Salivary gland stones

Also called Sialolithiasis, Blocked salivary duct

A stone blocking a salivary duct, so the gland swells at mealtimes. Distinctive, treatable, and easily mistaken for mumps.

What it is

A stone forming in a salivary gland or its duct, blocking the flow of saliva.

The submandibular gland under the jaw is affected in the great majority of cases, because its duct runs uphill and its saliva is thicker.

**The characteristic feature is timing.** The gland swells and becomes painful when saliva production is stimulated, at the sight, smell or taste of food and during a meal, and then settles over the following hour. That mealtime pattern is close to diagnostic and distinguishes it from most other causes of facial swelling.

It is frequently mistaken for mumps, which usually affects the parotid glands in front of the ears, is bilateral, and does not fluctuate with meals.

Dehydration, some medicines that dry the mouth, Sjögren's syndrome and radiotherapy to the head and neck all increase the risk. See xerostomia.

Small stones often pass with conservative measures: hydration, sucking something sour to stimulate flow, warm compresses and gland massage towards the duct opening. Larger ones need removal, increasingly by minimally invasive techniques rather than removing the whole gland.

Infection of the blocked gland is the complication to recognise, and it needs prompt antibiotics.

Signs you might notice

Swelling under the jaw or in the cheek, coming on at mealtimes and settling afterwards.

Pain in the same area, worst while eating.

A dry mouth.

Sometimes a stone visible or palpable in the floor of the mouth.

Urgent: increasing pain, redness, fever, pus in the mouth, or a swelling that is hot and tender and does not settle. That is an infected gland and needs same-day antibiotics.

Also: difficulty swallowing or breathing, or swelling spreading into the neck, which is an emergency.

Persistent painless swelling of a salivary gland, particularly the parotid, without the mealtime pattern, needs assessment for a tumour. See head and neck cancer.

How it can affect day-to-day life

The mealtime pattern is so distinctive that describing it clearly usually secures the diagnosis, and it is worth saying explicitly rather than just reporting facial swelling.

Conservative measures genuinely work for small stones and cost nothing: plenty of fluids, sucking lemon or a sour sweet before meals, warm compresses, and firm massage along the duct towards the mouth.

Medicines that dry the mouth are a common contributor: antihistamines, some antidepressants, antipsychotics, diuretics and anticholinergics. A medication review is worthwhile for recurrent stones.

Good oral hygiene reduces infection risk.

Recurrence is common, and continuing the hydration and stimulation measures long term reduces it.

Modern management preserves the gland where possible, and asking about basket retrieval, lithotripsy or duct surgery before agreeing to gland removal is reasonable.

Supporting someone well

Describe the mealtime pattern clearly; it is what makes the diagnosis.

Drink plenty of water throughout the day.

Suck something sour before meals to stimulate saliva flow.

Use warm compresses and massage the gland towards the mouth.

Keep the mouth clean, and treat a dry mouth.

Ask for a medication review if stones recur.

Get a hot, tender, painful swelling with fever seen the same day.

Ask about gland-preserving techniques before agreeing to gland removal.

Get any persistent painless salivary swelling assessed for other causes.

Where to get help

A GP practice or dentist for assessment; ENT or oral and maxillofacial surgery for removal.

Same-day care for an infected gland.

999 for swelling spreading into the neck or difficulty breathing.

ENT UK and Oral Health Foundation publish relevant patient information.