Sialolithiasis refers to the formation of stones in the salivary glands. Stones are most commonly found in the submandibular gland

Submandibular gland

The paired submandibular glands are salivary glands located beneath the floor of the mouth. In humans, they account for 70% of the salivary volume and weigh about 15 grams. Unstimulated in humans, the percentage contribution to whole saliva; ~25% Parotid, Submandibular and Sublingual ~ 67% and...

, where stones can obstruct Wharton's duct. It is frequently associated with chronic infection (Staphylococcus aureus

Staphylococcus aureus

Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of...

, Streptococcus viridans

Streptococcus viridans

Viridans Streptococcus is a pseudotaxonomic non-Linnaenan term for a large group of commensal streptococcal bacteria that are either α-hemolytic, producing a green coloration on blood agar plates , or nonhemolytic...

) of the glands, dehydration (phenothiazine

Phenothiazine

Phenothiazine is an organic compound that occurs in various antipsychotic and antihistaminic drugs. It has the formula S2NH. This yellow tricyclic compound is soluble in acetic acid, benzene, and ether. The compound is related to the thiazine-class of heterocyclic compounds...

s), Sjögren's syndrome

Sjögren's syndrome

Sjögren's syndrome , also known as "Mikulicz disease" and "Sicca syndrome", is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva....

 and/or increased local levels of calcium, but in many cases can arise idiopathic

Idiopathic

Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...

ally. Pain, when present, usually originates from the floor of the mouth, although in many cases the stones cause only intermittent swelling.

Since chewing

Mastication

Mastication or chewing is the process by which food is crushed and ground by teeth. It is the first step of digestion and it increases the surface area of foods to allow more efficient break down by enzymes. During the mastication process, the food is positioned between the teeth for grinding by...

 promotes release of saliva, symptoms tend to increase during meals. A palpable lump or visible swelling in the area of the gland is often noted.

Complications include persistent obstruction of the duct, leading to bacterial invasion, overgrowth and infection (sialoadenitis). This can require IV antibiotics such as nafcillin, and sometimes surgical drainage.

Diagnosis

Diagnosis is usually made by characteristic history and physical examination. Diagnosis can be confirmed by x-ray

X-ray

X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...

 (80% of salivary gland calculi are visible on x-ray), or by sialogram

Sialogram

Sialogram or sialography is imaging of the salivary glands using x-ray-Technique:A baseline radiograph of the required salivary gland would be taken , a cannula then is inserted in this salivary gland duct's opening in the mouth, then a Radio-opaque fluid is injected in the duct through a small...

 or ultrasound.

Treatment

Some current treatment options are:

• For small stones, hydration, moist heat, NSAIDs occasionally, and having the patient take any food or beverage that is bitter and/or sour. Sucking on citrus fruits, such as a lemon or orange, may increase salivation and promote spontaneous expulsion of the stone.
• Some stones may be massaged out by a specialist.
• An ENT
  Otolaryngology
  Otolaryngology or ENT is the branch of medicine and surgery that specializes in the diagnosis and treatment of ear, nose, throat, and head and neck disorders....
  
   or maxillofacial surgeon may canulate the duct to remove the stone (sialotomy).
• A surgeon may make a small incision near the stone to remove it.
• Sialendoscopy

• To prevent infection while the stone is lodged in the duct, sometimes antibiotics are used. In some cases when stones continually reoccur the offending salivary duct is removed.