Submandibular sialolithiasis—stones in the submandibular gland or Wharton's duct—is the most common form of salivary stone disease. At Sir Ganga Ram Hospital, Delhi, Dr Varun Rai treats submandibular duct stones with sialendoscopy, preserving the gland and avoiding a neck scar.
The submandibular gland produces thicker, mucous-rich saliva. Its duct (Wharton's duct) travels upward from the floor of the mouth, promoting stasis and calcium deposition. Patients often describe a stone under the tongue, jaw swelling at meals, or submandibular gland calculus on imaging.
A submandibular or Wharton's duct stone typically causes swelling below the jaw that worsens with meals, pain while chewing, dry mouth on the affected side, and sometimes a visible hard point under the tongue. If saliva becomes infected behind the blockage, patients may notice foul taste, fever, or pus from the duct opening.
High-resolution neck ultrasound is first-line. It locates stone size, position (ductal vs intraglandular), and gland viability. MRI sialography or diagnostic sialendoscopy may follow for complex submandibular sialolith cases.
In the past, recurrent submandibular stones often led to gland excision through a neck incision. Today, duct-accessible stones can frequently be managed through the natural opening under the tongue. Gland removal is considered only when the stone is deeply embedded, the duct is severely scarred, repeated endoscopic attempts fail, or another diagnosis must be excluded.
Dr Varun Rai has performed over 2,000 sialendoscopies since introducing the technique to North India's private sector in 2015. For cheek swelling near the ear, read about parotid gland stone treatment. For broader treatment options, see how to treat salivary stones. Book a consultation for submandibular stone evaluation at Sir Ganga Ram Hospital.
The submandibular gland produces thicker, mucous-rich saliva and has an upward-traveling Wharton's duct—both factors promote stasis and calcium deposition, making it the most common site for sialolithiasis.
Most Wharton's duct stones are reachable via sialendoscopy through the papilla under the tongue. Dr Varun Rai uses micro-instruments and laser lithotripsy to fragment large stones while preserving the gland.
Experienced centres report high success rates for duct-accessible stones. Cases with deep intraglandular calculi or severe duct scarring may need combined approaches or, rarely, submandibular gland excision.
Often, yes. A firm swelling or visible stone near the floor of the mouth may be a Wharton's duct stone from the submandibular gland, especially if it swells during meals.