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Giant Submandibular Gland Duct Sialolith: a Case Report Dev Submandibuler Gland Kanal Tașı: Bir Olgu Sunumu

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Giant Submandibular Gland Duct Sialolith: a Case Report Dev Submandibuler Gland Kanal Tașı: Bir Olgu Sunumu OLGU SUNUMU / CASE REPORT Kafkas J Med Sci Kafkas J Med Sci 2015; 5(2):75–77 • doi: 10.5505/kjms.2015.44711 Giant Submandibular Gland Duct Sialolith: A Case Report Dev Submandibuler Gland Kanal Tașı: Bir Olgu Sunumu Kamran Sarı1, Caner Șahin2 1Department of Ear Nose Th roat, Bozok University School of Medicine, Yozgat, Turkey; 2Ear Nose Th roat Clinics, Akyazı State Hospital, Sakarya, Turkey ABSTRACT giant sialolith is used when the sialolith is over 15 mm Sialolithiasis is one of the most common diseases of the salivary or 1 gram5,6. Giant sialolithiasis of submandibular duct glands and is characterized by the obstruction of salivary gland or has been reported rarely7. We will discuss giant sub- its duct due to the formation of calcareous plaque. The term of gi- ant sialolith is used for the stones over 15 millimeters or 1 gram. It mandibular gland duct sialolithiasis in this report. is rarely reported in the literature. We reported a case of a sialolith measured between 25 to 30 mm and located in the submandib- Case Report uler gland orifi ce. We excised the sialolith via intraoral approach. Normal saliva fl ow must be performed during treatment. Minimal A 55 year-old male patient complaining of intermit- invasive surgery is recommended. tent pain and swelling in left submandibular area was Key words: sialolithiasis; salivary gland diseases; submandibular gland admitted. Starting four months ago, the pain was in- creasing during chewing. Th e patient’s past medical ÖZET history was unremarkable. Siyalolitiazis, tükrük bezlerinin en sık karșılașılan hastalıklarından On otolaryngologic examination, palpation revealed biridir. Siyalolitiazis, tükürük bezinin veya kanalının kalkareoz plak olușumuna bağlı tıkanmasıyla karakterizedir. Dev sialolit tanımı 15 a swollen area corresponding to the anatomic location milimetreden büyük veya 1 gramdan ağır tașlar için kullanılmak- of submandibular salivary gland. Th e swollen area was tadır. Literatürde nadiren bildirilmiștir. Bu yazıda, boyutu 25 ile palpated extra orally and intraorally, it was fi rm and non- 30 milimetre arasında olan bir dev sialolit olgusu sunduk. Bizim tender. A fi rm yellowish mass of approximately 4 cm × olgumuzda sialolit submandibuler gland orifisinin girișine yerleș- 1 cm on the fl oor of the mouth was determined (Figure miști. Sialoliti intraoral yaklașımla eksize ettik. Tedavide normal tü- kürük akıșı sağlanmalıdır. Cerrahi olarak minimal invaziv yaklașım 1). A lateral occlusal radiograph showed a large radio- önerilmektedir. opaque calculus in the fl oor of the mouth (Figure 2). Anahtar kelimeler: sialolit; tükrük bezi hastalıkları; submandibuler bez Ultrasound revealed a giant stone in the submandib- ular area. Biochemical and serological studies were unremarkable. Introduction Th e calculus was excised via transoral sialolithotomy un- Sialolithiasis is one of the most common diseases of der local anesthesia (Figure 3). Amoxicillin-clavulanic salivary glands1. Nearly 12 of every 1000 adults are acid, 1 gram twice a day, and ketoprofen twice a day were referred to physicians with complaint of sialolithia- used till the post operative seventh day. Th e symptoms sis2. Males are more frequently aff ected than females resolved following operation. Th ere was no recurrence (2/1)3. It is observed in submandibular duct in 80% of and complication in the sixth month of the follow up. the cases4. and is rarely bigger than 15 mm1. In 88 % percent of cases, it is smaller than 10 mm4. Th e term Discussion Sialolithiasis occurs aft er the obstruction of the sali- vary glands or ducts8. Mechanism of the calculus for- Yard. Doç. Dr. Kamran Sarı, Adnan Menderes Blv. No: 190, Yozgat, Türkiye Tel. 0354 212 70 60 Email. [email protected] mation is not understood completely, however there Received: 11.06.2014 • Accepted: 22.11.2014 are some theories. 75 Kafkas J Med Sci Figure 1. Sialolith protruding from the Wharton duct. Figure 2. The opacity at the floor of the mouth is shown in lateral cervical X-Ray graphy (black arrow). leads to the formation of calculus. Th e nidus increases with the accumulation of inorganic substances10. Th e fl ow of the saliva is contrary to the gravity, thus, about 80% of sialolithiasis is encountered in subman- dibuler gland or duct, though the Wharton’s duct is longer and wider as the Stensen’s duct4. Th e saliva in submandibular gland is more alkaline. Submandibular gland has mucinous secretion which is rich of protein, calcium and phosphate11. An experimen- tal study showed that the magnesium content of the sa- liva secretion is the main factor for calculus formation12. Giant sialolith is defi ned when it is over 1 gram or 15 mm5,6. Th e calculus we excised was about 25 