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CASE REPORT
Year : 2022  |  Volume : 3  |  Issue : 3  |  Page : 82-84

Salivary gland calculus - A painless and self-regressing swelling


Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India

Date of Submission08-Jan-2022
Date of Decision13-Feb-2022
Date of Acceptance07-Jul-2022
Date of Web Publication16-Aug-2022

Correspondence Address:
Arpan Manna
Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcdoh.jpcdoh_2_22

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  Abstract 


Salivary gland disorder occurs commonly because of salivary calculi, which may occur at any age and involves any of the salivary glands. Most of the cases of sialolithiasis occur in the submandibular salivary gland as its duct is most prone to and common for acute and chronic infections. The symptoms include decreased or obstructed salivary flow. This case report presents a case of a patient with sialolithiasis of the submandibular gland and its treatment. It also includes etiology, signs and symptoms, diagnosis, and various treatment modalities.

Keywords: Occlusal radiograph, sialolith, submandibular salivary gland


How to cite this article:
Manna A. Salivary gland calculus - A painless and self-regressing swelling. J Prim Care Dent Oral Health 2022;3:82-4

How to cite this URL:
Manna A. Salivary gland calculus - A painless and self-regressing swelling. J Prim Care Dent Oral Health [serial online] 2022 [cited 2022 Oct 2];3:82-4. Available from: http://www.jpcdoh.org/text.asp?2022/3/3/82/353815




  Introduction Top


Sialolithiasis is common for large salivary glands, and it accounts for more than 50% of salivary gland diseases. Submandibular gland and its duct account for majority of the cases constituting for 80% of cases, parotid gland accounts for 6% of the cases, and sublingual and other minor salivary glands account for 2% of the cases. Males are more commonly affected compared to females. Bilateral or multiple sialolithiasis is not much common and may occur in 3% of total reported cases. Salivary calculi do not cause dry mouth and are found usually unilaterally. These stones consist of organic and inorganic materials. Submandibular calculi are composed of approximately 18% of organic and 82% of inorganic constituents. On the other hand, parotid calculi are composed of 51% of organic and 49% of inorganic constituents.[1],[2],[3],[4],[5]


  Case Report Top


A 32-year-old male patient reported to the department of oral medicine and radiology with the chief complaint of recurrent swelling in the left lower jaw for the past 5 months [Figure 1]. As per the patient, he had taken antibiotics for the same. The patient mentioned that the swelling used to appear just before meal times and get subsided gradually over 1–2 h. He also mentioned that pain used to occur during that time.
Figure 1: Extraoral swelling seen in the lower left submandibular region

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On extraoral examination, right submandibular gland was palpable. On intraoral examination, no such odontogenic cause was located. On palpation, a small, firm, nodular, nontender mass was palpable in the left floor of the mouth in the region of the submandibular duct. Bimanual palpation of the gland showed mild tenderness and enlargement. On milking of the gland, the salivary flow was seen to be reduced on the left side. Radiographic examination confirmed a radiopaque structure in the duct of the submandibular gland [Figure 2]. After correlating the clinical and radiographic findings, final diagnosis of “sialolithiasis of the submandibular gland” was made. Surgical excision was [Figure 3] done and prognosis was followed.
Figure 2: Computed tomographic scan showing the submandibular salivary stone

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Figure 3: Excised sialolith

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  Discussion Top


Salivary gland calculi most commonly appear as yellowish white to brown in color. They do not have a regular shape. Submandibular sialolith constitutes 18% of organic and 82% of inorganic substances. The inorganic material includes mostly calcium phosphate and carbonates as hydroxyapatite and also magnesium, potassium, and ammonia in smaller amounts. Carbohydrates and amino acids form the organic components.[1],[3],[5]

The exact pathogenesis of sialolith formation is not known. According to some literature, it occurs due to stagnation of calcium-rich saliva. Formation of calculi occurs in two phases: central core and layered periphery as stated by Cawson et al.[2],[6] The central core is formed by the precipitation of salts consisting of organic substances. The layered periphery consists of both organic and inorganic substances as given by Rauch and Gorlin.[7],[8] Submandibular calculi are more common compared to the parotid calculi. This is because saliva produced from the submandibular gland is more alkaline in nature, has increased calcium and phosphate concentration, and has more mucous content.[2],[6],[9],[10]

In addition, salivary duct of the submandibular gland is more longer and has antigravity flow. Systemic disorders related to calcium metabolism can also lead to the formation of sialolithiasis.[5] Systemic disease-like gout can also contribute to this. Sialolith causes pain and swelling of the salivary gland by causing obstruction of salivary secretion. According to the literature given by Williams, this causes stasis of saliva leading to bacterial growth and infection which ultimately leads to pain and swelling.[5],[7],[9],[11]

