Salivary Gland Stone Treatment in Sydney

Salivary gland stones (sialolithiasis) are calcified deposits that form within a salivary gland or its drainage duct, blocking saliva flow and causing painful swelling that typically worsens during meals. They are the most common cause of salivary gland obstruction, most frequently affecting the submandibular gland beneath the jaw. Modern techniques including sialendoscopy allow many stones to be removed while preserving the gland.

What Are Salivary Gland Stones?

There are three pairs of major salivary glands: the parotid glands (in front of each ear), the submandibular glands (beneath the jaw) and the sublingual glands (under the tongue). Each gland has a duct that carries saliva into the mouth. Salivary stones (sialoliths) are hard, calcified deposits that form within these ducts or within the gland itself, ranging in size from less than a millimetre to several centimetres.

Approximately 80 to 90 percent of salivary stones occur in the submandibular gland or its duct (Wharton's duct), because the saliva produced by this gland is thicker and more calcium-rich, and the duct runs upward against gravity. The parotid gland accounts for most of the remaining cases, while sublingual stones are rare.

Symptoms of Salivary Gland Stones

The hallmark of salivary stones is meal-related swelling and pain:

Sudden, painful swelling of the affected gland: typically beneath the jaw (submandibular) or in front of the ear (parotid)
Swelling that worsens during eating or at the sight or smell of food, as saliva production increases but cannot drain past the stone
Gradual reduction in swelling between meals as saliva slowly seeps around the stone
A palpable lump in the floor of the mouth (for submandibular duct stones)
Reduced or absent saliva flow from the affected duct opening
Foul taste or pus discharge from the duct opening if secondary infection develops
Difficulty opening the mouth or swallowing
Fever and redness if the obstructed gland becomes infected (sialadenitis)

Causes and Risk Factors

Salivary stones form when minerals in saliva (primarily calcium phosphate and calcium carbonate) precipitate and accumulate. Contributing factors include:

Dehydration: inadequate fluid intake concentrates saliva and promotes crystallisation
Medications: drugs that cause dry mouth (anticholinergics, antihistamines, diuretics, some antidepressants) reduce saliva flow and increase stone risk
Smoking: reduces saliva production and alters saliva composition
Duct anatomy: the submandibular duct's uphill course and the gland's thicker, more alkaline saliva predispose to stone formation
Gout: elevated uric acid can contribute to stone composition
Hyperparathyroidism: elevated blood calcium (hypercalcaemia) increases salivary calcium concentration
Previous stones: recurrence occurs in approximately 10 to 20 percent of cases

Diagnosis

At Central Sydney ENT, salivary stones are diagnosed through:

Clinical examination: Bimanual palpation of the floor of the mouth and the affected gland can often identify a stone in the submandibular duct. The duct opening is inspected for discharge or reduced saliva flow. The gland is assessed for tenderness, swelling and fixation.

Ultrasound: The primary imaging modality for salivary stones. Ultrasound has high sensitivity for detecting stones larger than 2 mm and can assess the gland for signs of chronic inflammation. It is non-invasive, radiation-free and widely available.

CT scan: Non-contrast CT is highly sensitive for calcified stones and provides precise localisation within the duct or gland. It is particularly useful for surgical planning or when ultrasound findings are inconclusive.

MRI sialography: A non-invasive technique that images the salivary duct system without requiring contrast injection. It can identify ductal strictures, stones and gland inflammation. Useful for complex or recurrent cases.

Sialendoscopy: Direct endoscopic visualisation of the salivary duct, which serves as both a diagnostic and therapeutic tool. Stones can be identified and often removed during the same procedure.