mm. Giant sialolithiasis usually has a dense concentration and a yellowish color. It is radio-opaque and sometimes interferes with teeth1. Th e symptoms include pain and Figure 3. Sialolith following excision. swelling during eating secondary to the distension in the gland1. If the calculus dilates the duct, it does not hinder the fl ow of the saliva. Th us, it may become giant 13 According to Harrison, micro calculus occurs in some without any symptom . instances, however it is excreted out of the natural os- Standard mandibular occlusal graph is the best diag- tium of the gland. Certain conditions causing changes nostic option to determine the calculus in the duct7. in the chemical composition of the saliva, secondary Sialography, ultrasonography and computerized to- to the partial or complete obstruction of the duct may mography may help in diagnosis14. We identifi ed the increase the size of the calculus9. Depending on an al- radio-opaque calculus with the aid of the radiologic ternative theory the mucous plaque forms a nidus and image. 76 Kafkas J Med Sci Sialolithiasis rarely may associates with salivary gland 5. Raveenthiran V, Hayavadana Rao PV. Giant calculus in the tumors. Hasegawa et al. and Batzakakis et al. report- submandibuler salivary duct: Report of the fi rst prepubertal ed a case associated with adenoid cystic carcinoma15, patient. Pediatr Surg Int 2004;20:163–4. 16. Sialoendoscopy is a new technique used in the di- 6. Bodner L. Giant salivary gland calculi: Diagnostic imaging and agnosis and treatment of sialolithiasis and it properly surgical management. Oral Surg Oral Med Oral Pathol Oral locates the stone17,18. However its use is limited in si- Radiol Endod 2002;94:320–3. 7. Gupta A, Rattan D, Gupta R. Giant sialoliths of submandibuler alolithiasis over 6 mm and in case where the sialolithia- gland duct: Report of two cases with unusual shape. Contemp. 18-22 sis is originated from the wall of duct . Despite the Clin Dent 2013;4:78–80. fact, Wallace et al. excised successfully a giant subman- 8. Epker BN. Osbtructive and infl amatory disease of the major dibular gland and duct sialolith with sialoendoscopy. salivary glands. Oral Surg Oral Med Pathol 1972;33:2–27. Sialolith was found at the gland in six cases and at the 9. Harrison JD. Causes, natural history and incidence of salivary duct in one case. Th ey could save the submandibular stones and obstructions. Otolaryngol Clin North Am gland in 86% of the cases and concluded that the sialo- 2009;42:927–47. endoscopy might be used successfully in sialolithiasis 10. Marchal F, Dulgerov P. Sialolithiasis menagement: the state of of submandibular glands and ducts17. Trans-oral si- the art. Arch Otolaryngol Head Neck Surg 2003;129:951–6. alolithotomy is usually performed for the sialolithiasis 11. Raksin SZ, Gould SM, William AC. Submandibuler gland palpated easily at the fl oor of the mouth17. sialolith of unusual size and shape. J Oral Surg 1975;33:142–5. 12. Grases F, Santiago C, Simonet BM, Costa-Bauza A. Submandibular stones can be removed surgically by Sialolithiasis: Mechanism of calculi formation and etiologic intra or extra oral approach17. Th e choice of the treat- factors. Clin Chim Acta 2003;334:131–6. ment depends on the stone’s location. Intraoral ap- 13. Manjunath R, Burman R. Giant submandibuler sialolith of proach is oft en used when the calculi is located ante- remarkable size in the comma area of Wharton’s Duct: A case rior to the lingual nerve and artery. Th e complications report. J Oral Maxillofac Surg 2009;67:1329–32. of intraoral surgery are lingual nerve anesthesia and 14. Lomas DJ, Carrol NR, Johnson G, et al. MR sialography. Work injury. Th e lingual nerve loops around the distal por- in progress. Radiology 1996;200:129–33. tion of Warthin’s duct. Excision of the submandibular 15. Hasegawa M, Cheng J, Maruama S, et al. Complication of gland by an external approach carries a risk of marginal adenoid cystic carcinoma and sialolithiasis in the submandibuler mandibulary nerve palsy in 0-8% of the cases17. Shock gland: reportof a case and is etiological background. Int J Oral Maxillofac Surg 2011;40:647–50. wave lithotripsy, basket retrieval, and endoscopic la- 22 16. Batzakakis D, Apostolopoulos K, Bardanis I. A case report of ser lithotripsy are new treatment opsions . A review coexistence of a sialolith and an adenoidcystic carcinoma in the found that the retrieval of stones by baskets or micro carcinoma inthe submandibular gland. Med Oral Pathol Oral forceps was usually performed for stones less than 5 Cir Bucal 2006;11:286–8. mm and extracorporeal lithotripsy was mainly used 17. Wallace E, Tauzin M, Hagan J, et al. Management of 23 for fi xed parotid stones less than 7 mm in diameter . gianth sialoliths: Review of the literature and preliminary We excised the calculus via transoral sialolithotomy. experience with interventional sialendoscopy. Laryngoscope Normal saliva fl ow must be maintained during treat- 2010;120:1974–8. ment.
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