Symptoms of Salivary Stones (Sialolithiasis)
The hallmark symptom of salivary stones is intermittent pain and swelling that characteristically occurs just before or during eating, when saliva production increases. 1, 2
Classic Presentation
The symptom pattern is highly distinctive and should raise immediate suspicion for sialolithiasis:
- Meal-related pain and swelling: Pain and swelling in the affected salivary gland area that specifically occurs at mealtimes or just before eating 1, 2, 3, 4
- Intermittent nature: Symptoms come and go rather than being constant 1, 2
- Recurrent episodes: Patients typically experience repeated episodes of painful swelling 5
Location-Specific Symptoms
Submandibular gland involvement (most common site):
- Pain and swelling under the jaw or tongue 6, 3
- The submandibular gland is the most frequently affected site for salivary stones 6, 5
Physical Examination Findings
When evaluating suspected sialolithiasis, specific examination techniques reveal:
- Palpable stone: Bimanual palpation may detect the stone, particularly in the submandibular duct 2
- Gland swelling: Visible or palpable enlargement of the affected salivary gland 1
Complications if Untreated
If salivary stones are left unmanaged, patients may develop:
- Chronic sialadenitis: Persistent inflammation of the salivary gland 7
- Glandular atrophy: Progressive loss of gland function 7
- Infection: Secondary bacterial infection of the obstructed gland 7
Important Clinical Pearls
Common pitfall: While many salivary stones are asymptomatic or cause minimal discomfort, the meal-related timing of symptoms is the key diagnostic feature that distinguishes sialolithiasis from other salivary gland disorders 7, 4. The temporal relationship between eating and symptom onset occurs because eating stimulates saliva production, which increases pressure behind the obstructing stone.
Bilateral or multiple stones: Though uncommon (fewer than 3% of cases), simultaneous involvement of multiple glands can occur 5