPearls (NCBI Bookshelf), 2024).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/sialolithiasis/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/sialolithiasis/