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.

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.

Clinico-Pathologic Study of Salivary Gland Disorders at a Sub-Urban Nigerian Tertiary Hospital: A 5 Year Retrospective Review

Background: The spectrum of salivary gland lesions is wide and the relative incidence of neoplastic and non-neoplastic lesions is variable in different studies. Despite the relatively common nature of salivary gland disorders, there is dearth of literature on these lesions, especially in sub-Saharan Africa. We therefore embarked on this study to analyze the differential diagnosis of salivary gland lesions seen and managed at our institution. Methods: A retrospective review of salivary gland disorders that presented at our facility from January 2012 to December 2016 was done. Information on patients’ demographic details, type and location of salivary gland lesion, histologic diagnosis and treatment were retrieved and analyzed with SPSS version 20. Result: A total of 65 patients were treated for salivary gland lesions of various types during the study period. The age of the patients ranged from 3 months to 68 years [mean 33.8 ±12.3]. Neoplastic lesions [n = 39, 60.0%] were the commonest followed by sialolithiasis [n = 14, 21.5%] while mucous retention/extravasation cysts accounted for 13.9% of the cases. Pleomorphic adenoma was the predominant tumor in this series [87.2%] and the commonest site was the parotid gland [58.8%]. On the contrary submandibular gland appeared to be the commonest site for sialolithiasis [57.1%]. The majority of mucous retention/extravasation cysts occurred in the sublingual gland [55.5%]. Conclusion: Neoplastic lesions remain the commonest salivary gland disorder and pleomorphic adenoma was the most prevalent. Sialolithiasis and mucous cysts are salivary gland lesions with equally wide disease spectrum.

Sialendoscopy: A Review of 133 Cases

Objective: The aim is to review the effectiveness of sialendoscopy in treating various salivary gland disorders related to the duct. Methods: A total of 133 patients who underwent sialendoscopy were included in this study. Data was collected from case records of patients and was analysed. A detailed history examination was taken and the operative findings were analysed. Causes of obstructive sialadenitis were evaluated and treated. Results: A total of 159 glands were subjected to sialendoscopy and pathology was identified in 149 glands. Forty one submandibular glands had calculi and twelve had non-calcular obstruction. Fifteen parotid glands had calculi and 81 had non-calcular obstruction, of which stricture was the most common. Calculi retrieval or dilation of stricture was achieved with a sialendoscope in 112 glands. In 23 patients, the calculi were retrieved by combined approach. In three patients, the calculi were fragmented with intra luminal Holmium laser and the fragments were removed. All these patients had a good relief from their symptoms. Duct perforation was seen in two patients and a false passage was formed in one. Conclusion: Sialendoscopy was a safe and effective procedure for managing ductal pathologies of salivary glands.

Sialendoscopy for sialodocholithiasis following submandibular gland excision:six variations on a theme

Sialendoscopy is a minimally invasive technique that facilitates the diagnosis and treatment of sialolithiasis.This case series presents the novel use of sialendoscopy to treat sialodocholithiasis in six patients with a non-functional or surgically absent submandibular gland by a single surgeon at the University of Pennsylvania Health System between March 2013 and December 2019.The four female and two male patients had a median age of 56 years and mean follow-up of 16.2 months(range 1-44.5).All stones were successfully removed using sialendoscopy,and in 5 patients a combined approach was utilized.All patients remain asymptomatic at last clinical follow-up.We conclude that sialendoscopy is a viable,minimally invasive method for managing sialodocholithiasis in patients with prior submandibular gland excision or atretic gland.It is also useful as an assistive tool when approaching complex transcervical or transoral procedures in previously instrumented patients.