Signs and symptoms: - Strictures are the second most common cause of chronic obstructive sialadenitis, after salivary stones. - Strictures may give rise to the mealtime syndrome, causing pain and swelling of the involved salivary gland upon salivary stimulation with the sight, smell, and taste of food. - In some cases, there is irregular and intermittent pain and swelling of the gland not related to meal times. - Swelling is typically present upon waking or occurs before the first meal of the day. - After several hours, the swelling goes down suddenly with a rush of foul-tasting saliva.

Causes: - Chronic inflammation of the duct system (sialodochitis) can cause segments of the duct to narrow due to fibrosis, while others dilate. - Saliva stagnates and forms a mucus plug behind the stricture during sleep when the salivary output of the parotid is reduced. - The mucus plug becomes stuck in the stricture when salivary secretion is stimulated. - The backlog of saliva behind the blockage causes swelling, and the increased pressure inside the gland causes pain. - When the mucus plug is dislodged, the built-up saliva is released and the swelling subsides.

Diagnosis: - Strictures are often diagnosed based on difficulty with insertion and manipulation during sialendoscopy. - Sialography or ultrasound can also be used for diagnosis.

Treatment: - Treatment options include endoscopic dilation or surgery. - Endoscopic dilation is the primary treatment method. - If endoscopic dilation fails, surgery may be necessary.

Epidemiology: - Approximately 20% of individuals with mealtime syndrome have strictures upon sialography. - Strictures seem to be more common in females, although the reasons are unknown.