The role of computerized tomography in the diagnosis and therapy of parotid stones: a case report

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.

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

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A Giant calculus of more than 3 cm is rare

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

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

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

Salivary calculus diagnosis with 3-dimensional cone-beam computed tomography

OBJECTIVE

The objective of this study was to evaluate cone-beam CT (CBCT) diagnoses of sialoliths in the major salivary glands.

STUDY DESIGN

Twenty-nine CBCT images containing salivary calculi were retrospectively evaluated for image quality and artifact influence. Additionally, the reproducibility of calculus measurement and the differences between CBCT measurements and ultrasonography (US) and histomorphometry (HM) measurements were determined. Diagnostic sensitivity and specificity calculations were based on the observations of 3 masked clinicians, who reviewed a total of 58 CBCT volumes.

RESULTS

Salivary calculi were sufficiently visualized in all patients. Metal artifacts were detected in images of 7 patients, and movement artifacts in 2. CBCT calculi measurements were highly reproducible, with mean differences of less than 350 microm. Mean CBCT measurements of calculi diameters differed from mean US measurements by approximately 500 microm and differed from mean HM measurements by approximately 1 mm. For calculus diagnoses, the mean sensitivity and specificity were both 98.85%.

CONCLUSION

Although poor image qualities and artifacts can reduce diagnostic information, salivary calculi can be evaluated adequately with CBCT. CBCT measurements of calculi are highly reproducible and differ little from measurements made with US and HM. Diagnostic sensitivity and specificity levels with CBCT are as high as or higher than those obtained with other diagnostic methods. Because of its high diagnostic-information-to-radiation-dose ratio, CBCT is the preferable imaging modality for salivary calculus diagnosis.

Salivary gland stones: diagnosis and treatment

Salivary calculi are a common cause of salivary gland disorder and may occur in any of the salivary glands and at almost any age. The stones may be small and intraductal or lie within the gland substance when they may become very large. They cause symptoms by obstructing salivary flow. Diagnosis is usually straightforward, and treatment is aimed at stone removal.