Complete salivary obstruction with submandibular calculi is rare. Usually, the patient experiences intermittent swelling or pain at meal times, when salivary flow is high. Both usually subside over the next hour. Spicy or acidic foods such as lemon juice stimulate salivary flow and may be used as a test. The swelling tends to appear before, and persist after, the pain. Pain is a less prominent feature, often described as a dull sensation of fullness which may radiate to the ear or into the tongue. Both the swelling and the pain may persist between meals if the gland is irreparably damaged. Less commonly, the patient presents with sialadenitis.
The submandibular area may feel enlarged and firm. On intra -oral examination, the tip of a grey-yellow stone may be visible impacted at the orifice of Warthin's duct. Bimanual palpation enables confirmation of glandular swelling and a stone. Palpation is performed from the back towards the front of the mouth to avoid displacing a mobile stone.
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