# Salivary gland stone (sialolithiasis)

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Anatomy, Head and Neck, Submandibular Gland - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK542272/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DD66.03 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care
- Salivary gland stone (sialolithiasis) - disease-level clinical article (sialolithiasis-clinical.txt)

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
SALIVARY GLAND STONE (SIALOLITHIASIS)
Sources: Anatomy, Head and Neck, Submandibular Gland - StatPearls - NCBI Bookshelf -
         https://www.ncbi.nlm.nih.gov/books/NBK542272/ · ICPC-3 (WONCA International Classification
         of Primary Care, 3rd edition) class DD66.03 - condition scope only, no dose · No dose -
         referral pathway, no medicine given in primary care
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care,
               Salivary gland stone (sialolithiasis) - disease-level clinical
               article (sialolithiasis-clinical.txt)  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (1)
    - Swelling on one side of a salivary gland, felt as a neck lump, with sudden pain that gets
      worse while eating is the usual complaint  [neck lump]
  SIGNS - what you find (3)
    - The affected gland looks swollen compared to the other side on exam
    - A large stone may be visible in the mouth as an oval or round white-to-yellow object
    - A stone that is not visible can often still be felt along the path of the duct or gland
  TESTS (7)
    - Plain occlusal X-rays catch large stones but miss small ones, and only about 8 in 10 stones
      show up on X-ray at all
    - Injecting contrast into the duct for X-ray imaging is the traditional gold-standard test,
      though it carries radiation and contrast-reaction risk
    - A non-contrast CT scan detects calcified stones well and quickly, but shows the duct system
      poorly
    - Adding IV contrast to the CT gives a better look at the ducts and soft tissue with less
      overall radiation
    - MRI of the salivary ducts avoids radiation and contrast but is slower, costlier, and less
      available
    - Direct scope viewing of the duct gives an accurate diagnosis and can remove the stone at the
      same time
    - On ultrasound a stone looks like a bright spot with a shadow behind it, and detection is best
      for stones over 2 to 3 mm
  IF NOT THIS - what else fits (5)
    - Gland inflammation or infection without a stone can look the same as sialolithiasis
    - A tumor of the salivary gland is on the differential for gland swelling
    - Skin and soft-tissue infection of the face can mimic gland swelling
    - Dental decay leading to an abscess can present with similar facial swelling
    - Shingles affecting the face is included among conditions that can resemble this presentation
  Source  StatPearls "Sialolithiasis" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    A calcified stone blocking a salivary duct (usually submandibular) causes painful
            swelling that worsens with eating. GP advises hydration, sialogogues (e.g. sour sweets),
            gland massage, and analgesia; gives antibiotics if the gland is infected; refers to
            ENT/maxillofacial for stone removal if it does not resolve. - Refer, with advice
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      A calcified stone blocking a salivary duct (usually submandibular) causes painful
            swelling that worsens with eating. GP advises hydration, sialogogues (e.g. sour sweets),
            gland massage, and analgesia; gives antibiotics if the gland is infected; refers to
            ENT/maxillofacial for stone removal if it does not resolve.
   Caution  No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - Specific physical examination signs indicating superimposed infection
            requiring antibiotic therapy (cervical adenopathy, purulent discharge from duct,
            periductal erythema) are omitted
            RED FLAG - Complications of chronic untreated obstruction include permanent gland
            fibrosis and atrophy.
            RED FLAG - Facial swelling with fever or pus, suggesting suppurative sialadenitis, signs
            of abscess, or recurrent stones.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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