(1)Wharton’s duct sialolith of aunusual size: A case report with a review of the literature

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Wharton’s duct sialolith of aunusual size: A case report with a review of the literature. Case Rep Dent 2014, Article ID 373245


Nithin Mathew Cherian, Sankar Vinod Vichattu, Ninan Thomas, and Aabu Varghese


Department of Oral and Maxillofacial Surgery, Mar Baselios Dental College, Kothamangalam, Ernakulam, Kerala 686691, India


報告者姓名(組別): 朱恩韡 Intern E 組 2014/12/8





- One of the most common diseases of salivary glands - Estimated frequency of 0.15% in the adult population - Slight male predilection

- Mostly develop in the submandibular gland

- Always found in the distal portion of the duct or at the hilum of the submandibular gland with a few in parenchyma

- Salivary stasis and salivary viscosity play a significant role in its development - Commonly measures from 1mm to < 1cm, rarely measure > 1.5 cm

 Aim:

- To present a case of an unusually sized sialolith and review of the literature on large sialoliths (1.5cm or larger)

Case Report

 Patient: 36-years-old male

 Chief Complaint: Pain and swelling in the floor of the mouth for 1 year

 Present Illness: Intermittent increase in the swelling in the early morning and pain during eating which later subsides on its own. The pain was of moderate variety that the patient could tolerate. There was no associated history of fever, malaise, or burning sensation in the oral cavity.

 Extraoral examination: No relevant findings.

 Intraoral examination:


口腔病理科 On-Line KMU Student Bulletin

A swelling of size 3 × 1 cm extending anteroposteriorly and mediolaterally on the right floor of the mouth from lingual frenum to the second premolar:

- Normal overlying mucosa - No salivary obstruction

- Hard in consistency and non-tender - Lesion not fixed, not pulsatile.

- No purulent discharge

 Radiographic examination: Panoramic radiograph, occlusal radiograph Radiopaque mass of size 3× 1 cm extending anteroposteriorly and mediolaterally from the mandibular lateral incisor region to premolar region in the floor of the mouth, suggestive of a sialolith

 Surgery procedure:

1. Local anesthesia

2. Retraction suture was placed around the duct distal to the stone, which was then retracted anteriorly.

3. Mucosal incision was placed and careful blunt dissection of the tissues was done and sialolith was located.

4. Longitudinal incision through the superior duct wall overlying the sialolith was placed.

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5. Sialolith was evacuated

6. Saline irrigation and milking of the gland was done to remove any small residual stones or mucin plugs.

7. Approximation of the wound was done with a few 3–0 vicryl sutures.

 Patient was recalled after seven days for review.

 The healing was found to be satisfactory and salivary

 Salivary flow normal, symptom relieved Discussion

 Formation of sialolith (Harrison et al.)

 Formation of the nucleus of sialolith in the submandibular glands is secondary to sialadenitis and is related to the duration of symptoms of sialadenitis

 During chronic submandibular sialadenitis inflammatory swellings would lead to the partial obstruction of a large duct with stagnation of secretory material rich in calcium. This would form a calcified core and later when this grows, it would become a sialolith

 Sign and symptoms

 Swelling

 Anatomical asymmetry

 Size fluctuation

 Rapid onset and partial resolution over one to several hours

 Residual glandular swelling, decreased salivary flow as compared to the contralateral gland

 Pain which intensifies during meal times or when salivary flow is stimulated

 Swelling and erythema of submandibular papilla for distal stones

 Unusually suppuration or localized cellulitis


口腔病理科 On-Line KMU Student Bulletin

 Mostly occurred in submandibular gland. Why?

(1) The submandibular duct is wider in diameter and longer than the Stensen duct.

(2) The salivary flow in the submandibular gland is against gravity.

(3) The submandibular salivary secretion is more alkaline compared with parotid saliva (4) The submandibular saliva contains a higher quantity of mucin proteins whereas parotid saliva is entirely serous.

(5) Calcium and phosphate content in submandibular saliva are higher than in other glands.

 Treatment of sialolith

Intraoral removal procedure Lithotripsy

Laser Sialolithectomy

Interventional Sialoendoscopy Submandibular Gland Removal


This case report demonstrates a case of an unusually sized sialolith and various anatomical and physiological considerations of the duct which contribute to the higher incidence of sialolith in the duct.

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題號 題目

1 Sialoliths mostly occur within which salivary glands?

(A) Parotid glands

(B) Submandibular glands (C) Sublingual glands

(D) Von Ebner glands 答 案

( B )

出處:Oral and Maxillofacial PATHOLOGY Third Edition pg.459

題號 題目

2 Which of the following statements is WRONG?

(A) Sialoliths typically appear as radiolucent masses in radiographic examination.

(B) Major gland sialoliths most frequently cause episodic pain or swelling od the affected gland.

(C) Minor gland sialoliths often are asymptomatic.

(D) Salivary stones can occur at almost all age, but they are most comoon in young and middle-aged adults.

答 案 ( A)

出處:Oral and Maxillofacial PATHOLOGY Third Edition pg.459




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