Giant sialolith of submandibular gland duct treated by excision and ductal repair: a case report

Long-term rare giant sialolithiasis for 30 years: A case report and review of literature

BACKGROUND

Sialolithiasis is one of the most common salivary gland disorders, most commonly affecting the submandibular gland. Submandibular sialolithiasis can be treated using non-invasive conservative measures and invasive treatments. Treatment selection was based on the ductal system anatomy and the size and location of the stones. This study aimed to review the updates on sialolithiasis treatment and compare the different management strategies of the variables.

CASE SUMMARY

This report presents a case of a long-term, rare, and giant sialolithiasis within the submandibular gland parenchyma for 30 years in an older adult. Our patient presented with painless right submandibular swelling. Computed tomography revealed a calcified mass measuring 35 mm × 20 mm within the right submandibular gland. In this case, the infection and fibrosis of the affected gland and size of the stone did not provide us with other alternatives except for the excision of the involved gland. Thus, right submandibular sialoadenectomy was performed via the transcervical approach. After the surgery, the patient recovered without any complaints, side effects, or complications.

CONCLUSION

Tailored management is important for preserving gland function, maintaining low risk, and reducing patient discomfort.

Long-term rare giant sialolithiasis for 30 years: A case report and review of literature

BACKGROUND

Sialolithiasis is one of the most common salivary gland disorders, most commonly affecting the submandibular gland. Submandibular sialolithiasis can be treated using non-invasive conservative measures and invasive treatments. Treatment selection was based on the ductal system anatomy and the size and location of the stones. This study aimed to review the updates on sialolithiasis treatment and compare the different management strategies of the variables.

CASE SUMMARY

This report presents a case of a long-term, rare, and giant sialolithiasis within the submandibular gland parenchyma for 30 years in an older adult. Our patient presented with painless right submandibular swelling. Computed tomography revealed a calcified mass measuring 35 mm × 20 mm within the right submandibular gland. In this case, the infection and fibrosis of the affected gland and size of the stone did not provide us with other alternatives except for the excision of the involved gland. Thus, right submandibular sialoadenectomy was performed via the transcervical approach. After the surgery, the patient recovered without any complaints, side effects, or complications.

CONCLUSION

Tailored management is important for preserving gland function, maintaining low risk, and reducing patient discomfort.

Unusual giant calculus of the submandibular duct: Case report and literature review

Introduction and importance

Majority of salivary gland stones (sialoliths) occur in the submandibular gland (Wharton's duct and parenchyma) accounting for 80% of cases. A Giant calculus of more than 3 cm is a rare encounter.

Case presentation

We present a 45-year old male patient who undergone surgical removal of a giant submandibular gland calculus which was reported by the patient as a result of a hard mass beneath the tongue with occasional pain being experienced during intake of meals.

Clinical discussion

Clinical assessment revealed a painless palpable hard mass beneath the tongue though with some dull pain being experienced during intake of meals. Local examination showed a hard mass at the sublingual region but not adhered to surrounding structures. The overlying intraoral mucosa appeared normal and not inflamed and with neither enlarged ipsilateral submandibular gland nor cervical lymph nodes. The patient was then prepared for surgical removal of the calculus under general anesthesia where a single giant calculus (measuring 4 cm) was extracted by marsupialization of Wharton's duct.

Conclusion

A giant calculus of more than 3 cm is a rare encounter and they remain to be one of the causes of submandibular gland dysfunction.

•

Most of the salivary gland sialoliths (80%) involve the submandibular gland

•

A Giant calculus of more than 3 cm is rare

•

Flow of saliva against gravity, high calcium and mucin content and its more alkaline pH explains calculi formation.

•

Patients normally present with pain either before or during intake of meals and may have a history of recurrent swelling of the involved gland

•

Intraoral extraction of a calculus should be advocated aiming at gland preservation