Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Salivary gland stones

Sara B Fazio, MD
Kevin Emerick, MD
Section Editor
Daniel G Deschler, MD, FACS
Deputy Editor
Daniel J Sullivan, MD, MPH


Sialolithiasis, the presence of stones or calculi in the salivary glands or ducts, is a relatively common condition. Although a 1 percent incidence is noted in autopsy studies [1], clinically symptomatic stones are much less frequently noted. A review of 15 health regions in England from 1991 to 1995 revealed an incidence of symptomatic sialolithiasis of 27 to 59 cases per million population per year [2].

The presentation, evaluation, and treatment of salivary gland stones will be reviewed here.


The three major salivary glands (parotid, submandibular, and sublingual), and occasionally the minor salivary glands, are subject to the development of stones. The anatomy of the glands and ducts affects where stones are likely to lodge and also affects the choice of therapies. (See 'Treatment' below.)

Parotid glands and Stensen's duct — The parotid glands are located on the sides of the face anterior to the external auditory canal, superior to the angle of the mandible, and inferior to the zygomatic arch. Most of the parotid gland is superficial to the masseter muscle. Stensen's duct arises from the anterior border of the parotid gland and is 4 to 7 cm long, narrows to 1.2 mm at an isthmus, and the os is 0.5 mm and is opposite the upper second molar (figure 1).

Submandibular glands and Wharton's duct — The submandibular glands lie beneath the floor of the mouth. Wharton's duct arises from the medial surface and is 5 cm long and 1.5 mm in diameter. The os is 0.5 mm in diameter and located on the floor of the mouth near the frenulum of the tongue (figure 1).

