1. Introduction Case Report
Giant Salivary Gland Calculi (GSGC): Report Of Two Cases
ÖZDEN.B,BAŞ.B,GURBANOV.V,YUCEER.E,KAZAN D,ACAR L
Ass Professor Department of Maxillafacial Surgery, Ondokuız Mayıs University Samsun, Turkey
1Research Asisstant Department of Maxillafacial Surgery, Ondokuız Mayıs University Samsun, Turkey
Introduction Case Report
Sialolithiasis or salivary gland duct calculus or salivary stones are the most common pathologi es of the salivary gland. Sialolithiasis accounts for more than 50% of diseases of the major salivar y glands and is the most common cause of a cute and chronic infections. Sialoliths are deposits obstructing the ducts of major or minor salivary glands or its parenchyma. Salivary stones larger than 15 mm are classified as giant sialoliths. The prevalence of sialoliths varies by location. About 85% of sialoliths occur in the submandibular gland and % occurs in the parotid gland. In about 5% of cases, the sublingual gland or a minor salivar y gland is affected. Sialolith in the parotid gland is less common when compared to submandibular gland. This case report describes a case of giant sialolith of submandibular salivary gland ductus.
A 51 year- old woman was referred to our clinic for extraction of right third molar . On intraoral examination diffuse swelling with normal overlying skin was noticed in the left side of the floor of the mouth. Patient had no idea about this nodule. The mass was hard and freely movable and there was no signs of pain, discomfort,ulceration, fistula, or infection. On palpation of the left submandibular gland , there was an absence of salivary flow from the left Wharton’s duct orifice. On extraoral examination, no submandibular swelling was detected. An occlusal radiograph, panoramic radiograph and CBCT were used for diagnosis. Radiographic examination showed a large radiopaque mass, round in shape and approximately 1,5x1,53 cm in size, in the left submandibular region.Figure 1,. CBCT scan revealed similar findings.Figure 2,3,4.
After the surgical removal of the sialolith, many complications may ocur. Among these complications, the most important one is obstruction of Wharton’s duct. To prevent obstruction we apply a method that we used our previous cases.
Sialolithectomy was performed with an intraoral approach under the local anesthesia..Figure 6,7 Upward and medial pressure was applied to the submandibular gland, and an incision was placed directly over the sialolith to expose it. A hemostat was used to expose the superior aspect of the stone. After sufficiently mobilizing the sialolith, the stone was removed with finger pressure. After the sialolith was delivered out, we placed a catheter that is used for providing vascular access ordinarily, into the Wharton’s duct to prevent duct obstruction. FİGURE 8. The catheter was fixed with suture for 3 days. At the follow up appoinment 6 months postoperatively there was no swelling of the submandibular gland and salivary flow was normal.
Discussion
Sialolithiasis is a rare disease with male predilection. The disease can occur at any age, but it appears more frequently in the third to sixth decades of life. Sialoliths can arise in any salivary gland, the submandibular gland being the most affected (80% to 95%). There are some factors that influence this incidence: saliva from the submandibular gland is mucinous, unlike that produced by the parotid gland, which is serous, having more calcium and phosphate; the pH of saliva rich in mucin is more alkaline, the Wharton duct is longer and more tortuous than the Stensen duct, and finally, gravity acts against salivary secretion in the case of the submandibular gland .
CONCLUSION Giant sialoliths represent a major challenge to oral surgeons in the choice of surgical approach to prevent excision of the gland and likelihood of hypoesthesia, dry mouth, or salivary fistulae. The surgical approach for removal of sialoliths should be minimized to prevent gland morbidity, preferring the intraoral approach. The purpose of this treatment is to restore normal salivary flow. Salivary obstruction for long periods can cause fibrosis and atrophy of the affected gland. Giant sialoliths should be removed even when asymptomatic to prevent complications.
Referans;
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