Which gland located beneath the tongue can develop a salivary stone?

Submandibular Gland (Wharton's Duct)

The submandibular gland, which drains through Wharton's duct located beneath the tongue, is the gland from which a salivary stone would emerge. 1, 2

Anatomical Location and Stone Distribution

• The submandibular gland accounts for 80-84% of all salivary stones, making it by far the most common site for sialolithiasis. 2, 3

• Within the submandibular system, 90% of stones are located in Wharton's duct itself (the duct that runs beneath the tongue), rather than in the gland parenchyma. 3, 4

• The duct opening can be visualized intraorally at the floor of the mouth, where stones may sometimes be directly palpable or even visible. 1, 2

Clinical Recognition

• The hallmark presentation is pain and swelling of the submandibular region that begins just before or during meals, as salivary flow is stimulated but blocked by the stone. 1, 5

• Bimanual palpation of the floor of the mouth allows direct detection of calculi within Wharton's duct, making physical examination a critical diagnostic tool. 1, 6

• Intraoral inspection with adequate lighting enables visualization of the duct opening and assessment of reduced or absent salivary flow from the affected side. 1

Why the Submandibular Gland Predominates

The submandibular gland's susceptibility to stone formation relates to several anatomical and physiological factors, though the exact etiology remains incompletely understood. 7 The duct's upward course against gravity, higher calcium concentration in submandibular saliva, and more viscous secretions all contribute to stone formation. 3

Contrast with Other Salivary Glands

• The parotid gland accounts for only 13% of salivary stones, and when parotid stones do occur, they are more often located in the gland parenchyma itself rather than in the duct. 3

• Minor salivary glands rarely develop stones and are not relevant to the question of stones "under the tongue." 8