Treatment Options

Conservative Management

For small stones, particularly those near the duct opening, conservative measures may promote spontaneous passage:

Hydration: drinking plenty of water to increase saliva volume and flow
Sialogogues: sour foods (lemon drops, citrus) that stimulate saliva production to flush the stone
Gland massage: gentle massage of the gland toward the duct opening
Warm compresses: applied to the swollen gland to relieve discomfort
Antibiotics: prescribed if secondary bacterial infection (sialadenitis) develops

Intraoral Stone Removal

Stones located in the distal portion of the submandibular duct (near the floor of the mouth) can often be removed through a small incision inside the mouth under local anaesthesia. The stone is palpated, a small cut is made over it in the floor of the mouth, and the stone is extracted. This preserves the gland and has a rapid recovery.

Sialendoscopy

Sialendoscopy is a minimally invasive endoscopic technique where a tiny rigid or semi-rigid endoscope (0.8-1.6 mm diameter) is introduced into the salivary duct opening to directly visualise and retrieve stones using micro-baskets, forceps or laser fragmentation. This gland-preserving approach is the preferred treatment for duct stones up to approximately 7-8 mm in size and is performed under general anaesthesia as a day procedure.

Our surgeons, including Dr Alexander Zhang and Dr Jareen Ebenezer, perform salivary gland assessment and surgery across Central Sydney ENT locations.

Submandibular Gland Excision

When stones are located deep within the submandibular gland itself, when the gland has been damaged by recurrent infections, or when other techniques have been unsuccessful, surgical removal of the submandibular gland may be recommended. The procedure is performed through a small incision beneath the jaw under general anaesthesia. Recovery takes one to two weeks. Removal of one submandibular gland does not cause noticeable dry mouth.

When to See an ENT Specialist

You should seek a referral to an ENT specialist if:

You experience recurrent painful swelling beneath the jaw or near the ear, especially during meals
You have a persistent lump in the floor of your mouth
Conservative measures have not resolved salivary gland swelling
You develop signs of infection: fever, increasing pain, redness and pus discharge
You have had recurrent salivary gland stones
You have painless salivary gland swelling (to exclude other causes such as tumours)

Related Conditions

Salivary gland stones are closely linked to several other conditions treated at Central Sydney ENT:

Parathyroid Disease: hyperparathyroidism and elevated calcium can increase salivary stone risk
Thyroid Nodules: neck lumps that may be assessed alongside salivary gland conditions
Dysphagia (Swallowing Difficulty): floor of mouth swelling from salivary stones can affect swallowing

Common Questions

Salivary Gland Stone FAQ

What causes salivary gland stones? +

Salivary gland stones form when calcium and other minerals in saliva crystallise and accumulate within the salivary duct or gland. Contributing factors include dehydration, reduced saliva flow, medications that cause dry mouth, and calcium-rich saliva. The submandibular gland is most commonly affected because its saliva is thicker and its duct runs upward against gravity.

Can salivary gland stones pass on their own? +

Small stones near the duct opening may pass spontaneously with conservative measures such as increased hydration, warm compresses, gland massage and sour foods or drinks that stimulate saliva flow. However, larger stones or those lodged deeper in the duct or within the gland usually require intervention to remove them.

What is sialendoscopy? +

Sialendoscopy is a minimally invasive endoscopic procedure where a tiny camera is inserted into the salivary duct to directly visualise and remove stones. It allows stone extraction using micro-instruments or baskets without the need for external incisions, preserving the salivary gland. It is performed under general anaesthesia as a day procedure and is the preferred approach for duct stones where available.

Will I lose the salivary gland? +

Not necessarily. Many salivary stones can be removed while preserving the gland, either through intraoral duct surgery or sialendoscopy. However, if the gland has been damaged by recurrent infections or if the stone is located deep within the gland itself, submandibular gland excision may be recommended. Removal of one submandibular gland does not cause noticeable dry mouth, as the remaining salivary glands compensate.

Does Central Sydney ENT treat salivary gland stones? +

Yes. Central Sydney ENT has seven FRACS-qualified ENT surgeons experienced in salivary gland assessment and surgery. We offer comprehensive diagnosis, intraoral stone removal, sialendoscopy and submandibular gland excision across seven Sydney locations including Burwood, Campbelltown, Gregory Hills, Ultimo, Drummoyne, Hunters Hill and Miranda.