Proper history and examination can lead to correct diagnosis. Swelling and pain of the salivary gland during salivary secretion as such during mealtimes can lead to the diagnosis according to Pollack and Severance. Bimanual palpation of floor of the mouth may reveal the presence of palpable stone which is similar to our case. According to Isacsson et al., sialolithiasis can be diagnosed properly with the help of radiographic modalities, which includes occlusal radiographs. Occlusal radiographs can show radiopaque calculi and stones properly. Sialography is also useful for this. This can be used in patients with sialadenitis or deep submandibular and parotid calculi.[5],[12],[13]

Treatment of sialolithiasis includes conservative management where small stones can be flushed out of the duct by applying moist heat and gland massage, and sialogogues are given to promote salivary secretions as given by Pietz and Bach.[7],[14] If infection is present, then penicillinase-resistant antibiotic course should be prescribed.[12],[14] Sometimes, submandibular calculi lie in the distal part of the duct and simple surgical incision in the floor of the mouth can cause release of the stone.[15]


  Conclusion Top


Proper examination of the patient can lead to correct diagnosis and prompt treatment. Management of this usually depends on the salivary gland involved, as well as the location of the stone. Dentists must be aware of all the signs and symptoms of this disease. Various diagnostic investigations should be considered immediately after the provisional diagnosis to provide prompt treatment. Correct and timely diagnosis of the disease is of utmost importance so as to deliver proper treatment modalities to the patients.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zenk J, Benzel W, Iro H. New modalities in the management of human sialolithiasis. Minim Invasive Ther 1994;3:275-84.  Back to cited text no. 1
    
2.
Cawson RA, Odell EW. Essentials of Oral Pathology and Oral Medicine. 6th ed. Edinburgh: Churchill Livingstone; 1998. p. 239-40.  Back to cited text no. 2
    
3.
Sharma S, Mody A, Trehan M. Submandibular sialolithiasis – A case report. JIAOMR 2007;19:564-9.  Back to cited text no. 3
    
4.
Siddiqui SJ. Sialolithiasis: An unusually large submandibular salivary stone. Br Dent J 2002;193:89-91.  Back to cited text no. 4
    
5.
Williams MF. Sialolithiasis. Otolaryngol Clin North Am 1999;32:819-34.  Back to cited text no. 5
    
6.
Carr SJ. Sialolith of unusual size and configuration. Report of a case. Oral Surg Oral Med Oral Pathol 1965;20:709-12.  Back to cited text no. 6
    
7.
Marchal F, Kurt AM, Dulguerov P, Lehmann W. Retrograde theory in sialolithiasis formation. Arch Otolaryngol Head Neck Surg 2001;127:66-8.  Back to cited text no. 7
    
8.
Rauch S, Gorlin RJ. Disease of the salivary glands. In: Gorlin RJ, Goldmann HM, editors. Thomas' Oral Pathology. St. Louis, Mo: Mosby-Year Book Inc.; 1970. p. 997-1003.  Back to cited text no. 8
    
9.
Leung AK, Choi MC, Wagner GA. Multiple sialoliths and a sialolith of unusual size in the submandibular duct: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:331-3.  Back to cited text no. 9
    
10.
Zakaria MA. Giant calculi of the submandibular salivary gland. Br J Oral Surg 1981;19:230-2.  Back to cited text no. 10
    
11.
Work WP, Hecht DW. Inflammatory diseases of the major salivary glands. In: Papperalla MM, Shumrick DF, editors. Otolaryngology. Vol. 3. Philadelphia: W B Saunders; 1980. p. 2235-43.  Back to cited text no. 11
    
12.
Pollack CV Jr., Severance HW Jr. Sialolithiasis: Case studies and review. J Emerg Med 1990;8:561-5.  Back to cited text no. 12
    
13.
Isacsson G, Isberg A, Haverling M, Lundquist PG. Salivary calculi and chronic sialoadenitis of the submandibular gland: A radiographic and histologic study. Oral Surg Oral Med Oral Pathol 1984;58:622-7.  Back to cited text no. 13
    
14.
Pietz DM, Bach DE. Submandibular sialolithiasis. Gen Dent 1987;35:494-6.  Back to cited text no. 14
    
15.
McGurk M, Esudier M. Removing salivary gland stones. Br J Hosp Med 1995;54:184-5.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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