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Feb 16, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Williams MF. Sialolithiasis. Otolaryngol Clin North Am 1999; 32:819.
  2. Escudier MP, McGurk M. Symptomatic sialoadenitis and sialolithiasis in the English population, an estimate of the cost of hospital treatment. Br Dent J 1999; 186:463.
  3. Pfaff J, Moore GP. Otolaryngology. In: Rosen's Emergency Medicine: Concepts and Clinical Practice, Marx J (Ed), Mosby Inc, St. Louis 2002. p.935.
  4. Mandel L. Salivary gland disorders. Med Clin North Am 2014; 98:1407.
  5. McKenna JP, Bostock DJ, McMenamin PG. Sialolithiasis. Am Fam Physician 1987; 36:119.
  6. Rice DH. Noninflammatory, non-neoplastic disorders of the salivary glands. Otolaryngol Clin North Am 1999; 32:835.
  7. Work WP, Hecht, DW. Inflammatory Diseases of the Major Salivary Glands. In: Otolaryngology, Papparella MM, Shumrick DF (Eds), WB Saunders, Philadelphia 1980. p.2235.
  8. Huoh KC, Eisele DW. Etiologic factors in sialolithiasis. Otolaryngol Head Neck Surg 2011; 145:935.
  9. Wu CC, Hung SH, Lin HC, et al. Sialolithiasis is associated with nephrolithiasis: a case-control study. Acta Otolaryngol 2016; 136:497.
  10. Hung SH, Huang HM, Lee HC, et al. A population-based study on the association between chronic periodontitis and sialolithiasis. Laryngoscope 2016; 126:847.
  11. Paterson JR, Murphy MJ. Bones, groans, moans... and salivary stones? J Clin Pathol 2001; 54:412.
  12. Ellies M, Laskawi R, Arglebe C, Schott A. Surgical management of nonneoplastic diseases of the submandibular gland. A follow-up study. Int J Oral Maxillofac Surg 1996; 25:285.
  13. Salivary gland anatomy and physiology. In: Head and Neck Imaging, Som PM, Curtain HD (Eds), Mosby, St. Louis 2003.
  14. Bryan RN, Miller RH, Ferreyro RI, Sessions RB. Computed tomography of the major salivary glands. AJR Am J Roentgenol 1982; 139:547.
  15. van den Akker HP. Diagnostic imaging in salivary gland disease. Oral Surg Oral Med Oral Pathol 1988; 66:625.
  16. Alyas F, Lewis K, Williams M, et al. Diseases of the submandibular gland as demonstrated using high resolution ultrasound. Br J Radiol 2005; 78:362.
  17. Zbaren P, Ducommun JC. Diagnosis of salivary gland disease using ultrasound and sialography: a comparison. Clin Otolaryngol Allied Sci 1989; 14:189.
  18. Hasson O. Modern sialography for screening of salivary gland obstruction. J Oral Maxillofac Surg 2010; 68:276.
  19. Fischbach R, Kugel H, Ernst S, et al. MR sialography: initial experience using a T2-weighted fast SE sequence. J Comput Assist Tomogr 1997; 21:826.
  20. Jäger L, Menauer F, Holzknecht N, et al. Sialolithiasis: MR sialography of the submandibular duct--an alternative to conventional sialography and US? Radiology 2000; 216:665.
  21. Kalinowski M, Heverhagen JT, Rehberg E, et al. Comparative study of MR sialography and digital subtraction sialography for benign salivary gland disorders. AJNR Am J Neuroradiol 2002; 23:1485.
  22. Chow A. Infections of the Oral Cavity, Neck, and Head. In: Principles and Practice of Infectious Diseases, Mandell G, Bennett JE, Dolin R (Eds), Churchill Livingstone, Inc., Philadelphia 2000. p.699.
  23. McQuone SJ. Acute viral and bacterial infections of the salivary glands. Otolaryngol Clin North Am 1999; 32:793.
  24. Diaz D. Oral Cavity and Salivary Gland Disease. In: Textbook of Primary Care Medicine, Noble J (Ed), Mosby, Inc, St. Louis 2001.
  25. Gottesman RI, Som PM, Mester J, Silvers A. Observations on two cases of apparent submandibular gland cysts in HIV positive patients: MR and CT findings. J Comput Assist Tomogr 1996; 20:444.
  26. Koischwitz D, Gritzmann N. Ultrasound of the neck. Radiol Clin North Am 2000; 38:1029.
  27. Ward MJ, Levine PA. Salivary gland tumors. In: Essentials of Head and Neck Oncology, 1st ed, Close LG, Larson DL, Shah JP (Eds), Thieme, New York 1998.
  28. Spiro RH. Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head Neck Surg 1986; 8:177.
  29. Eveson JW, Cawson RA. Salivary gland tumours. A review of 2410 cases with particular reference to histological types, site, age and sex distribution. J Pathol 1985; 146:51.
  30. Federici M, Guarna T, Manzi M, et al. Swelling of the submandibular glands after administration of low-osmolarity contrast agent: Ultrasound findings. J Ultrasound 2008; 11:85.
  31. Iro H, Zenk J, Escudier MP, et al. Outcome of minimally invasive management of salivary calculi in 4,691 patients. Laryngoscope 2009; 119:263.
  32. Iro H, Zenk J, Waldfahrer F, et al. Extracorporeal shock wave lithotripsy of parotid stones. Results of a prospective clinical trial. Ann Otol Rhinol Laryngol 1998; 107:860.
  33. Marchal F, Dulguerov P. Sialolithiasis management: the state of the art. Arch Otolaryngol Head Neck Surg 2003; 129:951.
  34. Raif J, Vardi M, Nahlieli O, Gannot I. An Er:YAG laser endoscopic fiber delivery system for lithotripsy of salivary stones. Lasers Surg Med 2006; 38:580.
  35. Phillips J, Withrow K. Outcomes of Holmium Laser-Assisted Lithotripsy with Sialendoscopy in Treatment of Sialolithiasis. Otolaryngol Head Neck Surg 2014; 150:962.
  36. Nahlieli O, Baruchin AM. Endoscopic technique for the diagnosis and treatment of obstructive salivary gland diseases. J Oral Maxillofac Surg 1999; 57:1394.
  37. Nahlieli O, Nakar LH, Nazarian Y, Turner MD. Sialoendoscopy: A new approach to salivary gland obstructive pathology. J Am Dent Assoc 2006; 137:1394.
  38. Strychowsky JE, Sommer DD, Gupta MK, et al. Sialendoscopy for the management of obstructive salivary gland disease: a systematic review and meta-analysis. Arch Otolaryngol Head Neck Surg 2012; 138:541.
  39. Luers JC, Grosheva M, Stenner M, Beutner D. Sialoendoscopy: prognostic factors for endoscopic removal of salivary stones. Arch Otolaryngol Head Neck Surg 2011; 137:325.
  40. Marchal F, Dulguerov P, Becker M, et al. Specificity of parotid sialendoscopy. Laryngoscope 2001; 111:264.
  41. Zhang L, Escudier M, Brown J, et al. Long-term outcome after intraoral removal of large submandibular gland calculi. Laryngoscope 2010; 120:964.
  42. Wallace E, Tauzin M, Hagan J, et al. Management of giant sialoliths: review of the literature and preliminary experience with interventional sialendoscopy. Laryngoscope 2010; 120:1974.
  43. Drage NA, Brown JE, Escudier MP, McGurk M. Interventional radiology in the removal of salivary calculi. Radiology 2000; 214:139.
  44. Brown JE, Drage NA, Escudier MP, et al. Minimally invasive radiologically guided intervention for the treatment of salivary calculi. Cardiovasc Intervent Radiol 2002; 25:352.
  45. Zenk J, Constantinidis J, Al-Kadah B, Iro H. Transoral removal of submandibular stones. Arch Otolaryngol Head Neck Surg 2001; 127:432.
  46. Sinha UK, Ng M. Surgery of the salivary glands. Otolaryngol Clin North Am 1999; 32:887.
  47. Bates D, O'Brien CJ, Tikaram K, Painter DM. Parotid and submandibular sialadenitis treated by salivary gland excision. Aust N Z J Surg 1998; 68:120.
  48. Jacob RF, Weber RS, King GE. Whole salivary flow rates following submandibular gland resection. Head Neck 1996; 18:242.
  49. Briffa NP, Callum KG. Use of an embolectomy catheter to remove a submandibular duct stone. Br J Surg 1989; 76:814.