An Unusual Case of Submandibular Sialolithiasis in Early Childhood: A Case Report

Sialolithiasis is the most common condition of the salivary glands and it is characterized by the development of a calcified structure within a salivary duct. This condition can lead to inflammation, bacterial infection, and abscess. The different forms of management range from the direct massage of the duct to the complete removal of the gland. This report describes an unusual case of submandibular sialolithiasis in a four-year-old girl. The main complaints were pain when eating and swelling in the floor of the mouth. The diagnosis was sialolithiasis in the duct of the submandibular gland. Since the salivary stone was palpable and located in the anterior portion of the duct, a minimally invasive procedure was planned. An excisional biopsy was performed and a unilateral salivary stone was removed. The histopathological analysis confirmed the diagnosis. Although rare in children, understanding the diagnostic process and the different treatment modalities leads to a favorable prognosis.

Giant Sialolith with 20 Years of Evolution in the Submandibular Duct

Sialolithiasis is a common disease that affects the major salivary glands, which is characterized by obstruction of the gland itself or its excretory duct due to the formation of a sialolith, resulting in decreased salivary flow. It mainly affects the submandibular glands (80% - 90%), probably because it has a long duct that surrounds the mylohyoid muscle and emerges against gravity through the Wharton’s duct. The size of the salivary calculus can vary from below 1 millimeter (mm) to a few centimeters in diameter, where most stay below 10 mm. Only 7% are greater than 15 mm and these are classified as giant calculi. This report presents a case of asymptomatic giant sialolith (approximately 60 mm in diameter) located in the duct of the right submandibular gland, with 20 years of evolution. The treatment of choice was the surgical removal of the sialolith (calculus) through the salivary duct with maintenance of the gland. Although the individual did not present complaints related to the presence of the giant calculi, its removal had a great impact on their quality of life, since a significant respiratory improvement was reported by the individual. The major difference reported was better sleep quality.

Surgical Removal of a Giant Sialolith by Diode Laser

Giant sialoliths larger than 20 mm are rare. The surgery has to be performed with the minimally invasive method in order to avoid the morbidity associated with the surgical techniques. In this report the surgical removal of a giant sialolith of 25 mm by using diode laser is described. A 57-year-old female was presented with a firm mass in the anterior part of the left side of the floor of the mouth. Following the clinical and radiological examination, the left submandibular duct sialolith was diagnosed. The diode laser was used with a power setting of 810 nm of wavelength, 4.0 W of power, 0.5 ms continuous wave and 1000 Hz of frequency for the incision. The giant sialolith was adequately removed under local anesthesia. The procedure was well-tolerated. The wound healing was uneventful in the postoperative period. By the 10th day after surgery the patient had no complaints and the salivary flow was normal. It was concluded that the use of 810-nm diode laser application is a safe and useful technique. Due to the excellent cutting and coagulation ability, there is a low complication rate, making it an appropriate alternative for this type of surgical procedure.